August 9 – Powerful Deterrents

So today, we went back to Patan Hospital to sign Dr. Bishnu’s training agreement. I also found out that Director Shrestha, while the Patan Birthing Center undergoes renovation, is working as coordinator of the night shift nurses. Unfortunately, that means that I have to show up either really late at night or really early in the morning. (I’ll be going at night, since there’s no way I’m waking up at 5AM).

To finally put some closure to the MDGP scholarships, I also went to NSI (The Nick Simons Institute) to sign our agreement with Dr. Zimmerman (and pick his brain about some clinic legal issues). One of the issues we discussed was medicolegal aspects of the clinic: how to deal with malpractice suits. Personally, I was curious about this as well, since I knew that Nepal was not a sue-happy place like America. Dr. Z enlightened me about the way things are done here: no doctors have malpractice insurance. The Nepalese don’t really sue in this department, and the law is somewhat loose as well. Apparently, until 15 years ago, medical malpractice had to be tried under assault and battery statutes. Even now, cases are seen more in the sense of consumer protection laws.

On the other hand, the Nepalese are more willing to take matters into their own hands. Should an egregious case of malpractice occur, threats, vigilante action, and out-of-court monetary demands are common. A more powerful deterrent is the press: families with connections can publish articles defaming physicians for their negligence. On top of being completely in the hands of the writers, such measures ensure humiliation and the fact that the doctor will probably be unable to practice in that city again.

That’s some scary stuff.

August 8 – Back in the Groove

After spending a day finalizing the agenda for my last week in Kathmandu, I got back in the swing of administrative duties, which was rather tough after the somewhat slow pace of life in Achham. Today’s agenda, however, took me through some areas that made me realize that there was inequity in the cities as well.

My first stop was the Nepal Medical Council, found all the way across town in Bansibar, Maharajgunj. For some reason, there was a massive traffic jam in central Kathmandu, so my cabbie made me a deal: he would work for a flat fee if he were allowed to take the side streets to save time. One of the rules of Nepalese city life (for foreigners, at least) is to go by taxi meter, but given the circumstances, I agreed. Doing so, he took the backroad (road is a relative term here—it was basically an unpaved rock path) that followed on the banks of the muddiest, brownest river I had ever seen. Trash literally made of several of the banks, and an overwhelming stench of waste (both industrial and human) hit me full-on. Nevertheless, hundreds of people were still making a living here. Young men waded in the shallows with nets, trying to catch something (I couldn’t believe anything could possibly survive in that river), while old women washed their clothes in the putrid water. Children splashed each other on the banks, shadowed by tin-and-cardboard shanties that looked like they may fall over at any moment.

“I asked to come this way because you told me you’d been in Nepal for a while,” said the cabbie, noticing that I was staring. “I usually don’t take foreigners this route.”

We then veered back onto the main road through a winding alleyway, and I was amazed by the sudden transformation. Bansibar is where many of the major embassies (French, Australian, Japanese) and organizational centers (Councils of Medicine, Nursing, Water) are, and the neat row of houses, sparkling government buildings, and shops were a stark contrast to the poverty omnipresent less than half a kilometer away.

Anyways, after doing some business at the Nepal Medical Council (okay, okay, I was getting documentation and applications so that we could bring in several expatriate doctors to work at the clinic) I took another cab to Patan Hospital to track down Rachanal Shretha, the director of the birthing center there (which is famous for reasons I’ve enumerated in a previous post). Nobody seemed to know where she was, so I took a stroll down the pediatric wards (for some reason, if you drop by in the afternoon, the security doesn’t seem to care if you just wander around the patient wards). In the words of Sachin, my pediatrician ex-housemate, “there were a lot of sick kids.” Many seemed quite cheerful though, and two with casts were actually playing with a ball in the courtyard.

This made me think that sometimes, I wish I could go back to being a small child. There’s a pure optimism kids have that we don’t anymore. Granted, as a young person, I’m still overly a glass-half-full person, but I can’t always believe that the best will come around. Bless them for it, I suppose.

August 7 - Rumors of My Demise are Greatly Exaggerated...

Home Sweet London Guest House. It's great being back in Kathmandu, with (more) consistent electricity, fewer insects, and chinese takeout.

That being said, if you've been following the news, there's been massive flooding in South Asia. Hundreds are dead across Nepal, India, and Bangladesh, and millions face suffering from waterborne diseases, displacement, and property destruction. In Nepal, the death toll is around 80, the last time I checked. Several tens of thousand are also in refugee camps because their homes are under several feet of water.

Fortunately (or unfortunately?) I was in the hilly regions (Achham) when the monsoon floods came, then made it back to Kathmandu, where the altitude is too high to flood (all the rain here went down into the valleys). Dangadhi was somewhat flooded on the way back, but it wasn't on the scale of a humanitarian crisis there. Nevertheless, it's been on the news and all over the newspapers recently, and my heart goes out to all the displaced people.

Sadly, this event has had some political ripples as well. Refugees in rural areas have been picketing at many locations due to the parliament's poor handling of the situation. In one town, the government imprisoned a political leader because they believed he was using the flood to disseminate anti-government propaganda. The consensus, though, is that he had always been critical of the current establishment, and the citizens have been protesting his arrest vigorously (despite the fact that they don't even have homes now).

We've concluded the political questions from earlier, and have decided to stick with the clinic in Sanfe Bagar. We will, however, put ourselves on the fast track to moving to Bodelgata, and hope this will work out soon.

Also, thanks to Brad, Erin, and all of you for being concerned about me in the floods. I'm dry as a bone, though I would have liked to provide some relief for the victims. It's good to know that I have awesome friends who care about my safety abroad.

August 5 – Big Changes

As encouraging as my trip with Dr. Sedhain was, our arrival in the village of Bayalpata added a layer of confusion to the Nyaya Health plans. We were intercepted by the local council, who took the opportunity to present their argument: we shouldn’t be working in Sanfe; we should look to restore the abandoned Bodelgata hospital. As explained earlier, the Bodelgata hospital was a 15-bed facility constructed 15 years ago that was never staffed and stocked. To this day, it has never seen a doctor. (See the video for more details.)

Apparently, the residents of Bayalpata had been putting political pressure on the central government to begin work once more on this hospital. They were working to bring electricity and water to the structure within the month, and noted that a road connecting Sanfe and Bodelgata would be built within the year. They wanted us in Bodelgata.

Though our goals as an organization are to eventually bring this hospital to full operative capacity, we had never planned to do it this soon. The timeline had actually been for the migration from Sanfe to Bodelgata over the course of 5 years. Bishnu, however, seems to advocate the Bayalpata route over the current Sanfe project, in which we have invested a considerable amount of time and money. Politics were in play once more.

Shortly after our return to Sanfe, we were approached by yet another coalition, this time from the Airport side. Their mission: to convince us one last time to relocate the hospital to the airport bazaar. After some discussion, they were placated by the concept of the clinic being at Bodelgata… despite the fact that the current clinic was only 20 minutes away (as opposed to a 1.5hour uphill climb to Bayalpata). The rivalry between the two sides is apparently that powerful.

We also finally met with Rajan, whose bus had been stalled in Nepalgunj for the past two days. He confirmed our suspicions that Rajan’s uncle had not been entirely upfront with us. The 40,000 Rupee work was actually a cost he had not yet paid previous builders before our arrival (i.e. he was trying to make us foot the bill for structural work he had done on the building before Nyaya even leased the clinic). Politics once more.

Duncan apologized to me when I returned to Dangadhi for having to watch things get ugly, but I think it has been the exact opposite. This trip has taught me that international health relief is not just about a fairy tale Paul-Farmer-saves-the-world-with-love-and-cutural-understanding scenario. I’m actually quite glad that I’ve had the chance to see the difficulties inherent in working with human societies.

August 4 – The Man on the Mountain, Part II

After our meeting, Dr. Sedhain informed us that he would be traveling to Sanfe today on his way to Kathmandu. As such, he dropped by to pick us up at the Mangalsen Guest House at 6AM. The trek was downhill almost all the way this time, and resulted in an extremely pleasant, insightful journey, completely unlike the grim uphill battle of yesterday. Since he had made the trip many times before, Sedhain also showed us the easiest, most picturesque of the routes.

As we passed by riverside Chettri hamlets and cliffside cornfields, he showed us the land to which he was so dedicated. An amateur movie-maker, he would stop at lengths to shoot some footage of a humming woman washing clothes and early-rising children making their way up the mountain to go to school. Everywhere he passed, residents would go out of their way to say a salutation to him. It was clear that Dr. Sedhain is very well-liked by his community.

“Life is hard in Achham,” he said, while watching a woman old enough to be my grandmother carry a bundle of firewood twice her size down the mountain. His eyes grew sad as he watched her hunched form totter down the rocks.

Part of the problem was the lack of roads and the difficulty of travel. Due to the difficulty of getting from villages to clinics, more than 80% of births in the region are performed at home, often without the aid of a midwife.

“This is why PMTCT (Prevention of HIV from Mother to Child) training needs to be deprofessionalized.” Sedhain notes. “What use is it to have a few highly-trained PMCT doctors if the nearest birthing clinic is hours away? Nobody will go.”

As such, Dr. Sedhain often brings the hospital to the people. Every few months, he holds health camps at the most remote villages. Hearing that the DHO was passing through, local authorities even came out to our travel party to ask Sedhain to see some patients. With Dr. Bishnu, Dr. Sedhain observed a gaunt man, his eyes yellow and his tongue extremely swollen. “It may be TB… Maybe even AIDS.” Even as we were eating, an elderly shopkeeper came to beg the doctors to see his wife. She had had a series of epileptic seizures this month that had never before occurred.

Despite the promise we saw in some these places, Dr. Sedhain noted, however, that custom and history was holding the region back.

“Achham almost exclusively practices Chaupati Goth.” He said. “Nobody knows why, but 90% of the families here do.”

Chaupati is the practice of forcing a menstruating woman to sleep in a cowshed. Unfortunately, even the cowshed is too glamorous. The actual structure the woman sleeps in is a 3.5ft by 3.5ft by 3.5ft hutch reserved for this occasion.

“The people believe that if the women are not separated, fire will burn down their homes or tigers will eat their livestock.”

“These are the types of problems we must deal with,” he noted. “There are many problems in Achham,” he mused. “They are not big problems, but they are complicated problems.”

August 3 – The Man on the Mountain, Part I

Rajan had still not made it back from Nepalgunj, so Bishnu and I decided to make the trip to Mangalsen, the district headquarters of Achham district. The daylong, strikingly uphill hike would have to be made entirely by foot on an unpaved rock path in 100 degree Fahrenheit weather with 20%+ humidity. The objective? To meet with Dr. Purosotam Sedhain, the District Health Officer.

I’d only heard stories about him, but Dr. Sedhain was supposed to be a soft-spoken MBBS-MPH with more than 10 years of experience. Sedhain was our best shot at understanding how health worked in this region, and his unadvertised field work (for example, he performed 4 vasectomies while passing through a small village once) were testament to this fact. He was also the man who could procure us our vaccines, ARVs (Anti-AIDS drugs), and some key lab equipment.

That said, the trek there was possibly one of the most miserable act of physical exertion I had ever experienced. The sun blazed, my legs ached, and the loose rocky trail repeatedly betrayed my footing. The weather was also unpredictable in the mountains. The Sun could go from shining to storming and then back again in minutes, adding to my despair.

It rained. I rained sweat. Repeat.
I had two liters of boiled water with me. I’m certain I lost all of it in perspiration.

For some reason, the fact that I was going there for business took all pleasure out of the otherwise-gorgeous trail (that wound through pine woods, mango groves, and tropical forest). Towards the end, my legs were spasming from the loss of electrolytes, and I was stopping at 15-minute intervals to catch my useless breath. Nine grueling hours in, we made it to Mangalsen. Another hour to the very top of the mountain finally brought us to the Achham District Hospital. Dr. Sedhain was waiting for us.

I felt rather silly as I stepped into his office, dripping sweat from my hiking attire. As I pulled my rain-soaked notebook from my muddy bag, Sedhain asked, “How was the trip?”

“Terrible,” I wheezed.

He laughed genuinely, but then he turned serious.

“That trip is a journey that hundreds of Achhamis make every year to get health care.” He gravely noted. “This is a problem.”

Over the next two hours, Dr. Sedhain then proceeded to describe the work of the District Health Office in trying to bring services to this unfortunate region. Achham is one of the remotest, least-developed, and poorest of the Nepali provinces. Unfortunately, it was also one of the hotspots of military conflict in the recently-concluded civil war. The war had left tens of thousands of Nepalis dead, and the structural damage (All of Mangalsen’s major government buildings were razed by Maoist forces—you can still see the burned-out foundations) was profound in a region that already lacks development.

Nevertheless, he provided us with some very encouraging news about the newly-implemented ARV programs and public health initiatives, and pledged his all to the Nyaya Health clinic. After that, he waxed contemplative for a moment:

“We don’t do this to print colorful brochures of all the great things we’re doing, and I hope you aren’t either,” he remarked.

“The problem with Nepal is that people are always talking, never acting.”

He then chuckled softly.

“Actually, even we are just talking right now.”

“But we are trying, aren’t we?”

August 2 – Strange Bathfellows

Today, while showering, I noticed that there was something large slowly moving about the tiny bathroom. Upon closer inspection, I realized it was a hairy five-inch long spider. My initial instinct was to panic, but the door to the shower opened up into the village square, so running out into the street soapy and naked was definitely not an option. The creature ended up being pretty chill, though, so after a few moments, I grew accustomed to its lazy lounging. I took my time and finished my bath, noting that my arachnid pal (sitting comfortably in my soap dish) seemed a little thinner than most American tarantulas. I then realized how much I had grown to appreciate the presence of it and its eight-legged brothers: Sanfe is bursting with flies, and without these guys, things could get really annoying.

Though the day was quite slow (still no Rajan), we managed to meet with the current clinic coordinator of HASTI-Nepal, an NGO working in rural areas as a VTC (Voluntary Testing and Counseling). The agreement was not in writing, but we will definitely be coordinating our resources in the coming months.

August 1 – Things Get Tough

We finally figured out the whereabouts of Rajan today—by asking his cousin, we discovered his mobile phone, and managed to talk to him. Apparently, his child had fallen suddenly ill (jaundice and blood in urine, apparently), and he left for Nepalgunj immediately. Unfortunately, heavy rains the previous night had destroyed the road back, and he would be taking another day to get back.

Though Rajan wasn’t around, we had some immediate business to do. It is impossible to get internet in Sanfe, especially not the standard wireless connection we use, called CDMA. By bringing in some awesome US technology (a Yagi antenna and internal amplifier) we hoped to pick up on the weak signal found in this valley. The result: failure.

Bishnu took a photo of me that pretty much sums up this IT nightmare: I’m clutching my laptop, sweating profusely in the blazing Nepali sun, a disgruntled look on my face from seeing “Signal Level Not Sufficient” for the umpteenth time. We tried the antenna (which was theoretically supposed to work) at multiple locations and a multitude of ridiculous positions, but all to no avail. I had brought this clunky apparatus all the way from Connecticut to rural Nepal, and now I was going to have to take it back to the States. What to do…

Anyways, Rajan’s uncle (from whom we are renting the place) gave us the key to the clinic, and we had our first look inside. Due to Rajan’s son’s hospitalization, all clinic work had stopped. Nevertheless, the building didn’t look half bad, considering it was only half done.

An unforeseen logistical problem resulted, however, from the fact that the clinic is apparently a bit further from the projected housing than we thought. Bishnu was quite clear about the fact that if he were to be expected to make night calls, the current housing was not an option. He would need to hike 10 minutes from the SEBAC house to the river, cross a rickety suspension bridge, hike up the side of a hill, then pass Haat Bazaar at night in order to get the hospital (which is right in the middle of a rice paddy). None of us had ever thought about this before.

While we contemplated this development, Rajan’s uncle came to meet us and tried to convince us that it was he who had shut down the clinic work (despite the fact that he has absolutely no control over this process whatsoever). Apparently, he had put 40,000 Rupees of his own money into the project, of which he had not received any from Rajan. In addition, he claimed that Rajan had been overselling the clinic as something much greater than what it actually was (advertising it as a posh medical facility with high-tier lab and fancy radiological equipment). How much we wanted to believe him was difficult, though. For some reason, Rajan’s uncle had always opposed the work of Nyaya, seeming to have his own agenda when he leased the location to us. Little did we know that the nagging nape of politics had begun to rise from the water.

July 31 – Getting There, Part II

Dr. Bishnu and I spent the night in Silgadhi, the district headquarters of Doti (the district adjacent to Achham) with Dr. Prakash Thapa, alumnus of Bishnu’s medical college. Apparently, the two were extremely good friends back in school, so Prakash took amazing care of us and showed me photos of the two doctors (partying) during their college days. Sigadhi, perched on the mountaintops (“hilly region” by Nepali standards) has a much milder, pleasant climate than the pressure-cooker environment of Dangadhi. Anyways, we made arrangements with Prakash to meet again in Kathmandu the following week and continued on our 9-hour jeep ride into Sanfe Bagar.

Travel there was interesting, since we traversed some of the rockiest passes in the region. The road was winding and twisted, and was full of oozing mud and jolting potholes. We wound our way around the mountains, experiencing major climate change from cold evergreen forest to sweltering jungle (then back again). We passed dozens of tiny mud houses and thatched straw huts, watching as disheveled children hopped in and out of the thick mist.

Eventually, our jeep drivers (who insisted on blasting Hindi pop at deafening levels and spitting chewing tobacco out my window at regular intervals) announced that we were nearing the village. The road then promptly proceeded to end. We got stuck in some thick mud, and ended up having to walk the remaining half-hour into town.

The trek offered us an interesting view of the town, though. First, we passed through Haat Bazaar, a precarious assortment of small tin shacks in which many Bagarians ply their wares. Considered the poorer side of Sanfe, Haat is populated with younger people and seems to have a fair crime rate. The Haat side ended when we crossed an iron suspension bridge for which Sanfe is named. The bridge spans the Seti River, one of Nepal’s largest rivers, and is the result of an early American development project. The name Sanfe Bagar is actually somewhat of an inside joke among Achhamis, which I don’t understand but the locals find hilarious. Here’s my best attempt at explaining this:

Originally, the village was divided in two by the river, but the US project promised to link the two sides. Unfortunately, the project moved along rather slowly, and the Achhamis began to joke that it would never happen. As such, they named the village “Napnu Bagar,” which roughly means “where the river reaches its banks.” Due to the peculiar local dialect, the name soon became “Sapnu Bagar.” And since humans are lazy, the people eventually defaulted to a simpler pronunciation of the word, “Sanfe Bagar” (say it out loud, it’s easier to say). Think of it as a country drawl, only Nepali.

Anyways, crossing the bridge leads us to the Airport Bazaar side of town. This name comes from the fact that there was once a small landing strip laid on this side of the river. It hadn’t seen much use, though, and what remained of it had been destroyed in the Maoist rebellion. The airport side of Sanfe is believed to have older, more established community members, and the fact that the houses are a bit nicer reflects this claim. Our lodgings were at the SEBAC House, a nice guest house on this side of the river.

Once we settled ourselves in, we decided to call up Rajan Kumwar, a young local political leader and our chief ally in town. Rajan, who went to school in Kathmandu and speaks solid English, was one of the first people to help out the clinic efforts, and is currently overseeing renovations of our clinic. Unfortunately, Rajan wouldn’t pick up his phone. A brief questioning of the residents confirmed our fears—he had unexpectedly left for Nepalgunj, a 14-hour drive from Sanfe. Nevertheless, he plans on returning tomorrow, and we will hopefully see him then. The majority of our business in town involves communicating with him about the status of infrastructure.

July 29 – Getting There

This may be the last internet contact I have in a bit, since I’ve begun my travels to the clinic site in the village of Sanfe Bagar, Achham. Since the more interactive (and less administrative) part of my trip begins now, I suppose this requires some more background.

Nyaya Health was originally conceived of by Jason Andrews, a Yale undergraduate. Through all his college summers, he traveled to Nepal to do medical work in the Kathmandu valley, where he helped secure HIV/AIDS resources for IV drug users in the capital city. This vision followed him into med school (at Yale again) where he formally created the NGO. During his travels, he met Kathmandu-ite Roshani Dunghana, a young Nepali filmmaker. The two ended up getting married, and their confluence of interests (Jason for AIDS relief and Roshani for using film to progressive action) inspired them to travel to far western Nepal. There, the two saw the deplorable condition of health and development in general, exacerbated by the recently-ended Nepali civil war. Particularly depressing was the fact that the national government had constructed a 15-bed hospital in nearby Bayalpata, but the clinic was never staffed and never stocked. To this day, it is an abandoned building. Upon returning to Yale, Jason contacted two friends, Duncan Smith-Rohrberg Maru and Sanjay Basu, and the three decided to begin an effort to rectify the problem. Duncan and Jason traveled to Achham, one of the western districts, in May 2007 and while there decided to establish a PHCC (primary health care center) in the village of Sanfe Bagar. The Nepal Health Equity Initiative was born.

Currently, the clinic building, a non-inpatient facility, is undergoing renovation and outfitting to become a suitable health center. In addition, agreements are being finalized with domestic agencies, other NGOs, and the staff. Much of my work in Kathmandu has been managerial, and I’m now shifting gears and going to Sanfe with our prospective medical director, Dr. Bishnu Kattel.

Our travels at this point have taken us from the capital to the southwestern city of Dangadhi. The town is just 10km from the Indian border, and is in the heart of the Terai, a sweltering jungle. Apparently, the region used to be almost devoid of inhabitants due to malaria falciparum. (In fact, Dr. Bishnu tells me that when he was a child, the prevalence of malaria and leprosy was so great in the Terai that his parents would joke about how your finger would fall off if you even pointed towards the forest). The few people who did persist in the Terai, the Tharus, were considered magical since they enjoy some measure of immunity to the disease. Modern development of the area via swamp draining, DDT spraying, and aggressive prophylactic measures, however, has wiped out falciparum (though vivax still stubbornly remains) and the region is one of the fastest-growing districts in Nepal. The place is still a breeding ground for mosquitoes though, and last night alone I was bitten over twenty times— while wearing a blanket. I’m paranoid about these things, so I've been making sure to take my doxycycline prophylaxis. Interestingly, none of the Nepalese finds malaria at all worrying, and Dr. Bishnu actually rejected my offer of doxycycline (which is understandable, since the drug has some minor GI side effects). The only person who has shared my worries about malaria is Chris, and he's in Kathmandu, where malaria is not present.

As for the climate, it's more humid than anything I've ever encountered in my life. Merely standing is good enough to get you sticky, and life is an endless quest to stay cool. In addition, it stormed (rained by Dangadhian standards) last night, and now the streets are a sea of brown water.

Populationwise, Dangadhi is interesting due to its proximity to India. Whereas I could blend in easily with the Gurungs and Rais of northern Nepal, I stand out pretty clearly here, since the majority of people are darker. This leads to a fair amount of staring and pointing. For the first time since coming to the country, people have been approaching me and asking if I’m Chinese or Japanese. This is facilitated by the fact that most people travel slowly. Poorer and more rural than Kathmandu and Pokhara, Dangadhi is largely an unmotorized city, with no taxis and only the occasional motorbike. As such, our (and everyone's) main means of transportation is rickshaw. The town is small enough that rickshaws will get us anywhere in good time, though, and the open-air travel is strangely refreshing.

A highlight of the journey, however, was meeting up with Dr. Japath Thapa and his friends, Dr. Krishna and Dr. Patan. The trio of young doctors (all in their mid-twenties) has been working at Seti Zonal Hospital for the past few months following the completion of their internships. They are also alumni of Dr. Bishnu and Bijay. As such, they’ve really gone out of their way to take care of us, offering us food, lodging, and even Tuborg Strong (the 15-proof local beer). In our quest to find them, however, I was afforded a unique view of the “medical district” of Dangadhi.

Nepal’s state medical system is broken up into several tiers. At the very top are a few national hospitals largely affiliated with universities. Most are in urban areas. Below them are zonal hospitals, set up to service a collection of districts. The next level contains the district hospitals, which serve individual districts. Following them are primary health care centers, which function to varying levels of capacity in villages. Lastly, there are health posts, which are irregularly-staffed clinics run by HAs (Health Assistants) or ANMs (Auxiliary Nurse Midwives), not doctors.

Anyways, I’m out of time, since the jeep that will take us to Doti, the neighbor district of Achham, is here. There, we will most likely stay at the home of Dr. Prakash Thapa, who is working at Doti District Hospital and interview our clinic’s potential ANM. More to come.

Oh

And before I forget, note that I've put up some of my photos on the link to the left. This isn't all of them, since I'm missing all Pokhara photos (which is a pity, since they're so gorgeous), as well as the most recent *ahem* steamy photos. They'll be up in due time, but do peruse what's already available.

July 28 – TANTRIC SEX!

No, I’m not kidding. That was today’s theme. Chris and I had been planning on biking down to Bhaktapur, a town 13km from Kathmandu valley for the past week. Alas, it rained today, so no bike. Nevertheless, we took a cab and did just fine. The appeal of Bhaktapur is that the city looks virtually the way it did pre-modernization. The town, already considered holy, was restored in the 1970s by a German development organization—on the condition that it remain largely untouched. As such, automated transportation (buses, cars, motorbikes) are not allowed within town limits, except for teachers, certain key businesses, and law-enforcement.

As the guidebook explained, the majority of the temples were constructed between the 14^th and 17^th centuries by the Newari people. The Newari are known for their eccentric sense of humor, and it definitely shows in their carvings. At first glance, all you see is gorgeously-intricate woodwork. A closer look, however, reveals a peculiarly literal interpretation of kama sutra. Their Pashupatinath temple, dedicated to Shiva, bears “the most obscene depictions of tantric sex found in Kathmandu valley.” Sure enough, the building’s struts had all sorts of… peculiar erotic artwork. Men and women are in all sorts of different positions (I won’t go into detail, check out my photos when I upload them), but the highlight was described in the guidebook as the beam where you “shouldn’t even ask what the midget with the bowl is doing.”

That being said, the next attraction, a Buddhist temple, had a sobering reminder of the result of such sexual excesses: depictions of Hell. The woodcarvings on this side of Shiva’s town had some pretty-painful looking images of divine wrath, including constriction by snake and tooth-pulling with a wrench.

Bhaktapur was still gorgeous, and we had the chance to see woodworkers making the city’s famous carvings (many of which had some more urbane images of kama sutra), as well as Nepal’s tallest shrine. We were also joined by an art student named Lama, who gave me a crash-course in Buddhism and showed me some incredible Tibetian paintings (some made entirely from 24-carat gold paint). The lack of vehicles and modern technology in the village make it feel as if time has stopped, and despite the massive amounts of rain we got, we enjoyed the trip immensely.

As all good things have to end, though, we needed to make an appointment. On our way out, however, we had one last chance to observe Newari creativity. One of the temples at the exit of Bhaktapur has all kinds of animals engaging in procreative acts on it. The most memorable of all, however, was “two elephants in the missionary position, their trunks entwined in ecstasy.”

“That's some kinky shi*,” said Chris.

I couldn’t agree more.

July 26 – This is for you, Nick Simons

Working in a developing country is interesting since you routinely encounter folks involved in a variety of development NGOs. We met today with Dr. Zimmerman (a *gasp* American) with the Nick Simons Institute. NSI is offering MD-GP (Medical Doctor-General Practitioner) scholarships for eligible MBBS doctors (Medical Bachelor/ Bachelor in Surgery). Though our current medical director is not interested, we hope this will be a sufficient incentive to attract future doctors to the Nyaya Health clinic. The problem with the program is that in the current Nepali system, a bachelor in medicine is usually sufficient to allow a doctor to enter the field. An MD-GP is nice, but unnecessary. In fact, most MD-GPs work in rural areas (with charitable intentions), since their additional training enables them to become proficient family doctors.

Anyways, you may ask “why a funny name like Nick Simons?”

The story gets interesting: According to Chris, Nick Simons was a wealthy young man who lacked a goal in life but enjoyed traveling to exotic places. During one such visit, he was trekking through rural Nepal. Somehow, something he saw here touched him so much that he decided to become a doctor and devote his life to serving the people of Nepal. Unfortunately, on the trip home, he stopped by in Indonesia, where he drowned while swimming in an atoll.

His parents, in his memory, decided to continue his work and have thus created the huge institute in Nepal to improve health in rural areas via MD-GP scholarships, nurse/midwife training, and improved clinical research methods.

With this in mind, Chris, Bibhav, and I went to the NSI offices—and were amazed. Though tucked away in a residential area, the NSI building is immaculate, A/Ced in every room, computer-enabled in every office (with wireless internet too!), and full of massive furniture. We actually joked with Dr. Z that we may consider working for him on account of the impressive setup. That aside, negotiations went well with NSI, and we’re well on track for signing a number of scholarships each year with the organization.

Upon leaving the building, Bibhav let us know that he had done his research. Apparently, Mr. Simons (father of the late Nick) is among the 60 wealthiest people in the world. NSI is actually just one part of the great charitable projects they’ve financed in this country. Patan Hospital’s birthing center (the model for all Nepali birthing centers and a fully-independent [no doctors] program that has seen only 2 technical complications out of the last 600 births) was built (and now being renovated) by a million-dollar gift from the Simonses. Sadly, the family has not been similarly blessed. Nick, the eldest, met his untimely end in Indonesia. The second son was killed in a car accident while riding his bike outside his home. The third son is apparently autistic. Though I haven’t had time to confirm these facts, they’re a grim, but encouraging reminder that philanthropy is an important and powerful factor in global development.

On a lighter note, Bibhav and I had pizza today. Chris is from Connecticut, so he remained a skeptical of Nepalese pizza-making, but I thought it was okay. Definitely no Peppe’s or even Papa John’s, but it was recognizable as pizza.

Power is the Problem, So We Go for Bananas

Chris and I woke up early today to get some business out of the way. After meeting with Mr. Dhungana to go over tax issues, we booked tickets for my flight with Dr. Kattel to Danghadi (the first stop on the way to Sanfe). The rest of the morning was spent doing research on a tricky issue with the clinic— power. Electricity is not consistent at all in Achham (Chris and Bibhav spent over a week sans energy during a blackout) so it’s absolutely critical we get a generator there. Alas, the 2.5kW diesel generator that we have in mind is nearly impossible to find. We took a list of procurement businesses off the web and went down them, calling everyone. I also took a hike through downtown Patan, stopping at every machine shop on the way back to the guest house. Ten phone calls and eight store visits later, we could sense a pattern: nobody carries diesel generators. Most stores seem to have petrol (gasoline) generators, though, so things are leaning closer to that end. There was a glimmer of hope for a moment, when Rajan called us to let us know that he had found a place—but they only sell larger industrial-grade generators.

In lieu of our disappointing morning, we met up with Bikram to go on the long-delayed sightseeing trip. First stop: Durbar. This square, bounded by the former palace of the royal family, was bursting with temples, buildings, and monuments. Particularly memorable was visiting the Kumari, a nine-year-old girl considered a living goddess (the only living Hindu deity). We weren’t allowed to take photos, but she did peek down from her window. “She doesn’t look very happy,” noted Chris.

“She does this every day for hours,” noted Bikram. “Who could be happy about that?”

Also worrying to the Kumari is the fact that her position is temporary: Upon the onset of menstruation, the reigning goddess is unceremoniously and literally thrown out on the streets. A new girl takes her place and the cycle begins again.

On the way out of Durbar Square, a little man solicited me to buy something from him. The plaza is bursting with peddlers, so I was prepared, but he presented an item I really wanted: a Gurkha knife (khukuri). The huge blades are traditionally made by the residents of the region by the same name and are symbols of Nepal. They also represent the Gurkha army. During the British wars of colonization, their defense of the Terai led to the two year Anglo-Nepali war. Despite the eventual defeat of the Nepalese, the English were so impressed by the Gurkha fighting force that they were regularly called upon in WWI and WWII to serve the queen. Their regiment ended up being awarded 13 Victoria Crosses, the highest British Military honor. In addition, Britain has designated one of its most feared dragoon units the Gurkha Battalion, despite the fact that there are no Gurkhas in it (and of which Prince Harry is a commanding officer). To this day, many Rai and Limbu men still have khukuris (which they always carried with them into war) tucked into their belts.

Anyways, back to this knife, it wasn’t as elaborate or decorated as most I see in gift shops, but when I pulled the sheath back, it had the stamp of the Ghorka Army, complete with a serial number. Needless to say, I made the peddler quite happy. If nothing else, it'll also make an impressive mango slicer for me in Achham ;)

Unfortunately, buying one item in Durbar makes you a salesman magnet. One man harassed me in an attempt to sell me a lock for almost 15 minutes as I repeatedly denied his attempt (not to mention he was asking 400 Rupees [$6+] for an inch-long trinket!). I had learned my lesson. From then on, I kept my mouth shut, letting the peddlers descend on Chris instead.

We stopped briefly for lunch, where I had a buffalo sandwich (buffalo are not considered sacred like cows here), and noted that it tasted just like beef, just a little tougher.

Our next visit was Pashupati, the holiest Hindu site in Nepal. Unfortunately, this meant it was so holy it prevented leather shoes, wallets, and belts (and their hapless non-Hindu owners) from entering. Nevertheless, Bikram wanted to show us the small village that had sprung up around it, and proceeded to buy a bunch of bananas. We quickly found out the reason, as he gave each of us one, bit one himself, then threw the rest into the street. A crowd of monkeys descended onto the pile, squeaking and scrambling for the fruity morsels. I hate to put it this way, but they were definitely among the most charming of the area’s attractions. The rest of the temple was blocked from our entrance, though we were allowed to photograph whatever we could see from outside. We hiked around the gate, though, and caught a glimpse of a gigantic golden bull in the midst of dozens of statues.

There was a funny smell in the air, so I asked Bikram what kind of incense they burned here.

“People.” He replied.

Apparently, the river that runs through the temple is considered holy like the Ganges, and many Nepalis are cremated here.

“Oh.”

Shifting gears in religion, we then took a local bus to the opposite end of Kathmandu to visit Swoyambu, Nepal’s most holy Buddhist site. The Buddhists were more accommodating, and after a rainy 15-minute hike, we made it to the monastery and stupa at the top of the hill. The temple, exploding with tiny statues, was incredible, and offered a stunning view of the entire capital city. We spent a bit of time meditating with the monks and listening to recordings of Nepali chants. To Chris’ amusement, Swoyambu was also overrun by monkeys. No bananas for them, though.

Note: In my haste to get this blog up, I forgot to enable commenting by non-google people. I've since unlocked it so anyone can comment, so feel free. I'll answer. (And thanks to Jordan and Ryan. Much love).

July 23, 2007 – Back to Work

We finally finished the somewhat murky process of taxes today with ace tax student Manoj. I admit we were a little befuddled by the circuitry of the system, but Manoj handled the work like a champ and promised us that all our tax woes would be complete by Thursday morning.

Later today, we also met with Dr. Bishnu Kattel, our prospective medical director and clinic doctor. Our insights:

- He’s articulate and intelligent. He was well-aware of the agreements prior to the meeting and got to the point about his thoughts right away.

- He’s very friendly. The meeting was really comfortable, and he actually apologized at one point for being too colloquial with us (which we didn’t mind at all). He said that since Bibhav and Bijay are colleagues and friends (he also personally knows many of the local doctors at Doti, Nepalgunj) he felt at ease with us all. Personally, I’m happy about this, since he’ll be my travel partner for a week.

- He seems dedicated. He’s gone through all the documents already and seemed set on signing. His application had some interesting personal insights about some of his experiences in resource-poor settings.

- He’s ready to travel to Achham. Since he recently returned to Nepal from the US, he’ll be taking the next 3-4 days to travel to Gorkha to visit his family, but wants to leave for Sanfe ASAP after that. Once there, we’ll meet with Sangita (our prospective ANM) and other staff, so we can start planning now.

Once Bibhav gets into town, we’ll meet and finalize everything. Our overall opinion of him was quite favorable and it seems the feeling is mutual.

July 22, 2007 – The Family is Wonderful. Mother Nature is not

The Acharyas have been so accommodating in opening up their home to us, and I’ve learned much about Nepali culture and family life from them. Bibhav’s parents are very religious (they’re members of Hare Krishna) so I’ve had a crash course in Hinduism. I can say that I’m now quite proficient at eating with my hands, and had the chance tonight to eat (okay, okay, so I didn’t eat it. I kinda licked it) what is called “Pepper that can set a hundred men’s mouths on fire.” Let’s just say I smelled it and my nose started hurting.

Bibhav’s parents’ religion prevented them from talking to us this morning (they’re in ritual prayer from 3:30AM-7AM), so Mr. and Mrs. Acharya “saw us off” last night. Bibhav walked us to the bus station at 6, though, and we parted until he arrives in Kathmandu to fly back to the States. I’m sure I’ll be seeing a lot of him back at Yale, though, which is awesome since he’s such a cool guy.

Mercilessly, the Himalayas remained hidden from view by huge clouds again. If anything, it was cloudier today than any of the other days we were in Pokhara. Thanks a lot, Nature.

July 21, 2007 – More Tourism and Bloodsuckers, Part II

One of the things I was most excited about seeing in Pokhara was the Himalayas (which you can see if it’s clear enough). Unfortunately, it drizzled yesterday, obscuring our view. Today, it rained buckets, so no dice again. We spent the morning watching Blood Diamond. It cleared up by 2PM though, so we rented a boat and paddled around Phewa Tal, a gorgeous lake north of the city. If you haven’t gone rowing, you should seriously consider it— it’s one of the most relaxing things you could possibly do. We then landed on the opposite shore and hiked up for 30 minutes to the World Peace Stupa, a huge pagoda with Buddhas from five nations (China, Thailand, Japan, India, and Nepal). Unfortunately, it was undergoing construction, but the sweaty uphill hike was still great exercise. The view of the city from up there was gorgeous as well.

A special highlight of the hike was the fact that we were occasionally solicited by leeches. Yep, leeches. At first, Chris got bitten. He thought it was awesome and took photos. Five bites later, he didn’t think the same. I luckily only got bitten once, and I pulled the sucker (heh, pun not intended) off pretty quickly after he latched on, but fought off three other buggers before they had the chance to sink their jaws in. By the time we got back down, Chris was bleeding a lot from his feet since leeches have an infamous blood anti-coagulant (which researchers are trying to use for stroke and heart attack medication). Nevertheless, paddling on the river was unbelievably nice, and though I crashed our boat into the shore at least three times, we got back to the operator’s shack in one piece.

We took a leisurely walk along the lakeside, and boy, is Pokhara touristy! There were dozens of hotels with signs in over ten different languages (the Korean hotel/restaurant claimed to serve dolsut bibimbap, which I haven’t had in over a year) and the number of gift shops is just staggering. This doesn’t change how peaceful the city is, and I’ll be sad to leave.

July 20, 2007 – We Become Tourists

Chris and I forced ourselves to wake up at 5:30 this morning to catch a bus. As a background, one of our team members (and incoming Yale med student) Bibhav Acharya invited us to come visit him in his hometown.

Pokhara, which is one of the Top 5 tourist trekking destinations in the world, is certainly deserving of its title. Whereas Kathmandu is loud, polluted, crowded, and smelly; Pokhara is peaceful, clean, and pleasant. Though it’s not as urban the capital, it’s actually nicer since we get all the benefits of electricity, running water, and internet without the annoying city byproducts.

One of the most notable parts about trip thus far, however, has been the ride there. Chris and I took the tourist bus for seven hours through many small mountain hamlets. The landscape is absolutely stunning, with huge cliffs, gaping gorges, and rushing rivers. Residents primarily grow rice in jagged paddies on the mountainside for subsistence, but supplement their income by catering to the bus passengers that stream by between Kathmandu and Pokhara. One of things that encouraged me the most about them, though, was seeing that children were still managing to go to school. Everywhere we stopped, there were uniformed kids of various ages marching (often long distances) down the mountain to go to school in the valleys below.

Once we reached Pokhara, Bibhav took us to Gupteshwor Mahadev, an awesome limestone cave with a long-hidden shrine. The lingam, which people are not allowed to take photos of, is actually a stalagmite that bears a likeness to Shiva’s “terrifying” or “great” form. There I paid tribute to the manifestation, and dabbed some red paint on my forehead (tika). That actually allowed me to get the local rate at the next attraction, Devi’s Falls (a huge waterfall that apparently swept a Swiss couple away in 1961), since I totally pass for a local (Bibhav’s dad noted that I looked just like the guy who used to do IT for his hospital). In fact, when we were on the bus to the central town square, a woman asked me to move aside since she wasn’t uncomfortable about sitting next to the “American” (Chris). I awkwardly had to explain in bad Nepali that I was from Korea. Chris did his best in the opposite direction as me and bought a brilliant hat which, coupled with his camera bag, made him the ultimate tourist.

Before returning to the Acharya residence, we spent some time wandering around the heart of the city, which was just urban enough to be pleasant. When I ducked into a music/movie store, I was surprised to find tons of Korean movies, an entire section by themselves! I had a great time translating some of the more hilarious titles for Bibhav. Again, small world…

July 19, 2007 – Chow Chow

Though we were planning a trip to the Social Welfare Council and having Bikram show us the holy Hindu temple of Pashupati, but endeavors fell through. Nevertheless, we still managed to pass by some notable landmarks such as the (outside of the) Royal Palace and the Queen’s Lake. We ducked into a small bookstore where Chris bought “Forget Kathmandu” and I picked up a long-overdue copy of “The End of Poverty.”

Since not much happened today, here’s a little update on Nepali food. Though most people are Hindu, meat is not difficult to find (called “masu”) and I’m at a guest house, which means they’re used to barbaric foreigners ordering chicken and pork and... buffalo? In addition, Nepal’s location between India and China means that it’s easy to get food of either region. Curry is a daily staple, and chow mein, fried rice, and chop suey are everywhere. I found Korean cup ramen at the local grocery store, but didn’t end up getting it. Apparently, you can even get Chinese food in Achham as well— according to Chris, there’s a vendor who just sits there and fries up tons of noodles every day. The domestic Nepali ramen (chow chow/ wai wai) market has boomed recently, and actually advertises it as a health food— the company Mayo enriches theirs with Vitamin A and has the slogan “One a Day.” Other than the fact that the whole thing is still just a brick of flour and sodium, I guess they’re not that far off…

My favorite Nepali dish (which is actually Tibetian) is a soup noodle dish called “thukpa.” It features thick noodles in broth and vegetables, and though a little heavy sometimes, is really good. In addition, a popular dish called momo is quite familiar to me since it looks and tastes very much like East Asian dumplings (Chinese dim sum/ Korean mandu/ Japanese gyoza).

Despite the wide array of foods, the traditional meal that all Nepalis eat is called “dhaalbhat.” Dhaal is a soup of varying thickness made with lentils and grains, and bhat is long grain white rice. Add a side of vegetable curry and chutney, and there you have it. Bon apetit.

July 18, 2007 – On Bloodsuckers

A note needs to be made for Anopheles mosquitoes. These are not your home-grown Culexes. I now see why malaria is so prevalent in the tropics. Anopheleses don’t buzz or hover around you before they strike. They hide on the walls, then silently beeline for your vulnerable areas. In a world of buzzing blood purloiners, they’re the F-22 Stealth Fighters. Needless to say, they’ve made short work of my legs and arms— a few have even bitten my hand! How they do it, I don’t know. Insect repellant has failed me (succeeding only in irritating my skin) and swatting has proven fruitless. Anyone have any suggestions?

July 17, 2007 – Reflections on UNICEF

We were all over town today, finalizing an agreement with MSMT (a non-profit drug procurement organization) and meeting with the director of the NCASC to discuss PMTCT training for our medical staff. In fact, Dr. Chand agreed to promote the Nyaya clinic to a full AIDS treatment center, complete with ARV (anti-retroviral) supplies and training, granted we could get approval from the District Health Officer.

In the process of running to DHL to discuss a long-term pharmaceutical delivery service, we made a quick trek through the twisted backstreets of Kathmandu. We actually got lost, but Chris asked for directions in Nepali and got us back on track within 15 minutes, right before I’d begin to panic. What a champ.

Anyways, to square off the day, we went to the UN House, where we spoke with a Maternal Health Consultant. Ms. Karmacharya was absolutely amazing and gave us some really inspiring news about the work UNICEF is already doing in Achham. For our clinic, she let us know that we could apply to get our doctor and ANMs (Assistant Nurse Midwives) training as SBAs (Skilled Birthing Attendants). In addition, we would be getting a powerful local support staff. One of UNICEF’s latest initiatives is to train all Female Community Health Volunteers (FCHVs) in Achham district to help promote proper maternal health, assist in home births, and provide support for mother and newborn child. To that end, she showed us a pictorial manual to be published in August and distributed in the region. The booklet, though mostly composed of large diagrams and simple words, was quite comprehensive in concepts, ranging from signs of complication to explaining financial incentives for rural mothers to have in-clinic deliveries.

Having observed the UN here in Nepal for the past few days, I can now say I’m a firm supporter. The organization is doing so much work for the people who need it the most. They preserve the peace (they’re mediating the post-civil war negotiations between the Maoists and monarchists), provide health services to the weakest populations (women and children), and project the message to residents that the First World cares. Despite the fact that the UN’s efficiency is debateable, they also stand as a symbol of order and stability in these tumultuous times.

I also understand why it’s so important for the privileged to do global service. As representatives of the international community, we’re in a unique position to meet with figures in power and can do so much more for the disadvantaged countryman— just because of our background. I’ll consider it both a blessing and a responsibility.

July 16, 2007 – Earning My Keep

This morning, I woke up to loud shouting of Nepali over a megaphone. When I poked my head out the window, I saw a government vehicle rolling down the street, loudspeakers blaring. A man was throwing pamphlets out the window. A closer look at a sign on the front of the car read “HERPES”. My grasp of the language is terrible, so it may have been something other than an STD campaign, but it remains an intriguing possibility of a pretty frank method of public health education.

Anyways, today was my first day of official duties, and Chris has been amazing in helping me get used to the work. First, we visited Patan Hospital (one of the best state-run hospitals) to request special Peds/Obs training for our MBBS doctor. We next dropped by the National Center for AIDS and STD Control and spoke with the Deputy Director there. Dr. Pant (who did his MPH at Johns Hopkins) seemed quite optimistic about providing our clinic with both documentation and supplies to help us set up a Prevention of Mother to Child HIV Transmission (PTMCT) program, something both exciting and encouraging.

As part of the “detective work” involved in securing medical resources, Chris and I went to Teku in search of the elusive Dr. Upreti, Chief of Immunization and Health Services in the Dept. of Health Services in Nepal. We had originally believed that he worked for the Ministry of Health, but that search proved fruitless, as the main office informed us he wasn’t under their direct organization. Since UNICEF is one of major provider of vaccines, we then attempted to locate him there, but that was a false lead as well. Finally, after wandering about the government buildings in town, we found his signature on a form in the Child Health Division. A quick meeting with him then provided us with more good news: all the vaccines for the major diseases are already present at the district hospital; we just need to talk to the local District Health Officer to procure them. Mission success!

To end a long day of trekking, we went to check out a big mall in a central plaza—and almost forgot we were in Nepal. The complex looks like a shopping center in the US (complete with glass elevators and AC) albeit a bit smaller. Puma and Nike sneakers cram storefront windows, while Beckham soccer jerseys and Armani slacks hang by the rackful. Young people with Ray Bans and iPods shuffled past in the consumer paradise we Americans know so well. Sometimes you realize what a small world it is.

July 15, 2007 – How to be Nepali, How to be Fat

I crashed inadvertently at 8PM last night, so I woke up at 5AM this morning. After spending some time staring out the window at the early-risers on the streets below, I embarked upon my first adventure— the hotel bathroom.

The toilet here doesn’t really… flush. It basically trickles water for a few minutes until you give up. I also decided to take my first shower upon entering the country. There’s a small problem. Most places only know one setting of shower: cold. Nevertheless, I managed to shiver my way through it and get clean.

Once I hit the streets, the first thing that struck me was the huge diversity of complexion in the Nepalese population. At one end of the spectrum, the people are very dark and South-Indo-looking. At the other end, individuals have highly East-Asian features. While I was standing in the visa application line, a Nepalese man approached me. “You look Nepali, but have an American visa,” he noted. He had seen the navy-blue booklet poking out of my pocket. When I explained that I was Korean, he asked, “Oh, so one of your grandparents is Korean?”

Apparently, I pass as Nepalese, which has its benefits and downsides. For one, I blend in well so nobody finds me out of the ordinary. On the other hand, unless I introduce myself as American, people will launch into Nepali when I approach them. Nevertheless, most folks here speak bits of English and some people are quite fluent.

Chris got a call from one of the kids he met in Sanfe earlier this month. Bikram, the cousin of a political figure in the town the hospital is in, met us at the guest house that afternoon. The nineteen-year-old sociology student spoke very good English, even picking up on bits of slang Chris and I tossed around. I was delighted to exchange pieces of cultural knowledge with him, as he proved an enthusiastic and friendly conversationalist.

At one point in the conversation, though, Bikram suddenly turned to us and said “how can I be like you and Andrew, Chris?”
Chris, with his dry humor, leaned back and answered with a grin, “it’s not easy.”

When prompted further about what exactly he meant, Bikram replied, “How can I be fat like you?”

(Note: Regardless of our personal opinions on our physiques, we’re definitely not fat).

After our initial laughter, he explained in detail: “I’m too skinny. My parents worry so much, because I keep losing weight too.”

I made some lame first world references to TV dinners and driving instead of walking, but there was no getting away from the truth of the matter— the American way of life is vastly different from an Achhami’s.

July 14, 2007 – Stranger in a Strange Land

True to the country’s reputation, the first thing that appeared on my initial descent into Nepal was a huge mountain poking its peaks through the clouds. As we broke the puffy cover, they were soon followed by rolling hills, dense forests, and pastures so green my eyes hurt. Before touchdown, Kathmandu, the capital city, exploded in a cluster of houses, factories, and phone towers.

When I finally made my way out of Tribhuvan International, I met Chris, my coworker. As he noted in his e-mail, he was easy to find— the only white person at the gate. He grimly noted upon our meeting that the taxi driver union was on strike again today. As such, we were forced to settle for a renegade cabbie who would only give us the 20-minute trip to our guest house… for 1500 Rupees. That’s about $23 US Dollars. I was getting better rates in NYC :/

The taxi ride afforded me an intriguing look at Nepal’s capital, though, and it really cemented in the realization that it’s developing. Women wash clothes by hand in ditches by the side of the road while Toyota SUVs thunder past. Momo-vendors cook dumplings off open coals under massive billboards advertising Motorola mobile phones. The streets are exploding with microbuses, motorcycles, and rickshaws, but there are almost no traffic lights. Dogs, goats, and cows freely roam the streets. “It’s two years in prison for killing a cow,” said Chris, punctuating my thoughts. That’s right. We’re in a Hindu country now.

Despite the glaring inequities of this heavily urban center, there’s a certain charm about the city. Everything is a mix of old and new (technology, buildings, culture, and people), and it works. As my guidebook notes, Kathmandu is a sensory overload of strange sights, sounds, and smells; but a fascinating place to be.

Background

Some of you may know that I’ve been working for the past year with Nyaya Health, a nonprofit international health aid NGO based at Yale. The goal of the initiative has been to build and maintain a primary health care center in western Nepal. The area is one of the most disadvantaged regions in the world, and the deplorable condition of health and living standards have been made critical by a recent civil war. This is my story about coordinating resources for the clinic, first in Kathmandu, then at the site in Sanfe Bagar, Achham. For more information about our work, please see this video: here. You won’t regret it.