Standards of medicine

Shangri-La, a mythical kingdom in the Himalayas, continues to fascinate tourists, writers, and artists since John Hilton first wrote about it in his novel Lost Horizon (1933). This chapter explores the imaginative geographies of a utopian Shangri-La in Euro-American cinema. More specifically, it argues that Shangri-La has most enduringly been located in Nepal, with its capital city Kathmandu providing many of the features that have come to be stereotypically associated with a Himalayan form of eastern mysticism. Films such as The Night Train to Kathmandu, released in 1988, and Doctor Strange, released in 2016, disclose a world of transnational imaginaries and colonial fantasies. At the same time, the warm reception of these films in Nepal indicates the role of Orientalist mythmaking and popular culture within tourist economies and local aspirations to gain a share in global markets.

Esse campo é destinado ao resumo do artigo que deve ter entre 180 e 300 palavras. O resumo, palavraschave, PACS, title, abstract e keywords constituem a primeira página do artigo, não devendo estenderse para outra página. O resumo deve fazer uma apresentação concisa do artigo técnico científico, contendo, uma introdução, o objetivo, uma síntese da metodologia, o principal resultado e a principal conclusão (preferencialmente nessa ordem). Assim, o leitor pode conhecer a essência do conteúdo do artigo. Lembre-se que o resumo é como o trailer de um filme, as pessoas ficarão interessadas em ler completamente o artigo se o resumo lhes interessar. O resumo não deve conter informações novas não contidas no artigo; abreviações indefinidas; discussão prévia de outra literatura; referências e citações e excesso de detalhes acerca dos métodos empregados. Ele também não é o parágrafo de introdução do documento, isso deve ser colocado no início do texto. Utilize apenas informações úteis e relevantes, faça um exercício de empatia com o possível leitor interessado. Para se obter um resumo coeso, elegante e de acordo com o artigo, escreva uma prévia, realize a escrita completa do documento e, ao final, revise-o observando se o conteúdo dele reflete de forma consistente o teor do documento. Seguindo o resumo, o autor deve listar até 5 palavras chaves (evite colocar as mesmas palavras que formam o título do artigo). Após essa etapa, há ainda os PACS, que são um sistema de classificação hierárquica (mais detalhes no texto) e, em conseguinte, título, resumo e palavras-chave em inglês.

A Revista Diálogos e Perspectivas em Educação Especial (RDPEE) é um periódico semestral com publicaçãode artigos científicos sobre temáticas diversas em Educação Especial.Atende à demanda de fluxo contínuo, podendo haver também números especiais organizados na forma de Dossiês, encomendados pela Comissão Editorial ou organizados a partir de seleção de trabalhos apresentados e/ou premiados em eventos científicos da área.Os autores e coautores receberão um exemplar da revista impressa, porém, a revista online estará aberta a toda a comunidade científica, com acesso por meio do site de Publicações da Faculdade de Filosofia e Ciências (FFC) da Universidade Estadual Paulista “Júlio de Mesquita Filho” (FFC/UNESP). Para garantir um maior número de autores na revista, cada autor e/ou coautor poderá publicar somente umartigo por ano.As colaborações para a RDPEE podem ser apresentadas como: ensaios teóricos; relatos de pesquisa; desenho universal; resenhas e dissertações e teses defendidas na...

Neoliberal development processes are increasingly pervasive across the globe, but they are incorporated unevenly into social systems at the micro-level with varying ramifications for the sustainability of social institutions. This paper investigates how kinship relates to ecology and exposure to development in two villages of Humla District, Nepal. A geospatial analysis using ArcGIS software, combined with ethnographic techniques, offers visual representation of socio-ecological information that could facilitate the application of social scientific knowledge to a variety of issues in sustainable community development. The findings we present suggest that increasing integration with a market economy and other outside influences exaggerated differences in social networks. Specifically, we found that those villages with more development activity had more dispersed households and fewer social resources at home. This was in part the trade-off for increased connections abroad and in cities around Nepal. We explore the potential impacts of diffused social networks on long-term vulnerability. NGO staff working to maintain the sustainability of development's successes in the region will need to include the dynamics of local social networks in their analyses.

Healthcare has often been 'weaponized' during armed conflicts, with parties to the conflict interfering with or violently attacking health facilities and personnel for their own strategic ends-for example to deny access to services to supporters of their enemies. Such strategies have damaging consequences for the health system that continue long after the fighting has stopped. In this exploratory study of the civil war in Nepal (1996-2006), by contrast, we look at a case in which both sides (with a few limited exceptions) came to see it as in their interests to avoid targeting health facilities or deliberately disrupting healthcare delivery. As we seek to show, this does not seem to have been solely the result of a desire to comply with international humanitarian law, but rather the product of a strategic choice made by the parties for their own internal political reasons. Drawing on key informant interviews and documentary analysis, we identify four factors that appear to have contributed to the two sides making this choice: i) their interest in the continued functioning of the health systems (specifically, the need of the Maoists to access government-run facilities for treatment of their cadres, and the fact that Maoist healthcare provision ensured that at least some service delivery continued in areas under their control, contributing to the government's efforts to ensure national health indicators continued to improve); ii) the fact that healthcare did not become an important 'ideological battleground' in the conflict; iii) the roles played by humanitarian and development organisations in shaping the behaviour of both the warring sides; and iv) the part played by health professionals in navigating the pressures on them and quickly mobilising to resist more sustained attempts at interference with healthcare.

Objective: This descriptive cross­sectional study was undertaken to describe the factors affecting the intention to accept vasectomy among married men. Materials and Methods: Simple random sampling was employed to interview 200 married men aged 20­49 years in Khadka Bhadrakali Village development committee (VDC), Kathmandu, during February 2007. Results: The mean age of the respondents was 35.7 years and mean duration of marriage 13.4 years. 39.0 % had an intention to accept vasectomy and were between 20­29 years of age, married for less than ten years, had two living children. The average number of desired children of the respondents was 2.42. The researchers selected factors that influence the intention to accept vasectomy by using backward logistic regression. The study found that the age of the respondent was associated with the intention to accept vasectomy (OR 6.77, 95% CI: 1.02­ 44.81). Beliefs about vasectomy were also found associated with intention to accept vasectomy (OR ...

Mary Des Chene: I want to do three things this evening. First, some audience members asked me to discuss a several issues that were neglected during the paper sessions. Second, Iwant to respond to some things Iheard in the afternoon sessions. Lastly, I want to suggest some issues that we all need to be thmkmg about.

The primary purpose of a thesis or dissertation is to train the student in the processes of scholarly research and writing under the direction of members of the Graduate Faculty. After the student has graduated and the work is published, it serves as a contribution to human knowledge, useful to other scholars and perhaps even to a more general audience.Therefore, the University Library, and the Universidade Federal de São Paulo have established format standards that theses and dissertations must meet before receiving final approval as fulfillment of graduate requirements. This publication sets forth those standards. Some of these requirements are purely technical; others have been established to ensure that certain vital information is presented in an orderly, uniform manner.<br>

In my attempts to test models evaluating the supposed risk aversion of "peasants", I was simultaneously forced to confront my own (non-peasant) risk aversion. In fact, it was Nepal"s "peasants" who forced me to challenge my cowardice and take on more risk. While the Nepali citizens among whom I did my fieldwork did take part in strategies that were intended to minimize vulnerability, I spent most of my time in Humla District, Nepal in awe of the strength, flexibility, and vivacity with which many of the villagers confronted change. This was all the more striking because Humla District is widely considered the least progressive of all of Nepal"s districts. The data articles in this dissertation speak to the revelation that conservatism and innovation are not mutually exclusive, and that the connotations we often attach to either one obscure the mechanisms by which people cope with vulnerability. To drive this point home, I first speak to one of the ways in which a commonly used risk mitigation strategy may imbue a great deal of risk on the actor. One day during my fieldwork in Nepal, I was walking down the path from my abode to the place in in the village where I could charge my computer, when I saw a young girl chasing after a calf that was confused and running down the wrong path toward me. I could have just stepped aside and let the girl corral her own cow, but I was so tired of feeling useless all the time, that I thought, "Hey, this is something I can do", so I stepped in the way of the cow. But instead of going the way it was supposed to, it ran in the wrong direction up a steep slope. Now, feeling like I needed to see this through, I went after it, caught it, and tried pushing it toward the girl. Not much of a livestock wrangler at home either, my way of directing cow traffic did not sit well with the calf. It turned, took a running start, and rammed me. It only rammed me in the thigh because it was that young, but I nearly fell over. By this time a small crowd had gathered and we 2 were all laughing, but the vindictive calf backed up, took another run, rammed me again, and just kept on ramming me until I was almost over a cliff. Finally, the mother of the girl gained her composure enough to come rescue me. From a baby cow. In this dissertation, I write about vulnerability and risk taking from the standpoint of my debts to and admiration for the people of Humla District, Nepal. They had to feed me, teach me how to behave, and rescue me from baby cows for over a year. Some of those things I paid for with money, but money does not begin to touch most of them, and this is why: being indebted in Nepal (and, in my experience, many parts of the Global South where communal ties often provide vital risk mitigation; see Mauss 1967) means placing a social contract alongside the money. Resources are so scarce there, and conditions so harsh that villagers take on each others" debt in a loosely rotating system. They know that the one certitude is that their day will come, tomorrow most likely. Being in debt is saying, "when and if I can, I will be there for you, too". This terrified me. I did not know how I could be there for them. This study investigates the impacts of western development projects, and my observations were that they often were nearly as costly as not offering anything at all, so heading up my own NGO (the most common suggestion of Humlis) did not seem right. But I also knew that participating in an intentional, if open-ended, social contract was the absolute biggest gift I had in me. My name is Catherine Sanders, and I am in debt to the people of Nepal. I will never be able to pay it back. And I will never give up trying. Debt is so complicated in the current American psyche because it is rife with social paradox (see also Graeber 2001). Our country is founded on notions of self-reliance that preclude fiscal dependence on others or the government. Nowhere was this clearer than at the recent Republican National Convention in Tampa, where the convention hall rang with mantras like "We built this" 1 I published a version of this introductory section in a blog post for the American Anthropological Association's page on the Huffington Post on October 17 th , 2012: http://www.huffingtonpost.com/american-anthropological-association/debts-and-indebtedness-in_b_1973589.html

Its almost 30 years of declaration of Alma-Ata for primary healthcare policy the health system in Nepal still facing shortage of trained medical doctors and health professionals reaching remote and rural part of the country to provide quality health services. There are number of issues such as financial or non-financial incentives, professional advancements, educational opportunities and workplace environment. Healthcare delivery system in Nepal is failing to meet the healthcare need of the general public and needs discussion and revision. However, despite of so many challenges more doctors are willing to work in the remote and rural Nepal. The government has to come out with effective planning and policy regarding health system and human resource for health. In this context, an attempt has been made for a analytical perspective from a medical doctor point of view to highlight some of the pertinent local and policy related issues to improve Health System in Nepal.

In this article, I reflect on the words of those male villagers in Nepal who told me how proud they were of having undergone vasectomy operations, and how their actions stemmed from and exemplified their qualities as true leaders of their village in a time of change.This reflection constitutes part of my larger study of the history of development discourses in Nepal. In general terms, I view the project of development as an ensemble of political technologies that aim, among other things, to reform subjectivities and reorganize the social fields in which the subjects act and are acted upon, with the aim of increasing the welfare of the individuals and the population as a whole [Asad 1992; Scott 1999; Fujikura 2001b]. Elsewhere, I have also shown that the notion of democracy, at least since the 1950s in Nepal, has been closely articulated with the ideas and techniques of development, so that democracy does not simply refer to the notion of popular sovereignty, but is also expected to further the wellbeing of the entire population [Fujikura 1996, 2001a]. Partha Chatter

Political, social and economic shifts in humanitarian responses to disasters have increased the prominence of short-term volunteers, often working through small, informal and non-governmental channels. Such volunteers offer the potential for a "surge" capacity in crises but are also often under-regulated, poorly trained and know little about the people they claim to help. In this chapter, we first draw on social theorists like Zygmunt Bauman and Michel Agier to argue that this represents a form of neo-liberal-"liquid"-governance that offers only fleeting, fragmented and privatized solutions to collective problems. However, we temper this critique with a review of the literature on short-term "voluntourism" that shows it can have an important pedagogical role, priming volunteers to engage in more long-term solidarity with people in distress. To illustrate our argument, we use ethnographic and participant observation research conducted in Haiti after the 2010 earthquake. We show the flaws of many short-term volunteer programs but also highlight efforts to manage them responsibly, as an attempt to cultivate an ethic of solidarity with marginalized communities. We conclude with a list of good practices for leaders of short-term volunteer programs in humanitarian crises.

Background: Pelvic organ prolapse (POP) is a global women’s health concern and one particular type of POP, uterine prolapse (UP), has significant prevalence in Nepal. Nepal has the distinction of being the only country in the world with government initiatives to address this puzzling and challenging health concern. Moreover, however, great stigma is attached to UP in Nepal, and it therefore must be considered from multiple levels in order to reduce deep-rooted physical, emotional, social, and sexual impact on the women of this region.

Its almost 30 years of declaration of Alma-Ata for primary healthcare policy the health system in Nepal still facing shortage of trained medical doctors and health professionals reaching remote and rural part of the country to provide quality health services. There are number of issues such as financial or non-financial incentives, professional advancements, educational opportunities and workplace environment. Healthcare delivery system in Nepal is failing to meet the healthcare need of the general public and needs discussion and revision. However, despite of so many challenges more doctors are willing to work in the remote and rural Nepal. The government has to come out with effective planning and policy regarding health system and human resource for health. In this context, an attempt has been made for a analytical perspective from a medical doctor point of view to highlight some of the pertinent local and policy related issues to improve Health System in Nepal.

The study analyzes the awareness of healthcare facilities among rural people. The already existing infrastructure and various provision mechanisms of healthcare facilities are adequate but still require massive programs to educate rural people. There is also a need to make the ruralites awareness on Government health schemes, usage of natural remedies, self-treatment. The analysis sample consists of 80 subjects, aged between Materials and Methods: 20 to 90 yrs and living in a rural community in Narsampet mandal of Warangal district, India. Attendees queried for the availability of health services, and recorded in proforma prepared. The results showed the awareness about Results: availability of the medical facilities provided by the Government. Majority in numbers are unaware about existing Primary Healthcare Center (PHC) or physicians availability in selected rural area. The association between laboratory facilities and PHC was evident from the studies. One notable relief observed among villagers that many Conclusion: are not preferring self-treatments for their ailments with modern medicines.

The trek continued on to Sertung village where the team of doctors and paramedics struggled to save the life of a Tamang woman suffering from septicemia. They maintained her blood pressure on dopamine and intravenous fluids. The trek in the dark across a treacherous ravine to Tipling using a flashlight to bring intravenous fluids was an act of courage. The fervent wish for a broad spectrum antibiotic and the fortuitous finding of a vial of Imipenem among the medical supplies has been beautifully described.

The evolution of population policy in Nepal has a history of about half century. This paper tries to discuss on the evolution of population policy discourse from the first five year plan to fifteenth five years plan. This study was based on descriptive as well as analytical in nature. Sources of information in this study are secondary in nature like published and unpublished research papers, national level report and journal’s articles. Data are presented into tabular form and they are analyzed into descriptive form. Nepal has been following anti-natalist population policy to regulate fertility, mortality and migration from its first five year plan. The population policy of Nepal mainly shifted into three phases during the year 1950-2019. First, fertility regulating policy was focused during the year 1950-1980. Second, it was shifted into mortality regulating policy during the year 1980-2007 and finally, it is shifted into migration regulating policy since 2007 to still now. Nepal’s...

Background: Pelvic organ prolapse (POP) is a global women’s health concern and one particular type of POP, uterine prolapse (UP), has significant prevalence in Nepal. Nepal has the distinction of being the only country in the world with government initiatives to address this puzzling and challenging health concern. Moreover, however, great stigma is attached to UP in Nepal, and it therefore must be considered from multiple levels in order to reduce deep-rooted physical, emotional, social, and sexual impact on the women of this region.

Health camps or outreach clinics are the effective strategies adopted by both government and non-government organizations, associations, and societies with various interests and scope. A well-organized health camp with a concentration on the various principles of planning, coordination, collaboration, tools, and techniques will not only make the health camp successful but also aids in improving the health status of the unreached community who are often deprived of basic to advance health care facility due to different circumstances.

Background: Previous research has documented that across South Asia, as well as in some countries in Sub-Saharan Africa, the private sector is the primary source of outpatient care for sick infants and children and, in many settings, informal providers play a bigger role than credentialed health professionals (particularly for the poorer segments of the population). This is the case in Nepal. This study sought to characterize medicine shop-based service providers in rural areas and small urban centers in Nepal, their role in the care and treatment of sick infants and children (with a particular focus on infants aged <2 months), and the quality of the care provided. A secondary objective was to characterize availability and quality of such care provided by physicians in these settings. Methods: A nationally representative sample of medicine shops was drawn, in rural settings and small urban centers in Nepal, from 25 of the 75 districts in Nepal, using multi-stage cluster methodolo...

Mary Des Chene: I want to do three things this evening. First, some audience members asked me to discuss a several issues that were neglected during the paper sessions. Second, Iwant to respond to some things Iheard in the afternoon sessions. Lastly, I want to suggest some issues that we all need to be thmkmg about.

The study analyzes the awareness of healthcare facilities among rural people. The already existing infrastructure and various provision mechanisms of healthcare facilities are adequate but still require massive programs to educate rural people. There is also a need to make the ruralites awareness on Government health schemes, usage of natural remedies, self-treatment. The analysis sample consists of 80 subjects, aged between Materials and Methods: 20 to 90 yrs and living in a rural community in Narsampet mandal of Warangal district, India. Attendees queried for the availability of health services, and recorded in proforma prepared. The results showed the awareness about Results: availability of the medical facilities provided by the Government. Majority in numbers are unaware about existing Primary Healthcare Center (PHC) or physicians availability in selected rural area. The association between laboratory facilities and PHC was evident from the studies. One notable relief observed among villagers that many Conclusion: are not preferring self-treatments for their ailments with modern medicines.

Neoliberal development processes are increasingly pervasive across the globe, but they are incorporated unevenly into social systems at the micro-level with varying ramifications for the sustainability of social institutions. This paper investigates how kinship relates to ecology and exposure to development in two villages of Humla District, Nepal. A geospatial analysis using ArcGIS software, combined with ethnographic techniques, offers visual representation of socio-ecological information that could facilitate the application of social scientific knowledge to a variety of issues in sustainable community development. The findings we present suggest that increasing integration with a market economy and other outside influences exaggerated differences in social networks. Specifically, we found that those villages with more development activity had more dispersed households and fewer social resources at home. This was in part the trade-off for increased connections abroad and in cities around Nepal. We explore the potential impacts of diffused social networks on long-term vulnerability. NGO staff working to maintain the sustainability of development's successes in the region will need to include the dynamics of local social networks in their analyses.

Background: Previous research has documented that across South Asia, as well as in some countries in Sub-Saharan Africa, the private sector is the primary source of outpatient care for sick infants and children and, in many settings, informal providers play a bigger role than credentialed health professionals (particularly for the poorer segments of the population). This is the case in Nepal. This study sought to characterize medicine shop-based service providers in rural areas and small urban centers in Nepal, their role in the care and treatment of sick infants and children (with a particular focus on infants aged <2 months), and the quality of the care provided. A secondary objective was to characterize availability and quality of such care provided by physicians in these settings. Methods: A nationally representative sample of medicine shops was drawn, in rural settings and small urban centers in Nepal, from 25 of the 75 districts in Nepal, using multi-stage cluster methodolo...

Background: Previous research has documented that across South Asia, as well as in some countries in Sub-Saharan Africa, the private sector is the primary source of outpatient care for sick infants and children and, in many settings, informal providers play a bigger role than credentialed health professionals (particularly for the poorer segments of the population). This is the case in Nepal. This study sought to characterize medicine shop-based service providers in rural areas and small urban centers in Nepal, their role in the care and treatment of sick infants and children (with a particular focus on infants aged < 2 months), and the quality of the care provided. A secondary objective was to characterize availability and quality of such care provided by physicians in these settings.

... First, the poverty and hardship associated with life in rural Nepal can mask the effects of ... Human rights are indivisable: social equality goes with political equality which in turn goes with ... At some point, social consciousness must be stimulated and encouraged to change to a ...

Background: There is a global health workforce shortage, which is considered critical in Nepal, a low-income country with a predominantly rural population. General practitioners (GPs) may play a key role improving access to essential health services in rural Nepal, though they are currently underrepresented at the district hospital level. The objective of this paper is to describe how GPs are adding value in rural Nepal by exploring clinical, leadership, and educational roles currently performed in a rural district-level hospital. Case presentation: We perform a descriptive case study of clinical and non-clinical services offered at Bayalpata Hospital prior to and following the initiation of GP-level services in 2013. Bayalpata is a district-level public hospital managed through a public private partnership by the nonprofit healthcare organization Possible. We found that after general practitioners were hired, additional clinical services included continuous emergency obstetric care, major orthopedic surgeries, appendectomy, tubal ligation, and vasectomy. This time period was associated with increased emergency department visits, inpatient admissions, and institutional birth rate in the hospital's catchment area. Non-clinical contributions included the development of a continuing medical education curriculum and implementation of a series of quality improvement initiatives.

Introduction: Uterine prolapse is a major public health problem in rural Nepal. It is a medical and social problem, deeply rooted with poor health services and socio-cultural beliefs. Prevention and management is crucial for maternal health. This study aimed to explore the situation of uterine prolapse problems and attempts of health response through mobile camps.

The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in ''voluntourism,'' health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in short term medical volunteer work in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data.

Its almost 30 years of declaration of Alma-Ata for primary healthcare policy the health system in Nepal still facing shortage of trained medical doctors and health professionals reaching remote and rural part of the country to provide quality health services. There are number of issues such as financial or non-financial incentives, professional advancements, educational opportunities and workplace environment. Healthcare delivery system in Nepal is failing to meet the healthcare need of the general public and needs discussion and revision. However, despite of so many challenges more doctors are willing to work in the remote and rural Nepal. The government has to come out with effective planning and policy regarding health system and human resource for health. In this context, an attempt has been made for a analytical perspective from a medical doctor point of view to highlight some of the pertinent local and policy related issues to improve Health System in Nepal.

El derecho a morir con dignidad es un concepto vago y que recibe múltiples interpretaciones, muchas de ellas inapropiadas. Se propone la necesidad de que sea el médico quien se haga responsable de proteger los derechos del paciente, de garantizar el uso racional de los recursos y de velar porque las decisiones sean apropiadas y proporcionadas a la situación del paciente, a su pronóstico, expectativas y deseos, pero también, a la utilidad esperada y a la relación costo-beneficio. Se enfatiza que la dignidad puede ser entendida de muchas maneras y que, a veces, en su nombre se somete al paciente, o lo hace él mismo, a sufrimientos, dolor y complicaciones que podrían haberse evitado, no necesariamente en busca de prolongar la vida. Se hace énfasis en que, cuando no hay probabilidades razonables de supervivencia o cuando no puede ya buscarse mejorar la calidad de vida, deben enfocarse los esfuerzos en procurar calidad de muerte.

Nepalese agropastoralists' confrontations with forces of change in the last generation have altered vil-lagers' abilities to gain access to health services, clean water, and nutrition in Humla District, Nepal. Development efforts and Nepal's recent armed conflict, in particular, introduced novel technologies and ideologies that a subsection of villagers have responded to in a fashion that we did not expect. In this article, based on theories about the diffusion of innovation and risk, we argue that, together, villagers and other change agents have cocreated new contexts of vulnerability in the postconflict setting of rural Nepal, as observed in remote Humla District. Using ArcGIS to represent landscapes of health and health-seeking behavior, we explore the integration of neoliberal health development in this postcon-flict setting in which medical pluralism, caste, Hinduism, and cultural conservatism all shape decision making. Based on in-depth and long-term research conducted in the region over the past 15 years, we describe the strengths and weaknesses of GIS as a tool for enhancing our understanding of this " health landscape. " In Humla, topography is a major determinant of access to healthcare. Our analyses reveal interesting relationships among health, culture, and vulnerability and provide insight into directions for future health interventions in similar contexts elsewhere.

Nongovernmental Organizations (NGOs) are one of the most trusted and visible institutions recognized by community, Nepal government, donors and development stakeholders in Nepal. Nepal government has given authority to Social Welfare Council (SWC) to create favourable environment for NGOs to work effectively in the field. The study was conducted in Karnali Zone, Midwestern Development Region of Nepal where Nepal government and donor communities have highly prioritized to address people’s needs. The objective of this research was to explore the contribution of Non-Governmental Organization (NGOs) in Karnali Zone, Nepal. The study was qualitative based with an explorative and descriptive approach. The study had collected the opinion of beneficiaries, NGO board and staff members, government and civil society representatives. Purposively qualitative research instruments were administered to generate the information i.e. key informants interview, focus group discussion, case studies and observation were done for data collection. Instruments were self-reported semi-structured. A total 45 interviews (beneficiaries - 20, NGOs board - 5, NGOs staff - 5, Civil society representative – 5 and Government Official – 10), 15 focus group discussions were conducted and 15 case studies were collected. NGOs contributed to enhance the knowledge of health service utilization, promotion of education, child rights and women empowerment as well as impact of climate changes. NGOs also contributed to develop the infrastructures; schools building, road, building drinking water’s tank and sanitary units. It was also observed that some NGOs were working from 'need based approach' and some were working from 'right based approach'. NGOs had made significant contribution in change and development of Karnali Zone in relation to the up-lift of socio-economic status of community. Joint collaboration between the like-minded organizations was needed to reduce the duplication of activities and will be effective to provide the services in hard to reach areas of the Karnali Zone.