Nuwakot, a district in the northern region of Nepal, was one of the areas that was impacted the hardest by the earthquake that hit the country in April 2015. Over 55,000 of the 60,000 buildings in Nuwakot were either damaged or collapsed as a result of the earthquake. The hospitals and community care centers in that district were destroyed and this disrupted the provision of health services and prevented people from accessing the care, and support that they needed.
Trishuli Plus, a community based organization that also serves as a community crisis center in Nuwakot, was established to provide HIV related health services and home based care for people living with HIV in the district and the surrounding areas. It was founded in 2006 with support from the National Association of People Living with HIV in Nepal. The center is open for 24 hours everyday and has thus far served 202 of the 458 HIV positive people in Nuwakot, 24 of whom have been children.
During the earthquake, the building in which Trishuli Plus was housed, collapsed. With very few habitable buildings left in Nuwakot, the center was forced to relocate to a tent and resume its business with the little that it was able to salvage.
“During the earthquake time, the ART [Anti Retroviral Treatment] Counselor from the district hospital who used to distribute ART was away at a workshop,” said Raj Kumar Shrestha, Trishuli Plus Administration and Finance Officer. “Fortunately, Trishuli Plus had the key to the store so we were able to access the medicines and distribute them to our clients.”
The tent in which Trishuli Plus was working from not only served as a center for people living with HIV, it also provided accommodation for the staff, the clients, and some earthquake survivors. It was overcrowded and faced problems of privacy, hygiene and sanitation. “After the earthquake, we [Trishuli Plus] were providing services from the tent. There were lots of challenges there. The tent was overcrowded. There were also people who were living with HIV and had tuberculosis. They were supposed to be in a secluded place but unfortunately, this was not possible,” Mr Shrestha concluded.
Following the earthquake, UNDP has been assisting the government of Nepal to rebuild local governance systems and public service delivery, restore livelihoods, recover the economies of communities and to generally build a disaster resilient nation. As one of the recovery efforts, UNDP along with other partners gathered preliminary data on disrupted HIV services in the earthquake affected districts. For the emergency recovery of HIV services in these districts, UNDP in collaboration with other UN agencies assisted Save The Children, an International NGO, to mobilize emergency relief funds from the Global Fund in the amount of $2.1 million.
“The earthquake was devastating for Nepal. The health sector was gravely impacted, particularly in the hardest hit districts such as Nowakot and Sindhupalchowk” said Bharat Man Shrestha, Human Rights Officer, UNDP Nepal. “Accessing HIV related services was particularly difficult in these districts, but UNDP, along with the Government of Nepal, implementing partners and civil society organizations, worked together to ensure that community care centers were able to operate, that those on antiretroviral treatment were able to access it, and that HIV prevention services such as harm-reduction and community out-reach were maintained.”
Trishuli Plus was one of the recipients of this support and has since been able to relocate to a more permanent building in Nuwakot. With the Global Fund grant, it has been able to deliver earthquake relief materials such as food and nutrition items, mattresses, blankets, mosquito nets and water purifiers. So far, Trishuli Plus has distributed these items to 80 HIV affected households from the Nuwakot district as well as to 10 migrant HIV affected families from surrounding districts. It has provided mobile health services for people living with HIV in Nuwakot and Rasuwa districts. It has also used the Global Fund grant to provide cash transfers for the educational and daily needs of children affected by HIV. And now, Trishuli Plus is in the process of implementing a livelihood recovery program for those living with HIV who lost their businesses in the earthquake. The programme gives these HIV positive entrepreneurs a micro-grant of NRs 15,000 (approximately US$ 140) to support the restoration of their livelihood.
“The center [Trishuli Plus] needs to be here for its vision of giving quality of life to HIV positive people and creating an environment where HIV positive people can live safely and with dignity,” said Mr Shrestha, Trishuli Plus Administration and Finance Officer. “Before, when there was no project funding we still provided services. And if there is no project funding in the future, we still hope to continue our work no matter how difficult it gets.”