The forgotten people of the Himalayas 


Focus on the situation of women

Mugu is the only region worldwide where women die earlier than men. The maternal and infant mortality rates are among the highest in the world and not just because of the medieval living conditions, the hard struggle for survival, hunger coupled with hard physical work determining their daily existence, but because of a long-standing superstition that threatens the lives of women and newborns. To safeguard their families against the possible revenge from the local deities, a woman must, if she bleeds, i.e. if she is having her period or bringing a child into the world, leave the house. She is regarded as "unclean" and can only retreat to the barn or the woods.

Every month the women and young girls of Mugu have to endure several nights exposed under the most inhuman conditions in small, pitch-dark barns reeking of animal faeces or in the forest unprotected against the bitter cold wind, rain or snow, and the wild animals of the high mountains. They also must give birth here. It is the sad case that the mother or child often does not survive birth because there is no medical assistance even in the most extreme emergency. The women have to fend for themselves. The woman can only re-enter her home 20 days after the birth of her child. She has to care for it herself in the filthy, windowless barn, infested with flies.

Due to the unhygienic conditions in the cow sheds almost all women in Mugu suffer from severe untreated infections, chronic progressive diseases of the female organs, bleeding, abscesses, pneumonia, diarrhoea throughout their lives… Most women have already lost at least one child under these catastrophic birth conditions. Each village can annually report of mothers who have died from internal bleeding or similar fatal complications during birth or babies who have suffered drastically in difficult births, to bone and skull fractures.

The surviving infants suffer from all kinds of infections frequently from lung diseases, since they lie in the narrow barn in dense smoke by an open fire that the mother needs for a light source and cooking.

Women often report that in the forests, the "jackals" would always come and take their newborns away after birth and devour them - infants simply sometimes do not survive because the harsh cold.

These miserable conditions are exacerbated by poor nutrition during and after pregnancy. Moreover, women need to work hard until the moment of birth. Even though they are heavily pregnant they still carry all kinds of loads such as water and wood. The women in Mugu suffer greatly from this social restriction and urgently require our help to overcome these hostile circumstances.

After having worked together for a few years with the people of Mugu and after having got to know them better, they are now starting to come to the idea of how we can help the women more effectively.

The no longer forgotten people in Mugu - project work

Projektarbeit im Himalaya

Our sustainable aid will take the form of several factors in order to combat poverty in Mugu effectively:

to reduce maternal and infant mortality rates, to improve the educational situation permanently and to facilitate both boys and girls in education, changing the hygienic situation in the villages through education, construction of toilets and washing facilities.
We jointly safeguard the villagers' natural resources, i.e. the forest from logging, through the introduction of solar systems and smoke free stoves. Together we develop meaningful and locally customized plans for drinking water and agriculture, because almost the entire population is dependent on agriculture and the keeping of livestock. The families get a real chance to start a business through micro-credit, we provide medical care through birthing centres and health camps. In addition we are also investing in the future and promoting the training of midwives, medical staff and agricultural training. The young women and men receive their education outside Mugu and then return to the region to be active there.

Our programs, set out in the long term, are intertwined and are always oriented to the active and energetic participation of the villagers so that they can stand on their own feet after 3-5 years and not be dependent on the circumstances of our help, but under their own power to improve in the long term.

The project villages are served by our 25 local staff, project managers, social workers and medical staff.

We started our project work in Mugu with 5 project villages and almost 4,000 people in March 2009. Because of the visible success we expanded our radius steadily and peaked at about 18,000 people, which is already more than a third of Mugu (as of 2013), wherein it is always painstaking now that we have to penetrate into a deeper area.

We are progressively implementing the following project plan in Mugu:

Birthing houses - this is a revolution for the women of Mugu

Since women have no alternative than the dirty cowshed or a self-dug hole in the earth in the woods for the birth of their children, we searched for a solution that the village community, both men and women as well as shamans (local healers), could accept and developed the idea of birth and community houses, both the women and the entire community will benefit from young to old. Our goal is not to break with tradition, but to offer a solution that is also culturally acceptable and we succeeded.

We realized our first birthing house with the village community of "Loharbada", it is intended to serve as a pilot project for other villages and we opened it in mid-November 2012.

The village established a "birthing house committee" for the planning and construction, in which the shamans of the village are actively represented. They say that as long as there is no God enunciated in the birthing house like there is in homes, there is therefore no risk of disrespecting him through blood allowing women to take advantage of these houses. The two-floor building was built in true community spirit and with real manual labour against a slope, the soil removed by hand, without dredging or technical aids and then subsequently straightened. Mules or donkeys are used alongside men for the transport of stones, gravel and earth. Each stone of the house, walls and stairs was shaped to fit manually with a hammer, the woodwork such as doors and windows and their frames, the entire floor, the support, the decor, everything was timbered in the village independently and subsequently fitted. The village community worked for over a year at the completion of the building. The materials originate mainly from the Mugu region, but we also had to fly stuff into the mountains and carry it back into the village, such as sewer lines, water tanks, solar panels etc..

The birthing house really is a revolution in the lives of women of this village:

Accommodation, protection, welfare, warmth and assistance. Human dignity now awaits a new life into the world. What a contrast to before.

The different rooms have different functions: for childbirth and reconvalescence, for women during their menstrual period, a washing and bathing area, a playroom for younger children, a reading room with newspapers and books, students also have access to learning possibilities, a multifunctional room and a meeting room in which training in the areas of hygiene, health, equality and income generation can be held. The rooms are each equipped according to their purposes and the majority of furnishings such as beds, tables, chairs, cabinets have been timbered in the village itself. The toilet stall is located outside.

The necessary medical and nursing tools and materials for birthing have to be flown in, from birth beds, sterilization equipment for the instruments, ultrasound, scales, materials for wound dressing etc.

The first children's playground of the region was constructed on the large forecourt in front of the house, the kids are enthusiastic about the self-constructed seesaw, swing and slide.

This first birthing house not only serves the 200+ families in the settlement of Loharbada and the neighbouring villages, but also the women from the further surrounding villages which contain about 500 households.

Sushila, simultaneously the head (as a woman) of the birthing house committee of the municipality, was extremely happy at the inauguration: "We used to suffer a lot. But the next generation will have it better". No longer will a woman from our village give birth in a barn and nor will our babies freeze to death or die from the filth. The women no longer have to bleed to death. A whole new period begins for us."

The families have embraced the birthing house and it has already filled with life. The first birth took place only two days after the completion of the facility and this was decisive for the future of the whole concept: if the mother or child didn't survive, then all the omens would be bad.

However, accompanied by our midwife, the birth was uneventful and a little, strong, very lively boy came into the world. He was Banchu's (22 years) third child, she called him "Pradeep" (ray of light). Her first baby died shortly after birth in a cowshed and the following girl just survived in the barn. Therefore the all the more white Banchu appreciated the safety and cleanliness, the warmth, the nursing and security of the birthing house.

It is like a miracle for women and the word is spreading fast: a woman has experienced a humane birth for the first time in this mountainous region, with full care, protection and skilled support. We can obtain a skilled midwife for the care of pregnant women and the births as well as follow-up treatment, this midwife is able to tend to her post in the village immediately. She is assisted by a further team, a nurse and several assistants who maintain the birthing house as well as keep it clean.

The birthing house is a focal point for health and for the protection of women, but also for their needs, questions and concerns as well as for the education of young girls. Besides the childbirth, the midwife also informs the women about contraception, sexually transmitted diseases and HIV. Our midwife regularly attends the surrounding villages and offers her support to the women there.

More births soon followed, the first dozen babies were born healthy, even when the births were difficult. The young women from neighbouring villages also register for birth preparations because they want to bring their child into the world in the birthing house. The village community is proud of their birthing house, the women are very excited, grateful and relieved. The idea is transferable to other villages.

This birthing house really is a revolution for women in Mugu!

Our birthing house has already been checked and approved by the Ministry of Health of Nepal, it meets the necessary technical, structural, hygienic and medicinal standards necessary and the Nepalese government grants each woman bringing her child to be born here, a single payment of 1500 NRs (15 Euros, a carrier earns NRs 400 per day). This is a great success for our work. Every woman declared themselves fortunate, wishing thereby to buy clothes for their child.

It will enable us to visibly reduce maternal and infant mortality rates in Mugu if we build more birthing centres, duplicating the idea for the entire region. In the long term we want to transfer the responsibility of the whole concept to mountain dwellers but to do this we have to give the opportunity to young woman (as well as finance them) to obtain midwifery education as well as training young men and women in the knowledge of nursing. They are able to return upon completion of such education and thus take their place in the health care system of Mugu and keep the important birthing houses running into the future.

Still, it is not easy to find enough suitable candidates since, for a state-recognized education such as this one, a school leaving certificate is the prerequisite and these are few and far between for these young people in the Mugu mountains.

This is why it is so important for us to concentrate all our energy on the educational situation and provide the opportunity and access to information, education, awareness and knowledge for the young generation.

Regular training sessions and workshops that can reach all

We hold regular training sessions on the different programs in all project villages, to which each household sends one person. The participants then talk to their families and neighbours about it. Since there are often cultural restrictions, a vibrant discussion between the villagers is extremely important, because only together can they define, accept and finally forge new ways. The only way to do this is to raise awareness.

1. Active health care

Participants will be informed about health care through training courses in hygiene, personal hygiene and dental care, clean drinking water and handling thereof and hygienic preparation of meals. We have developed illustrative visual material for this purpose, so that illiterates can see all the important information in terms of understanding and to be able to remember it, for example, the need to regularly brush their teeth and wash their hands thoroughly. We encourage discussions between the participants each time, form groups "for and against" or tackle the respective theme through games - through role play or competitions. Our workshops are geared towards men and women, young or old, so that they can find access to new information, without pressure and in a cheerful manner.

In order to improve the (medieval) hygienic conditions in our project villages, we have conducted awareness campaigns in all project villages, granting more awareness of toilet use to the families. Inhabitants would relieve themselves outside their front door, on the paths or in the fields till our intervention. The women hold in any toilet urges during the day because they see it as shameful so only go in the dark in the early morning or night next to the house (which is very harmful for their health). Water as well as food can be easily contaminated because of this (through the attracted flies, mosquitoes, worms, maggots and other insects) and be infested with parasites, which in turn leads to regular annual fatal diarrhoea diseases as well as cholera and typhoid outbreaks.

Due to the low level of education, the connection between extreme unhygienic conditions and recurring diseases was not previously known to the people of Mugu. Even more important is the fact that because of their extreme poverty, they could not even afford the "luxury" of an outdoor toilet for their houses.

Through the construction and use of toilet houses, many emerging diseases can be prevented early on and therefore easily save lives. Therefore, we support the residents of our project villages in building their own toilets through the provision of wood or stone as well as the necessary materials (drain pipe, toilet bowl in Indian style), which must be brought initially to the region. The residents themselves are responsible for the actual construction under the guidance of our employees. Our goal is that every household has a toilet house.

We repeat our campaigns to improve hygiene conditions on a regular basis in terms of periodical visits to each project village, in order to see what they have already achieved through change and to continue to educate and motivate them.

Another important issue is to educate about HIV. Both the youth as well as the adults receive regular informational workshops on the subject in order to reduce the infection and spread in Mugu. Since many men are away for months or years working as unskilled labourers in India, they run the risk of bringing HIV to Mugu. In order to reach as many people as possible, we take up several regular radio informational spots on radio Mugu. News, updates and social grievances have always been passed on to the public in Mugu by traditional songs called "Deuda". The words are composed spontaneously depending on the occasion and tell a story.

2. Education boost from building schools, promoting education and literacy

Adolescents have a right to education, at least to learn how to read and write, in order to break away from the inevitable toil they can expect that depends on helping others. But since few children currently have the chance to attend school regularly and only very few have the opportunity to visit these until the end of the eighth class and gaining a leaving certificate, the population threatens to remain trapped in the Middle Ages.

Mugu can only be changed in the long term through education, awareness, information and intercommunication and it can hopefully be further developed to some extent in connection to the modern era. This can only happen when the kids get a chance to go to school.

We will promote the educational situation of children and young people in a noticeable and long-term manner through the following measures:

We will give almost 1,800 children the chance of school education through the construction and furnishing of 8 school buildings. We shall build the schools where they are most needed.

Through direct support, by schooling a total of 600 students in the course of 3 years in their respective village schools and supporting them with the necessary school supplies and school uniforms and shoes.

We managed to build the first school building in the Seri community. The former school, which offered teaching for 75 students from the first to the third years, was destroyed through a devastating landslide during monsoon season in 2012. The school education of children was thereby interrupted, because the next school was more than a 2-hour walk away and it did not have the capacity to take up so many children. Our new school building is designed for a total of 125 students from classes 1 to 5 and is already being used, as well as two other completed schools.

We take special efforts to raise awareness among (even those mostly uneducated) parents of the immense importance of school attendance of their children and carry out regular workshops in the villages that demonstrate the long-term benefits of education for the children.

However, the adolescents can only in fact attend school regularly if their parents can afford to dispense with the labour of the children for half of the day - without jeopardizing the survival of the family. Therefore, our following programs are aimed (point 3, 4 and 5) primarily at new opportunities for income generation, entrepreneurship and improvement of agriculture, so that all families can send their children to school through the improvement of their living conditions and economic situation.

Since almost no adult woman is literate in villages, we offer training courses in which they learn to read and write. We are trying to improve the rights of women and girls with additional gender training (gender equality). These workshops will be held in all schools.

3. Socio-economic prospects for agriculture

The meagre agricultural conditions and the extreme altitude cause a permanent food crisis, which threatens the daily survival of all villagers. They are in constant battle against the elements with hard labour and only one crop a year - in these conditions the families cannot eat sufficiently never mind make money.

We jointly develop ideas on how individual households can increase their productivity and thus their income and seek solutions to optimize agricultural production with agricultural training. For example, through better tools, greenhouses for vegetables, seeds adapted to altitude conditions, through hydroculture in the river beds, sophisticated irrigation systems and cultivating the Ayurveda herbs growing there.

We begin by choosing a few farmers with which we set up (as a demonstration) arable land in order to teach the other villagers modern farming methods. Somewhat later we then lead community training sessions to teach the mountain farmers to apply these methods on their own land.

Also, a better exchange and arrangement among themselves - deciding who plants what can improve the situation in the villages. We provide all households of our project villages with seeds and have got to the point where now, for example, green leafy vegetables grow in the Mugu mountains which then can be eaten. The villagers furthermore learn to pick out the seeds from the first harvest for the next crop, so that they can continue this in the future without our help. The health of the entire family benefits from it.

We provide young men and women with the opportunity of a 30-month training session at an outlying agricultural institute. They can then incorporate their new knowledge into the project and thus share their new knowledge in the future with the village communities.

4. Environmental and resource protection

The people of Mugu live in darkness and have only firewood for heating, cooking or as a light source. But since the houses have no windows because of the cold, the women sit for hours in the smoke of the open fire. Up to 70 different diseases result because of this, from respiratory diseases-up to eye problems. Furthermore they also do harm to the environment because people have to get the wood from the forests thus dramatically altering the landscape of the surroundings. This often leads to landslides that can be fatal for some settlements or villages during monsoon season. A family consumes up to 40-60 kg firewood daily for their necessities.

Smoke-free stoves

In order to protect the environment and natural resources actively, we have produced special smoke-free stoves specially tailored to the needs of Mugu that serve as a cooking and heat source. The new stoves retain the heat of fire wood for up to ten hours longer and use 60% less wood. The 35 kilo stoves are transported by means of trucks, small cargo aircraft and subsequently a two day trek just to get to the mountain villages. We train the villagers on the use and maintenance of the stoves upon installation of them. Since the smoke is now drawn in through a stovepipe, families no longer sit in the soot, which will have a positive impact on their health in the future.

Solar energy

The people of Mugu have lived to date without electricity and light. The days are short in the mountains, the darkness comes early. In addition to the smoke-less stoves, solar systems contribute to the direct improvement of the living conditions of the villagers. Our selected solar systems are designed and developed so that the accumulators are able to supply enough electricity to each set of three connected LED lights for up to 5 days long with low power consumption and high light sensitivity of solar cells even in total cloudiness in the monsoon season or in the winter time.

Prior to installation, the families proudly hand over the outright amount of 1500 NRs (15 Euros), which we in turn then place into their savings group (see point 5). As a result, the accumulated capital increases to a considerable sum per group, and is ultimately put back into the community.

The villagers learned about the maintenance of their solar system during training sessions. It is important to clean the solar cells and the battery box as well as the LED lights once a week from dust and dirt. In addition, young men from Mugu have been able to attend a 6 month course at the company in Kathmandu/Nepalgunj that produce the solar panels, so there they get an insight here into the technical conditions involved.

These people have never seen light in their homes before, it signifies a jump from the Middle Ages directly into modern time for them, which not only improves their day-to-day lives but also protects the environment as there is now no need to cut down wood for a light source. The women no longer have to spend hours collecting wood and painstakingly carry it home. They have recovered the evening time so they can spend time with her family. Previously they went to sleep immediately after eating, but now the family can sit together, concern themselves with manual work (e.g. weave wool and ropes) and slightly extend the day somewhat. The children use the light to play or for doing homework.

5. Promoting sustainability by micro-credit - savings groups

Our social workers respectively form several savings groups of 15-20 members in the villages. Each household sends one person, while we try to encourage women in particular to take part. Our team gradually teaches the groups how to forge on ahead independently in a democratic manner while showing the members how they can indeed save money, despite their harsh living conditions in order to work jointly build capital stock. Through the supervision of the social worker, the individual groups have learned how to organize their meetings themselves and to document them writing. The group agrees upon a savings contribution applicable for all, e.g. 50 or 100 NRs per month (100 NR's= 1 Euro).

Steps to independence:
Credit training and association with micro banking

After successfully implementing savings plans, the granting of credit training sessions begin after about a year when the savings group has saved up some capital stock to prepare the groups for admission in a micro bank. The savings groups, that (voluntarily) want to join together, form a cooperative and merge their saved-up capital stock in a state-approved micro bank in order to potentiate it. Credit will then be approved for a low interest rate of 2% respectively in consultation with everyone. The money to be awarded is taken only from the interest earnings, i.e. the total capital is preserved.

Then the individual households can borrow money, for example, to repair their houses to buy seeds or to create new livelihoods through opening shops or small businesses (carpenters, tailors ..).

This is a concrete step towards independence, from this moment on they are able to take their fate into their own hands.

The successes in the savings groups, medical assistance through the "Health Camps" and training sessions, the solar cells …, all this gives these people hope because they are given the chance to actively improve their lives step by step, significantly and in a long lasting manner. During the time setting up the banking system and the granting of credit system, the groups are obliged to take part in all further training sessions that our project staff carry out so that a visible and lasting change in their way of life can be assured.

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Business start-up:

Ser Singh Bishwokarma from the village of Dhuma borrowed the sum of 2,000 NRs (20 Euros) in the summer of 2010 to set up a small business in haberdashery. The business is his only possible source of income, since he wears a prosthetic leg so he cannot work as a carrier of goods or in the fields. He is married and has two daughters, the elder one already goes to school.

He was able to pay the credit repayment and interest rate of 2% back within 4 months. The small business is a stable source of income for the family and if nobody frequents he shop, which also doubles up as his family's living room, Ser Singh knits scarves and hats from wool as extra income.

Projektarbeit im Himalaya

6. Medical help through "Health Camps"

The nonexistent medical infrastructure in Mugu is, next to hunger and poverty, the meagre harvests due to the altitude and the remoteness of the area, one of the reasons why life expectancy in Mugu only averages 44 years. There is only a very badly equipped hospital in the provincial capital Gamghadi to serve the people throughout the mountain region that is not usually staffed by a doctor, no medication is available either yet "theoretically" it is responsible for approx. 55,000 people.

We organize regular "Health Camps" in order to help the acutely ill and needy. To have no prospect of medical care means that many families live in fatal distress and cruel hopelessness. We want to counteract this by sending doctors to the remote areas of these mountains. These must be ready for about 10 days, the physical hardships and both the dangers as well as the deprivations which a stay in Mugu brings with it, must be considered as well as - the amount of days spent in gruelling marches at high altitudes, overnight stays with poor villagers that include meagre and partly prepared meals due to the lack of cleanliness and the minimal possible hygiene.

The usual 5-7 man team of doctors consisting of general practitioners, paediatricians and gynaecologists, sometimes dentists, then meets in Mugu with our team of medical assistants, nurses and social workers. There is usually around 20-30 people who take care of all organizational and preparatory measures.

In the month before the "Health Camps" our employees - the "social mobilisers" pass through the villages and those who require a screening are registered on the list, so that we can roughly estimate how many drugs we have to move to the mountains. When and where our "Health Camps" take place is also always broadcast on Radio Mugu. The crowd is always massive.

Our project villages have received simple stretchers so that even the ill and the injured can make it to the "Health Camps" without obstruction. Beforehand these unfortunate people had to be carried on the backs of the well-abled in the typical load baskets but, particularly for women bleeding, that is fatal because they are in danger of bleeding to death by perching in the basket en route.

Our local team sets up the camp in each case and directs those waiting because of complaints to the queue for the 'correct' specialist, perform preliminary tests such as measuring pulse or weight, so that doctors can begin examinations and treatment of patients promptly every morning. If medications are prescribed, our team shall inform the patient with strictly applied notes. We mostly treat people in the camps who have never even seen a doctor before. The requirements are overwhelming. We have been able to provide emergency medical treatment to over 8000 people so far.

The most common complaints and diseases include heart problems, gastritis, diarrhoea, allergies, asthma, migraines, conjunctivitis, ear infections, burns, various skin diseases, lung diseases, infections, parasites, fungi or worms as well as malnutrition. The gynaecologists deal with urinary tract infections, uterine prolapses, sexually transmitted diseases, bleeding or different pregnancy problems.

The most severe cases - we fly them out

We come across many dramatic cases, which we simply cannot handle in the "Health Camps", each time since laboratory tests, special devices or surgery result in care we cannot provide. Therefore, our doctors compile a list of acute and life-threatening cases so that we can save the lives of these people or to avert serious damage to health by letting them fly out and give them the necessary treatment or surgery in the lowlands (Nepalgunj or Kathmandu). We place a special focus on children and mothers with children.

The list always includes cases such as burn victims or complicated fractures, lung and heart patients, infections and ulcers, women with severe uterine problems or patients for whom surgical intervention is vital.

A flight to Kathmandu and back can cost up to 300 Euros and is totally unaffordable for residents of Mugu, so they are thus sentenced in case of emergency to death due to the lack of road access. Each patient also requires accompaniment that takes care of them throughout the hospital stay, because food intake, medication and accompaniment of the patient to the toilet is not a job for nurses in Nepalese hospitals, but for the relatives. It is often difficult to find a companion who is educated enough to control various hospital issues and who simultaneously has enough time. Those helping a relative in the lowlands cannot contribute to family income at home.

We assume the transport costs and our team organizes a stay in the hospital for patients. There is an agreement with the Ministry of Health that when we have to fly out the needy, there are no costs charged at the government hospitals. If this does not work or medical treatment in another hospital looks more promising, we meet such costs.

Hiralal Thapa, a 12-year old, arrived to one of the "Health Camps" with severe pains and a markedly curved abdomen. Our doctor diagnosed an acute bowel obstruction and ordered further treatment at a clinic in Nepalgunj as fast as possible. The boy, who was very weak due to the pain, was initially carried on a stretcher for two days by his uncle and several helpers to the airstrip in Thalsa, from where he was flown. After landing, he was rushed to the hospital and underwent an emergency operation there because his condition was life threatening.

The operation was successful and after two weeks Hiralal was able to leave the hospital. He was re-examined again 14 days later and then returned to Mugu, he is fit again and he is already back contributing to family life.

We also take care of other individual medical cases regularly, you can learn more about this HERE.

We have managed to offer help to around 18,000 people out of the total approx 55,000 population of Mugu. This is almost one-third of the population. But we want to expand our "sustainable aid for self-help" program further and step by step throughout Mugu over the coming years.

Please help other families and villages in Mugu to achieve sustainable aid for self-help in order to improve the living conditions in the villages and fundamentally to allow children to attend school through a project sponsorship. Thank you for your support!

Projektarbeit im Himalaya