A broken hip, a disgruntled cook and a thing called raksi - Medical Trek Part II

Medical Trek Part the Second

Awake at 4.30am to the sounds of a kid from the village practicing his singing or yelling or whatever it was supposed to be. Snooze till about 5 when the sounds of chickens being...hmm 'processed' for Dashain festival awaken us all to a chilly morning. Later that morning we would see goats being walked up a hill and then having to be carried back down with a plastic bag in the place where a head used to be. Nepalis love goat meat and Dashain seems to be the best time to eat it, nice and fresh anyways!

I climbed to the top of the partially constructed new section of the school to enjoy my morning coffee and admire the architecture. In the second photo bamboo poles are used to prop up the cement floor above. I guess once all the 'support' structures are in place the poles are removed and you hope for the best. 

We managed to make a fairly early start for Kelleri, only about 3-4 hours walk away. As our group entered the very pretty hillside village children seemed to come from everywhere. We took refuge in a community centre for some lunch before setting up for another medical clinic.

Today, our focus was on health education and not just medical check-ups. Even though it was a Sunday most of the children showed up in their school uniforms, most likely because they were their best clothes. I don't know exact numbers but probably 200 or so children showed up and were divided into class groups. One English speaking person and one Nepali translator were assigned to each group and proceeded to educate the children on the importance of hygiene, handwashing, teeth brushing, covering your mouth when you cough and eating properly. One suggestion from Qwe, our Vietnamese-American engineer was to distribute recordings of our message in Nepali to villages to be played over-and-over through loud speakers, much like communist parties do with propaganda in certain countries. This way the importance of hygiene and dental care could reach thousands and hopefully the message would sink in. A little extreme I know but with the Maoists in power you never know......

The school at Kelleri was pretty much on top of the hill at the highest part of the village. This may have helped keep numbers down for the afternoon clinic as we only saw a handful of sick older people amongst the 100 or so patients. The previous day's clinic, however, people were carried in on stretchers from their homes. One elderly gentleman of 95 years of age complained of having a painful hip for the past 8 years. Turns out he fell 8 years ago and, by the looks of his significantly shortened leg and feel of his hip, he had actually fractured the hip. So I gave him a few boxes of paracetamol and sent him on his way. On the bright side, it probably wouldn't bother him for too much longer. 

Our clinic that afternoon saw about 100 people in a few hours, mostly the health was pretty good and only a few cases of significance had to be referred to Kathmandu for further treatment. Mostly these were obstetric/gynaecological cases which needed proper review and potentially surgical treatment in some cases. 

That night an argument erupted down in the village at the community centre where the medical team was sleeping. Our cook, Raz (above right), got pretty drunk as he seemed to most nights and had a pretty heated exchange with Jenee, one of our Nepali guides/translators/organiser. Raz then proceeded to rile up some of the locals against the group so Binod removed the large gas cylinder from his reach and used it to barricade the door. The next morning the majority of the porters left with a lot of the equipment to head home for Dashain. This was the arrangement, however, as the medical part of the trek was now over and were to be staying in homestay from now on. Four of us, however, were oblivious to the commotion as we camped at the school on top of the hill.

The walk to Patle was beautiful, passing through a high mountain pass, down to a bazaar for lunch then continuing over hills, and down ridges to reach our homestay accommodation. 

 We received a very warm welcome at our homestay, a cluster of 20-30 houses near the village of Patle where all the farming is organic, people live very traditionally and they produce their own biogas using cow manure, human waste and water. Another thing they produce is Raksi. Made from millet grown locally and usually distilled at home. The potency of this evil home brew is unknown but it is usually served with a certain vigour from the host and a wry smile.

Our homestay hosts knocked up a very nice feed of rice, dhaal and goat meat which we devoured whilst sitting cross legged on the kitchen floor. The host then cracked open the 'local raksi' and proceeded to pour out generous helpings for each person. I tried to refuse as I had fallen prey to this evil potion whilst on my rafting trip to Chitwan. The taste is not unlike Japanese sake and it doesn't taste too strongly of alcohol. Have a couple of glasses, though, and a monkey soon whacks you on the head, your eyes glaze over and you begin to wonder why you are drinking from a 5 litre motor oil bottle. I discovered that only the best raksi is served from motor oil bottles where it is stored after distillation to, I can only presume, age and take on a delicate polyurethane and engine oil taste.

Millet

 Donuts Nepali style for breakfast with curried spuds and some pickle all washed down with several cups of coffee to get the batteries charged. The previous night's sleep had been somewhat interrupted by our inability to locate the light switch so the 5 of us sharing a room slept with the light on all night. The light switch was in fact disguised as a powerpoint and none of us bothered to check that switch even though it was located just next to the light globe. Live and learn I guess. Next time I'll just drink more raksi and the light won't bother me. Scott's snoring on the other hand....

Hills, fields of eggplants and a bizarre rash - Medical Trek Part I

Heading to a part of Nepal where white people don't go with a small number of medical staff, a bunch of meds, little equipment and a vague idea of what to expect when we get there. This was essentially the brief from Scott, our trip leader. Scott is the head of The Mountain Fund, a not for profit organisation in Nepal that, amongst many worthwhile projects, has conducted medical treks for the past 7 years in various areas of Nepal. This year, however, would be the first foray into the Dhading district, an area approximately 150km from Kathmandu where people are mostly subsistence farmers and access to medical care is very limited and often a long walk away.

Scott - the boss with the funky moves

The Motley Crew!

The night before departure we went through our boxes of donated meds. Our inventory appeared limited considering we had no idea how many patients we would see. Essentially we had a bunch of painkillers (panadol basically), antibiotics, antifungals, worming tablets, eye drops and stuff for gastric reflux. Hardly a full doctor's kit but we would have to make do. 

After a 3 hour bus ride, our motley crew assembled on the side of the highway as the Nepali porters argued over the amount of gear they would have to carry. They hardly made things easy on themselves with one carrying a 12kg gas cylinder, another loaded up with about 20kg of potatoes and cauliflower, and many other unnecessary items. As it turned out we would be able to get food along the way in the villages, however this was an inexperienced group of porters who were about to receive a baptism of fire. 

Our first stop was Manchu, a village about 3-4 hours hike straight uphill. The Nepalis like to make tracks that go straight up hillsides, none of this gently gently crap. 

Uphill, always uphill!

Mankhu is a poor village where The Mountain Fund runs a farm for widowed or abandoned women who have nowhere else to go. Basically they can come and work on the farm and grow food to sell whilst being housed in a safe environment. There is a child-care facility attached to the school so single mothers are able to work too. 

With no time to rest we grabbed our medical stuff and headed to the school to set up for the afternoon. The greeting from the villagers was the warmest I have ever experienced, they were just so grateful for any type of medical care. News of our visit spread quickly and before long a crowd of about 100 had gathered to get medical checks. Another 100 or so just came along to see what was going on. 

Our team consisted of 3 nurses, 2 doctors, 1 paramedic (me), 3 non-medical people, Scott the leader, a handful of Nepali translators as well as the porters. We set the clinic up as follows: all potential patients first had go through 'Triage' and undergo a basic assessment. Triage was staffed by myself and 2 of the nurses. Patients were given brief medical checks and then referred to either the 2 doctors, directly to pharmacy for medications or referred elsewhere (such as there is nothing wrong with you or there is something wrong with you but today we can't help so you best walk down the hill and get on a bus to Kathmandu!)

Working by candlelight, and we think the health system in Perth is bad!

Getting Nepalis to line up to go through triage was like herding cats. If they weren't pushing past each other they were trying to climb in through windows. Our door guard, Nora, did an awesome job and managed to get people through with some semblance of order. That evening we saw probably close to 100 patients through triage with about 30 referred to the docs and bunch of others sent straight to pharmacy for basic meds. We worked on with only candle light as there is no electricity in the village for the most part. 

After a good feed and a good sleep we were up early for what was to be a very long day. It began with an attempted mutiny by a number of the porters who decided to leave and take a bunch of equipment with them. So fiery exchanges took place and the rest of us headed off over the mountain. 

Fields of eggplants, a couple of beers and a bit of extra weight in the form of two tents the porters were fighting over.

Ask a Nepali how long it will take to walk somewhere and you need to apply the formula. First, take the figure they give you, double it, add at least an hour, figure out if they understood the question in the first place, multiply by pi, subtract that figure from midnight and you're nearly there. What started out as a 5 hour walk turned into a 9 hour slog through heat, humidity, dust, fields of eggplants, up hills, down hills, around hills, up another hill and arrive by sundown!!! We finally arrived in Dumrichaur at about 6pm after setting out at 8am. It is a dusty, dirty, isolated village and word soon spread of the whities who had gathered in the school courtyard. 

Our dusty camp in the school 'quad'

Not a bad view for a morning coffee

Waking up above the clouds with views of the Himalayas is a pretty good way to start the day even if you're freezing cold, covered in dirt from the day before as you could only get half a bottle of water to have a 'bath' with, and someone has 'misplaced' the milk powder for the coffee!! Ahh, first-world problems. 

The previous day we lost one of the nurses to injury and she caught a bus back to Kathmandu. This made the task even more onerous for myself and Paula in triage. Starting at about 9.30 a crowd steadily grew and we didn't finish until after 6pm. In that time we channelled over 200 patients through triage, conducted basic health assessments using translators, and sent patients on their merry way. The average time per patient was approximately 4 minutes!! Using translators was interesting to say the least. You first had to figure out if they understood what you were asking, watch closely for body language which may suggest they were asking the patient the same thing, get an answer which bore no resemblance to the original question, re-word your original question and start over again. Manisha was my translator the for the first clinic and her english is very good. With so many of the same complaints coming in one after the other I barely had to say a word sometimes as she would basically do the job for me. Binod on the other hand tried very hard...he was too ashamed to admit he hadn't understood something I said so would just carry on regardless. We soon figured each other out but it did make it very difficult at times.

 

Manisha

Binod

Word quickly spread and crowds grew to get a glimpse of the 'whities'

We eventually whittled the crowd down and were able to wrap up for the day. We saw a lot of arthritis aches and pains, stomach pain (they woof down mounds of rice with craploads of chilli all cooked in old shitty oil in about the time it takes to sneeze!), fungal infections, chest infections, eye infections, ringworm, worms, and one of the strangest rashes I have ever seen. No-one had a clue what it was (it was widespread and looked like his skin was turning to wood!!) but we promised the family we would find out and get the kid to hospital for treatment.

My decision to pack a couple of beers in my pack for the last long slog up the mountainside the day before had finally paid off. A hard earned thirst needs a big cold beer, and the best cold beer is Gorkha, Gorkha Lager!

The first 3 days of this medical trek were absolutely full-on. It was one of the most fulfilling experiences, seeing all these bright happy faces, working at break-neck pace to get through everyone in time, being part of an awesome team and experiencing a part of rural Nepal that I'm sure most tourists never see. This has been a long post so I'll leave this one here but I'll be back.....

Skinny white legs, elephants and buses.

Hello once again from Kathmandu!

I've just arrived back in town from a lovely seven hour bus ride from Chitwan National Park. I think it is less than 200kms but the roads here are bloody slow. The last 40kms took about two hours to cover. There appears to be some road rules such as drive on the left, however these are only loosely adhered to. The hierarchy appears to go bus beats truck, truck avoids car, car overtakes truck, motorcycle goes where it wants, horse and cart avoid everything just slowly, pedestrian wanders nonchalantly, bicycle avoids potholes and, as it always has, rock beats scissors! The tourist buses are not too bad, padded seats and some semblance of suspension fitted. The local buses on the other hand are a box of metal with wheels with an engine strapped to it. Best bet is to wedge yourself in and hang on for a bumpy ride!

I left Kathmandu about four days ago with an Israeli, a Swiss and a couple of Sepos to go whitewater rafting, canyoning and exploring the Chitwan National Park. The rafting was great save for a few clashes of personality with the hyperactive American so-called tour guide. After surviving the rapids we camped along the banks of the river in a village with the sonorous klaxons of the trucks from the nearby 'highway' entertaining us through the night. The melodic horns make the trucks sound like a cross between a taxi and a clown car.

From rafting to abseiling down waterfalls. This was an exhilarating experience, not least because of the faith you have to have in the old looking ropes and equipment used. Our Nepali guide seemed to know what he was doing so I maintained the faith and plunged down a 30 metre water fall attached to a rope. The cut down wet suit I'm wearing in the photo, I believe, accentuates my masculine skinny white legs.

That night we took a local bus to Chitwan National Park to bunk down at the Jungle Lagoon Safari Lodge. I love the names they come up with to make the accommodation sound exotic! It was pretty basic but the food was plentiful and the Nepali hospitality first class. Our guide, Nalim, earns just 1500rupee a month (about $25) for working up to 12 hours a day keeping tourists happy. He always had a smile on his face and he was always happy to help. His dream is to open a Nepali restaurant somewhere in a neighbouring country, make some money and take a wife. I wish him well as he was a very nice man.

In Chitwan I saw elephants, rode and elephant, and got sprayed with water from an elephant's trunk. On the elephant ride we saw a rhino and a whole family of monkeys, I love monkeys, except when they try to bite you.

Unfortunately our second day in Chitwan was fairly light on as our guide hit a cyclist in his car on the was to the bus port to drop off some American tourists and he had to drive the poor soul to the hospital. The cyclist wasn't too badly hurt, however. In any case, a day lazing under the shade of fruit trees watching exotic birds wasn't too bad a way to pass the time.

Back in Kathmandu now and after a good shower to clear the dust I'm feeling a tad more human. The medical trek looks like it is all set to go ahead in a couple of days time. I'm meeting up with the crew tomorrow before heading out to some remote part of Nepal on the 18th. The area where we are trekking is supposed to be far from the tourist trail and many will never have seen Westerners before. I can't wait!

Take care!

Temples, red hats and woollen shoes.

Namaste. After a good night's repose at the lovely hotel depicted above I hit the streets on the tourist trail. I'm staying at the Kantipur Hotel in the Thamel district of Kathmandu. It's very nice, quite swanky for this part of town but it also has a very nice eco philosophy. There is no plastic used, water is delivered in jugs not bottles, food is grown organically and they recycle all their waste. It's quite progressive compared to other parts of Kathmandu.

A couple of good coffees later at KC's restaurant I took a self-guided walking tour past numerous temples, historical landmarks and all manner of colourful stalls. Trying to admire 16th century buildings, dodge traffic and tell hawkers to piss off politely becomes quite an art form, however I think being an ambo has taught me some valuable skills in this regard.

The winding streets of kathmandu took me past numerous colourful stalls, bead sellers, sadhus, shrines and hash dealers. Eventually arriving a Durban Square, I climbed to the top of the Nine Story Temple to admire a Communist Rally in the square below. The DFAT website did warn against becoming involved in political rallies, however they also warn against talking to strangers, walking alone and engaging Texans in polite conversation. The rally seemed peaceful enough with the 3000Watt loud speakers and swarms of armed riot police. The sensible thing to do seemed to wander through the crowd, take a spot in a roof-top bar and watch the scene unfold. After being disappointed with the absence of anarchy I headed off in search of woollen boots.

Sunni sells woollen boots. He trots out a familiar story of selling wares made by disabled people from an impoverished village however after chatting for a while he convinced me to purchase some gloves for trekking and some woollen slip-ons for wearing at night after my hiking boots have been put to bed. He then invited me to his home for dinner and a beer. Good on you Sunni! Cheers!

Tomorrow it's whitewater rafting, elephants and potentially a mild dose of malaria! Fun times ahead!

Airports and a friendly cat

One last beer for the road! Cheers Steve and Mel for the seeing me off and to all those who helped me out over the last few days.

After a cruisy flight I found refuge on an airport couch for the 14 hours layover in Bangkok with a beautiful view of the runway and a loudspeaker overhead announcing everything in screeching Thai whilst I tried to get some shut eye.

Arrived in a dilapidated Kathmandu airport to a throng of Taxi touts and looked for the guy who had arranged to meet me. He was holding a tiny sign with Mr Smith written on it....could've been for any one but turns out being a Smith here is almost a novelty!

Ram and his driver took me on a chaotic ride through Kathmandu to meet the head of the Mountain Fund who organises the medical trek which I'll be taking part in in just over a week. After checking into my nice little eco-hotel in downtown Kathmandu I headed off in need of refreshment and found Nepali beer by the long-neck full for only 4 bucks! Beats Perth prices that's for sure! After a couple of Gorkhas I headed back to the hotel only to realise it was now dark and I didn't have a map of the tiny streets of Thamel and all the lights were out due to a rolling blackout. Eventually my teenage orienteering experience paid off and I found my little sanctuary for the night.

So far...Kathmandu seems chaotic, colourful, friendly, a little scary, but hey that's travelling for you.

And what is it about me and travelling that seems to attract cats? As I write this another one has decided to take a nap on my lap!
Good night everyone!