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 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.