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 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.