Rugin, Bajura, West Nepal in pictures.
Tag: Travel Writing
Living and Mentoring healthcare workers in Dhim, Bajura, West Nepal (pre earthquake)
Journey to Dhim
The 6 hour trek through the midday sun seemed never ending. The last 3 hours were a punishingly steep incline, and i was ready to throw my backpack down the hill. I arrived slightly sun stroked and beaten, and Yogesh ( the healthworker supervisor) with broken shoes. We were pleasantly welcomed to smiles, laughter, tea and home made cel roti (a bit like doughnuts). Then 2 paracetamols and a sweaty sleep beset upon me before waking for Dal Bhat.
Dhim and the community
It was spectacular, the healthworkers’ narrow balcony overlooked mountains folding in like huge interlocked fingers deep into the valley. During the week the weather changed dramatically from sunshine to perpetual rains and snow higher up- the shifting views were incredible. One early morning I decided to meditate on the sun rise over the distant mountains. Phase staff often used early mornings for studying phase guidelines in bed- ‘when the mind is fresh’! Impressive dedication, which inspired me to get back into daily early morning meditation and yoga.
The water tap for the village was very far away from all residents. You would see people throughout the day, including very young children carrying up to 40 litres of water. I forced the health workers to let me help them collect water, partly to help, but also not to feel guilty for using the water that is so arduous to collect.
The communities gratitude to the health workers presence resulted in donations of spinach, coriander or fresh buffalo milk and even some nettle curry on one occasion. It was interesting in the community, by looking at the children, you could see some families managed to keep their children well nourished and clean, while others struggled. In clinic, the health workers were counseling mothers of malnourished children well, proved by impressive weight increases on follow up. There seemed to be many children not in school, which was a problem in all the villages I visited. Without an education it made me concerned for the development of future generations to lift themselves out of poverty.
The health post
Kalpana and Sumjana are two healthwor
kers based in Dhim and have had the clinic running for 3 months. Strangely the government also set up a sub health post 2 weeks before I arrived, but as they do not have many medicines patients prefer the phase clinic, and also prefer the service. I can see why. The health workers spend time with the patients, and check everyones blood pressure as per the patients expectations. However, patients here like anywhere will complain that they have been waiting too long! A very small fee is charged to the patient for the upkeep of the clinic, and most are happy to pay it, and if they cant afford it they are not turned away. The government plan to build a new better health post in the village to accommodate the phase and government staff. Phase being present means more community development work, more medicines, and support and company to the government health workers. I wonder how frustrating it must be to be a government health worker here with limited medicines, limited training and no guidelines to help, while also being isolated from family and friends with little communication to the outside world.
Interestingly in this community the women rarely call the phase staff for help with birthing as culturally having tears sutured is not well received. Women prefer to risk the complications as there is a perception it would otherwise affect future pregnancies. The tradition here is also to keep the mother and baby below in the barn for 20 to 30 days, they are also not allowed to use the public tap at the same time as others and would ideally bathe in a local river or stream. They are not allowed to touch anything or enter the house. When menstruating also the women follow the same rules for 4 to 5 days. The phase staff attempt to raise awareness that the lack of hygiene and cold conditions in the barn are a major risk to the newborn and mother.
The clinic was very quiet, it usually is for some reason. But the bad weather made it less likely for people to come. We did still see many cases of severe malnutrition, gastritis, skin problems, psychosomatic complaints, and significant neurological disease. Delayed presentations were common. Time, money and the many days journey to a hospital meant many lived with serious disease in the community risking long term complications or worse.
May 2015: The above account was written pre-earthquake- however I understand that this part of Nepal has not been so affected as the Ghorka regions also discussed in this blog. I wish the best for all the people of Nepal in this very difficult time. I understand the healthcare workers here had returned to Kathmandu for their routine break and training, but have volunteered to some of the more affected rural communities to offer their support.
Flying to the far West Nepal
Journey to Nepalgunj
2 days after returning from Gorkha and enjoying some sights around Kathmandu with Maria I was ready to plan my next venture out to far west of Nepal. This area has some of the poorest and hard to reach communities, resulting in the worst health indicators for Nepal. When we arrived in the Phase office, I met Yogesh, a very friendly and relaxed health supervisor who would accompany me to the
west. We did some planning for the 3 health posts I would visit and decided our route. The first leg was a overnight 16 hour bus journey, that with frustration seemed to break less than hourly for unknown reasons. We took with us 16 boxes of medicines, a solar battery, and an oxygen cylinder and some special food health workers relatives had given to us to deliver to them. The roof was packed, and to get to your seat you had to clamber over dozens of solar batteries which fitted so neatly into the isle, it was as though the bus was designed for this purpose. Once again my down jacket rescued me, as cold air blasted through the broken window for the many hours to come.
In the darkness of the early morning, one long break was next to four identical rustic chai stalls, with warm welcoming fires enticing you to sit down to greet the new day with a tiny cup of milky sweet goodness. We arrived tired in dusty hot border town of Nepalgunj. After some rest went shopping for more essential goods to take back to the far west. Another sleepless night came as I wasn’t prepared for the onslaught of Mosquitos and couldn’t wait to get back up into the mountains.
Onwards to Kolti
The following days chartered plane ride was beautiful. Flying through impressive mountains and again lush wheat terraces dotting the rough brown valleys. The people here believe these 3000m plus mountains to be hills, I wondered what they would think to the mountains we think we have in the UK. We landed in Kolti, a low lying part of the west with the ability to grow banana, papaya, guava among all sorts of veg. People still stick however to potato, spinach and occasionally just tobacco in their gardens. That is why Phase has agriculture advisors here who promote better kitchen gardens, with more variety and improved nutrition.
Other Phase staff here work in the local primary health post along side government doctors and midwifes improving the service provision. The delivery room is so cold however, that they prefer to deliver the baby on a mat outside in the sun, overlooking the valley behind the primary care centre. Sounds nice in a way.In Kolti, there was a midwife from America, who had impressively been staying in the west for 2 months. They are currently building a new accommodation for the staff who at present squeeze into 2 bedrooms. She was helping to improve the standards, and it was great to hear some of her insights before I ventured onwards. I slept incredibly well that night. The next day was a strenuous hike deeper into the mountains to visit 3 more health posts over the next 3 weeks.
The trek up to Keraunja
Me, Anne (retired UK GP) and Rita and Namratha (two health supervisors) set off to Soti the jumping off point before our respective hikes to different villages. It was an overnight and 2 bus rides to Soti- the dust was phenomenal- a rusty brown coated all areas exposed to the air. Me and Ann cramped up on the hard seats- being prepared Ann had a cushion to gentle the pain. As I ponder about what I have done since comp
leting my GP training- a handful of locums, travel and now this I wondered how I can pass my appraisal. Luckily Ann is an appraiser and shared pearls of wisdom and comforting words that made me feel confident that with my experiences I could prove to the powers that I remain a competent GP. I hope!
It was impressive already Soti and we w
ere only just about to start our walk. Crossing of the first classic hanging bridge and oncoming weary mule train was within minutes of the start point. Milky blue glacial waters roared through the valley with long drop waterfalls already in sight. The health supervisors were amazing- they organised our every step from food and accommodation and hustling for us to pay non-tourist prices. They were great company and offered me an introduction to the Nepali culture of never ending hospitality.
The trip was the start of never ending combinations of rice, dhal, spinach and potato with the odd roti and egg treat provided. I managed well with the diet and to be honest my gastritis improved no end with the nourishing food.
The first hike was 5 hours across the valley- Rita tells me that they counted 108 waterfalls at one time. Mule trains, and people carrying incredible loads over strapped around their heads were a plenty. The backdrops of dusky to radiant green terraces contrasted out, and the intermittent brief smell of musty mule urine encroached on the fresh mountain air. I still feel very slightly embarrassed by my expensive walking boots while the locals manage in wrecked flip flops. But I definitely recognise my inferior walking skills as children hop and skip up and down rocky slopes and I watch every step.
The climb a thousand or so metres up on the second day was eased out as we had a local woman help carry our bags- she was incredible. We 3 ambled up the mountain via the dry muddy terraces, bullock carts, and hard working farmers of all ages scattered along the valley side. As we tipped over the brow lush green wheat terraces emerged and a sprawling village of Keraunja where I was due to be for the next week.
GP Mentor with Phase Nepal: An intro
I am a newly qualified UK trained GP and among other things I love the mountains and I love the concept of health and wellbeing for all. Hence I was accepted as a volunteer with an incredible organisation called PHASE which is working to provide such help to poor remote Himalayan communities. Just because they were born in this far flung environment in an economically deprived country they are the victims of the unequal distribution of healthcare, education and opportunities to earn an income.
PHASE
PHASE ( Practical Help Achieving Self Empowerment) has been running approximately 9 years. It is well respected through its achievements of bringing health and wellbeing to so many.
‘It specializes in improving health, education services and livelihood opportunities for disadvantaged populations in very remote and resource poor Himalayan mountain villages in Nepal. PHASE aims to support the most vulnerable people to break the cycle of poverty; by assisting communities and local authorities to lay the groundwork for a self-sufficient future.’
PHASE has demonstrated success – Between 2006 – 2013 we treated over 230,000 patients in 13 health centres for an average cost of £2 per person. At least one child’s life is saved every month. 294 women completed our literacy classes and we have trained 306 teachers. We have provided 647 farmers with agricultural and livestock training.
The Mentor GP
Volunteer GP’s, often from the UK, regularly take time off to hike out to the villages to help in teaching the health workers who have little formal training in primary care itself. The government assistant health workers themselves have only 15 months training before sent out to these remote areas to do the job I would do as a UK GP (10 years of training), however in a very difficult environment with limited medicines, no lab, and a hospital a rough few days away by foot and road. With this in mind, the health workers do an impressive job with care and dedication. Because of this the communities often see them as treasured members. The role of the GP here is also to provide some moral support to the very dedicated young staff that work and live in a community often very far from their own home and comforts.
http://www.phaseworldwide.org/get-involved/Volunteer-in-Nepal/Primarycare
I am currently set out to visit a total of 5 health posts. I have been to 2 in the beautiful Ghorka area and will set out tomorrow to go to the far west Bajura to visit 3 more. Ghorka was quite developed for the rush of tourists that come through a few months a year where as the rural west has little development and very poor health indicators.
Travelling with General Practice 