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?”