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As I walk the rugged and cramped streets of Kathmandu, I often reminisce about a place far away, a place where I spent my childhood, New York City. The son of a Nepalese diplomat, I was raised in a world that seems very distant today. The wide streets of Manhattan, the extravagantly expensive Fifth Avenue shopping malls, the idyllic smells of Central Park in the winter, hotdogs in the summer, and the nonchalance of childhood; all just memories now of a life I used to know. It is different here in Kathmandu. Insurgency, poverty, and political unrest are a part of everyday life.
My Childhood Essay In Nepali
Yet, in these imperfections I find inspiration. I will never forget optimism in the eyes of a crippled boy from Markhu who trekked and limped his way to school, half a mile every morning without shoes. I will never forget the sight of famished street children in my neighborhood as they fought for scraps of food on the road. I will never forget the damp room in the cancer hospital in Chitwan, which housed the dying patients who couldn't afford their own treatment. And I will never forget the tears shed in my own family over the death of an innocent man. Throughout my childhood I saw the beautiful side of life, then the darker side, and today I've ended up with far more questions than I have answers for.
I remember my childhood when we were always reminded to keep our heads down; since even looking into the eyes of elders was totally unacceptable. In none of the family matters were we asked for opinions or allowed to have our say. This was true even when those opinions were directly related to our life; for example, choosing our fields of study or what we wanted to do in our lives. Unquestioned obedience was the only permissible rule.
After hearing about individual stories for years, I wondered if the source of the suicides is rooted in our collective refugee story. Now, as a 21-year-old, I wanted to understand the context behind my childhood.
After hearing about individual stories for years, I wondered if the source of the suicides is rooted in our collective refugee story. Now, as a 21-year-old, I wanted to understand the context behind my childhood. I learned that there was in fact a higher suicide rate for Bhutanese refugees, compared to the general U.S. population.
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Anxiety disorders are the most common mental health conditions in the U.S. They affect about 40 million Americans. They happen to nearly 30% of adults at some point. Anxiety disorders most often begin in childhood, adolescence or early adulthood.
The COVID-19 pandemic has disproportionately affected all essential healthcare services delivery in low-resource settings. This study aimed to explore the challenges and experiences of providers and users of childhood immunisation services in Nepal during the COVID-19 pandemic.
Semi-structured qualitative interviews were conducted with childhood immunisation service providers and users (i.e., parents of children) from Kathmandu valley, Nepal. All interviews were conducted through phone or internet-based tools, such as Zoom, WhatsApp, and messenger. All interviews were audio-recorded, transcribed verbatim, and analysed using theme-based content analysis in an Excel spreadsheet.
Despite experiencing disruptions in childhood immunisation service due to the COVID-19 pandemic, service users and providers were determined to vaccinate the children. There is an urgent need for effective preparedness plans to be in place to address the observed barriers and to ensure resilient immunisation services during ongoing and future pandemics.
In Nepal, routine childhood immunisation is conducted under the National Immunisation Program implemented by the Child Health Division of the Department of Health Services. Under this program, a total of 11 antigens are provided to children throughout the country, including those of geographically, economically hard to reach, marginalised communities through district hospitals, primary healthcare centers and health posts [12]. The immunisation services are delivered through all government health facilities, including outreach programs and mobile clinics in communities (VDCs and municipalities) all over the country in a periodic manner. In addition to these, immunisation services are provided at private hospitals, Non-governmental Organisations (NGOs)/International non-governmental organisations (INGOs), medical colleges/teaching hospitals, and district ward offices [13]. Among various members of the healthcare delivery system, Female Community Health Volunteers (FCHVs), vaccinators, immunisation officers, Auxiliary Nurse-Midwifes (ANM), and immunisation supervisors are key members involved in the routine childhood immunisation in health posts, outreach clinics and during the community vaccination campaigns [14].
Like other South-East Asian countries, the Government of Nepal adopted mitigation efforts such as preventive and hospital-based interventions based on the guidelines provided by World Health Organization (WHO) to tackle the COVID-19 pandemic. However, little is known about how the COVID-19 pandemic affected the immunisation service delivery and utilisation among the Nepalese population [19]. To the best of our knowledge, this is the first qualitative study that aims to explore the perceptions and the experiences of service providers and users of childhood immunisation services during the COVID-19 pandemic in Nepal.
The content of the result were analysed using simple thematic analysis. The findings from this qualitative research were categorised into six general themes: (1) impact of COVID-19 and lockdown on childhood immunisation services; (2) motivation and resilience for childhood immunisation; (3) biosafety practices and PPE availability during the COVID-19 pandemic; (4) service Adjustments and Guidelines during a pandemic; (5) availability of Childhood Vaccines; and (6) vaccination program resilience in view of COVID-19.
Most participants agreed that the pandemic had impacted the childhood immunisation service delivery and utilisation. In addition, most of the service providers mentioned that COVID-19 affected the delivery of some vaccines during the initial phase of COVID-19, along with the decrease in parents bringing their children for vaccinations.
Despite the fear in society, service providers were determined to deliver the services with high morale, while most service users reported taking their children for vaccination. The service providers were motivated by their family members and moral obligation to continue providing services during the pandemic and lockdowns. In contrast, prior health education provided by the service providers regarding the importance of childhood vaccination motivated the service users to bring in their children for vaccination amid the global pandemic and lockdowns.
Health service users noted a lacklustre in terms of Standard Operating Procedure (SOP) compliance. The government of Nepal has put forward to continue the childhood immunisation services amid COVID-19 pandemic by taking necessary precautionary measures, such as physical distancing and using protective and safety gears [23]. However, they observed lapses in fever screening and social distancing measures.
The COVID-19 pandemic has affected and disrupted the health services delivery at all levels of the Nepalese health system. Immunisation is an essential health service delivery for every country. The addition of new vaccines and immunisation schedules, a complex supply chain involving multiple stakeholders at an international and national level, cold chain infrastructure and public healthcare delivery structure and process makes immunisation a micro-system in itself [24]. Effective management of immunisation both during normal and disaster time shows the resilience and strength of the health system. In this present study, we explored delivery of the national immunisation service during COVID-19 pandemic and the nature and extent of impact of COVID-19 pandemic on childhood immunisation services.
Overall, our study shows that despite many barriers, both providers and users perceived that childhood immunisation service delivery continued during the COVID-19 pandemic; however, there was a disruption of services at specific points/periods during COVID-19 pandemic. There was an attempt to trace those children who missed their regular immunisation during the COVID-19-related disruption by the service providers. Despite such attempts, a lack of a real-time dynamic immunisation database and temporary migration and movement of families during COVID-19 pandemic affected the tracing of all the children missing immunisation.
In the current study, even though the childhood immunisation service deliveries were affected during the early phase of COVID-19 pandemic in Nepal, the ground level members of the immunisation team, i.e., FCHVs, ANMs were delivering the service in the later period. In addition, although the regular immunisation service and the mass immunisation campaign were continued intermittently, taking appropriate precautionary measures, only a smaller number were brought for vaccination shots because of the fear of COVID-19 transmission. Almost consistent findings were observed in Saudi Arabia and the United States, where the reasons for low vaccine coverage were the fear of contracting COVID-19 at healthcare facilities, restrictions in movements for the public, limitations within healthcare facilities, and unavailability of vaccination services during lockdown [27, 28]. Indeed, the additional potential reasons mentioned above may have led to fewer children attending the vaccination service in Nepal. In addition, in case of the current study, this might also be due to lack of effective communication about the operation of vaccination centers during COVID-19 pandemic. The effective tracking of the missed children and administering the missed doses of vaccines is crucial. Failure to do so might lead children to the resurgence of vaccine-preventable diseases (VPDs) [29]. A study in Africa has reported that the benefits of routine childhood vaccination outweigh the risk of COVID-19 transmissions and death and focused on continuing the vaccination process amid COVID-19 pandemic [30]. 2ff7e9595c
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