The Madi area in Chitwan district regularly faces flooding following a surge in the water levels in the local rivers during the monsoon. With no bridge over the Rewa River, access to the district in general is cut off. Around 400 families in Madi have already been displaced due to floods in the past 10 years.

Madi is situated southwest part of Chitwan district, which is 45 kilometres far from the district head quarters of Bhagalpur. It is surrounded in part by the Chitwan National Park and its northern border is India.

It seems like Madi is a separate district. The population of Madi is more than 70,000, however there is: poor health, no communication facilities, reliable electricity, good transportation links, no tar macadam roads or any new developing infrastructures. Literacy rate is very poor and therefore those that are literate are called the ‘upper classed’. The socially excluded and economically poor indigenous groups, the Chaudhary’s, Tharu’s, Dalit’s and Janajati’s, dominate the dwellings and settlements. The land here is totally dominated by non-productivity.

There are no well-managed schools in Madi and the Government has ‘averted its eyes’ for development of Madi. The non-existence of the bridge over the local Reba River is the main reason Madi is so isolated and cut off. Students routinely leave the area and travel to Bharatpur to get a better education both at secondary and university level.

Report by Dr. Klaus Harbig The rural, remote Madi area is a complex of several small villages like Meghauli. During my previous Health Camp in Madi, I worked in the villages of: Bagoda, Jeevanpur, Dachin Ayodha, Kantipur and Madi. The geography of Madi is very unfavorable, this is because the jungle surrounds the entire area, and as it is deemed to be in the Chitwan National Park, the wild animals (tiger and rhino’s) cannot be shot. This leads to a consequence of the animals destroying the land, farm buildings and sometimes the villagers themselves. The VDC of Madi has asked the government for a fence, so far without success. Madi borders the mountains of India, and the jungle terai area of Nepal: mountains on one side, the Rapti river the other – a dead end of the road!

Access to the area is via a vulnerable ‘bridge’ (the only one), which has to be guarded by the Nepalese Army against the threat of Maoist Terrorists intervention in the villager’s activities. The river is fast flowing and increases its size 10 fold during the monsoon season. At that time it is not possible to cross the river by bus, buffalo cart or by jeep.

Most of the inhabitants belong to the tribe of Tharu, and understandably feel abandoned by the government, as they are part of the ‘forgotten West of Nepal’. So the Maoist propaganda was very successful and during the recent elections the area of Madi, showed a high proportion of votes for them. However, since the Maoists have been elected the ‘promise of a better life’ for the Tharu’s has not materialised.

Travelling form the clinic in Meghauli to Madi takes approximately 2-3 hours by motorbike or jeep. (This however depends of the military controls, condition of the jungle roads and the water level of the Rapti river).

Due to the above-mentioned unfavourable natural and political conditions, any kind of help would support the moderate section of the Tharu people and weaken the anachronistic form of communism. People thank us for any kind of help either to by a single person or for by a whole group.

Since 2008 - Health Camps have now been held there over a dozen times: One doctor told us us:- “ In the past, we have had between 80 -100 patients attending per day, with the doctor(s) treating them in the makeshift surgeries constructed in school classrooms with Gynaecologists, Paediatricians and Physician making up the team. Periodically the Friendship Clinic arranges for minor surgery to be conducted by a visiting Nepalese surgeon. There is no electricity, no clean piped water, and can often be 30ºC in the shade so we work long hours taking full advantage of the daylight. All our food is sourced locally which channels hard cash money into the local economy), and to ‘relax’ we swim in the Rapti. Many a time we have fallen asleep on make shift beds without any mattresses, we were that tired.

Due to the limited ‘hours of the day’ and doctors time available, unfortunately we sometimes have to send home patients without then have being seen - even though they sadly had been carried for 3 hours, to hopefully see a doctor.

Most of the patients seen were mothers with their children, when there we have to select (because of the numbers) the women because of their low status within the Hindu society, especially widows. As most of the patients come from the lower caste, many of them being will be Dalits locally treated as ‘the untouchables’. Klaus writes: If the current support from the Friendship Clinic (through its Health Camps etc.) doesn’t continue the Madi area will return back to a poverty level that is lower than Meghauli. This is my own experience gained over numerous visits. It is not only the acute medical help the villagers get, but with that help come hope, and they feel encouraged and motivated, when they see that foreign doctors, nurses and funding coming from outside there own country from all over the world. The Villagers do not feel forgotten anymore.

I have heard this conversation in several meetings I have had with the locals and elders: they are very grateful and so surprised that Hari and the Friendship Clinic Nepal team support them, it is just a miracle that they cannot understand.

After a site visit to Madi from The Friendship Clinic Nepal (UK) and Hari and his team, consultation with numerous Doctors who had worked on the health Camps (both Nepalese and International) it was decided to see if we could do something more positive in the area, to alleviate some of the problems. We agreed to:
· Increase the number of times a Health Camp in conducted in the Madi district · Build an outreach station at Madi (outpatient clinic operated on the same lines as the Friendship Clinic Nepal NGO – using the experiences gained during previous visits to augment the proposed plan) · Finance the salary of 1 ANM (Auxiliary Nurse Midwife) and the supply of a local Doctor to be in attendance twice a week. · Undertake a survey by NEWAH / Water Aid with regard to the provision of Fresh Water (tube wells) and Sanitation, in the Madi district. · Provide Health education and training in all the kindergartens (in the Madi district) akin to that being conducted ad Daldale.

2013 - The plans have been drawn up, Health Camps have increased, discussions are underway to secure some land, and finance to complete the project is slowly coming in.