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."

Gynae OPD at Dhulikhel Hospital – Uncovering the Norm of Social Stigma

A few days ago, I interviewed a female patient in the Gynaecology Outpatient Department (Gynae OPD to those familiar with the term). She was 29 years old and nine weeks pregnant with her fourth child. She already had three girls, the eldest being 13 years of age and the youngest still a toddler. All this was perfectly normal; average even for a patient in Gynae OPD in Nepal; however, this patient caught my attention because she was not here for a simple check up.

Maiya Rana had been instructed by her husband to find out the sex of their unborn child, and to abort it if it was a girl. I looked at her while Dr Shakya, the gynaecology doctor, translated to me, word for word, Maiya's husband's demands. The only emotion I detected in Maiya's countenance was stress as she tried to subdue her irritable toddler, while glancing from me to Dr Shakya. 
Maiya's problem is a problem many married women in rural Nepal face; the burden of bearing a son.  Such a burden rests heavily on the mother's shoulders, who must also carry the weight of social stigma if she does not produce a male successor for her family.

Maiya told us that this was an unwanted pregnancy. In fact, she says, her last daughter, who was born with a cleft palette, was also an unwanted pregnancy. "I only wanted two children," she sighs as she shifts the weight of her sleeping daughter in her lap. Maiya's husband had expected their last daughter to be a boy, but as Dhulikhel Hospital has a policy of not disclosing the sex of the baby during ultrasound check ups for fear of situations such as Maiya's, neither Maiya or her husband knew that they would be having a daughter until she was born.

Maiya says that her husband longs for a boy so badly that they will keep trying until she can conceive one, and every female they conceive from now until then will be aborted - because he says so. I wait for a reaction of shock from the doctor, but she merely continues to listen to Maiya intently. When Maiya pauses, Dr Shakya turns to me and quietly says, "Have you ever heard anything like this before? This is perfectly common here in Nepal. A lot of men here are used to abusing women's rights."

And it's true. Women here who have total control over their bodies are the more privileged ones, for want of a better term. What is considered a basic human right in any developed country is a constant uphill battle for many women here in Nepal, particularly rural areas where literacy levels are low, and fertility rates high. Once a woman such as Maiya is married into a family, she is then and there considered the property of said family. She will cook, she will clean, she will work if the husband wants her to, and she will raise their children – the luckier ones will not have to care for the elder generation on top of her daily duties. Maiya is considered one of the luckier ones.

I ask her why she cannot stand up to her husband. "He tells me I have an easy life, and he is the one earning money. All I have to do is look after the household and bring up our children. I have no money, so how can I say no?" She tells us that she has actually been on the contraceptive pill on and off for nine years, but is reluctant to disclose whether or not her husband knows about this. I ask if she wants to have the baby or the abortion if it was her decision. She replies without thinking, "Choosing either way is criminal. It's a life."

Clearly, her husband's concern is only that Maiya will conceive a boy, with no second thoughts or guilt about using abortion as a form of contraception. No questions have been asked in the first half hour of the consultation about how it will affect Maiya's health. Only after she has spoken to us about her husband's desire for a boy, only after she voices her concern for the health of the baby, and only after she enquires whether or not we can find out the sex of her baby, does she ask, "How will an abortion affect my health?"

But Maiya does not show a shred of self pity, which is the admirable part. She is stronger and more mature than her 29 years betray, possibly because she had to grow up so much quicker than the average 29 year old I know. Married at 17, she knows very little about the world outside of her work and her family. Perhaps this is blessing in disguise, because Maiya's life is not likely to change anytime soon.

Then Maiya tells us something surprising. She says her 13 year old daughter has already said she never wants to get married. "She says I can't take control of anything in the home, so why would she get married?" Maiya says rather bemusedly. She also knows that she is not alone in bearing the pressures of needing to conceive a boy. She tells us a story about a friend who gave birth to four daughters, and then a fifth. According to her friend's husband, they would only be able to bring up the child if it was a boy – so he gave his wife an ultimatum; the daughter or their marriage. The friend chose her marriage, and abandoned their fifth child at the hospital.

As the consultation and interview draws to a close, I am caught off-guard by a question directed at me. Dr Shakya turns to me and asks, "What advice would you give her?"

The only advice going through my mind is too obvious, yet impossible for Maiya to take. I think for a few moments, and try to reply without sounding too ignorant of Maiya's circumstances. "I think you should take control of your body. It's never too late to stand up for yourself, and if you want this child, regardless of the gender, you should keep it. An abortion should be your decision, because it's your health."

Maiya seems satisfied with my answer and is smiling as she leaves, because, she says, having someone to listen to her for a change has been lovely. "Sometimes even when we can't change their lives, just listening to them is a form of a help," says Dr Shakya. "I can't help every woman the way I want to, but I can listen."

Small Luxuries

Sometimes it's good to move out of your comfort zone. Sometimes it's incredibly hard to push yourself to even find the edge of said comfort zone. And then sometimes, you just need to be reminded of why you need to recognise what lies beyond your comfort zone.

Moving to Nepal was never a carefully thought out decision on my half, I'll admit it. It was a self-indulgent act of impulsion which I have no regrets about, but it was a hastily made, not very well thought out move non-the-less. Not many of my friends know that. It's only now as I sit in my apartment, trying to proof-read some documents on water sanitation that I've had a chance to reflect on the past four weeks of my stay here in Nepal properly.

Hearing your mother's voice break as she tells you she misses you, or reading an email from a friend telling you she is incredibly proud of you wakes up something inside of you. It reminds you that you can't just lie in bed when you're having a bad day and missing home, because you need to go to work, and have deadlines to meet. It reminds you that you're only one person, in the grand scheme of things such as the world, the universe, trying to make a difference to someone, (anyone's) life. Most of all, it reminds you that you're really nothing special, and hundreds of thousands, maybe millions of people in the rest of the world are going through exactly the same motions.

As I write this, I'm reminding myself all of these things over and over in my head. It's a National Holiday, it's not stopped raining since last night, and I'm sat alone in my apartment thousands of miles away from everyone I love, and I'm almost ready to feel sorry for myself - but here there's a lot more to life than feeling sad. While I sit in my room, indulging in my emotions, many people here don't have the satisfaction. Here, if you have time to stop and review your day, it's considered a small luxury. Here, people don't pity themselves.

In a country where 90 percent of the population live in rural areas, roughly only half of that percentage has access to a clean water supply. Yes, I guess people here just have more to worry about. Sadly, Nepal also contribute to the 30,000 deaths worldwide of children under five who die from preventable diseases, and to the 6,000 who die due to contaminated water and inadequate sanitation.

Some other statistics;

• 
  
  
  
  1.4 million children die every year from diarrhoea.
• 
  
  
  
  A further 1.6 million people die from other water related diseases.
• 
  
  
  
  Approximately 1.1 billion (nearly 20%) of the global population do not have access to standard water supply sources.
• 
  
  
  
  About 2.4 billion (41%) of people worldwide do not have access to basic sanitation facilities.
• 
  
  
  
  More than 125 million children under the age of five live in households without access to a clean water source and more than 280 million children lack adequate sanitation facilities.
  
  
  

I guess then, one could say I'm out of my comfort zone, along with maybe another 2.4 billion people in the world who never had the opportunity to escape back into a comfort zone in the first place. There's nothing brave or indeed exceptional about moving to Nepal, unless, perhaps you came here to become a doctor, a soldier or the Prime Minister of the country (which we actually currently are in need of). Most of the time, all I have is my pen and notebook, or when there's electricity, my laptop – hardly life-saving instruments or weapons of protection.

 

There is one thing I want from this experience though, and I think that judging from some of the responses I've had about my last post, I'm on the way to achieving, and that's awareness of Nepal. Someone said to me the other day, "Now why would anyone care about a little country like Nepal, so far from the West?"

 

Perhaps a cynic would say people should care because it has close relations with what will soon be one the greatest powers of the world and is one of the fastest-growing economies; India. Or maybe because it is a relatively violence-free country, despite its "Democratic Socialist" politics not quite achieving what it aims for. Personally though, I'd like people to learn about Nepal at the same rate I'm learning about it. Simply because it's a country rich in culture, steeped in history, and overflowing with kindness. Nepal doesn't need Western Sympathy, it needs Western Faith. If raising awareness of it by working at Dhulikhel Hospital turns just one head back home, then I've served the hospital. However, if my writing continually informs people back home of how "a little country like Nepal" can overcome poverty, ill health, and start enrolling all the children here in schools rather than in rice fields, then I've done more than just what I needed to do.

 

And all this would take is stepping outside of my comfort zone. Put into context, being outside of it, doesn't seem like such a bad place to be.

The Road to Solambu

Tara was just another illiterate girl from her village of Panchet, hoping to make a better living in Kathmandu.  At the age of 19, she had never learned to read, write or count – she could barely write her name.  Then something miraculous happened; Tara fell in love with someone who barely spoke her language.  Utaka fell in love with Tara and whisked her away to his home country of Japan, where they went on to have two beautiful girls.

But Tara was still illiterate.  It didn’t matter to Utaka, because Tara had learned very quickly to speak Japanese and he loved her, but it upset Tara when her daughters asked her to check their homework and she couldn’t read a single word.  Tara decided that if she wanted to prove to her children that education was important, then she would also have to learn, so she enrolled in Japanese classes.  She studied whenever she could and worked hard, in fact she worked so hard that she went on to fulfil her childhood dream of becoming a nurse; something unheard of for a girl from her village especially.

Yet Tara still felt something was missing.  She was happily married, had her own loving family but she never forgot about Panchet or the people whom she grew up knowing before she met Utaka.  She knew that she had to do something for the people in her village because she had been lucky.  Her dreams had come true, but there were thousands of people from her village who never dared to dream.  Working in healthcare in Japan had made Tara realise that this level of medical help could be provided in her village, if she could find the funds.  Each month from then on, Tara put aside a portion of her salary, until one day she had saved up almost five million Nepali rupees.

There was just one thing – Tara didn’t know how to build a health centre.  She could only remember basic Nepali, and she spoke no English.  One evening, she decided to ask her kind-hearted Japanese teacher Kyoko (whom she had remained close to even after graduation) for help as she knew Kyoko had contacts who could speak English.  Kyoko and her husband Yukio listened to Tara as she expressed her pain at her inability to help after all this time.  Yukio, who at the time was the Director of a Japanese bank, agreed to go to Nepal with Tara then and there to help her find doctors and contractors.  Together, they left Osaka for Kathmandu.

But when they got to Kathmandu, nobody was willing to help them.  “Why would you want to put money into Panchet?  It’s so far from any big city, spend your money wisely and invest it in hiring doctors in Kathmandu,” hospitals told her and Yukio.  Every night, Tara cried herself to sleep and felt sick at the prospect of being so close, yet further than she had ever felt from home. 

Tara had told her family of her plans for Panchet, and had asked all of them to find help and extra funding for the health centre she wanted to build.  Her cousin, Hira, was one of the few in her family who had left Panchet with a full education.  At the time, he worked as an Office Manager at one of Kathmandu’s most prestigious hotels, and as a result had met many people who worked in business and healthcare.  One of the people he met, just so happened to have recently accomplished exactly what Tara was setting out to do in a small village named Bolde.  Hira’s friend told him that he had gone directly to one of Nepal’s NGO hospitals in a small town called Dhulikhel.

Tara, Yukio and Hira set off for Dhulikhel the next day.  Tara told Dr Ram, Dr Koju and Dr Biraj her story slowly, in her broken Nepali and about her fears that her money wasn’t enough and she had no idea how much everything would cost. All three doctors listened intently and after Tara had finished her story, there was a calm silence.  Dr Ram finally spoke.

“Tara, you came to us with a brilliant idea, why dwell on the amount of money you have?”

With that, Dr Ram, Dr Biraj and Dr Koju accompanied the three on the treacherous six hour journey from Dhulikhel to Panchet.  The doctors loved Panchet, and saw for themselves the beauty of the village which Tara spoke of.  How could it be that in a village where there was no plumbing or electricity for most of the evenings, that there could be such raw compassionate people?  All this time Westernisation had taught people world-wide that modernisation was the key to development, yet there was more civilisation and humanity in this tiny village than you could imagine in any regular city in the West.

On the way back to Dhulikhel, the doctors stopped off in a village named Solambu.  Roughly two hours walk from Panchet, the doctors came up with an idea.  They asked Tara if it would be OK to build a health centre here instead, as it would almost double the catchment area for patients.  Tara was so thrilled, she agreed, because two hours walking for the people in her village would be better than two days to get to the nearest hospital.  Together with Yukio she returned to Japan with hope, not despair.  Yukio later used his knowledge to gather funding for building the health centre. 

What you see in this picture is the finished result of what started as a dream, and was completed brick by hand-carved brick (literally) by people who dared to believe in it.  Tara never stopped dreaming, and together with Yukio she started an International Non-Governmental Organisation (INGO) called Nepali Tara which translates as Nepali Star.  And because Tara truly is a bright shining star, she went on to build a school near her village.

Yukio san quit banking permanently, and now runs Nepali Tara from an office in Osaka.   Hira also quit his well-paid job in hotel management to oversee a new bridge project which will connect Panchet to Solambu Health Centre (SHC).  Once completed, this bridge will increase SHC’s catchment area to 75,000 people – that’s more than twice the number who can currently reach SHC.

 This weekend, I accompanied Yukio san, Hira and two representatives from the Japan Overseas Cooperative Association (JOCA) who are monitoring the funding given by Japan Post to build Solambu Health Centre’s latest development; a Community Centre where micro-finance meetings can be conducted, and various programmes can come to life. 

If you ever decide to visit, which you might well do, walk down the steps to the right of the Health Centre towards the canteen.  About six feet down the footpath, you may notice a small orange tree.  This small orange tree, rather like the person who planted it, will one day grow to see other small trees planted around SHC to provide fruit and vegetables for the storage rooms in the completed Community Centre.

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.