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!"

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.