One of the IEM fellows travelled to Surkhet, Nepal to work with the International Rescue Committee (IRC) on a Clinical Development Project. The Fellow conducted a 4-week intensive health program aimed at training national IRC medical staff, assessing sub-health post (SHP) capacity building and rebuilding community outreach programs. Although mired by absent health-post providers, conflicting health campaigns, steep cliffs and a Nepali protest, the program was successful in providing 27 days of intensive training and in-field analysis. The program comprised of 6 days spent on didactics, 17 days spent in the field, and the remainder used as off-days. Field days resulted in visits to 11 Village Development Committees (VDCs) within which the team worked in 9 SHPs and one outreach clinic (ORC). Two VDCs were multi-day visits and one had no local staff present.
Overall, each IRC national staff member showed marked improvement in clinical practice and training of auxiliary health workers (AHW). Nepali training typically involves passively learning by observing the teaching physician work. In contrast, field training focused on more interactive methods of teaching clinical skills to the AHWs. At the conclusion of the project all IRC medical staff found the interactive approach much more conducive to teaching and unanimously agreed to continue using these methods. Finally, in-field clinical instruction was centered on UNICEF's Integrated Management of Childhood Illnesses (IMCI) protocol. IMCI registers were analyzed and current practices by AHW's were assessed.