The Middle of Nowhere

Godamchaur Outreach Centre, just one of Dhulikhel Hospital's 10 Outreachs.

On Sunday I got the chance to visit one of Dhulikhel Hospital's Outreach Centres.  This tiny brick room attached to the side of a village primary school is literally all there is to it.  Godamchaur is in Kathmandu district, but so far removed from the liveliness and pollution (!) of the city that you could be anywhere else in Nepal.
Getting to Godamchaur Outreach is more than trying; don't even think about it unless you have a sturdy 4x4 or actually live there, which is essentially what it was built for.  We drove through Dhulikhel, Basghari (where I live), Baskapur, Kathmandu and then finally reached Lalitpur.  Godamchaur Outreach is a partnership outreach of Dhulikhel Hospital's which makes it more technical support than patient support.  Still, for a country where 80 percent of people aged 5-18 years live in rural areas, it makes such  a huge difference to access to healthcare.

Yesterday I went to Baunepati Health Centre, which is roughly two hours down the worst dirt road from Dhulikhel that I've ever seen.  I felt that this was really what I had been waiting to see since I've been here; how much of a difference Dhulikhel Hospital's Outreach Centres are making to people's lives.

Under Sudip's care ( a trained paramedic) dermatologists, orthodontists and other professional specialists visit Baunepati Health Centre once a week.  When doctors are not dispatched from the hospital, there are usually three paramedics on duty, 24 hours a day.  I accompanied Sudip, two orthodontists, two dermatologists and two other doctors to see first hand how one of Dhulikhel Hospital's Outreach Centres operates.
Oh boy did I see a lot.  I witnessed five tooth extractions, and the complications which went behind them; an armpit abscess; a snake bite which had become infected; and lastly before lunch a bad case of osteomyelitis of the foot.  It was not so much the severity of the cases which got me though.  Seeing the paramedics and doctors work away case after case really made me think that the medical profession is not one for people who only care for themselves.  The journey to the outreach was over two hours long.  The journey back had taken around about the same time, with the snake bite victim rocking back and forth with us along the decrepit road, eyes narrowed in pain the whole way.  No, what really amazes me again is simply how much people care about each other here.  I get the feeling here that nobody treats their occupations as "just a job".  Maybe it's because they all work for a non-for-profit hospital built specifically to aid the poor, but I have yet to hear one doctor, nurse, paramedic, or any other medical professional who works 14 hour days, six days a week, complain once.
Seeing the patients made me see how much those working at Dhulikhel Hospital love helping them.  After seeing the patient with the underarm abscess, I heard Sudip sigh and mumble something quickly in Nepali at her.  The patient turned her head away and said something softly, so that Sudip had to lean in closer too.  "What's the matter?"  I asked.  "I gave her seven days antibiotics to take, but she only took one.  She said it makes her weak, see?"  Sudip shrugged his shoulders and looked at me helplessly.
It was then it suddenly hit me.  The medical staff here did not train merely to help their patients recover, they go out of their way to try and teach them how to improve their lifestyles.  They have a relationship with their patients I've never seen before back home, where patients are a statistic and doctors do not remember your name.  I was moved by what I saw at Baunepati, not because I saw a paramedic trying to explain to a patient that she had to take her antibiotics even if it meant she was too weak to work for a couple of days, but because I've seen other medical staff attempt to do the same thing.
It is incredibly difficult to try and change a way of thinking which has been embedded into a tradition so rich and full of history.  In a country where 80 percent of under 18s still live in rural areas, how does one find the time and access to education?  It is not merely drumming into someone why they need to take their medication, there need to be so many changes from the bottom upwards.  Essentially, change is upturning a whole tradition of values.  Why someone needs to go to an Outreach Centre over a witch doctor, why someone should always use a toilet rather than the bushes, and why someone should let their child go to school rather than stay at home and work so that they have food for now is not going to be easy to explain to someone who has never known any different.
Which is where Dhulikhel Hospital's "micro-finance groups" come in.  DH fund several "micro-finance" groups to help women in the community earn a living.  Unfortunately Nepal is still a patriarchal country, where women have less say then men and are mostly just considered wives, mothers or labourers.  The micro-finance groups attempt to change this perception of women by giving them a means to support themselves and their families without relying on others.  In each micro-finance group, roughly 10 women are given a loan of 6,000 rupees (roughly 450 GBP) each.   With this money, each woman can find their own entrepreneurial path; from candle-making; soap-making; farming to breeding livestock. The micro-finance group is a typical example of helping developing countries through trade rather than aid, as the four percent interest creates another pot of money which goes to another woman.
I can only write about what I've seen over the past few days, but there is so much more to the healthcare system, Dhulikhel Hospital, the people, and the culture here I've yet to learn.
"Dhanyabad" for coming with me, and I'll be sure to update you as I learn.