Arriving at the house
The hacked stone from the rocky paths leading into the village are the same stone the houses are built from. A stone grey with bright sparkling silver glitter embedded in layers, which rubs off on your jacket as you lean against the walls. Sumjana and Apsara, the 2 phase health workers greeted us with big smiles and sweet ginger black tea. We sat around with the small but strong lady who carried our bags and we slurped on 2 minute noodle soup together. I peered around just wishing I could converse a little with the conversation being all in Nepali of which I had regretfully failed to learn a little before hand. I realised the hospitality here was going to be overwhelming, however, my lack of Nepali meant many frustrations to come between me and the health workers.
Outreach
The first day was an outreach clinic which meant a 2 hour walk along a beautiful valley with a snowy mountain backdrop over to the next village. Again I stumbled down lush green terraces with the health workers and set up a few chairs outside a large school
There was a sea of women who had come for their contraception injection. This was a good opportunity to go over some of the main issues to consider when issuing contraception with the health workers.. Then usual cases of gastritis and dizziness ensued – cases reminiscent of my GP registrar job in hackney. A problem here was that this out reach had only a few chairs, no private room, no drug cupboard, no tests. The community had been asked to organise a drug cupboard, a bed and a curtain for some privacy but had not managed to as yet. It was clear instantly the difficult conditions the health workers were in and at the same time
managing remarkably well. Some people were asked to come to the health post where we can check HB and do urine dips for glucose, and also have an otoscope. It means a 2 hour walk one way and maybe a day less crucial income from work, this means a few do not turn up.
The local female community health volunteer invited us to sit inside around a fire pit to cook our 2 minute noodles, drink tea and toast some rotis before heading back to Keraunja. On the way out we were asked to see a very sick groaning elderly patient in her dark tiny shack of one room held up by worn stilts. It was the first time of many to come that I realised the tribulations of falling sick this far from any hospital and being poor. I can only assume she died in the coming weeks where we left her. It left me feeling somber as we climbed up the hill back to Keraunja and for days after. I wished I had some decent advice, a few ideas later popped into my head that may give some symptom relief. We sent a message for a relative to come to our clinic so we could give them some advice, but they never came. The staff will follow up in the village after a month so I hope to find out eventually. Maybe they used a traditional healer, or maybe she died, or maybe by miracle she got better.
Children of Keraunja
Keraunja’s children, like many rural mountain kids often wore thick snot on their upper lip with raw skin underneath. Muddy hands and dry dusty skin seems to be commonplace, but kids being kids maintain their cuteness to a high standard. The staff say it is lack of awareness of hygiene, but also it is bitterly cold and a lack of fuel to heat water. There is no private area to bathe, so it means washing under the ice cold public taps. I didn’t wash for the time I was there. With a constantly running nose, I joined the club of occasional snot hanging from my nose and with the my lack of tissue had to join the tradition of blowing it out aggressively on to the floor. My attempts often ended up a little messy and embarrassing at best, I have a long way to go before mastering this technique. However good I get I probably shouldn’t be trying it out in London. I think I’ll stick to tissue.
Although there is a big school close by many kids are not there, instead doing household chores or working in the field. I hear also however often the government teachers are not at school when supposed to be, and the quality of education is not good. I wonder how without an education the younger generation will lift out of poverty, maybe some will, but I imagine the majority will not.
Poverty
Someone explained to me even though many people are poor in Nepal they are happy and wear a smile on their face and spend time laughing. They told me the age old quote that ‘money doesn’t bring happiness’ but then agreed some is important. I left unsure how many of the people here fit into this category of having enough to be happy. I have studied a module called ‘understanding poverty’ I understand why people become poor and poverty traps but I will never understand what is like to be poor. With never being poor how can you ever really understand how you would be in that situation. In some regions Phase has community mobilisers who do needs assessments and try with very little resource to act on some of the solutions that come up in community meetings. I write more about this later when I meet a community mobiliser in west Nepal. I suppose you need the opportunities, and if there are none, then the probability is you will accept your situation and try to survive.
Keraunja Village in the distance
A couple of months ago visiting a tribal health project in India, regardless of the mild malnutrition and rogue kids not in school, the villagers sit and laugh and appear relatively happy. The health workers here tell me people in general work until they have enough to survive then will stop for a few days. I thought it is good they have that option, and so much work is available, but if this was the case then why is there malnutrition? Is it lack of education on what constitutes a good diet, or is this less of a priority over other needs.
In Keraunja everyone seems to be working- women, men, children and the very old also seem to be grafting hard. When I went to the bathroom in the morning I would look up the valley to see streams of mostly women zig zagging down the mountain at speed occasionally barefoot with baskets strapped to their heads, and puffing on a cigarette. It wasn’t a surprise why musculoskeletal problems were a common problem in the clinic, especially knee pain. I went on to teach the health workers basic physio exercises to try out and teach their patients. They really appreciated it, and the patients also seemed to show some interest. But asking them to rest was not a realistic option, as resting meant no money for that day, and hence maybe no food.
Teaching
We covered a lot of topics in the week I was there, including discussing consultation skills, and taking a good history to rule out serious illness. We reviewed all examination techniques and the importance of follow up advice. It was incredible to see the improvements achieved over the week, and very rewarding to teach such keen health care workers.
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Another GP was sent out the following month and sure the team there will benefit even more. Taking into account the health workers 29 months of training to be Auxillary nurse midwives plus a couple of years in the field, they do a great and very necessary job of providing primary care to an in need population.
Travelling with General Practice 