The trek from Keraunja to Sirdibas
I met Maria (my partner, also volunteering with PHASE), Sunita (a health supervisor) and Peyma (helper/porter) at the bottom of the valley. It was 2 further days trek in the stunning Ghorka valley to Sirdibas, with more long drop waterfalls and beautifully striped boulders smoothed out by the rapid icy blue waters.
Next to a striking pagoda was the health workers house, just minutes from the clinic. Kalpana and Uma were the Auxillary nurse midwifes(ANM) here, and Sangita was the on the job ANM trainee. They have to cook on a fire, and the smoke can sometimes get intense in the kitchen. They still manage, and cook great dal bhats! They are lucky to have a water pump right outside their house, so water collection is not a problem. As in all villages, bathing is public and the water is bitterly cold.
The Health Post
The Phase staff were all supporting a government health post that was run by a newly trained Auxiliary health worker. A new health post, 5 times the size was part constructed nearby. Currently patient confidentiality is compromised, with no doors to the clinic room, and any procedures done in the waiting area. The confined space and the high number of potential TB patients coughing and spitting outside the clinic door made me feel a bit uncomfortable so along with the other health-workers I wore a face mask.
I was sent here as they were seeing a high number of complicated cases, and I really found this to be. Severe burns, septic arthritis, plenty of potential TB, and potential malignancy were all on the cards in the limited time I was there. The long distance from any road or hospital, along with the poverty made referral difficult and frustrating. Helicopters are occasionally sent out by the government for pregnancy cases. Otherwise the community may club together to pay for a helicopter for someone if they see fit. But it costs 100,000 rupees (about 650 pounds).
The government supply 32 medicines which the government staff are trained to give. Extra medications and staff are supplied by phase. This can have the affect of sometimes encouraging the government health staff to spend more time at the clinic with less isolation and more medicines from Phase. It is well known for government health posts to be left unmanned and without medicine for long periods, hence the need for PHASE support. The phase staff will dedicate time also to community outreach or holding health education sessions.
It is a tricky community- people travel for hours to attend, while commonly speaking a different language to the health workers. They have even further to travel than Keraunja which makes it difficult to refer. Patients will often prefer a treatment and hope for the best than be referred to hospital for necessary investigations. A common scenario maybe gastritis, where endoscopy might be indicated, but the patient is unlikely to go even after counselling.
Teaching
It was difficult to teach due to my lack of Nepali,, but the government health worker, with slightly better english, attended all our teaching sessions, and helped with translation. While in clinic I focused on helping the team with taking clinical histories, examining, and ruling out serious conditions. Phase teach health workers to stick to their comprehensive clinical guidelines, and I tried in most cases to reinforce this. It was incredible to see the improvement the health workers made during the few days I was there, and the keenness to learn. It was also very special to see their dedication to the community they were serving.
Upper Gorkha and the PHASE School and clinic
Maria went onwards and up the valley to higher snowy ground to visit two further health posts and a school created by PHASE. Being higher up meant it was colder and people were less likely to wash. Many carried their own silver spoon to eat with since it was more hygienic than the traditional hand. Kids faces were more intensely snot encrusted, and the vibe got more Tibetan as you reached the border.
The clinics were quieter, but still well appreciated by the communities there. The views were spectacular, with mount Ganesh at one point of the trek in full view. On their return they bought a yak tail and 2 puppies with them that one if the health supervisors had requested. Of the hundreds of adorable, excessively fluffy puppies we saw on the walks, the two they returned with were exceptionally cute with slightly weird blue eyes.
Travelling with General Practice 