Organized by Building Bureau, Inc
Closing the Healthcare Gap in Nepal: Ekuwa Health Post
See Project Introduction Below!
Proceeds will go to NPO Nepal for construction of the Ekuwa Health Post. Donations provided on and after December 2025 will be utilized to complete interior finishes and insulation, and connect the facility to the village water supply.
November 2025 Update
The Ekuwa Health Post opened its doors and welcomed its first patients in August 2025! The former health post, which had been situated in a temporary Monastery kitchen space, is now open and operating after the completion of the project's first phase. Nurse Usha Rai provides wound care, family planning services, administered vaccines, and medicines with proper oversight and counseling. The healthpost has capacity to expand care options to include critical assistance to expecting mothers, severe wound treatments, and host visiting specialist doctors including dentists as additional equipments are secured.
The community is currently seeking additional funding to complete interior finishes and insulation, as well as connect the facility to the village water supply.
June 2025 Update
The first phase of the Ekuwa Health Post is nearing completion. Construction began in March 2025, and over the past 2.5 months, 8 local villagers have been employed for construction and oversight. With the enclosure of the primary structure now finished, only electrical work, plumbing, and interior finishing and furnishing remain before the facility can become operational.
Working closely with Ekuwa community leaders, the project team made several adjustments to the original design to better suit local conditions and available resources. Most notably, the building has been constructed from locally sourced stone—unearthed just a few hundred meters from the site—instead of the originally planned mud.
To ensure feasibility, the project was divided into three phases. This first phase delivers the main structure, which includes a treatment room and a hygienic bathroom facility. Upon completion, residents of Ekuwa and neighboring communities will have access to essential healthcare services.
Additional funding is needed to procure a water tank, complete room finishing, and purchase necessary medical equipment. Further funds will also support the initiation of the second and third phases, which aim to expand the facility’s capacity and broaden the range of healthcare services offered.
INTRODUCTION
The Ekuwa Health Post is a sustainable, community-centered health facility, located in the remote Sankhuwasabha District in the northeastern region of Nepal, that will provide essential healthcare to an underserved population with limited access to medical services. This project aims to bridge a gap to healthcare access that is very prominent in Nepal: according to the Nepal Living Standards Survey, 41% of rural households do not have access to a health post or secondary health post to aid basic emergency services that can be life saving.
A rendering of the proposed Ekuwa Health Post
Ekuwa, the site of the health post, is located at 2,200 meters (7,200 ft) under the shadow of Mt. Makalu, the fifth-tallest mountain in the world just east of Mt. Everest, on a steep slope without vehicular access. Those seeking medical care must hike three to four hours down the hill to the nearest health post below. And above Ekuwa, three villages sit at even higher elevations, extending their travel time. The monsoon season makes it dangerous to take this journey, which in rare cases has caused fatalities from flash flooding incidents. State-initiated road development is slowly reaching Ekuwa but, in the meantime, expecting mothers often endure pregnancies unassisted and emergencies are often not treated fast enough. Without access to healthcare, a simple cut that becomes infected or a tooth ache that turns rotten can quickly turn into an emergency.
Building Bureau traveled with NPO Nepal to Ekuwa with a model of the proposed Health Post, also pictured in the cover photo with Ekuwa school children.
Site of the Ekuwa Health Post, above the Arun River valley.
HEALTH IMPACTS
Upon completion, the Ekuwa Health Post would serve approximately 98 households and 495 people across five villages. The health clinic will:
- Offer timely treatment to the residents in four villages. Simple, avoidable health concerns have ballooned into large complications due to an inability to take immediate action (including birthing complications, severe swellings from infections, etc.). It is not uncommon for days to pass until a patient is seen.
- Reduce the cost of care, which constitutes a major obstacle to seeking treatment.
- Offer critical assistance for expecting mothers during pregnancy, along with emergency first aid treatments. Maternal complications and fatalities are still prevalent in the area due to a lack of planning and care.
- Increase access to health specialists in remote areas. For example, dentists may visit and offer clinics from the health post site.
Lakpa Nurbu Sherpa of NPO Nepal shows the health post model to a village elder.
PARTNERS
The Ekuwa Health Post is a joint project between Building Bureau and NPO Nepal and we have been working on this proposal directly with Lakpa Nurbu Sherpa, who founded NPO Nepal to provide much needed infrastructure and services to his native rural Makalu region. So far, he has supported the successful development of schools, dental clinics, drinking water pipelines, and libraries across several wards in the Makalu area. Given our own connection to the Makalu region, the evident need for healthcare access, and Lakpa’s local-based, community-engaged approach to development projects, we are excited to partner with him and the community on the Ekuwa Health Post.
Structural engineer Arun Rimal of Building Bureau with a rendering of the health post in Ekuwa.
The plan for the Ekuwa Health Post was co-developed by Building Bureau and NPO Nepal, and has been signed off and approved by NPO Nepal associated board members native to the Makalu rural region.
ENVIRONMENTAL IMPACT
The Ekuwa Health Post will address the healthcare gap in the Makalu region and serve as a sustainable, community-centered health facility that blends local materials and passive design for long-term resilience.
Rather than using corrugated iron and other materials that have become ubiquitous to the region, this design utilizes rammed earth for its thermal mass in response to the region’s climate where temperature fluctuations are significant. The thick walls absorb cool nighttime air in summer and retain heat during sunny winter days, reducing reliance on active heating and cooling. At the heart of the health post is a healing garden, where the community can grow indigenous medicinal plants, promoting natural remedies. The design is organized around this central courtyard, with covered walkways for circulation. The east-facing orientation captures valley views, while the covered south-facing outdoor area provides a sunlit space for the community.
3D diagram of the Ekuwa Health Post and its components.
For more information and images, visit the Ekuwa Health Post webpage.
ORGANIZER
Organizer Tyler Survant is a co-founder of Building Bureau, a registered 501(c)(3) charitable organization in the United States with a mission to further the social impact of public organizations and civic institutions through architecture. Building Bureau will act as a fiscal intermediary; all funds raised through GoFundMe will go directly to NPO Nepal for completion of construction. Depending on your particular tax situation, your donation may qualify as a charitable deduction for federal income tax purposes.
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