This article is about my solo journey to Rara where I was able to validate the opinions and sayings of hundreds and thousands of people about the imperishable beauty of Rara alongside noticing a community, not very far away from Rara with very poor access to health care. On one hand, I saw divine Rara and such a magnificent bio-diversity associated with it. On the other hand, I noticed a community with no road access and poor health but wanted to thrive at the optimum level for promotion of tourism and betterment of its people. This article not only reveals Rara as the undying allure of the enchanting destination but also sheds light on the pressing healthcare needs of a neighboring community, while discussing one of the potential solutions to address them.

Mahendra Rara Lake

Never had I been so overwhelmed about any travel before a solo trip to Rara lake. Unlike my last trip to Ghorepani, Pokhara, I felt supported by my parents to visit this much talked about lake in Nepal’s remote region of Karnali.

Rara is more than just a lake; it looks like a sea dancing by the side of the mountain. I haven’t seen such a magical place ever and thanked myself for taking this trip.

When I first saw Rara lake, I thought that if all lakes in Nepal were to compete for the title of “The Most Beautiful Lake of Nepal”, Rara would take the crown. It is no surprise that King Mahendra wrote the poem “....rara ki apsara…” dedicated to Rara for its heavenly beauty when he stayed there for three weeks in 1964. The vision of the late king to establish Rara National Park for the conservation of Nepal’s biggest lake and its surrounding materialized in 1973. The contribution of King Mahendra towards protecting the lake, improving livelihood of local communities and promoting tourism have made locals decide to rename Rara as “Mahendra Lake”.

Location and travel

Rara lake lies in Chayanath Rara Municipality-9, Mugu. Everyone’s travel bucket list in Nepal nowadays doesn’t miss this popular destination. Traveling to Rara, which sits at an elevation of 2900 meters, is relatively easy these days. You can either choose to travel by Karnali Highway (375 km from Kathmandu) or take a 40 minutes flight from Nepaljung.

Murma village

Even more popular is the view of this fresh water lake from Murma village, which is located at an altitude of 3800 meters. It is the only village located within the premises of the national park. Murma is home to around 80 households and is one hour’s walk from the lake. Two other villages; Chapra and Rara located at the periphery of the lake were moved to present day Chaisapani, Banke after the establishment of Rara National Park in 1973 to keep the lake at its most natural form.

Health services in Murma

One morning, I was asking the other travelers at a homestay for muscle pain relief ointment. I was told that the one-storey building in front of the homestay was in fact a health post. This information offered me immediate relief. But soon enough I learned from one of the staff  at the health post that they did not have the ointment I was looking for. “No good medicines are available in the health post. We are sorry, but you can use oil instead,” was his reply.

Locals from Murma village have understood the importance of embracing tourism that could explore the economic potential. They also probably understood the importance of roads as a foundation of development. But considering the negative consequences of the road access on the lake and the diversity of wild inhabitants, Murma has limited road connectivity. Access to health service has also been poor, which largely depends on the road. 

Although this was a holiday trip, I grabbed every opportunity to speak to the locals to better understand the local context. The owner of the lunch shop on my way back to the airport told me: “Health facilities don’t offer birthing service, except for the hospital at Gamgad.” 

Another local said: “Most of the medicines are not available and health posts offer less than the minimum health services.”

The District Hospital, which offers birthing and other services, is the first choice for the people here.  As I reached Gamgadi and interacted with a midwife, she told me that a health worker from Murma Health Post was receiving skilled birth attendant training at Bheri Hospital, Nepalgunj. 

While I was waiting for my flight at Talcha, I was thinking about the poor healthcare service in Mrma. Reaching the district hospital at Gamgadi is a six-hour walk from the village. I recalled one of the villagers telling me: “In case of complications, we have to carry pregnant women and sick people on stretchers all the way to Gamgadi.” It pained my heart. 

The attention required for maternal and child health is severely lacking in Murma and I don’t know how many other villages in Mugu. A community health program designed and tested using the network of community health workers (CHW) could be one of the best interventions for communities like Murma. The program is currently being piloted at two municipalities, and the government plans to expand it all over Nepal.

CHWs are paid health workers and an important cadre in low-income countries where human resources for health and health care infrastructure are limited. In hard to reach areas such as Murma where the access to health facility and availability of the health service are limited, regular household visits that CHWs conduct could keep the community under routine health surveillance, supporting the timely identification of health problems in an individual and referral of the high-risk population to a well-equipped health facility. 

CHWs can bridge the gap between the community and the health facility. They are essential to primary health care systems and are a cost-effective strategy to achieving the Sustainable Development Goals. The return of this program is a great investment as evidence has shown a huge increase in antenatal care (ANC) visits of pregnant women and institutional delivery, which supports in improving maternal and child health. It is well known to everyone that the good health status of children is an indicator of a prosperous nation. 

Skilled care during pregnancy, childbirth and postpartum period is essential to prevent adverse maternal health outcomes, yet utilization of care remains low in many resource-limited countries, including Nepal. CHWs in villages like Murma can mitigate health system challenges and geographical barriers to achieving universal health coverage if we employ them closely aligning with WHO recommendation and following the community health program guidelines endorsed by the Ministry of Health and Population.

The author is a public health professional