Back to Katmundu

Return from Gorkha
Tuesday 10th
Before our porter arrived for our bags, I was asked to go up to the clinic for a meeting. It turned out to be a ceremony of putting scarves round my neck as a farewell ceremony as I was the first doctor to visit the clinic.

I was quite moved and thankfully one of the officials was able to translate my thanks for me. Then 'lunch' and Namrata and I set off back to Manby. What had been a dreadful slog up hill the previous week was a much easier crawl downhill and then a level woodland walk before a bit of a slog up to the Manbu clinic, altogether a much better trek, punctuated by a very welcome cupof tea from a delightful man who used to be in the Indian army and now lives between 2 villages making tea.

It was good to see Laxmi and Rita again, and we had a delicious last dinner of dahlbhattalkari.
Wednesday 11th
Our porter came for bags at 7am and we set off about 10.00 and got to the bus stop in 2.5 hours, only 30 minutes longer than most people, and that included getting lost 2 or 3 times. One would expect that just walking straight downhill should be foolproof, but there are so many alternative tracks we got quite confused. This woman in her bare feet to collect wood put meto shame.

One of our detours accidentally took us to the government health post. Quite a surprise to come across a 2 storey well built building with 3 large downstairs rooms and presumably accommodation upstairs, the windows had glass in them, a thing I have not seen for 2 weeks! There were 4 staff doing nothing, but reasonably chatty. It turns out that they see around 12 patients most days, which is a lot less busy than the PHASE clinics.
The bus to Arughat scheduled to leave at 1pm eventually set off at 2.15, which gave Namrata a chance to watch TV in a cafe for a bit. The 2 hour journey was every bit as exciting as 2 weeks ago, and this time I had a front seat view of the astonishingly bad road,

and several times watched the 'conductor' leap off the moving bus to remove rocks from its path before jumping in again.

Thursday 12th.
Up early to leave the hotel for the bus at 07.00. Had been assured a porter would carre our bags to the bus, but again found I had to lug them myself for 29 minutes. Does not sound far but with back and hip problems only just controlled it was not a good start to the morning. The bus eventually did leave at 8.00 so we had a boiled egg for breakfast, before the gruelling and awful journey. 5 hours on no roads, in 1st gear, (we got 3rd gear twice for about 1 minute each) the 30 seater holding about 60, some stinking of alcohol, unable to move a muscle or see a thing. At 1.00 PM we got to the tarmac and most of the passengers and their pots, pans, bags of veg, rice, rags, grinding wheels and bags decanted, so at least for the 3 hours on tarmac most people had a seat and we could breathe.
The taxi to the hotel got lost as usual! And there was a planned power outage on arrival so still no Internet!  However I got a hot shower at last and felt almost human again by dinner time.
So here ends the  blog,  though I will try to add photos when I get any decent Internet speed.
All in all this has been a fascinating 3 weeks, definitely benefitting 7 people's English skills, 4 nurses benefitted from the teaching and I learnt a lot about very basic living conditions and experienced the dreadful frustration of being unable to supply even basic medical care. There have certainly been frustrations and humiliations, but also such rewarding smiles and genuine gratitude from a curious population many of whom have never seen a westerner or a doctor.
Would I do it again? If I do I will need to be fitter and will have to master some Nepali!
Would I encourage others to come out? Definitely yes as there is such a need and it is such an amazing privilege to experience life here other than as a tourist.

Kashigaun now with photos

KASIGAUN
Tuesday 3rd Feb
OK, so the description of the walk was not quite accurate. The first 2 hours were up and down with lovely level bits and several small rivers to cross, the porter came back to assist us (well, me) over one. The next 3 hours seemed almost relentlessly up hill, increasingly slowly as I found it more and more difficult. Partly heat exhausted (I wore a fleece as I had got so cold the previous week getting to the outreach clinic), and partly hypoglycaemic as I had shared my bar of chocolate and had removed my emergency snacks due to the rat problem. The girls did try to get some tea in one of the villages, but apparently nil available. To my embarrassment I had to ask them to carry my rucksack,  which was not at all heavy,  and they managed it with no problem. Thankfully I did make it all the way, and 2 cups of tea and bread and honey later felt human again. An hour later I had my first strip wash in 2 weeks, and clean and dry I sat on a BED and fell asleep, to be woken for dinner, a quick tutorial and properly in bed asleep by 8.30. Sadly woke at about midnight to discover the other 5 asleep, light on, and rats running all over the plastic sheeting that acts as a ceiling. No more sleep due to the rats, and the baby upstairs got its father up 3 times too. I discovered in the morning that the light is left on to discourage the rats!
Wednesday 4th Feb
Dahl bhat breakfast with less talkari as this village is less developed, and does not grow much veg. They eat much more meat, and alcohol is more common. The PHASE accommodation is the lower storey of a house, extremely well ventilated! The kitchen area is smaller, but there is a dedicated wash area which is a square of stones for drainage and a hose which can be periodically attached to the village tap. In this area there are frequent taps many installed by British Gurkhas. The sleeping space has 2 beds and a floor mattress:I am very lucky to have one of the beds and the five girls share the other one and the floor. Sadly no sunlight as the house faces north and is in a congested area.
 Then the first clinic here:much less busy than in Manbu, but a better facility

as the clinic is held in the government building of 3 separate rooms, but with no government health worker present. It is one storey, with some of the roof replaced by clear plastic so the daylight is adequate to see by.  There are 2 ANMS here

and a recent health worker graduate coming to the clinic voluntarily to learn, as well as the staff nurse, so consultations are crowded and well debated. I think the Nepali language must use 10 words to every one of english judging by the length of discussion when I ask a question!
There is constant electricity at night here but none during the day at all. So the power monkey has been needed for my tablet, as indeed I have needed to use the tablet quite a bit for teaching. The 2 livelihood programme workers have been useful to help make some simple medical devices (spacers) and in fact when not busy they tend to gather in the sun near the clinic and sometimes help with translation too; a very informal community effort!
tutorial and study again in evening.

A much better night thanks to cotton wool in ears and exhaustion.
Thursday
Another clinic day, starting with 15 minutes cleaning, but as no patients initially we had a 30 minutes tutorial in the sun going through new guidelines, and I think the first patients were impressed to see the 5 of us all busy looking things up in 5 different books and discussing the findings. Unfortunately we then got very busy, including several small babies in baskets on mum's backs,

and I had to insist on a break for everyone after 4 hours, so we went back to the house and had tea & biscuits before carrying on for another hour. That sounds a very short day, but the clinic is freezing and translating all the time (sometimes between 3 languages) is surprisingly tiring, and of course teaching/learning takes energy. Also the routine of life with no bathroom, no running water, no shops, and only 2 gas rings and a wood fire

 to completely feed 6 people who are all out at work is very time consuming.
In the evening the girls wanted to teach me to make chow mein as a snack; delicious but so filling I could not manage dinner after a further tutorial.
Friday 6th
A cooler cloudier day, interesting clinic cases and a home visit made an interesting change, and there were actually 2 antenatal cases too. Had a chat in English with the school teacher who was doing his laundry at one of the village taps and wanted to practice his English. Apparently the school has 10 teachers and 400 pupils! He is new to this school, but at his previous village, about half the pupils left at 16 to 'farm', the other half went on to the higher secondary 3 hours walk each way.
The girls are cooking goat meat for dinner. .....and this is how the upstairs neighbour helped them chop the meat!

Saturday 7th February
Day off and a 'picnic' has been organised by the community as the village has us visitors, I am told an hour's walk, and have confirmed that it is of course vertically up hill.
So after a morning of all 5 of the girls washing their glorious long black hair and putting on their best clothes

we had a lovely ( vertical) walk up to a very modern looking government facility which is at least partly a mobile phone mast, and I don't know its other functions. There were about 30 people already gathered from 4 years old, a group of pre teens, 2 completely separate groups of teenagers the girls 10-16, the boys older and more extrovert, some young mums, the 5 PHASE girls, 2 teachers and me, senior by at least 20 years.

More appeared during the day too, to join in with singing and dancing after we had been presented with a cup of tea and red rhododendron flowers!

We were obviously guests of honour. At 2 pm a full lunch was served-the wood fire had fried puri for everyone, and prawn crackers,

there was a hot stew of beans and veg as well as goat meat and a cold sort of salad of onion (chopped at the picnic) and chick peas on a bed of churi which is dried rice flakes. An enormous plate of food was presented, sadly a lot wasted. However the rest of the assembled group ate the lot! More singing followed,

incomprehensible to me but obviously enjoyed by the gathering, and then we all wandered back down the hill; it amazes me that they had carried up all that food, and water to wash up as well. It turned out to be the Christian church outing, and I was invited to the eve service.
So after a much needed cup of tea and short rest 3 of us ventured out to church. Quite a shock, very very loud, excellent singing at full microphone level by 3 young women accompanied by boys on drums, then frenzied and very loud prayer, then excellent well rehearsed dancing by the boys, more singing and dancing. To begin with it was just us 3, but various people appeared during the 90 minutes until about 30 were there for the final 10 minutes. We escaped with our headaches and lots of smiling, to find a vast amount of puri (round sweet dough, deep fried) and neemki (salt dough strips) being cooked, I thought for dinner, but dinner was produced as well! What a day!
Sunday 8th
Outreach clinic 1.5 hours easy walk away, in Airsay (?) in a part of a house,  no light at all and girls had to clean

and fetch water.  It isn't easy to achieve privacy for patients in the open air,

but we eventually persuaded the queue  to wait on the other side of the track.

had taken some boiled water with us, needed for dressings and powdered medications. An interesting clinic with a nasty scalp laceration and several severe infections as well as 2 complicated medical problems both sadly unresolvable due to lack of facilities and refusal of either patient to make the 2 day trek to get investigation and treatment. Thankfully we got a cup of tea and the left over puri after 3 hours, but did not finish seeing patients till after 4, so it was almost dark by the time we got back. Then a blissfully bowl of hot water to soak feet!
Monday
Last clinic today was very quiet so time to complete the feedback forms. The 2 girls doing the livelihood programme for PHASE, Poosa and Santi, were doing some training for 24 of the farmers and we all went to support them, 20 women and 4 boys and men, accompanied by 5 breastfeeding babies and about a dozen assorted children; lots of coming and going, and it was very cold in the hall, but the afternoon snack of 2 hardboiled eggs and chickpeas was very welcome.3 of us then had a climb up and down the village trying to find a pair of scissors to replace the clinic's broken ones. Failed. It is interesting that in the NHS we throw away scissors after a single use, but here we cannot even replace the only pair.
Start to head back to Katmundu tomorrow, a 3 day journey but both walking days will be fairly easy; I am really keen to get back to an Internet connection after 16 days of being completely cut off from any news or information or communication with the world outside these 2 remote villages.

Manbu continued. ppictures now added

Wednesday am
I was brought a cup of tea before I had to get up, then a bit of time to sort my bags and work stuff before lunch at 9am-dahlbhattarkari-and then straight into clinic as the first patient arrived at 9.30.

27 patients later at 3.30 with absolutely no break and freezing cold the clinic finished. In future I will require a toilet break in order to warm up in the sun!  The girls were very efficient doing a job they simply are not trained for as best they can, and were very receptive to bits of teaching.
We then had an interesting and very necessary snack of pidalloo,a small potato like veg that was cooked in its skin, and needed peeled and dipped in spice to eat; delicious. Some of the girls washed their hair while I wrote up the cases briefly, after that they wanted a tutorial, even the agricultural girls joined in and it was fascinating to share medical experiences while teaching.

A game of uno was very well received with lots of laughter, and now they are cooking dinner: dahlbhattarkari...again.
Thursday
is outreach clinic day, involving setting off at 7 am for a 3 hour walk. Up, above and through some of the spread out village, ie literally climbing the field walls, like this one that even the mules disliked

and sometimes walking along them, then down to the river, across a very suspect bridge

and vertically uphill through a forest for an hour; extremely hard work even in my boots and with poles. One of the girls had flip flops on! And the 3 girls just skipped along, one of them behind me all the time incase I fell! You can see how tired I am and how energetic the youngsters seem!

We eventually arrived in the school just at 10.00 as the pupils were gathering for assembly,

so I was able to be their audience and join in with the physical stretches counted in English,  and also hear their Nepal national anthem. The clinic was in a very dusty room in the school,  no water, no soap, 3 and a half chairs and 1 table. It is astounding how these young girls manage to take a history, sometimes examine, and guess a treatment. Not always right, but never dangerous. I suspect the 33 people we saw was rather more than usual as a doctor was there and so a curiosity. Noodles and tea was produced thankfully and we ate in the sun as it was absolutely and literally freezing inside the room. We then emptied and tidied the wooden cupboard full of medications and sorted them out before setting off back at 3.30. We got back at 5.30 as I found going downhill so much easier, and in fact was sometimes a little quick for the young girls. Walking through these shacks and terraced farmland with the backdrop of wooded slopes and mountains in the distance is a fascinating experience.
On return a personal wash was essential, and luckily it was nearly dark and there was some warm water (they keep the steriliser on and full!) so I had a discreet public ablution, my feet getting a wash for the first time for 4 days, and undies changed. Dinner (dhalbhattarkari) warmed me up before a tutorial and sleep.
Friday 30th
was much quieter as there is usually no clinic we only had about 16 patients including 3 ear problems, a really nasty injury to the thumb of a 13 year old girl with a grass cutting knife (only dressing available is betadine liquid and gauze swabs), and a horrid abscess. We got 3 breaks for a few minutes in which to warm up in the sun, so the day passed quickly, and then we all froze in the strong wind doing our laundry.

Then it rained, the only rain I have had all the time. Typical. So all washing still wet.Dahlbhattarkari for dinner and then one of the girls had an internet sim card which worked in my samsung tablet. They watched some indian and nepali song videos in absolute rapt silence. It was such a shocking contrast to their lives here where they have no radio or TV and do not go to any town for weeks or months on end. They work hard for 6 days each week, and have been unremittingly cheerful all the time  I have been here, so this brief reminder for them of entertainment they are missing must have been hard for them. One is married with a 4 year old son she sees once every 2 or 4 months.
However they all rallied and we had a hilarious game of uno before bed.
Saturday 31st January
The only day off for the clinic, so the whole establishment was scrubbed and cleaned, instruments were autoclaved, and the the 3 of us, Lakshmi,  Namratta, and I went to take part in the agricultural training day that the livelihood programme was holding. Poosa and Santa, the other 2 young girls in the PHASE house here, had organised it, and I was told it was just a 30 minute walk. It was in fact a 40 minute vertical downhill climb precariously teetering on the sides of walls and banks the whole way.

They of course lightly ran down in their flipflops while I crawled on all fours! It was fascinating day; about 30 women farmers ranging from 14 to 70 years and around 5 men from 14 to 50 concentrated and made notes in the supplied notebooks sitting on the ground in the sun with several young children dogs and hens helping. The 2 girls gave talks

and demonstrations of seed planting, maintenance, infection prevention, and propagation, and after about 90 minutes there was a break for some singing and

dancing, before the practical session of preparing seed compost with earth dung and ash, filling propagation pots,

and creating a seed bed and cold frame from bamboo lengths and plastic supplied by PHASE.

Then everyone was fed with veg stew and rice crispies and very welcome tea, all paid for by PHASE and cooked by a local woman. At the end of the day there was more dancing

before every participant was given seeds, plastic pots and plastic sheets to make their own seedbeds. More tea then the vertical climb back, all very happy, but I am certainly tired. More than usual power cuts in the evening made the chores and cooking more difficult.
Sunday
A clinic again today, and unfortunately very busy indeed; Laxmi saw 5 patients between 8 &9 before our 'lunch' and well after the clinic should have finished at 2 people just kept coming.  Thankfully we all had a 5 minutes break for some nuts and tea about 2pm but we were all exhausted by 5pm and I insisted the clinic was closed. We then walked 30 minutes to a 'shop's to try to buy some chicken as a treat, but it was shut. It was very close to the Christian church which was a long fairly well built shed with a raised platform and unusually actually had a floor covering instead of just a mud floor. There was a set of drums at one end, but not a lot else. The windows were partially open as I suspect there had been a service that day. We briefly met the pastor who at 22 years of age was also the 'shop keeper', but as he spoke no English and I spoke no Nepali we did not get far. One of the PHASE girls is Christian but can never get to church when in the villages as Sunday is a working day. Just before dinner, in the dark, I did a little essential laundry as I was told there was no electricity at the next village, which inevitably would mean all tasks would be even more difficult. In fact I didn't do my washing as Laxmi and Namrata insisted on taking over!
Monday February 2nd
Patients were already waiting at 8 am when all of us were traipsing to toilet in night clothes, trying to get washed -which of course is done in the open in public,  trying to cook lunch before work starts,  filling up the water and all the other chores. So after Laxmi had seen the first, I insisted she told the others they had to wait till the clinic opened at 10.00. Most of them disappeared but 3 lots hovered a few yards away the whole time. However the reprieve gave Laxmi her only chance in a week to wash her hair. So after lunch (late at 9.15') we started the clinic, but thankfully after 12 patients the queue had disappeared.so by 1pm we were all 6 of us elbow deep in cold water

and soap washing all the linen and some clothes. What a job, thank goodness for my washing machine! I had , for the 2nd time 30 minutes to myself in the whole week while the others, much more expertly finished their laundry. Later we completed the paperwork and assessment forms and repacked for our walk to Kashangaun tomorrow, apparently a 4 hour fairly level walk with bits of up and down, round the mountain rather than right down to the river and up again.

Manbu, with pictures