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.