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.