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.....