PROCESAMIENTO SEMÁNTICO

While volunteers were able to earn community respect over the years, they admitted the

existence of negative views by community members on their voluntary services. These

hindered the FCHVs’ from effective service provision. Three key themes were identified: a) FCHVs were considered as paid workers, b) their provision of medicine

was seen as unnecessary or detrimental and c) their services were not accessed by

certain ethnic groups.

6.6.2.1 Considered as paid workers

Some volunteers reported that they were being treated as paid health workers and

expected to produce the same amount of work as paid health workers, but the volunteers

could not do so, one of them commented:

“Some people say, ‘she gets a salary every month, but she does not come to our home.’ Many people do not say this, but a few people do so. I think we need to ignore such comments and keep working.” FCHVD7.

One of the reasons for this misunderstanding was the volunteers’ uniform which not only promoted their wider community recognition, but also created confusion among

community members:

“People think that we get a lot of benefits, only the volunteers understand what we actually receive and what we do not. When we walk into the village with a new and clean uniform, the villagers think that we have earned a lot of money from this work.” FGD2 Participant2.

Some women also reported that FCHVs get money for their work. One of them

commented:

“What they (FCHVs) need to do is they should go to different places and

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a low or high salary because one should fulfil one’s responsibility.” Woman S17.

While many volunteers complained about the misconception of the villagers, two

volunteers were found to be working in a full-time position to maintain their livelihood,

which was against the national guidelines for the volunteers:

“When people from the village see us working in other places, they ask us, ‘from how many places you are earning?’ People feel that we are working for money; we have a big salary, so we are not volunteering.’” FGD3 Participant3.

6.6.2.2 Medicine provision seen as either unnecessary or detrimental

As discussed in Section 5.6.1, FCHVs provided some basic medicines for mothers and

children. Sometimes, the volunteers were mobilised in mass distribution of drugs by the

Government of Nepal. For example, they distributed drugs to treat filariasis (See

Appendix 6) and experienced many unexpected problems. The volunteers reported that

they were accused of distributing unnecessary drugs and were also blamed for its side

effects, as one of them commented:

“Interviewee: While we were giving medicine for filariasis, people chased us away with their sticks.

Interviewer: Why?

Interviewee: Some children became unconscious, some had fever and some developed typhoid due to that medicine, so people came several times to complain about the matter.” FCHVS9.

Some FCHVs reported that villagers talked to them rudely, as they did not have faith in

the medicine:

“Participant4- Some villagers said, “You brought medicine to kill us”.

“Participant1- Some people ordered ‘you go away, you go away, you go away, we don’t take your medicines.’ The people who reacted in such a manner were

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the ones who were usually educated. They didn’t take the medicine for filariasis.” FGD4.

In the hill region, FCHVs were supplied with medicines, but some FCHVs distributed

the medicines without careful consideration. One of them reported that she was giving

zinc tablets to treat diarrhoea in adults, which she should have been using for treating

diarrhoea in children under five years:

“I realised that zinc tablets could be given to older person with diarrhoea too. A man in my village had this tablet for 10 days and he became all right

afterwards.” FCHVD4.

In the Terai, one FCHVs was found to be injecting people without adequate training (Section 5.6.1).

6.6.2.3 Not accessed by certain caste or ethnic groups

The lack of use of FCHVs’ services by certain ethnic minorities such as, Chepang and Tamang in the hill region, and Madhesi and Muslims in the Terai, were noted. The main

reason for this was either the service users were unaware of the FCHVs’ presence or they had cultural misconceptions about modern healthcare services.

Some FCHVs reported that ethnic minority groups in the hill region did not understand

the importance of immunisation, as some parents were reluctant to immunise their

children:

“I went walking two to three hours to provide polio drops. The woman did not accept the medicine. She said, ‘Our children do not need medicine, they will survive’. It took me three hours to reach them. I did not go there with my self- interest, yet I could not do anything about it.” FCHVD7.

A health worker reported the challenging aspects of the work while working with

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“It is mainly associated with the level of awareness among people. In this ward number 4, Chepang community is in the minority and the mothers’ group is functioning well. There are many members in the group. However, the issues such as hygiene are very poor among Chepang community. The enthusiasm for the work is also lower in this community and so is women’s participation in mothers’ groups.” HW5.

A health worker commented that people in the community were only interested in

immediate health benefits from FCHVs’ services and not the long-term changes in lifestyle that was needed:

“People in the community would like to see immediate results rather than actually learning the skills. It is their nature. We have a limited budget and people have big expectations.” HW6.

In the Terai, pregnant women and mothers from Muslim and Madhesi group did not

access the services as one FCHV commented:

“Some people do not understand the importance of healthcare check-ups during pregnancy or motherhood. Usually Madhesi women do not understand it.” FCHVS14.

Women from the Muslim community were not accepting FCHVs’ services due to their misconceptions about the use of healthcare services and medicines:

“I work in the Muslim village. They have been saying that if the polio medicine is taken, then it reduces the power of reproduction. People think that they can’t have children later in life, so refuse the medicine. We go their houses and ask them. Currently, when we go their houses and drag the children to have the polio drops; at least they do not stop us.” FGD3 Participant1.

Another FCHV commented:

“They said, ‘the wound from immunization makes our God angry. I don’t want to have any injection. Why did you ask me to have an injection? If my mother-in law or father-in-law knew about this, they would be annoyed.” FGD3

165 A Muslim woman had her all four children delivered at home:

“There is no need to go to the health centre. I had all my children delivered at home. If I need any help then, my mother-in-law would assist me. She knows how to rotate the baby in abdomen, if needed.”

Some ethnic groups held misunderstandings regarding the available healthcare services

and the services offered by FCHVs. There is a need for special awareness education for

these ethnic groups.