Tuesday, January 24, 2012

Trip Conclusion

This trip truly has been a life-changing experience for all of us involved. I'm not sure I ever really truly believed how much difference a dedicated group of individuals can make. When this trip was first being formed, the only image I could conjure of Nepal was Buddhist monks dressed in maroon robes meditating as their chants are swallowed by the enormous space looking over the silent Himalayas. About a month later, I found out that about 80% of the population of Nepal practices Hinduism. It took a couple more months before I could reliably find Nepal's small crescent shape snuggled between India and China.

The weeks here have been supremely educational and enlightening. Kathmandu has a rich cultural heritage waiting to be discovered every couple blocks. With my lack of directional sense, I think I discovered much more of this history than I could have intended or planned.

The major historical monuments seem randomly dropped around the city. One way I could reliably tell if a temple was around was the presence of packs of mean-looking macaques that feast on the offerings of food people leave for the resident deities. At the aptly named Monkey Temple, I found myself surrounded by a large family of these monkeys and couldn't have been more afraid of getting knocked down the dizzyingly tall flight of stairs.


After a couple days of orientation with some of Kathmandu's tourist must-sees, we started to tour the surrounding hospitals. Coincidentally, I started developing a nasty cough at this point, but I'll assume I picked it up on the streets of Thamel, the tourist district around our hotel. It astounded me what people had to accept as healthcare. Just seeing how crowded and chaotic the emergency room at Patan Hospital was made me cross the street a little more carefully to prevent an ER visit.


Unfortunately, we had to face the fact that a good number of people don't even have access to even the most poorly funded of hospitals. One 90-year-old woman that I interviewed had never seen a doctor or been to a hospital before our medical camp. 


Interviewing and interacting with the local community members and leaders made the rough conditions worth the trip. We heard a great deal about the struggles of framers barely making ends meet having to choose between antibiotics for themselves and food for their children as well as single mothers working night and day to save up for educational opportunities for their daughters that they didn't have access to.

One story particularly stands out as I've been mulling over our trip. We all woke up on the cold, concrete floors of a school after shivering all night in below freezing temperatures. It was the fifth day without access to running water, so everyone was looking bedraggled. Once we could drag ourselves out of our sleeping bags and grab some piping hot milk tea, we walked to a small hill a little ways away to bid good morning to the Himalayas stained pink with the rising sun. We felt a little more human as the temperature rose to the high 50's and even took off our outer jackets. Work continued for us in our business-as-usual, well-oiled machine as the clinic started seeing patients and the students conducted interviews as part of our public health research. It was a little curious to us when we saw a doctor and some nurses leave the camp, but we thought that they were taking a well-deserved break to take in the sweeping, terraced hills before our perilous bus ride back down the mountain to Kathmandu and civilization.

Our main contact and partner from Schreer Hospital, Milan Gurung, pulled us aside later at lunch to tell us what the group had been up to.

Tuberculosis is a very serious illness, especially in rural areas of developing countries that lack healthcare infrastructure and education. It's incredibly contagious and fatal without proper treatment. The woman the team was visiting in the community had contracted tuberculosis. The only solution that her family had seen to protect everyone else in the household was to put her in the barn in freezing winter temperatures and wait for her to die. Our medical team paid her a house visit and provided her with transportation to and treatment in a tuberculosis hospital, where she will likely make a full recovery.

This story was very striking to me because our camp's presence not only provided over 1,700 other patients with basic but essential healthcare but was also the difference between recovery and death for one woman. On top of that, undergraduate students got valuable experience in developing and implementing a research study that was created to direct future student involvement. Already from just talking to patients from our medical camp, our group has recognized a devastating lack of education about basic sanitation and healthcare practices. Educating the people we serve can prevent health problems from becoming serious and life-threatening conditions and improve the community's quality of life.

As the trip comes to a close, I'm not sure I can trade in the ex-patriot lifestyle saturated with mugs of milk tea and the busy streets of Thamel for the struggling student life. Nepal holds this magnetic allure that's hard to break away from. I'll miss the places where time travel is possible over the city, whether it's back to the 60's with American and European tourists flooding Freak Street or thousands of years ago when Pashupatinath Temple was first being built. I'll also miss my fellow group members. None of this would have been possible without everyone sacrificing their time, energy, and creature comforts. For now, we must say "Namaste" to Nepal until next year!

Katie

Sunday, January 15, 2012

Naldum

Naldum - a beautiful place located nearby Nagarkot where one could get a most magnificent view. A place where many people live on less than $5 a day, where people walk miles to get water to drink.

Our team arrived in Naldum driving on a bumpy road. People at the village welcomed us with beautiful flower garlands and hopes and expectations.

Shortly after we arrived, our breakfast was ready to eat. We enjoyed our meal while sightseeing breathtaking mountain views of the Himalayas and quickly we got ready to set up our medical camp. We got a huge number of Tamang residents who came for free health check ups at the camp. We almost got over 260 patients to our camp, even though we got such a late start. Throughout the day everyone looked busy helping out sick Naldum residents. Free medicine was distribute along with free treatment and care we found so many Tamang people were unaware of their health conditions. They all deserved our help, our time, and our resources. We could not promise to alleviate all of the illness we saw, but we will surely try to help as many as we can. We have one more day to go and we hope we will see as many patient as possible.

Shrishti Kharel

Saturday, January 14, 2012

The First Village: Bhumlutar

After what seemed like hours of slowly traversing dangerous mountain roads winding steadily upward, we arrived in our first village, Bhumlutar.  I remember thinking, as we got off of our overcrowded bus, that this was certainly not what I had been expecting when our gracious host Milan Gurung first described the place.  It was simply memorizing.  In every direction rolling hills could be perceived, and at first glance, it seemed that a few steps in the wrong direction could lead to a catastrophic fall off of the side of a cliff.  However, on further inspection I came to really appreciate the complexity and beauty of the agrarian steps carved into the hillside, and their steady, yet safe descent downward.  After quickly surveying the area, we were ushered up some steps carved from rock and were greeted in spectacular fashion.  What seemed like the whole village was standing in anticipation of our arrival, loose flowers in hand.  As we walked past, each of us was handed mound after mound of these beautiful offerings, and I began to wonder what else this wonderful new place had to offer.

Later that day, our team got down to business and began work on our collective research.  I began the day interviewing patients and learning much about the special beliefs and obstacles that this village faced to adequate healthcare.  An answer that seemed to become a theme was that the village and its people lacked proper sanitation.  The extent and exact meaning of this seems vague, so a thorough analysis of our collected data will be necessary to say for sure, but I believe this problem stems from an education need - one that we as a team in the future may be able to fill, which is incredibly exciting!  Another vein of research, which i participated in the next day involved creating a general map of the village and its various off-shoots using a gps locating device, eventually overlaying this with GIS generated maps.  Professor Kevin and I walked around the mountainous area, up and down paths, here and there, eventually guided by a young boy, named Ujwal, who eventually became a good friend of the research group.  On the very first day, he coaxed me into following him to his grandparents' house by telling me "you, come" and "My house, come".  He spoke decent English, and seemed to relish the opportunity to practice speaking it with me.  This personal connection with a member of the village served to alter my perception of those we treated and helped, allowing me to relate to them not as research subjects, but as human beings.  I believe that with this personal connection to the village, and the information we shall glean from our research, a hearty, thriving partnership can be created, and more importantly, made sustainable.

-Ralph Cook


Thursday, January 12, 2012

A village in the second camp we hosted in Naldum. Professor Vose would hike 
during the day to take GIS points to map out the community to further our research.
My eyes are closed unfortunately, but we got up early one day in Nagarkot before our second camp to see its famed sunrise. Boy, was it worth it. The rising sun cast a pink glow over the Himalayas that was breathtaking: Professor Kambis, we wished so much you could have come seen it with us!

Bhumlutar and beyond

I love Kathmandu. It's a complete sensory overload: the constant honking and roaring of engines as cars and motorbikes careen through the narrow, twisting streets; the tiny shops all crowded together where storekeepers follow you trying to make profit off of the foreigners (you can normally haggle them down about half the price); the bumpy roads whose potholes make William & Mary's crooked bricks look like pathways to heaven; the golden mum garlands hanging above doorways and the prayer flags fluttering in the air; the smell of momo's (dumplings) cooking on the street as well as the smell of butchered something laying skinned on a table outside of a store. Kathmandu is a stimulating city, no doubt about it. After a week of touring hospitals and exploring Thamel (the part of Kathmandu where we are staying), we left the comforts of city life and embarked on the next part of our Nepalese adventure: the medical camps.

I almost feel like the trip to Bhumlutar, the location of our first of two locations, deserves an entry of its own. We met our medical team of around forty people -- security guards, doctors, lab technicians, pharmacologists, and nurses from different hospitals headed and directed by Milan Gurung -- in Banepa where we loaded all our belongings and supplies for the next five days onto one bus and then proceeded to cram ourselves in as well. Every bus also has what is called a "conductor" who hangs out by the door to help guide the driver through more tricky spots. He, I would learn shortly, was invaluable to our journey. We left all evidence of civilization behind as we traveled up the mountains. Higher and higher, until I thought we couldn't go any higher, and still up we went. We left "paved" roads and learned what bumpy roads truly mean, and then left even the rocks and drove on crumbling dirt roads barely wide enough for our bus that was meant to be a two way road. The conductor would hang onto the side of the bus and whistle and bang on the door if the bus driver came too close to the edge of the road that dropped precipitously a thousand, two thousand, and eventually five thousand feet down when we came to our first village. Milan laughed and told us to imagine we were on a Disney ride and that he himself had been on bus rides where there were drops on either side of the road. It was the most realistic Disney ride of my life.

The local people prepared a welcoming ceremony of little bouquets of gold mums wrapped in delicate, pink leaves, filling our hands with these little flowers and calling out "Namaste" to us as we walked through a double line of waiting villagers. It was a warm welcome and a happy foreshadowing of the relationships we would eventually forge with them. The medical camp was being hosted at their school, which was on top of a little hill on the mountain, dwarfed by two larger plateaus, the first plateau about half the size of a tennis court and consisting of only one school building (a "building" being two rooms) and a very rough ping pong table (a cracked stone tablet help up on two more slabs of stone), and the second plateau the size of a full tennis court consisting of one more building and a bunch of benches that would serve as our dining tables. The climb up to the second plateau was a precarious one where you had to scramble your way up a very dusty hill with stone footholds few and far in between before you slid down, though the view from the top was reward in itself: on a clear day, we could see the snow-capped mountains in the distance. The medical camp set up straightaway, and villagers who had walked for hours to get there began to line up for screening and treatment (one elderly woman was carried in a basket for four hours). They would go to the nurses first who took basic measurements (weight, blood pressure, etc.) before directing them to the doctors (we had an eye doctor, a dentist, a general practitioner, and a pediatrician). Then, they would head to the "pharmacy" to get their prescribed medication.

When they had finished their visit, either Arati or Shrishti approached them about consenting to the interview that constituted our student research. We were attempting to find out their basic lifestyle and knowledge of healthcare to assess what the steps that we as students could take for a preventative approach (i.e.: a  major problem among women was uterine prolapse-- look it up-- which could be partially prevented with the right health education). These interviews were compelling, emotional, and very personal, as some poured out their life stories and worries of not being able to feed their children, barely having enough money to put food on the table twice a day (meat was a luxury afforded usually around once a month) let alone having enough money to receive the full treatments that they were in dire need of. In total, we conducted around thirty interviews and saw close to a thousand patients just in Bhumlutar.

Although our own personal comforts were not so comfortable (we didn't shower during the medical camps, no one wanting to brave the freezing cold water spurting out of an outdoor water spigot, and the toilets being little more than holes in the ground), it was worth it. We are not yet doctors, still just undergraduate students slowly working our way up, but the amount of change we could make for these people by putting together health education packets and classes and working with their health post is immeasurable. I feel like I've left out too many details that capture the essence of the village and its people we were privileged to meet, our day-to-day activities (where did we sleep? what did we eat? what did we do during our spare time? what was the weather like? This last one I can answer quickly: hot as long as the sun was up and then freezing cold, a curious sensation of being burned and frozen, over and over), and the general sense of camaraderie that permeated through the camp, but this blog post is already too long and it's time to leave to visit a temple in Bhoda during Professor Vose's last few days (whom I've also neglected to mention but whose presence has been priceless and much appreciated!). Besides, Ralph still has to blog and we have many, many photos to put up that will describe far more accurately everything I want to say so I'll cut myself off. Check the blog again for photos, they're amazing.

Joyce Oh

Saturday, January 7, 2012

Life in Kathmandu


We've been in Kathmandu for about five days now, and the days we've spent here have been absolutely wonderful. On the 3rd (the day after we arrived), we had our meeting with Mr. Kul Chandra Gautam.  Since he has served as the Deputive Executive Director of Unicef in the past, and is a very renowned personnel in Nepal and elsewhere, we were  excited to meet him. He is also the founder of Nepal Public Health Foundation, and he gave our group a general overview of some of the problems in public health relevant to Nepal. He gave us an  idea of where Nepal stands in terms of public health, what are some of the issues that are understudied, and how it has been progressing compared to the past.From what he said, it seemed that Nepal is doing progress in many issues that were seen before, like availability of basic health care facilities, and nutrition related problems. However, he also pointed out that issues like child bearing behavior and women status in Nepal need to further improved in order to uplift the overall public health status. The conversation we had with him was a very good transition for us from what we have learnt about Nepal's health related issues when we were in the US and what we will be doing for the next few weeks while we are here. Dr. Gautam was a very decent and nice man to talk to and we were really glad that we got to meet him. His insights were definitely very valuable for us, and will be considered while we work on our project further.
Besides the meeting with Mr. Gautam, we also have been touring different hospitals in the valley. We went to some of the big and central hospitals in the nation like Bir hospital and Paropakar Maternity hospital in Kathmandu, Patan Academy of medical sciences and Patan hospital in Lalitpur district, Siddhi Memorial Hospital in Bhaktapur district, and Scheer memorial Hospital in Kavre district.  These hospitals are the biggest ones in the valley providing services to the people in large numbers. Among these hospitals, Bir hospital and Paropakar Maternity hospital  are  national hospitals run entirely by the government, Patan hospital is a mission hospital on a semi-government level, Siddhi Memorial hospital is a private hospital, and Scheer Memorial is a mission hospital. Touring these hospitals and understanding how they operate were very interesting for us. Especially for a group like us who are trying to work for the upliftment of health care in rural Nepal, understanding the current condition of health care and facilities prevelant here were a good insight we could have had before we begin our research and survey on public health via our medical camp.
Apart from the hospital visits and meetings, our time in Kathmandu has been a lot of fun. Walking around Kathmandu, especially the Thamel area  and touring to beautiful places like  Swayambhu have been a wonderful part of our time here and we have absolutely loved it. Whether it is the waking up at 6 am because of the dog fight on the corner of the street or walking up to the height of Swayambhunath admiring cute little monkeys on the way,we are always admiring whatever we see, and i personally have loved being here so far. Even though it's been just 5 days we've been here, we already have been a part of the crowd in the streets of Kathmandu.Tomorrow morning ( on the 8th), we are leaving for our medical camp in the village of Naldum. We are all very excited to get there and finally work on the medical camp and our research.
 I will be writing more about our trip on the next blog to update about our adventure, for now it is time to stop and prepare for tomorrow. Namaste!
-Arati Pudasaini

Monday, January 2, 2012

Arrived in Kathmandu

We've officially arrived in Kathmandu! It was definitely an interesting journey getting here. We flew from Washington D.C. to London and then onto Bahrain. When we got to Bahrain, the people at the ticket counter for Gulf Air informed us that we would be flying on a different flight than the one we had already booked. But they ended up giving us a free stay at the Golden Tulip, and I got to spend my first night ever on Middle Eastern soil. The city of Bahrain was absolutely beautiful driving in at night and even better during the day when we could see the palm trees and the blue water. Then we finally got on our flight to Kathmandu, and by this time we were slightly worried about Professor Vose. We didn't have a phone number for him yet, but we sent him an email the night before hoping he would get it in time and not have to wait at the airport for hours. We were very grateful to see his smiling face when we stepped out of the airport with our bags.

Kathmandu has been wonderful. We have yet to see it during the day, but we got to drive through the city on our way to the hotel last night. Unfortunately, there weren't very many lights to speak of because it was a scheduled power outage in Thamel until midnight. We all regrouped and got dinner and then quickly retired so that we can be well rested for today's activity of navigating the city and meeting Kul Guatum.

Katie Kaugars

Sunday, January 1, 2012

Bahrain

We have just arrived at the Golden Tulip Hotel to stay for the night while we wait for our newly changed connection flight to Kathmandu.  It is safe to say that we are all very excited to arrive, and that Shristi will be relieved once she has her stroller returned.  I personally cannot wait to speak with Mr. Kul Gautum, and learn more about his view on public health and its future direction in Nepal.  Also, I think it will be incredibly interesting to visit many different hospitals while in Nepal and to observe the differences between there and the American health system.  I will post more on this later, but for now, it is time to get some dinner!

-Ralph Cook