Home, Sweet Home...?

Sorry folks, my blog name may now be interpreted as misleading, because after a tumultuous year of ups, downs and round and arounds, I'm finally home in Old Blighty.
To say that I'm happy, would be pushing it, but relieved? Perhaps.
Nepal is everything you want it be and more, or as one my Nepali friends stated "You can be anything you want to be in Nepal." While Nepal is no place for the American Dreamer, there is a shred of truth lies in his statement. The things I experienced and the opportunities living and working in Nepal gave me, are beyond my own understanding. I struggled to believe that this was really my life, my job, and that other people's kindness was real sometimes, because that's what living in my own society had bred me to think and believe. One German medical student said to me upon reflecting on her three month internship at the hospital I was working at - "When you see the way people live and work out here; the way they believe nothing is impossible, it makes you... ashamed at how little we've accomplished back home." I couldn't have agreed more.
Nepal is  mystical, beautiful, ethereal in some ways because the identity of the Nepali people is not as easy to describe or label as western culture have so easily labelled other South-East Asian communities. The people there who I met were kind, passionate, god-loving and redefined the meaning of 'hardworking' as I knew it. Those that I had the pleasure of coming into contact with were fiercely passionate about their desire to change their country, to make it a better place to live for themselves and for the future of their families. My friends who were mostly ordinary middle-class citizens were all political, inquisitive, and self-motivated to be the best they could be at whatever they had set their minds to.
Then I came home, to my country, this land of all hope and glory that so many Nepali people waxed lyrical about, and realised that I didn't recognise it anymore. Cameron's Britain. Rioting Britain. Unemployed Britain.
I hasten to admit that when I left the UK, it was only in slightly better condition; the coalition Tory/Lib Dem government had just come into power promising big things, bankers rather than being punished were being patted on their backs for hideous failings and humongous bonuses, and unemployment was steadily climbing in the wrong direction.
But riots? Kids as young as 11 damaging property and stealing on their own doorsteps? I can't claim to know much about society and politics other than living in the former and being surrounded by the latter, but this behaviour screams that the people are feeling various degrees of dissatisfaction.
Yes, to some level the damage was caused by people who felt as though the world owed them something, or that their actions were merely an offset of what the government was depriving them of. I do however, find it hard to believe that an 11 year old child from a disadvantaged background and no one to encourage his/her intellectual development can mastermind the break in and destruction of a jewellers on a high street.

To quote one Brit,

"These young people have no sense of community because they haven’t been given one. They have no stake in society because Cameron’s mentor Margaret Thatcher told us there’s no such thing."

And that, I do believe, is what sets 'us' apart from 'them'.

From the families I visited in the heart of Kathmandu to the rural mountainous regions of Solukumbu, I noticed one thing was inherent in every household - solidarity. Most Nepalis live in joint households, where as many as four generations live side by side, sharing meals and responsibilities without a word of complaint. It stunned me to see such love and care in a society I had been informed was part of a "developing country".
Perhaps then, we in Britain are the ones who are still 'developing'. Or perhaps our pride is somewhat misplaced. I find myself submerged in a culture of 'I want one those' and 'Mine should be bigger and better than yours'. I sometimes lose sight of how ridiculous it all is, and buy into it, literally, myself, of course. I am after all, a member of this culture but it does not excuse my behaviour. I realise only now that we are the best in the world at alienating ourselves from one another.
Of course, a well-bred, middle-class Etonion could never represent my views or opinions, or even the majority of the country's, but instead of standing divided and pointing fingers and blaming (politicians or police tactics? Bad education or just laziness?), we could try a different angle.
There will always be someone richer, better, and more good looking than you. Fact. The more you have, the more you want. Also a fact.
But Shakespeare wrote,
"Nature's bequest gives nothing, but doth lend,
And being frank, she lends to those are free."

Rheumatic Heart Disease: "A Disease of Poverty"

Rheumatic Heart Disease still affects over 15 million people worldwide, particularly in impoverished countries such as Nepal.  Find out why in Republica.

N.B. After being alerted by a fellow Tweeter of the fact that my article links are no longer working, I have since gone through my old blog posts and updated the links. Thank you followers, for your eagle eyes and taking time out to read my blog!

Pesticides on Prescription

Why are pesticides so dangerous?  Who do they affect the most?  How much do farmers really know about the dangers of pesticide use in Nepal?  Find out here.

[Link updated.]

An Alternative Education in Rural Nepal

Sorry it looks like I haven't been updating my blog followers, it's due to copyright laws etc. that I have to redirect you to Republica for my latest articles.
Happy reading.

[Link updated.]

Tara's Story Before and After

For a revised version of 'The Road to Solambu', please go to the Republica website.

[Link updated.]

Grassroot Feminism

"Feminism... does that word have the same negative connotation in the UK as it does here in Nepal?" One very respected doctor asked me one day.
I stared back blankly, searching for the right words to respond as I swallowed back my shock.
The Oxford English Dictionary describes feminism as "the advocacy of women’s rights on the ground of the equality of the sexes," while the Cambridge English Dictionary defines it as "the belief that women should be allowed the same rights, power and opportunities as men and be treated in the same way, or the set of activities intended to achieve this state".
But I still to this day cannot define that single word in one sentence, so here's what I think is the definition of feminism in an article I wrote for Republica.

Bolde Outreach Camp

A small stoopa in Bolde Phediche

Bolde Phediche i s a beautiful secluded village nestled almost precariously in the sloping hills somewhere in South-East Nepal. Seven years ago two doctors had to travel six hours by foot without water to get from Dhulikhel Hospital (DH) to it. A few months later, one of the same doctors and a Community Programmes Coordinator from the hospital endangered their lives during one of Nepal's civil wars by walking through a jungle to reach more patients at the same place. They were mistaken for Maoists, and nearly shot by the Nepalese Army.

Today, patients from Bolde and its surrounding areas can find medical help every day, 24 hours a day at a Health Centre built and funded by DH and its Department for Community Programmes (DCP). A 'camp' of 14 doctors can now walk uphill for half an hour (safely) to reach the Health Centre to provide 25,000 people with specialised care, as they did on Friday the 2^nd of October this year.

Through word of mouth and the artful distribution of flyers to the right people, these 25,000 people know exactly when such doctors will be visiting the Outreach. This way, patients living in the catchment area of the beautiful but remote Bolde Phediche can not only receive quality healthcare, but arguably the best healthcare available to them, for close to no money. As it turned out on Friday the 2^nd of October, patients were surprised by a group of specialists all the way from Austria who accompanied a team of doctors, nurses and staff from DH to specialise particularly in the gynaecology, orthopaedic and physiotherapy departments.

The Austrian team led by Professor Doctor Rudolph Schabus included Physiotherapist Matthias Pakosta; Massage Therapist Angela Krottendorfer; and Medical Engineer Kahr Jurgen. As Angela put it, "This is not something which the average tourist can experience." The four professionals are just part of the example of how healthcare in Nepal can develop and change people's lives; literally transcending thousands of miles to get to patients who have never seen a non-Nepalese person before, and who had no idea that their ailments have led to intricate studies in other parts of the world.

Surgeon Dr Rohit of DH's Orthopaedics Department says that on that day alone, the medical team saw a total of 64 patients in a little over six hours. Also assisting him was Medical Officer Dr Pujan and Physiotherapist Nishal, and Health Assistant Sudip. "35 patients came just for the Orthopaedic Camp, at what I like to call 'my' Outreach," he says smiling at the thought of the progress DH has made to reach out to villagers.

Dr Rohit is particularly attached to Bolde Outreach for a few reasons. He has managed it since he first started as a Medical Officer at DH. He still visits frequently despite the bumpy ride and long journey from the hospital. Most of all, Dr Rohit is still attached to Bolde Outreach because he is one of the two dedicated doctors who used to walk for six hours through jungle and uphill to see his patients. He says that the cases he has seen the most are occupational injuries. "We saw many cases of traumatic injuries from work-related situations, and due to years of neglect the healing process has been made much harder, and the pain worse."

In most cases, physical therapy was the only cure or way of easing discomfort. "This visit was different for us because every patient had two or three doctors or specialists attending to them," said Mattias. "It's a good job we all agreed on the diagnosis every time!" Mattias was on hand to manipulate three spinal cases, and along with help from Professor Dr Schabus taught orthopaedic patients some physical exercises which can be performed when they are at home.

Angela had more difficulty discharging her patients compared to her colleagues. "I treat with Acupuncture Pressure Massage, so a few patients were gesturing to friends to come and try or asking for their other foot to be massaged!" she laughed. Meanwhile, Kahr had the tough job of gathering what materials he could to make several splints for patients. "The splints are only made to hold out until surgery," he said, whilst holding a piece of flimsy looking wood - and quite a few patients do require surgery.

Surgery can be an unaffordable option for most rural villagers under normal circumstances. At DH through the Outreach Centres however, surgery can be charitable. "We know some of our patients really can't afford surgery, and we will still operate," Dr Rohit explains. In fact, most of the time the price tag on a general check-up is just to "Ensure patients understand the importance of health. If something is free, sometimes it can take away the meaning. A check up and follow up treatment only costs 10 Rupees."

At least 15 of the total patients that day were gynaecological consultations, seen by Dr Shakya, Medical Officer Dr Prativa, or Nurse Krishna. Dr Shakya was also at Bolde for other reasons. "A lot of girls don't feel they can even talk to their mothers about their 'women' problems, they're so shy," Dr Shakya said after her talk on women's health to a group of 30-odd female students from the ages of 14 to 18. At one point the girls even stopped answering questions Dr Shakya was asking when they saw a group of men walk by outside their classroom.

Sessions such as these are not common at schools and happen only on a voluntary basis, which means a lot of girls still shy away from discussing issues such as puberty with anyone other than their friends – who only know as much as they do. Having someone to talk about such issues with is still rare in Nepalese society. "Some girls don't understand why they menstruate, and others don't know why they have menstrual pains, for example," begins Dr Shakya. "It's really good to come and speak to them here, in their own environment because they are willing to learn, they're just shy." Without the Health Centre, the girls may never have had a chance to discuss these issues openly.

Samita Giri, the Women's Health Programme Coordinator from the DCP was also on hand to give a talk on uterine prolapse to a mother's group. 16 mothers turned up at Bolde Outreach to talk about the risks and signs to detect prolapse. "They talked very openly about it because there were no men present," said Samita who highlights the all-important absence of men in order for women to be able to speak frankly about feminine issues.

Part of the discussion was to encourage women to let go of the traditional view that operations on older mothers are pointless as they do not have "long to live". "When uterine prolapse occurs in older mothers, they don't want to have surgery because they think, 'Well I'm old now anyway'. I had to explain that they shouldn't think like that, and that prolapse is dangerous." A contributing factor to this way of thinking in rural societies is because operations, taking medication, and getting treatment in general are perceived as ways to weaken the body further, thus hindering a person's ability to work in the future.

Samita taught the women how to identify the three stages of uterine prolapse, and more importantly, how to look for signs of stage one prolapse so that in the event of such problems, they can seek medical assistance immediately. "The women mentioned one case of a woman they knew who used hot water to 'cure' herself. They also said at the beginning of the session that they felt it was unnecessary to teach them, and that their daughters and granddaughters were the important ones. Afterwards however, they understood why we were addressing them."

Samita recognises the progress that can be made through talking to women in the community honestly and in a coherent manner. Most of them, just as Dr Shakya said, want to learn. Through community programmes little by little changes can be made in the way people think and act. "At the end of the session mothers were saying 'We should bring our husbands next time!'"

As a community-focused hospital, camps such as the one conducted at Bolde Phediche earlier this month are what keeps DH's message of working for the community, and with the community burning bright. From stopping off to pay a patient a visit on the walk to the Health Centre, to changing the way women think permanently about their bodies; every subtle difference each member of staff has made to each individual person in the community work as push and pull factors. Such changes keep the hospital going and they are also why the hospital exists in the first place.

As so many of the doctors point out, "Why wouldn't we want to visit an Outreach? It's the best part of the job!"