Behind Palace Walls

2012 Gynecological Surgery Camp at Anandaban

2012-01-28T03:20:00.000-06:00

Last week, a team of surgeon’s led by a Texas-Filipino couple came to lend their hands to perform surgeries for women in need. Uterine prolapse is a very common problem here, stemming from early and multiple births, hard physical labor, carrying very heavy loads and very steep hills. The US doctors said that they never see cases this far gone in the States. In one of field medical camps, up to 45% of women of child bearing age had this condition, many for decades with no options for receiving proper care. The surgeons arrived late Saturday afternoon, performed pre-op assessments of previously screened candidates on Sunday and then performed surgeries simultaneously in our two theatres Mon-Wed. I did not go into theatre this time to take pics. However, I lent my camera to a clinician and scavenged pics from other clinicians and nurses. True to type, though, most of their selections would be considered, by the general public,…a bit gory for viewing. Don’t worry, I won’t post those. Here are some of the others, mostly from lunch break (you guessed it: dahl bhaat). The two white bags are sand holding the IV stand upright. I must confess, my favorite is the 12hr jet-lagged surgeons on lunch break in the sun. J

Anandaban Christmas activities and get togethers

2012-01-02T11:15:00.000-06:00

Every year, we carol and give short messages in each of the patient wards. Every patient gets a blanket that they can take home. However, the compound kids are usually so excited to pass them out, that it makes it difficult to catch good photos of the blurs in action! It took me almost 4 wards before I caught a good shot. J

Anandaban Christmas activities & get togethers

2012-01-02T10:56:00.000-06:00

Anandaban Christmas activities & get together photos

2012-01-02T10:48:00.000-06:00

Anandaban Christmas activity & get together photos

2012-01-02T10:42:00.000-06:00

September 18th 2011: Earthquake in Nepal

2011-09-19T12:09:00.001-05:00

Dear Friends, The earthquake last night was very much felt here but I am ok and everyone at Anandaban is ok. It was my first earthquake and it took some moments to process what was happening. It felt like an impossibly enormous train was running on the other side of the wall. The floor shook and the windows rattled. I ran outside and prayed while dogs barked and the city screamed. It seemed to go on for maybe a long minute. I’d stayed in KTM – where we never lost power or internet during the earthquake. The phone lines, however, were quickly overwhelmed by those trying to check loved ones. It was very odd to sit and wait for google news to detect anyone reporting it. It was too big, even in my inexperienced opinion, not to rank immediate international news. It took about 30 minutes. But contextual and infrastructure limitations are restricting rapid checking of those closest and possibly more strongly affected.

Due to the mountainous and remote terrain, many Nepalese potentially affected by this earthquake live in areas difficult to assess. By remote, I mean 1-5 days walk over steep, high hills to the nearest road or health facility for trauma care. No pictures, reports or video from those areas in Nepal, Tibet or India will be very fast in coming unless someone dedicated is going trek or helicopter out there. Please pray for those people and the others still trying to contact loved ones.

Thankfully, the seismologists are saying that the rapid occurrence of lesser aftershocks immediately following the 6.9 earthquake was a good sign (barely felt here). They say that if there had been no aftershocks, then it would mean that pressure was building for another soon and bigger earthquake.

Also, if you look at scientific seismological websites, you will observe that the epicenter is just inside the border of Nepal very high up in the mostly uninhabited parts of the Himalayas – but most news websites are initially labeling it the Sikkim or Indian earthquake. This is likely because the Indian news agencies had the infrastructure, immediately accessible populations affected and capacity to upload pictures and video more rapidly for distribution to many connecting networks nationally and internationally in English. I had trouble even finding news on the radio in Nepali after it happened and did not have a TV to check. Therefore, most of the news first reported that I saw came from India online with pics and video rapidly following.

Regardless, the maps of the border position mean that Indian, Chinese, Nepalese, Bhutanese and Bangladeshis likely all had impact, and all have populations that need to be checked. These are difficult terrains that, going southward, have increases in population densities as altitude rapidly decreases into the more farmable flatlands (green on the map). http://neic.usgs.gov/neis/eq_depot/2011/eq_110918_c0005wg6/neic_c0005wg6_l.html (It’s kind of reminiscent of the hurricanes that often hit the region I grew up in: websites follow the track of the storm’s eye but everyone knows to also consider the broad expanse of territory that the storm can actually effect.)

The epicenter that high up in the hills means that the worst shaking happened where there is thankfully most likely few. But the broad coverage of the earthquake was felt by many across Nepal and down to Delhi, India. If you look at this hazard map (where darkness indicates higher risk areas), you’ll see that there were far worse places hosting far more population that could have been hit. But then again, you have to remember that in this region, population densities are relative to millions and billions. http://neic.usgs.gov/neis/eq_depot/2011/eq_110918_c0005wg6/neic_c0005wg6_w.html

The people at Nilphamari in the Leprosy Mission Hospital in the northern tip of Bangladesh are also shaken but ok.

Thanks for your thoughts and prayers.

110728 Random recent pics

2011-07-28T12:09:00.000-05:00

Well, in KTM, I have better access to internet. So, time to try and catch up on posting some pics. This post should include these photos listed. Not sure in what order the email will post them, but you can surely figure out which is which.

1. Setting the foundation stones of the new dhobi house (laundry). I’ll post some pics from the old building sometime so you will understand why this is needed! The visiting foreigners on compound were given the honor of laying the four cornerstones and a stone in the middle. But, we were short a visitor, so I was asked to set the last one in the middle. Louise, from the TLM England Wales Office has a close up shot, after setting the first stone. Damaris, a Swiss nursing student volunteer in her white coat, set the 4^th cornerstone. A glance up the steps at some of the staff audience to the early morning ceremony. The group shots are of Machen dai with the work team that is actually building it. If you notice that the ground looks damp…well, it’s monsoon season! Monsoon awakens all the eggs laid last year. Exponential hatching. Haven’t seen a leech yet, personally, but I try to avoid contact with those. The giant slugs and slug tigers are out. As are the love bugs. And the cicadas are steadily gaining in volume, but nowhere near seasonal peak noise levels yet.

2. Staff and visitors crammed in the van nepali style trying to get back to KTM at the end of the day. The road is bumpy, so I took several shots trying to catch the staff sitting on the floor between seats. Who needs seatbelts when packed like this?

Serving remote areas: Opinions of some young Nepali doctors

2011-02-02T23:26:00.001-06:00

Young Doctors Talk (by SAHARA SHARMA)
http://www.myrepublica.com/portal/index.php?action=news_details&news_id=27876

KATHMANDU, Feb 3: Back in primary school, everyone asked us one and the only question monotonously: What we wanted to be in future. And we spontaneously burst out doctor! doctor! The answer was almost ubiquities because all of us had vivid dreams of wanting to become a doctor. For some, as they grow into adults, their childhood fantasies vanish like dreams, for others, it will be a dream come true. But, how far will this profession bring along that immense name and fame as instilled right from our childhood? In this edition of gennext, we exchanged some chitchat with doctors who spoke on what it is like to be a doctor. Dr Subash Thapa Magar, 31, Dr Bibek Khanal, 27, Dr Jolisha Singh, 25, and Dr Sailendra Kushwa, 27, joined us in the chit-chat.

Asked if becoming a doctor was absolute aim for them, Dr Jolisha replied in one word: "Completely!" At a glance, Dr Joshila didn't conform to the usual stereotype of a doctor. But as conversations intensified, it became crystal clear that she enjoys and respect the profession very much. Dr Shailendra too has carried the dream for as long as he can remember. "All of us have aims to become a doctor. So was mine and I am here today," he says smilingly. Appearance can be deceiving sometimes. As the conversation progressed, it turned out that among the group, Subash was the eldest and experienced doctor. He was the power pack of the group, extremely vivacious and beguiling. Getting back to the basics, he answered, "I knew this is what I wanted to do" (implying that he was satiated with his profession). And there was yet another doctor - Bibek - who was more of an observer, carrying the look of a sober thinker, who suddenly burst out: "It is probably the esteem attached to the profession that lured me." He, then, went on elaborating and accepting the fact that doctors are bestowed with immense respect and kept in higher social strata.

When asked to comment further, Jolisha replies, "It is probably the toughest job." She then adds, "There is always a pressure, a kind of bondage." When asked to clarify the points, she sighs, adding, "We are expected to talk and walk in a particular way, we are expected to heal all of our patients." Shailendra adds here: "We're taken as if we possess magic or some sort of supernatural power; we can't cure every single patient coming to us. All we can do is to try and we do that." Bibek nods on and says, "We are not God, we can't blow in some magic air and bring back life, we work according to science and do our best to solve our patients' problems." "If it were solely our decision we would heal every sick and wailing person in the country," puts in Subash.

His answers evoked a flurry of questions: Why then our healers are confined to the wards of the modern capital city hospitals alone? Why then do they not take an initiative to go to places where people can't find a doctor? Are there not enough hospitals and doctors in the capital already? "We do understand the need of a medical professional in remote areas but we are helpless," answered Bibek. He elaborated that since the health posts in the villages have no equipment, there is not much that they can do. Subash narrated his own story as to how he once went to a village through an INGO (the name of which he does not wish to disclose) but soon discovered that the health camps set up there had only limited medical facilities. And so he quit.

"I have bought medicines from my own pocket many a times, but how long could I do this?" he asked, looking frustrated. After all, a student on average pays Rs 4 million to complete a medical course and he/she has family to look after, he adds. "We do want to go to villages and serve there but at the same time we demand proper arrangement," Jolisha said. She further said that a few of her friends who are working in remote places have sad stories to tell. "They are as helpless as the patients there without a chance to update themselves on their vocation and latest developments in the medical sciences." "Being there is limiting us to knowledge and what discourages us more is the dismal pay," she argues.

Tis the Dry Season...

2011-02-02T23:16:00.001-06:00

Lights out for TV news in Nepal
(AFP) –
KATHMANDU — Nepal's most watched television station is to broadcast
its main evening news bulletin in semi-darkness from Tuesday to
highlight the problems caused by the country's chronic electricity
shortage.
Kantipur Television said it would rely on traditional kerosene
lanterns -- a common sight across Nepal -- to light the studio every
night in a symbolic protest over the power crisis.
It hopes to pressurise the government to resolve an electricity
shortage that sees homes and businesses in Nepal plunged into darkness
for up to 18 hours a day, despite the huge potential for hydropower in
the Himalayan nation.
The programme, broadcast every evening, is to be renamed after the
Nepalese word for lantern and will carry themed news reports, starting
with an interview Tuesday with Nepal's energy minister.
"It is a symbolic protest, but we hope it will strike a chord with our
viewers," Kantipur's news chief Tirtha Koirala told AFP.
"These power cuts have brought people's daily lives to a standstill.
Media organisations are losing money because no one can watch the
television in a power cut and we are forced to use expensive
generators to broadcast.
"There are no penalties on the government for failing to provide these
basic needs, so we wanted to put moral pressure on them to do
something."
Impoverished Nepal relies mainly on hydropower for its electricity,
but produces only 634 megawatts a year, well short of the national
requirement, according to the Nepal Electricity Authority.
Experts say the Nepal's huge mountain river system could be generating
up to 83,000 megawatts of power, allowing it to sell surplus
electricity to other countries.
But political instability and the lack of security have prevented the
necessary investment.

http://www.google.com/hostednews/afp/article/ALeqM5jhnCveq25rUkItf2nPc3-E8Osxew?docId=CNG.72f35b593e08eb3d3aa2924fd12e2e1b.131

The view just outside my front door

2010-11-03T06:38:00.000-05:00

A nice view from just outside my front door, looking down into the village of Tikabhairab and onto more of the foothills of the Himalayas. Some of the terraced fields are just beginning to turn yellow with mustard greens.

New Delhi International Airport

2010-09-25T20:52:00.000-05:00

In the newly opened Delhi International Airport, this large sign is posted on the wall above immigration. Something interesting for you to think about as you wait in line to enter the country. There is tremendous preparations activity in Delhi for the upcoming Commonwealth games. Be forewarned, even if you have an Indian multi-entry or work visa: no one is now allowed to “arrive” in India more than once in a two month period without visiting an Indian embassy in-between arrivals and obtaining a special stamp permit. This process takes a day or so; and could be enjoyable if hours of people-watching in an Indian embassy is considered an entertaining tourist attraction for you. If you do technically arrive to enter India (to leave the airport) more than once in two months without a special stamp encompassing that particular dated arrival, immigration will put you on the next flight back to wherever you last came from. No leniency. This would apply to circumstances such as using the Delhi airport as a hub for South Asia travel or swinging to Nepal (to visit us!) and then going back to India. I’ve heard stories from those who’ve had travel plans suddenly changed mid-path because of it. Luckily for me, I had a prearranged connecting flight in less than 24hrs and was offered the option to sit in the new airport transit zone area for 18hrs. There is supposed to be free wireless internet – but you have to provide a mobile phone number to access it without explanation as to what will be done with your number. Phone spam is an issue in India. No thanks.

Water is out

2010-09-25T05:13:00.001-05:00

This happens every once in awhile – but today I caught a photo for you. The water pipes leading uphill must have broken again. It is nearing the end of monsoon, and there have been some landslides along the road that curves around the mountainside to reach Anandaban. Some hospital guys took a tank and a small pickup truck to go find water. So, in this pic, you see one of them transferring two buckets of water to my house buckets. Sometimes it takes a few days for the pipes to be repaired.

Other china pics

2010-08-26T23:29:00.001-05:00

The leprosy science meetings have concluded (one pic below). It was very good to hear everyone’s presentations about what leprosy research is being done in their countries and then to discuss what can and should be done in coordination with each other next. Answers we find in research need to be applicable to many different countries – which means not only different cultural contexts but different genetic backgrounds (which affects immunology). We had representatives from many involved: India, Pakistan, Ethiopia, Columbia, Brazil, Philippines, Korea, Japan, Thailand, USA, China, Nepal, UK, Netherlands. Several represented Leprosy Mission sites. Netherlands Leprosy Relief provided the funding to support the meeting and discussions (formally called IDEAL: the Initiative for Diagnostic and Epidemiologic Assays for Leprosy). Unfortunately, our Bangladeshi colleagues had visa issues at the last were unable to attend. In the evening, we had dinner together at a famous dumpling house, which were something like Nepali momos. There was a crew that could be seen through a glass window preparing the dumplings. They had many varieties, including pumpkin with shrimp (pic). We had three tables of people, but I only have photos from the table where I sat. At the end of the day yesterday, Nora and I walked in a nearby park. Our hosts have planned and organized this meeting very well and we greatly appreciated their warm hospitality.

Riding with kids 2

2010-08-26T18:21:00.000-05:00

China

2010-08-26T05:13:00.000-05:00

Did you know that Facebook cannot be accessed in China? The pages just do not work here. If you ever travel there, Kunming airport is not intuitive and finding someone who speaks English is not a good possibility around 5am. Upon arrival at the hotel in Beijing, however, there were already a group of familiar faces in the lobby from Colombia, Brazil, India, USA, etc. As we awaited the delegates from other countries to arrive, we rode out to the great wall of China (about 1&1/2 hrs away). I will not be posting pics from the days of workshop meetings, discussions and presentations. Somehow, I do not imagine them as interesting for you!

These are some pics from the Great Wall. Many of the bricks have scrawled Chinese graffiti, but I sighted one with “Nepal” written on it. There is a pic with Nora, a leprosy researcher from Columbia and then a group shot with other researchers that also had arrived at the time. Strangely, I also met some people from Louisiana touring the wall. This is only the second time that I have accidentally met Louisianans on this side of the planet. The accent is unmistakable. J Of course, one of the leprosy group said that my accent appeared suddenly stronger when I spoke with the Louisianans. One guy and his wife was from Alexandria, while the other was from Denham Springs (his street name was even familiar). The wife had taught at Central for years. Imagine that!

The 54th momo and beyond

2010-08-12T21:31:00.000-05:00

Short term medical student interns and volunteers often come from all over the world during the summer to Anandaban. Many have helped to make and then tasted Dr. Indra and Jwala’s momos (steamed dumplings). Last night, a visiting prosthetics student broke the record: 54 momos (when we ran out) and still had room for dessert (cake and homemade icecream). I do not know if he will have room to eat anything today!

Training local students

2010-08-12T21:21:00.000-05:00

Our labs also have visiting academic and medical students and staff that come for some exposure. These are some students that came this week and are observing one of our lab techs take slit skin smear samples from a patient for testing.

Cracked laptop screen

2010-08-12T21:12:00.001-05:00

When this laptop was purchased, it came with an accident “anything” will be fixed or replaced policy. “Do you know that I’m taking this to Nepal??” Thankfully, when I came to the US for a leprosy meeting in July, IBM sent for it, fixed it and shipped it back before I flew back to Nepal.

Patan Dhurba, public taps & things that sometimes happen to patients on their way to proper diagnosis

2010-06-17T12:12:00.000-05:00

Elisa and I took some Aussie and an American guest a few blocks from Patan Hospital to visit Patan Dhurba Square.

Very common sight: people line up to get water from the public taps (because they do not have water in their homes).

A new leprosy patient reported to our doctors recently. His right hand was swollen from a leprosy reaction. No one had correctly diagnosed him previously. A well-meaning relative had placed a traditional hot poultice on him – which explains the burns. Another patient came in with 3 severe burns on his elbow. Wanting to test nerve damage by sensation of hot and cold, a doctor from somewhere else had taken a glass test tube of boiling water and held it to the patient’s skin in 3 sites around an elbow lesion. “Do you feel this?” The patient felt nothing because the nerves were damaged from leprosy. However, one is supposed to use warm water – not boiling water!

View from within the burned out forest above Anandaban (hilltop)

2010-06-16T07:27:00.001-05:00

To see information about the forest fire, see postings from April 2010.

Mountain hawk-eagles and more nature observations

2010-06-16T06:45:00.000-05:00

There is a pair of these that stay in the trees about my house for many hours every day. From these steep hillside treetops, they have a nice view overlooking a rural valley of hand-farmed fields. Whatever they are, they’re a very talkative species with piercing cries as they circle and land, circle-dodge ravens– and land, soar – circle and land, etc, etc.

Someone saw one of them in the tree with a serpent in its mouth. In the high hills, we do not see many snakes and most are not poisonous. (Snakes/poisonous ones are more common in the hot Southern flatlands, but here we see maybe 2 slow moving rat snakes a year.) Nevertheless, the mongoose and hawk-eagle yard patrol is much appreciated as well as entertaining.

The monsoon rains have not officially begun – but the insect eggs from last year are awakening with the pre-monsoon occasional showers. The cicadas, locally called the “boring bug”, have started their monotonous monotones. They won’t begin to die out until the end of July or August. Sometimes they are so loud in the evening, that even with the windows closed, it is difficult to hear someone trying to speak on the other side of the room! I typically do not see many roaches – but the other day sighted one that probably could take on a mouse. The giant slugs (~5-6” length, 1” diameter) and their arch enemy, the slug-tigers with green glow-in-the-dark spots on their rears, will appear within the next month or so. But, thankfully, the summer leeches have not yet become a common sight. J

Mongoose sightings & Nepalese Orange mosquito hawks

2010-06-14T10:29:00.006-05:00

Nuwakot Camp Pics: last patient

2010-06-14T10:29:00.005-05:00

The last patient of the camp: he walks boldly in, declaring vague stomach symptoms to Dr. Pradeep as Dr. Indra looks on. Dr. Pradeep began to ask the standard questions without receiving the normal answers. “Well, it’s not happening now. Sometimes.” A smile and a another question. “Well, really it’s for my Grandma.” Dr. Pradeep writes a prescription for a one dose chewable dewormer (something essentially everyone, kids to Grandmas, needs here anyway). J

Nuwakot camp: Dental room

2010-06-14T10:29:00.004-05:00

I did not spend too much time in the dental room this camp. They extracted around 30 teeth with anesthetic. Extraction is essentially what Yam and Karuna can do during these camps – and it is amazing to see some people so happy to have a troublesome tooth removed. Honestly, though, when I went in the room, Yam was removing a tooth. And the cracking sounds weren’t pleasant. The next patient looked on indecisive. The receiving lady calmly declared she felt nothing while Yam yanked, cracked and pulled. So…I did not stay in that room that long this time. J

Nuwakot camp: General, skin, women & children rooms

2010-06-14T10:29:00.003-05:00

Sylvia, a Swiss nurse, and Neeru (a translator) talk to a patient. Dr. Ponkaj listens to a mother and daughter. Two Swiss nursing student volunteers weigh and take the blood pressure of women patients for the gyne room. Dr. Min checks a baby’s feet while his mother describes symptoms. Nearly everyone has recurring stomach complaints, so antiparisitics and dewormers are essentially given to everyone.

Nuwakot camp: Ortho room

2010-06-14T10:29:00.002-05:00

For this camp, I performed door patrol duty mostly for the orthopedics room, which also took in general patients. An 8yr old boy came with a shortened Achilles tendon. It was obvious when he walked that something was wrong. Living in a steep hill area, he is carried to school. A 10 minute subcutaneous surgery, 3 wks in a cast and week of physio could fix it. We’ve asked them to come to Anandaban for surgery. He could then walk to school on his own. Dr. Pradeep checks a man’s leg. Dr. Indra checks a lesion on a girl’s neck to see if it is leprosy. It wasn’t. If it was leprosy, she would not feel his pen touching her there. Skin diseases are a common problem here (fungal sores on someone’s stomach). Also, handing out donated clothes to people (sleeping baby in new shoes). And a baby who was not all enthralled that I was around – so I left his field of vision before he cried. If you notice, his hair is not coal black – a sign of malnutrition. Most kids are also small for their age and so are older than whatever your first guess.

Nuwakot camp: Setting up

2010-06-14T10:29:00.001-05:00

Extremely common site of women carrying basket loads of fodder and/or kindling. We quickly sorted the rooms for gyne/pediatrics, ortho, dental, general and skin, clothes and pharmacy with registration just outside of the main doors. We went to the roof for a quick cup of tea, local donut and a boiled egg for breakfast. Prepped some of the vegetables for Shudarson to cook dal bhaat for lunch and then headed back down to work.

In the group photo: anandaban staff, Elizabeth (student, American Leprosy Mission volunteer), Natalie & Isabelle (Swiss nursing student volunteers), Dr. Betty (KTM volunteer), Sylvia (Swiss nurse instructor, volunteer) with her translator Neru, health post staff and volunteers. We were very high up in the hills. If it had been a clear day, you would see a strip of gorgeous white Himalayas behind us. But clear days like that only happen maybe 60 days total out of the year! They are breathtakingly beautiful when do they happen.

Nuwakot camp: Getting there and arrival

2010-06-14T10:29:00.000-05:00

3 hrs bus ride there + 3hrs bus ride back = 6hrs in a bus

6 hrs at the camp

377 people provided free medical checks

About 30 teeth pulled

We drove to the Kakani Health Post, which is VERY high up on a steep hill. For the final steep descent into the driveway, we had to get off of the bus. J Pictures never show enough depth to do mountain justice. Good picture of Kedar, our bus driver. On narrow mountain roads, we much appreciate his skill. When the clouds threatened rain, he laughed and said that he would take the bus downhill if it began to rain. There was no way we could navigate that thing loaded downhill on slick clay roads (mostly just wide enough for one vehicle)!! Patients began to come as soon as we arrived. Pictures from the village closest to the building. Due to the steep hilly area, people live in small scattered villages – wherever flat space for a home or garden can be carved. Anandaban staff had come the week before to spread the word over a wide general area that a free medical camp was coming. Some people walked 2-3hrs to come. The health post was a really nice building – but usually in harder to reach places like this, staff, supplies and ability are limited. Can you imagine having the nearest health facility 2-3hrs walk away (or even days walk away)? What if you broke a bone, had a relentless fever or needed a c-section? For contextual reasons, these places are often at the top of a steep hill on public land no one else has use for. Often a doctor may not be available (ie, “gone to KTM”), the meds needed may not be available, the goat paths are steep and narrow (meaning the patient must be carried up), and you had best not need anything remotely like surgical intervention. Nevertheless, it was a nice building and local staff and volunteers came to help sort the people.

Sad News

2010-06-01T09:24:00.000-05:00

A few days ago, an elderly woman died in the wards. During the past year or so, she had been admitted more and more frequently – I think with the wounds and ongoing foot problems too commonly left from leprosy (see pic on blog update April 20, 2009: http://behindpalacewalls.blogspot.com/2009_04_01_archive.html ). The others called her Grandmother and her husband, Grandfather. Her husband was unique. So often spouses abandon or reject when someone is diagnosed with leprosy. But he did not. It was a common sight to see him walking uphill every day to be with her. I heard that she would not eat until he would come. Even when she was cranky and her wounds disturbing – he came. One of the guests took this picture of him about a month ago weaving one of his baskets. A few nights ago, she died on her bed. He came. Someone told him not to cry – but he refused saying that he was the one to know what it felt like. Please pray for him. We may not get to see him now, since she is gone. He makes my heart hurt.

Scenes from the forest around Anandaban after the fire

2010-04-19T09:02:00.000-05:00

The distant picture is of Anandaban’s mountain a couple days after the fire of Sunday April 11th. The dark areas are burned forest where the fire raked uphill. Anandaban hospital is obscured in the pine forest to the left of the burn zone. A farmer’s fire lost control and raced up hill, fueled by the carpet of dry pine needles in the forest. Hundreds of villagers alongside the army and police came to fight the fire to protect the hospital. Water is not something there is a lot of on a hilltop. It is pre-monsoon, and water supply is limited even in the valley. People tore leafy branches from trees to beat at the flames. Some new guests who came to volunteer arrived from the UK during the fire. They texted their home church to pray. At a critical junction point when the fire bordered Anandaban’s uphill road, the wind changed direction and blew the flames back into the burn zone away from the hospital. No one was hurt and the hospital was not harmed. Only the mainline phone wires from the tower uphill were destroyed. Of course, someone saw a leopard fleeing.

From leprosy asylum to medical profession

2010-01-27T23:52:00.001-06:00

BIKASH SANGRAULA http://www.myrepublica.com/portal/index.php?action=news_details&news_id=14027

KATHMANDU, Jan 14: He was born in a community of leprosy patients living in an asylum provided by Dadeldhura´s Team Hospital. He spent his childhood forging lasting bonds with strangers who had been banished by family and society. Many of these people, whom he lovingly calls “uncle”, “aunt” and “grandmother”, have lost their nose, or ear, or arm to the ailment.

Now a medical doctor, Arun Budha, 29, has a clear life goal.

Dr Budha wants to devote his entire life to providing medical services to people living in rural hinterlands. He has already spent three years at the Team Hospital, and another year at the Mission Hospital in Palpa, doing exactly that. But, as a longer-term goal, he wants to provide surgical services to patients in rural Nepal by becoming a general surgeon.

“Imagine! For seven hilly districts in the far-western region, the Team Hospital in Dadeldhura is the only medical institution that can provide surgeries like a caesarian,” said Dr Budha, an unassuming youth with a low, polite voice and clear priorities.

For a man who has made it through an epical journey that started from an asylum for leprosy patients, took him to Xian Jiaotong University in Shaanxi, China to study MBBS, and then took him back to Dadeldhura equipped with skills to treat people he loves, Dr Budha remains a strikingly grounded and modest youth from Dadeldhura.

“Looking back, I feel it has been a strange, yet interesting journey,” he said reflectively. “I was lucky that my different childhood gave me the opportunity to understand people who are in need of medical care,” he told myrepublica.com on Wednesday.

Banished to Dadeldhura

Dr Budha´s father, Raghubir, who was born in Kalikot, contracted bacillus Mycobacterium leprae at the tender age of ten. Raghubir´s father tried faith-healers and other traditional healing methods to cure his eldest son, but to no avail. Eventually, the stigma associated with leprosy that is still considered in many rural villages as divine retribution for sins, proved too great a burden for the Budha´s family to live with.

“The situation back then was so bad that people who had contracted leprosy were segregated from the society and forced to live in caves. Many were eventually eaten up by wild animals,” Dr Budha said.

When Raghubir was 15 his father sent him to Dadeldhura so that he could lead some kind of ´normal´ life by receiving treatment at the Team Hospital and doing odd jobs for locals.

At the Team Hospital, Raghubir met Parbati, also a leprosy patient, who had arrived there from Bajhang with a similar story. They eventually got married. Parbati bore three children.

Two doctors from the family

“The three of us grew up in the community of around 60 families affected by leprosy,” said Dr Budha.

His father Raghubir initially did odd jobs. But being a senior member of the community (his registration number was three), Raghubir was eventually employed by the hospital for taking care of the garden, taking posts to and fro the district headquarters, and later as an interpreter, though his knowledge of the English language was limited.

Raghubir´s earning, supplemented by what Parbati made by taking care of paraplegic women, was enough to finance the studies of Arun, his younger brother, and a sister, all of whom studied at Ugratara School in Dadeldhura until SLC.

“Father was a sensible man. He taught us discipline,” said Dr Arun.

Raghubir, who was also a pastor at a local church in Dadeldhura, died of a heart attack in 1999.

Dr Arun did his ISc from Patan Multiple Campus, and was supported by the Team Hospital and friends for his M.B.B.S study in China, which he completed in 2005.

His younger brother, Kaleb Budha, was closely following his footsteps and eventually became a doctor himself after completing M.B.B.S on scholarship at Nepal Medical College. Dr Kaleb is currently posted at Chaurjahari Hospital in Rukum.

Service is supreme

Leprosy has been considerably contained in the country with many organizations working in that direction and the society growing more accommodative to those suffering from the disease. But the state of overall health service delivery in rural Nepal remains dismal.

Dr Budha has resolved to devote his life to strive to change this. If not in anyway else, he will try to do this by making his services available to people in remote districts. “Most of the country is rural. If the state intends to make health services reachable to the common man, it must expand health infrastructure in rural areas where people need the service most,” he said.

Dr Budha, who was part of a team of doctors that provided treatment in Rukum during a diarrhea and cholera epidemic last year, stresses that it is the state´s neglect to rural health that leads to such epidemics.

After another six months at Dadeldhura´s Team Hospital, Dr Budha hopes to study general surgery and then return to the needy people of rural Nepal for good.

“I have no interest in leaving the country,” he said, adding promptly, “I don´t mean to criticize others for leaving. It´s an individual´s choice.”

For a man who spent his childhood receiving love from people with medical needs, it isn´t hard to guess Dr Budha´s motivations.

“I can love patients unconditionally,” he said. “I can understand them.”

Dr Budha, who is a Christian, added, “The love God has showered on me is my driving force. I believe in love that doesn´t discriminate.”

Sita and other kids

2010-01-26T02:49:00.002-06:00

This site has a small article with a picture of one of Anandaban’s patients and scholarship recipients, Sita. I’ve ridden on the bus with her in Nepal. J

http://www.inspiremagazine.org.uk/news.aspx?action=view&id=4138

The Leprosy Mission through Anandaban currently provides educational funds or scholarships to around 400 kids across Nepal affected by leprosy so that they can attend a school or receive vocational training. It makes a difference. As leprosy is linked with desperate poverty, it can change the outlook of life for generations that were otherwise desolate.

I love these verses (Isaiah 61:1-4):

The Spirit of the Lord God is upon me; because the Lord has anointed me to preach good tidings unto the meek;he has sent me to bind up the brokenhearted, to proclaim liberty to the captives, and the opening of the prison to them that are bound; to proclaim the acceptable year of the Lord, and the vengeance of our God, to comfort all that mourn in Zion, to give unto them beauty for ashes, the oil of joy for mourning, the garment of praise for heaviness; that they might be called trees of righteousness, the planting of the Lord, that he might be glorified.

And they shall build the old wastes, they shall raise up the former desolations, and they shall repair the waste cities, THE DESOLATIONS OF MANY GENERATIONS…

It is God’s business to build up the desolate – the destroyed and destitute – that He be glorified. We are His Body. It is what we together do.

Ankit & Shakshyam on the road to Anandaban

2010-01-19T07:49:00.002-06:00

These two compound staff kids are so used to travelling the road to Anandaban, they can fall asleep amidst the bumpy ride.

A Protest a Day Keeps Progress Away in Nepal

2010-01-05T22:25:00.001-06:00

Nepal celebrated New Year's Day with a nationwide banda, a forced closure of businesses and roads. That's no surprise: Every day there are bandas, transport strikes, labor actions and disruptive protests throughout the country. Nepalis are fed up with incompetent governance caused by political bickering and, despite a long tradition of patience and civility, are taking action into their own hands when they have a grievance.

The costs are high. Students suffer because schools find it impossible to operate for the legally required number of days in a year. Businesses suffer from reduced productive capacity and lower sales. Development work slows to a crawl with 100 or more days of forced inaction each year. And the poorest of the poor, those dependent on hourly wages or day-labor, suffer the most, sometimes to the point of going hungry when they can't work.

At least seven major protests disrupted Nepal on Monday, about par for the course recently.

Maoist cadres in Taplejung district continued a week-long forced closure of government offices over a demand that three of their activists killed in 2006 be declared official martyrs by the government. On Monday six protesters were hurt when police clashed with Maoists while trying to reopen the offices.

In Dhading district a student union affiliated with the ruling party enforced a district-wide banda after one of the student union members, 15-year-old Bir Bahadur Tamang, was hauled out of a school examination and attacked with knives and iron rods. Tamang's assailants, the UML student union says, were members of the Maoist YCL militia.

In Kailali district Maoists continued an indefinite transportation and business strike over police action to clear squatters from a community forest last month. Police allege that the squatters were motivated and transported to the forest by agitators bent on pulling down the government. The Maoists are protesting the "disproportionate violence" of the police move, which left several protesters dead and scores injured.

In Sano Thimi, outside the capital, students have locked administrators of the university there out of their offices for the last month, protesting plans to close the campus after enrollment slipped from 4,200 students to about 3,000. The university says that the school is not economically viable at that size: The students want the university to offer additional majors to increase enrollment.

And in Kathmandu, lawyers, teachers and doctors all protested on Monday, disrupting essential services and snarling traffic.

Several hundred lawyers staged a large sit-in on a major street in front of the Constituent Assembly building to protest delays in the constitution-writing process and what they call the failure of the government to enforce the rule of law in the country.

Tribhuvan University contract teachers - those without permanent appointment letters - demonstrated for a second day at the University over their demand for tenure status and what they say is a failure of the university to post job openings on a regular basis over a 12-year period. The teachers vowed more serious action if their demands were not met.

And a doctors' strike at government-run Bir Hospital entered its thirteenth day. The doctors want the government to implement an earlier agreement on pay and security at the hospital. The original strike by junior physicians has expanded since it began, and now all doctors, helpers and security guards have joined the protest. Bir hospital is the only low-cost medical facility in the capital and served approximately 12,000 poor and indigent patients daily before the strike.

Apart from the impact of the protests individually, the sheer number and frequency of them has severely disrupted the country and has led to growing public frustration and incivility here.

If Nepal could get back to only one protest a day everyone would be grateful.

By John Child in Kathmandu (http://newsblaze.com/story/20100104220449chil.nb/topstory.html )

Can you recognize this song before the chorus?

2009-12-03T07:03:00.002-06:00

I have arrived in the US for home leave and will be here until mid-February. Have had a few re-entry issues this past week since arrival (AM/PM swap-jetlag, bronchitis and gastro resettlement), but things are getting better now. It is such a wonderful gift to be able to visit with people personally, look them in the eye, hear their voices and talk with them (and, of course, hold their babies). I can now exploit the high speed internet available in this country to post videos and pics from the last year!

This first installment is a clip from a leprosy research conference dinner held in Fukuoka, Japan in July. We were in a small boat when a couple of street singers happened to come by. I did not recognize the song until the chorus.

What is suspicious in this ad?

2009-12-02T10:24:00.001-06:00

Annual staff picnic pics

2009-11-23T16:08:00.000-06:00

"AIDS, malaria eclipse the BIGGEST child-killers: Diarrhea & Pneumonia

2009-11-20T12:10:00.000-06:00

Sometimes it is difficult to understand the reality difference between what media portrays as epidemic health problems in light of what preventable deaths are occurring in populations lacking similar wealth and power (which generate media volume).

By MARGIE MASON (AP) – 22 hours ago

http://www.google.com/hostednews/ap/article/ALeqM5izfFuOGZyDVUQRBli6B_2qH-ppCQD9C2PQ9O3

HANOI, Vietnam — Diarrhea doesn't make headlines. Nor does pneumonia. AIDS and malaria tend to get most of the attention. Yet even though cheap tools could prevent and cure both diseases, they kill an estimated 3.5 million kids under 5 each a year globally — more than HIV and malaria combined.

"They have been neglected, because donor or partnership mechanisms shifted their emphasis to HIV and AIDS and other issues," said Dr. Tesfaye Shiferaw, a UNICEF official in Africa. "These age-old traditional killers remain with us. The ones dying are the children of the poor." Global spending on maternal, newborn and child health was about $3.5 billion in 2006, according to a report by the Bill & Melinda Gates Foundation. That same year, nearly $9 billion was devoted to HIV and AIDS, according to UNAIDS.

Pneumonia is the biggest killer of children under 5, claiming more then 2 million lives annually or about 20 percent of all child deaths. AIDS, in contrast, accounts for about 2 percent. If identified early, pneumonia can be treated with inexpensive antibiotics. Yet UNICEF and the World Health Organization estimate less than 20 percent of those sickened receive the drugs.

A vaccine has been available since 2000 but has not yet reached many children in developing countries. The GAVI Alliance, a global partnership, hopes to introduce it to 42 countries by 2015.

Diarrheal diseases, such as cholera and rotavirus, kill 1.5 million kids each year, most under 2 years old. The children die from dehydration, weakened immune systems and malnutrition. Often they get sick from drinking dirty water. The worst cholera outbreak to hit Africa in 15 years killed more than 4,000 people in Zimbabwe last year. The country recently reported new cases of the waterborne disease, and more are expected as the rainy season peaks and sewers overflow. Rotavirus, a highly contagious disease spread through contaminated hands and surfaces, is the top cause of severe diarrhea, accounting for more than a half million child deaths a year. A vaccine routinely given to children in the U.S. and Europe is expected to reach 44 poorer countries by 2015 through the GAVI Alliance.

"Every child in the United States gets it, even though they have access to clean water and hygiene," said John Wecker, of the Program for Appropriate Technology in Health, a Seattle-based nonprofit that is part of the vaccine alliance. "The only effective way to prevent these deaths is through vaccination." Diarrheal diseases received more attention in the 1980s and 1990s, he said, but interest has waned or been diverted elsewhere, allowing them to creep back. "How did the leading killers end up at the bottom of the global health agenda? I don't know," Wecker said at a recent GAVI meeting in Hanoi. "We've got the tools. We're not looking for the next technological breakthrough. It's here now and it's not being used."

Death can often be prevented by giving children fluid replacement, a simple recipe of salt and sugar mixed with clean water to help ward off dehydration. Yet 60 percent of children with diarrhea never receive the concoction, according to a WHO and UNICEF report released last month. "It is so preventable," said Dr. Richard Cash, a Harvard University expert who helped develop the oral rehydration therapy 40 years ago. "Preventing the deaths is at the very least what we should be striving for."

The recent slapping incident

2009-11-17T18:18:00.001-06:00

“PM 'trying' to make Begum apologize, Civil servants demand Begum's arrest, apology within five days” KATHMANDU, Nov 15: Prime Minister Madhav Kumar Nepal has said he is working to make Minister of State for Agriculture and Cooperatives Karima Begam apologize for her mistreatment of Parsa Chief District Officer Durga Prasad Bhandari, a high-level government source said. The prime minister said this during a meeting with senior bureaucrats at his residence Sunday who met him to discuss the matter. Nepal Government Employees Organization (NGEO), which is close to the ruling CPN-UML, on Sunday issued a five-day ultimatum to the government to arrest Minister of State for Agriculture and Cooperatives Karima Begum and make her apologize for beating up the chief district officer. The organization submitted memorandums to this effect to the Office of the Prime Minister and Council of Ministers through the District Administration Offices throughout the country.

A group of government employees led by NGEO-Kathmandu President Ganesh Thapa handed over the memorandum to Kathmandu CDO Bhola Shiwakoti. NGEO has threatened stringent protests if the demand for arrest and apology are not met within the set deadline. Government offices in Parsa that were closed for five days in protest of the minister´s misbehavior opened Sunday. All government offices in Parsa remained closed for five days reopened Sunday keeping in view the plights of the ordinary people seeking government services. The offices were opened after eight different associations of civil servants on Saturday made a decision to this effect.

Last Tuesday, Begam accompanied by about 50 of her supporters had beaten up CDO Durga Prasad Bhandari at his office allegedly for sending an old vehicle to pick her up at the airport. Begum represents the Madhesi People´s Rights Forum. After the minister faced strong criticism from various sides including the government, she changed her statement and accused CDO Bhandari of misbehaving with her and "not doing people´s work".

The District Police Office, Parsa has already issued arrest warrant against Begum and sought support from police in Kathmandu Valley following a formal complaint by Bhandari´s bodyguard. Begum is in Kathmandu but police have not arrested the minister saying it is unaware of such arrest warrant. http://www.myrepublica.com/portal/index.php?action=news_details&news_id=11826

Nepal slips in corruption index

2009-11-17T18:11:00.000-06:00

Kathmandu, Nepal. November 17. Transparency International (TI), the global anti-corruption watchdog, said the level of perceived corruption in Nepal worsened in the year 2008. "Malaysia, Nepal, the Maldives and Afghanistan, on the other hand, saw their scores decline, representing worsening levels of perceived corruption," TI said in its annual report released globally on Tuesday. Nepal was ranked at 121 position of the index in 2008 but this position slipped to 143 position in the corruption barometer in 2009, according to TI. Only war-ravaged Afghanistan is behind Nepal in the index among the South Asian countries. Afghanistan ranked at 179 position has highest level of perceived corruption. (Neighbouring India ranked#80) http://www.myrepublica.com/portal/index.php?action=news_details&news_id=11894

Oct 24, 2009 Lamatar Medical Camp

2009-10-25T03:27:00.001-05:00

Yesterday we performed a free medical camp in a small village area in the hills on the other side of Kathmandu valley, approximately 2 hours from Anandaban. We set up in a combined school/health post building in the area. Compared to other camps, fewer people came (<200). It was a smaller community than others we’d previously targeted but there were people there in need. Many of the first to arrive were children and orphans. Some were so small. Nine year old boys that were the size of a properly fed Nepalese 4 year old. (I asked several times and checked with an adult nearby.) In our team for the day, we had several foreigners that work here in Kathmandu – a Swiss nurse, a retired pharmacist, an Aussie pediactric nutritionist - plus a Nepalese dental assistant and a couple of Nepalese doctors that were in town who’ve served for years in more remote outposts, besides some of the Anandaban clinical staff (doctors, nurses, pharmacist). There was also a Aussie couple that is volunteering at Anandaban for 3 months (GP and occupational therapist). We collect clothes during the year for these camps and we never seem to bring enough for the kids. An older local boy (maybe 12-14yrs) in a school uniform helped to distribute the clothes with us. For most of the morning while the clinical people tended those who came, one of the Nepalese women in our team talked with the kids, clipping their fingernails. Some of the orphaned kids were managing to live with extended relatives but were supporting themselves by working odd jobs (no schooling). Child labor is common here with estimates that 42% of children 5-12 years old are working. I could not get much information on how they had lost their parents. Life here is hard. The hills are steep, falls and injuries occur with little access to or money for health care.

Early on, we found a woman needing cataract surgery in both eyes. We made arrangements for her to get checked in KTM and potentially have surgery (1-200 USD). One tiny elderly women hobbled in for gynaecological consult. She had a prolapsed uterus about the size of a grapefruit. The nurses helped her onto a couple of school desks arranged back to back in order to give her an exam. The Swiss nurse was stunned at what they saw. The woman had been in this condition for 5-6 years. Unfortunately, the demands of life here make this an all too common problem. This woman had been living for years hauling water and bags of supplies up and down hills, planting and harvesting rice and other crops, hand laundry, tending the animals and family in this condition. I do not even know how she could sit much less work. The medical staff discussed what to do. As there were no lights in the room and the windows had to be closed, I stood to block the door from others coming in while also trying to not block too much light so the doctors could see (Seth’s flashlight once again was most gratefully appreciated). A nurse tried to explain what the doctors wanted to do (push things back into place and something to hold things back in place). The tiny woman got very nervous and wanted her husband. One of the nepali doctors walked to the hill behind the building to get the husband who agreed to the procedure. It was over in a few minutes (performed on the desks pushed together). They gave her some Tylenol and water to drink. She sat there shaking. After 5-6years, in a room full of strangers, it was traumatic. Aftercare and provisions for further problems were explained – she may still require surgery. They were given some clothes and she quickly went home.

The medical team told me that they had done 3 of these at a previous camp – but as I had not helped in the OB/GYN room, I’d been unaware. With hundreds coming in a day, I can only glimpse some of the cases. The dental team stayed the busiest, extracting 28 teeth. A maoist motorcycle rally was going on for a couple of hours a few hundred meters downhill. As we were finishing the clinic, one of the kids that had been running about all day appeared again waving the red communist flag that someone from the rally must have given him.

As we packed to leave, someone mentioned that there was a tent resort area nearby with great views. We visited it on the way out. There was simple restaurant with a number of tents spread out on the steep hillside. But the view was stunning: the breadth of the Kathmandu valley with the crowning white Himalayas becoming visible in the clouds above the surrounding dark foothills. Afterwards, we drove back for a couple of hours downhill on roads that are mostly only wide enough for one vehicle. If another vehicle is encountered someone has to backup up until a site is found where one can squeeze past the other. I really appreciate the Anandaban drivers!

I’ve tried to post some of the pics from the camp below. I’ve now figured out how to compress photos making them easier to post with our internet issues.

These can be difficult places to work – but the need is great. It is a privilege to be given the opportunity to do something here. I hear stories from others that have been placed abroad to work. Horrible tales, unfathomable need. And the problem is that what we see is not isolated – it is all too common. But common does not dull the pain. Lift up your eyes. There is just so much that needs to be done.

Lamatar camp: clothes distribution

2009-10-25T03:26:00.001-05:00

Sorting donated clothes and then passing them through a window to people standing in line. The kids graciously helped one another to sort which pieces fit which kid best. The boy in the blue school uniform (maybe 12-14yrs old) helped the entire time to sort the clothes to the other kids, many of whom were orphans living and working in the community.

Lamatar camp: team arrives at the school building

2009-10-25T03:05:00.013-05:00

Lamatar camp: Dr. Indra discussing plans for the day

2009-10-25T03:05:00.012-05:00

Lamatar camp: view from behind the school

2009-10-25T03:05:00.011-05:00

Kathmandu valley is behind the hill.

Lamatar camp: prepping vegetables for lunch

2009-10-25T03:05:00.010-05:00

Lamatar camp: Jwala and Sally picking stones from the dahl (lentils)

2009-10-25T03:05:00.009-05:00

Lamatar camp: one of the doctors seeing patients

2009-10-25T03:05:00.008-05:00

Lamatar camp: Dr. Indra and Sylvia providing info for cataract surgery

2009-10-25T03:05:00.007-05:00

Lamatar camp: checking for malnourishment

2009-10-25T02:58:00.001-05:00

Did you know that 49% of the kids in Nepal are malnourished? One of the most obvious common effects is stunted growth.

Lamatar camp: playing hide and seek with my camera

2009-10-25T02:56:00.003-05:00

Lamatar camp: dental workers (and surgeon) in action

2009-10-25T02:56:00.002-05:00

It was a slow day...only 28 extractions!

Lamatar camp: signing up at registration

2009-10-25T02:53:00.007-05:00

Lamatar camp: Sylvia with patients

2009-10-25T02:53:00.006-05:00

Lamatar camp: Jwala clipping nails and talking with kids

2009-10-25T02:53:00.005-05:00

Chatting at lunch with Sylvia, the Swiss nurse

2009-10-25T02:53:00.004-05:00

One of the kids after receiving donated clothes

2009-10-25T02:53:00.003-05:00

Hill top view of Kathmandu valley with white himalayas behind in the sky

2009-10-25T02:49:00.000-05:00

Rice Fields ripe for harvest

2009-10-25T02:47:00.000-05:00

No comments please on this picture not being level!!!

1. Level places are not common.

2. It is difficult to take level pictures while riding in a bus on these roads. J

Reese's Peanut Butter Brownies

2009-10-15T23:09:00.000-05:00

This is a recipe that has been tested in my kitchen here (using a “miracle oven” over gas stovetop). Therefore, it comes out in a form slightly like a 2-tone bundt cake. It has been field tested here on Aussies, Brits, Scots, Irish, Dutch, Nepalese, Americans, etc. with favourable reviews!

Reese's Peanut Butter Brownies

3/4 c Butter or margarine

3/4 c Reese's creamy peanut butter

1 3/4 c Sugar

2 tsp Vanilla extract

4 Eggs

1 1/4 c All-purpose flour

1/2 tsp Baking powder

1/4 tsp Salt

1/4 c cocoa

Recipe slightly adapted from: www.hersheys.com

1. Heat oven to 350 F. Grease 13x9x2-inch baking pan.

2. In saucepan, melt butter. Add peanut butter; stir until

peanut butter is melted. Stir in sugar and vanilla. Add eggs; beat well with spoon. Add flour, baking powder and salt; beat well. Pour about 1/3-1/2 of the batter into the pan.

3. Mix cocoa into the remaining batter left in the mixing bowl or pot. Pour on top of the other layer in the pan.

4. Bake ~30 minutes or until brownies just begin to pull away from sides of pan. If you want your brownies American style, take it out “just” as it becomes cooked (don’t over bake). Cool completely in pan on wire rack. Cut into bars. About 36 brownies.

Update Oct 9, 2009

2009-10-09T12:29:00.000-05:00

The monsoon rains just keep coming and coming and coming. They normally have tapered off by now. Since the rains keep the rivers flowing and the hydroelectric power running, there is a useful side to it. However, they are also saying that continuing rains will damage the rice that is ready for harvest – knocking the ripened grains to the ground. Food prices have already shot up from general shortages. Their reduced yield of crops from the late start of the rains this year. This is the season when many are trying to grow enough to sustain their family for the rest of the year.

The temperatures are also beginning to fall. I wore a sweater today for the first time this season (cardigan for non-Americans J).

With the weather report finished, what has the hospital been up to? Well, the Dashain holiday has officially finished. Tihar happens next weekend and part of the following week. During that festival one day is spent worshipping each of the following: crow, dogs, bull, and then sisters worship their brothers. Dogs get a tika (red forehead dot) and sometimes a garland on their day. Have I ever told you about the street dog population here? J

Similar to the Christmas season in other countries, longer term patients here (who are able) request to go home for the holidays and then return afterwards. Others will delay seeking treatment until after the holidays are over.

The other day riding to town in a the hospital jeep, an ambulance with sirens blaring overtook us. One of the staff told me about the patient inside that ambulance that had arrived at Anandaban just minutes before we had left the hospital. The man’s leg had been struck by lightning 3 days before deep in the steep hills south of Anandaban. For about 200,000 people spread out for many hours drive in those hills, we are the nearest hospital. And many of those people live many hours walk from the nearest road. It had taken that man 3 days to get to Anandaban. He probably had to get someone to carry him partway until they could find a road and then some form of transport. By the time he reached us, the leg was infected. Although we have a general ward and an emergency room, this case was too critical and had to be referred to a hospital in Kathmandu... which meant that he had to ride another hour over rough roads. As we sat in the traffic jam listening to the wailing siren stalled ahead of us, one of the staff mentioned that maybe after 3 days the nerves were damaged so badly that maybe he would not be in serious pain anymore at this point...maybe...

Other current events: A church group from the UK has come to help out for a week. Dr. Hugh Cross (Leprosy Mission Country Rep for Nepal) and his wife Diana are here in Nepal for a month. They will be working with various groups, leprosy organizations across Nepal, visiting Lalgadh Hospital and having meetings with the staff here. The first free medical camp is tentatively scheduled for later this month. Next month there is a UK specialist hand surgeon coming to have a surgical camp here and at Lalgadh. The camps are especially good. We line up patients from across Nepal in need of specialized reconstructive surgery as well as interested nepali doctors that need to learn the specialized techniques. Then the surgeons team up for all day surgical marathons! It is amazing to watch people “operate” in their gifting with joy and excitement. They pray before each one. The doctors wear themselves out giving and the patients...it is such a blessing to even see them receive it. It can make such a tremendous difference in their life to have a hand somewhat functional again and not be so obviously disabled in a stigmatized culture. Also, a Japanese surgical nurse who “happened” to visit last year alongside the UK specialist team has decided to come again to help out. More news later...

The surgery pic is from a hand camp last year around this time. Dr. Indra and Dr. Donald (guest UK hand specialist) work on a boy’s hand. In the other photo, a few weeks later, I was able to get a picture of some of the surgery camp patients around the hospital (they have to stay for a couple of months for recovery and specialized physical therapy). One boy is holding his cast out of view while one of the others is trying very hard to resist smiling at me! Please pray for the patients here at the hospital. Many come from far or remote places. Due to the difficulties of life here, sometimes families cannot spare someone to be with a child patient during a long hospital stay.

Leprosy Article Excerpt about Perspective

2009-10-07T06:07:00.001-05:00

Below is a portion of an article written by an MD comparing funding amounts of wall street executives, war initiatives and public health campaigns. He uses leprosy to prove one of the points. the whole article by Dr. Tom Engelhardt is here: http://www.atlanticfreepress.com/news/1/11840-tomgram-matt-bivens-pox-americana.html
When Curing Millions of Leprosy is "Failure"
...But wait. Aren't some of these public health campaigns wasteful failures? Sure they are. Let's look at one public health failure: The drive to eliminate leprosy.
Caught early enough, leprosy can be cured today with the antibiotics dapsone, rifampicin, and clofazimine. Over 25 years -- courtesy of Novartis pharmaceuticals and the Japanese Nippon Foundation -- these medicines have been handed out for free, and have cured more than 14 million people of the disease. They work so well that the WHO now recommends integrating the world's 250,000 known leprosy patients into primary-care settings, just like those with any other illness.
Treatment is so effective, in fact, that several years ago the WHO launched a campaign to eliminate leprosy entirely. Ultimately it sank 15 years and about $200 million into the project. (I cannot find a link for the $200 million figure, provided to me by WHO officials in e-mail correspondence.)
But there's a logistical nightmare when trying to eliminate leprosy. Other targets such as smallpox, polio, and Guinea worm exist in one reservoir only: sick humans.
Not so with Mycobacterium leprae, a bacterium that attacks skin and nerve cells. Even today, we don't know everywhere this bug lives. It has been found in the oddest places: in armadillos in Louisiana and Texas, in the noses of healthy people in some parts of the world, and even in some soil samples.
Such a bug was never an easy target. Even so, in 1991, the World Health Organization vowed its "elimination" -- and then defined "elimination" to mean less than 1 case per 10,000 people. At such a low background level, it was hoped, the disease might dwindle into irrelevance. It hasn't worked. That 1-in-10,000 target was arrived at via politics and hopeful thinking. It was achieved worldwide in 2000, putting the WHO in the risible position of claiming "elimination!" and then seeking more money to, like, eliminate it some more.
The organization was bitterly criticized. Earnest, indignant treatises have been written noting that there is too little money to go around, and accusing the WHO of risking the credit of the more promising drives against polio and Guinea worm.
So, the anti-leprosy push was a $200 million failure.
Because it didn't eradicate leprosy.
It only cured 14 million people.
Of leprosy.
For half the price of an Alaskan bridge to nowhere.
Oddly enough, $200 million is reportedly the tax deferral enjoyed by former Goldman Sachs CEO Henry Paulson -- he of bailout infamy -- when he joined the Bush cabinet as treasury secretary.
So there you have it, finally: For $200 million of public money we can take a walk in the footsteps of Jesus Christ himself, curing millions of leprosy. A truly inspiring future is, as always, easily within reach, if we choose it.
Or we can just give Hank Paulson a tax break. Maybe throw in a credenza by way of thanks.

another favorite goat pic

2009-09-13T11:56:00.000-05:00

This animal was totally calm.

Riding the goats in Kathmandu

2009-09-13T11:22:00.000-05:00

Sept 13 Update

2009-09-13T11:12:00.001-05:00

Namaste. It’s been busy. The power outages are beginning again to cut into the days – but at a mere ~4hrs per day right now, that’s manageable! Tuesday, I depart for Karigiri Leprosy Hospital (www.karigiri.org) outside of Vellore (Tamil Nadu, India). Dashian, the biggest festival of the year is coming in a couple of weeks. Look it up: http://www.nepalhomepage.com/society/festivals/dashain.html . Many goats will die – but then again, many turkeys will soon die in my own country. Although the festival lasts for ~10 days, Anandaban will just have a 4 day weekend. Almost everyone travels to their home village for related rituals, etc; therefore, practically EVERYTHING in the nation closes…newspapers, public transport, all shops, etc. Many of the patients will check out of the hospital to go home and then come back. In leprosy, they may not feel the pain and this is the most important religious festival of the year.

A couple of med teams left to go to some districts in the far west region that are experiencing cholera epidemics. They’ve now returned and given presentations on their trip. I hope to post some pics and stories from that soon. Those areas are so remote and the terrain extremely difficult. Far, far from roads. Days of walking or mule trains into steep, steep hills. Many of the people there have never seen a vehicle. During one health education session the doctors held with some village kids, they asked, “Who has a toilet?” No one did. The teams split up into two districts and walked days between villages. In total, more than 3000 people were seen by doctors etc in the camps. These areas are so difficult to reach and to live in that few educated health professionals want to even go through the effort to get there, much less live there to provide health care. The med teams found buildings that had been built at district headquarters some time in the past, but no doctors.

Around the house pics

2009-08-26T21:23:00.000-05:00

I'm not sure which order these will appear. My personal laptop went blind
(screen lamp dead) and there is no treatment available in Nepal. Therefore
it has taken some time to get some of my files etc retrieved from the hard
drive for posting to the blog. So, the white cement house is my home: No 4
Hansen House. Hansen was the Norwegian scientist that discovered the leprosy
bacteria. My friends may also have heard it before, since I worked at the
US National Hansens Disease Program in some capacity for around a decade or
so. J Looking up from my home on the right, there is the two story guest
house. There are 5 rooms with capacity to host a total of 11 people
comfortably. Higher up on the left is a small "canteen" on the edge of the
hospital driveway. I buy my eggs there, which are carried up in a crate
from the valley village below, Tikabhairab. Right now the going price is
roughly 10 cents an egg. The other pic is a current favorite: looking up
through the pines on a not-too-monsoon day, there is a rainbow about the
sun. J

It's that time of year again...

2009-08-26T11:12:00.000-05:00

The monsoon rains make the grass grow. It can take days to cut a patch. In this picture is the largest stretch of flat space on the entire compound. So, even if someone had a lawnmower, it’s not as if it could be easily applied to the other 98% of the compound. But I think the method is maybe not so great for avoiding the leeches which stand on their tails and wait with gaping mouths for anything to pass by. Because they inject anesthetic first, you usually do not know unless you look or until they are finished and the blood just flows (from blood thinner) after they’ve gorged themselves. Pretty disgusting. Someone told me that tobacco juice wards them off, but since I do not spit…I keep to the clear areas as much as possible.

Eclipse in Nepal

2009-07-22T07:55:00.000-05:00

This morning was the 96% eclipse of the sun here in Nepal (~6:42AM). Elisa and I tried to get good pictures of this “once in a lifetime event”; however, monsoon clouds protected us! Nevertheless, as you can see, the valley below Anandaban is beautifully green as it should be this time of year with rice fields. The pics are during, after peak and then later as it was brighter. The last pic shows a small dam set up in the valley. Although the monsoon rains have come and the fields are green with rice plants, you can easily see that the small reservoir only has a minor stream compared to what it is designed to catch. Monsoon is definitely less this year and it will be reflected in the crop yield.

The leprosy clinic at Patan in KTM was the quietest I have ever seen. Schools and govt offices were closed. There are strong cultural traditions here regarding eclipses (http://news.xinhuanet.com/english/2009-07/22/content_11749650.htm). We also heard that there were two bandhs going on in different parts of the valley.

Crow talker man threatens to halt Nepal's airport

2009-07-19T00:28:00.001-05:00

http://www.ptinews.com/news/180986_Crow-talker-man-threatens-to-halt-Nepal-s-airport

STAFF WRITER 16:21 HRS IST Kathmandu, Jul 18 (PTI) A man who claims to converse with crows and gather thousands of them by his command has threatened to paralyse Nepal's only international airport if the government does not help him get his name enlisted in the prestigious Guinness Book of World Records. Gautam Sapkota, 27 who has reportedly got the unique skill could not get his name enlisted in the Guinness World Records due to financial problems, though he has already initiated the process of registration last year. Speaking at a press conference in eastern Nepal town Dharan yesterday, Sapkota gave three month ultimatum to the government to help him get his name registered in the Guinness World Records.

why sheep? pt3

2009-07-18T23:43:00.001-05:00

Why does a developing world hospital keep sheep onsite? Blood. Lab people often seem the vampires of the hospital. Have you ever given a blood sample for lab testing? Blood is one of the easiest things to get as a sample to reveal a lot of information for a doctor to use. Ever heard of a petri dish or an agar plate? Well, in order to test body fluids for bacteria that eat or destroy blood cells, a little bit of blood is mixed into the agar gel in the plate. Usually this is 5% sheep’s blood because that is easy. If the bacteria are staph or strep from a throat swab, it will grow on the gel and “clear” the red blood color as it consumes it (see pic or visit http://en.wikipedia.org/wiki/Agar_plate).
There are families of bacteria that thrive on the iron in blood. These tests, a microscope and a good lab technician can help in diagnosis so that the doctor can prescribe proper treatment.

So, the well fed handful of sheep act as regular blood donors to help patients receive proper diagnosis. The lab people told me that it is common to also use out-of-date human blood from the blood bank when available, so nothing is wasted. In more developed countries, blood agar plates are just another item to place on order from a science supply catalog. The sheep are housed elsewhere.

Should the next trivia question be easier? J

Why would a hospital need sheep pt2

2009-07-15T21:11:00.001-05:00

Well, the answer is not:

to cut grass – this would make sense to people who have to cut weekly. Here, though, animals aren’t fenced in – cattle roam the streets anyway. Plus it may not rain 9m/yr. So, if the grass does need cutting for cosmetic purposes (very rare & not a high priority), it’s done maybe 2x/yr.
Scare off monkeys – I wish.
Milk – have not heard of that one. Water buffalo is the staple here.
Meat – Nope. A handful of sheep wouldn’t do much for a hospital of 200 beds.
Bait for wild animals that would otherwise eat the humans – Nope. There is an uncontrolled street dog population available.

There is a “scientific” reason. Those who have lab experience, even microbiology lab class, have an edge. Although, I did not figure it out. Someone told me. J And it was spoken as if it was the most reasonable and obvious thing for a lab person to know. This is way more hints than I had.

Why would Patan Hospital in Kathmandu keep a few sheep roaming on the grounds?

2009-07-13T21:05:00.000-05:00

There is a good scientific explanation. Give me your best answer. J

090712 Blog Update

2009-07-11T07:54:00.000-05:00

Do you recognize the two trees on either side of the outpatient clinic sign? They are both native in my hometown and one is my state tree. J This morning when I walked outside it sounded like a pet shop. I hard time trying to see them in the trees, but it sounded like a good sized flock of happy parakeets had decided to descend on compound. The power outages are at the annual minimum about now. We just heard that we are down to 1 “scheduled” hr per day off. It’s a pity that this extra energy cannot be stored properly against the other 9 months of the year when rain does not fill the rivers with hydroelectric power.

The past few weeks have been spent writing grant proposals and evaluations. This coming week, two of our Masters students from Tribhuvan University are hoping to have their final thesis defense. They both worked hard at Anandaban for almost 3 years on a project investigating strain typing for tracking short range transmission of leprosy. It was a lot of work! There are also several sets of government paperwork that need to be submitted this week and next. Next week, a project auditor from the US will come to check on the skin test project paperwork. At the same time, Dr. Hugh Cross, our TLM national rep, will be here for strategic 5yr planning meetings for the hospital. Doesn’t everyone enjoy back-to-back all day long intense meetings?

The week after that… I leave for Japan and Hong Kong. In Fukuoka, Japan there will be an NIH US/Japan cooperative Leprosy and Tuberculosis meeting. Scientists will present their latest findings for discussion. It’s a great opportunity to learn, meet with collaborators and see friends and colleagues! After that, I’ll fly to Hong Kong for a biosafety and good clinical practices training workshop specific for leprosy and TB. The last time I attended a workshop hosted by this group, we were in sessions essentially from breakfast til evening – lots of information. This trip and workshop is funded by the US National Institutes of Health. So, US tax payers, this is something that you are funding. Many sincere thanks! Two of us from Nepal are receiving the training as well as another Leprosy Mission lab staff from Cebu. Hopefully, the training will help us maintain the best levels of lab procedures in handling human samples for hospital testing and research.

By the way, working in a developing country diagnostic laboratory makes for special opportunities. Yes, my office door is right next to where samples are taken for lab testing. How often do people bring their sputum to you in bottles like this? This patient had shown considerable thoughtfulness to carry this with him on his journey to Anandaban. Ishwor promptly added Lysol. I think we prefer our sputum samples freshly hacked on site.

The internet has slowed again of late. Oh well, when you notice that I don’t post as much it is most likely due to power, internet and/or workload issues. It is never, ever because there is a lack of things going on! If I have good internet access in Japan or Hong Kong, I will try to find time to post pics and maybe even video.

Dozen Daughters in Pursuit of a Son (A baby's gender considered a woman's "accomplishment" or "fault")

2009-07-10T20:26:00.000-05:00

http://www.myrepublica.com/portal/index.php?action=news_details&news_id=6821

CHITWAN, June 28: She used to be sprightly and had an aura among her peers in the neighborhood. But a dozen failed attempts at a son later, 47-year-old Krishna Maya Latoula looks like an elderly. Physically and mentally exhausted, she now lives on medicines to support her ailing body that has taken the toll of her indomitable pursuit of that elusive dream and the nightmarish fallout of her failure. Wed to Dashrath of Kumroj-6 while just 15, she has spent 27 years of her married life pursuing the ultimate dream of a Hindu woman. But she had to finally surrender to the ever-ticking biological clock and have not been able to deliver after the youngest daughter Joshna five years ago. Ironically though, the final blow has brought with it a sense of relief for the mother of a dozen daughters. “I take solace in the fact that I no longer have to go through his physical abuse and snide remarks for failing to conceive a son,” Krishna Maya says with misty eyes. “I endured everything for the son but…,” the emotions take over and she fails to complete the sentence.

Living in a joint family with Dashrath´s mother and brother, who ironically has two sons, Krishna Maya has had three of her 10 alive daughters married. The eldest Kala has given a grandson, who lives with Krishna Maya, but that is no consolation for Dashrath. “I had hopes that the son would look after me through my old age, make my name in society and get me across Baitarni (a filthy river on the way to heaven described in Hindu mythology that can only be crossed after rituals performed by a son) but my hopes remain unfulfilled,” Dashrath complains. But Dashrath´s octogenarian mother Laxmi—who still actively heads the middle-class family that owns two tractors, two bigaha of land and a small shop—surprisingly has a different perspective. “There is no difference between a son and a daughter,” Laxmi believes. “Even though I harbored hopes of a grandson, I had advised Dashrath to stop after five. But he did not listen,” she reveals. Dashrath, to his credit, has not neglected his daughters despite being paranoid about having a son. Chanda and Jamuna, like the eldest Kala, have been married while Leela and Sita are studying in the 12th and 11th grades respectively. Ram Maya is in the eighth grade, Shova in seventh, Rama fourth, Durga second and Joshna in kindergarten. “Despite having many daughters, he (father) has never left us short on food and education,” the seventh daughter Shova says. "But he still craves for a son," Shova adds. Krishna Maya knows that craving and empathizes with Dashrath, and even looks to have that feeling of having let him down despite all his criticisms and abuses. “I could have died peacefully only if I had a son,” she completes her earlier sentence. (Sometimes a new wife is obtained in an attempt to resolve this issue, further solidifying the first wife as a failure in the community or leaving her abandoned.)

Monsoon & Rice Planting

2009-07-05T19:50:00.000-05:00

Monsoon means rice planting season. Flooded patties in the valleys and steppe fields cut into the hill sides are everywhere possible. Rice is the daily staple for most Nepalese, so this season is important for the year’s food supply. EVERYTHING is done by hand (or water buffalo). The rains have come late and little so far. People are trying to flood the patties artificially from valley streams to get things going. The temps could begin to fall again before the crop yields.

(Late monsoon brings fear of food shortage in Nepal http://www.google.com/hostednews/afp/article/ALeqM5iERBwP52jPAUFvFoR0qz6vOVee7Q)

Further up into the Himalayas, where people cannot get rice, they eat a thick play-dough like mix of barley meal and water (it lands like lead). The first time that softball sized lump came on my plate, someone recommended that I hurry up and eat it while it was still hot and pliable – because it would only get harder as it cooled. I tried for awhile pulling off pieces like taffy with my hand to dip in lentils; but then my friends had mercy and gave me some rice (which they had all requested – serious hint there). Rice is the preferred food when available. By the way, a leopard has been sighted on compound twice within the last week, at least once in daylight. I haven’t heard of a leopard attacking a person around here. Tigers have a different record within nearby village areas. It’s difficult to tell though sometimes as the word “leopard” is mostly used here for both. Remember Bagheera the black leopard in The Jungle Book? The word here is bagh. The monsoon rains have also helped to ease the water shortage here in this high altitude valley. Here is a sample of today’s tap water. I had just got back from KTM and needed a shower. J All water for drinking has to filtered and then boiled for 5-10 minutes; but a lot of people don’t do it. It costs fuel to boil water like that for daily use in a household.

Late monsoon brings fear of food shortage in Nepal

2009-07-05T08:41:00.000-05:00

(By Subel Bhandari) http://www.google.com/hostednews/afp/article/ALeqM5iERBwP52jPAUFvFoR0qz6vOVee7Q

(The pic is mine taken in the valley below Anandaban last year during rice planting. Deanna)

LALITPUR, Nepal (AFP) — Every year, Nepalese rice farmer Ratnakaji Maharjan celebrates the arrival of the monsoon rains by attending a centuries-old festival in this historic town near Kathmandu. The annual event, in which a huge chariot said to carry the Hindu rain god Machchindra Nath is pulled through the streets of Lalitpur, draws crowds from across the Kathmandu Valley to celebrate and pray for a good monsoon. But this year, Maharjan's mood was more subdued than celebratory as he queued to worship before the wooden chariot. "The monsoon is almost a month late," complained the 35-year-old, whose family has farmed here for five generations. "The weather patterns seem to have changed, and we don't know how to adjust."

Nepal's long-delayed monsoon finally arrived in the Kathmandu Valley on Monday, allowing local farmers to begin transplanting their seedlings to the waterlogged rice paddies after weeks of anxious waiting. But there are fears the delay could prove devastating for this year's rice crop, and experts say the increasing unpredictability of the weather is causing huge problems for farmers in one of the world's poorest countries. "The monsoon this year started around three weeks late," said Krishna Prasad Paudyal, senior scientist with the government-funded Nepal Agriculture Research Council. "This was a major setback for rice planting, which requires lots of water. The delayed monsoon meant a lot of young seedlings died, and even those that could be planted won't have time to mature enough to yield a good crop." Rice accounts for almost 50 percent of cereal production in Nepal, which is particularly dependent on rainfall because less than one-third of its agricultural land is irrigated. The delay to the monsoon came after the landlocked country suffered its driest winter for 40 years, resulting in a fall of 20-25 percent in the production of wheat, Nepal's second-biggest crop after rice.

-- Serious food shortages looming --

Three years after Nepal's decade-long civil war came to an end, the World Food Programme (WFP) says many people are still living in near-crisis conditions, with 41 percent of the population undernourished. Almost one in four Nepalese people live on less than a dollar a day, and around 2.7 million depend on WFP food aid. "There are 16 districts that are highly or severely food insecure as a result of the drought and underlying factors like high food prices and poverty," WFP country director for Nepal Richard Ragan told AFP. "WFP has food-for-work projects in these districts, but we are rushing to include people living in drought-affected villages not covered under our activities." Ragan said the latest drought was particularly devastating because it followed more than 18 months of high food prices and years of poor crop production in many areas. "Many people have used up all of their food and cash reserves and are now forced to take drastic measures to survive -- like skipping meals and selling off agricultural assets," he added. Some local officials are predicting worse to come if this year's rice harvest is poor. Balgobinda Pathak, a government agriculture official in western Achham district, said he was expecting serious food shortages later in the year. "Last winter, food production was down by 60 per cent decrease due to erratic weather and some floods," he said. "This year, 50 per cent of crops have already been destroyed due to lack of rainfall. We will see a massive food crisis later this year." Experts say Nepal is unprepared for the changing weather patterns, and will have to do more to adapt to rising temperatures and increasingly erratic rainfall. "What we have seen lately is not just a change in the weather, but extreme variability in weather patterns," said Pitamber Sharma, a professor and expert on urban and rural planning. "These kind of erratic weather patterns will have a huge impact on farming and cultivation."

Headline news in Nepal

2009-07-02T00:47:00.000-05:00

Nepal sees only 12 days free of strikes in 6 months

http://news.xinhuanet.com/english/2009-06/28/content_11613992.htm

KATHMANDU, June 28 (Xinhua) -- Nepal's statistics showed that in the past six months only 12 days were free of any kind of strike, local media reported Sunday. According to a report of The Himalayan Times daily, strikes or bandhs have lasted for 166 days in the past six months, disrupting traffic and shutting down government offices, business establishments, hospitals and bazaars. All days in January, February and April saw a strike in some part of the country. Except for March 18 and June 13, strikes were recorded every day in the two months. In May, 46 bandhs were recorded, while June has seen 57 bandhs and strikes so far. The statistics, compiled from incidents reported by mass media across the country, also reflect that the Unified Communist Party of Nepal (Maoist) (UCPN-M) has been using bandh as a tool for protest after it stepped down from the government in the first week of May, according to the report. Organizations affiliated with UCPN-M enforced 22 bandhs and strikes in June and 17 in May. The party enforced bandhs for 69 such programs in the past six months. Other parties are also not far behind when it comes to enforcing bandhs. The Nepali Congress and the Communist Party Nepal-Unified Marxist Leninist organized 15 and 17 bandhs respectively in the last six months. Not only the political parties, even locals have started enforcing bandhs to fulfill their demands. In the last six months, the locals organized bandhs and strikes across the country for 175times. They mainly blocked roads demanding compensation for the families of accidents victims.

Armed outfits and Terai-based groups in southern Nepal enforced such programs 145 times while the transporters and traders enforced bandh 92 times in the period. According to the daily, the increasing culture of bandhs is severely affecting the poor's ability to feed themselves, forcing many to skip meals and scavenge for food or borrow money and sell off assets to survive, the United Nations World Food Program said in a bulletin. The Federation of Nepalese Chambers of Commerce and Industries also informed that the nation loses revenue worth 7 to 14 million U.S. dollars on every bandh day. According to the police, bandhs and strikes were recorded on 254 days in 2008. The strikes were carried out by political parties, ethnic groups, students, labor groups, journalists, traders and teachers, among others.

Just how unpredictable are strikes & protests (bandhas) in Nepal??

2009-06-28T22:20:00.001-05:00

Bandh = everything closes, no public transport available (very few individuals own a vehicle), with tire-burning road blocks that threaten to enforce retribution on those that violate the bandh; can be called at any time by practically anyone, but most commonly by protesting people & political groups making demands that are not being otherwise met…in other words, kids get a lot of days off from school, tourists may find themselves walking from the airport to the nearest hotel and the availability of supplies coming into the valley to support millions is more often under threat than not.

Soothsayers fail to put their finger on the date

http://www.kantipuronline.com/kolnews.php?&nid=197190

Kantipur Report

KATHMANDU, June 2 - How could the meticulous calculations go wrong? Or is it that the genius soothsayers simply miscalculated. However, in Kaliyug anything can happen, some say, at least to find some solace. On Monday afternoon, renowned astrologers from around the world gathered in Kathmandu for an international conference on astrology. They were heard whispering whether their science malfunctioned. The event was scheduled for June 1 terming it the best day after rigorous calculations, but it seems none of them could put their fingers on the right tab. A general strike called by the ethnic group Newa Mukti Morcha brought the capital city to a standstill, leaving the astrologers red-faced. While scores of national and international participants were stranded at Thankot, the entry point to the valley, several others in the Capital could not make it to the venue due to the strike. And those who managed to had another problem: how will they go back? The august gathering that was to see at least 700 astrologers of international repute was to discuss ways to make this ancient science more accurate. Ironically, the banda threw cold water on the programme. Though not raised by any participant, a question that must have been hovering in everyone's mind was: How could the astrologers fail to fix a hassle-free date for an international event? Organisers agree that a mathematical error might have led to the wrong astrological calculation. "We had earlier chosen May 30 for the event, but had to reschedule the event to June 1 owing to some problems," said Lok Raj Poudel, chair of the Astro-Council of Nepal and one of the organisers.

"We are no gods," said Dr. K. Divakaran, another veteran astrologer from India. "Astrologers cannot be accurate all the time." However, Kim J. Baaden, a participant, said this question had popped up in his head. He quipped that astrologers might have organised the event on the very day of banda, thinking people would have ample time to participate in the conference in a big way. However, some have different excuses. "June 1 is the perfect date by all means, including lunar position, but predictions generally go wrong in Kaliyug," said Dubindra Serma, an acclaimed head guru and astrologer in the Kiranti community. Astrologers prophecise things as per the message of God but God is also facing problems these days, says Divakaran.

The two-day conference aims to promote astrology as a science, initiate collaboration between Eastern and Western astrologers and modernise the traditional science. Interestingly, the conference also aims to sort out problems of inaccuracy in astrology. "Our astrology still predicts that one will have 12-15 children. Nobody believes such predictions however accurate the calculations astrologers claim to be," said Poudel.

Toenails and fellowship

2009-06-27T05:12:00.000-05:00

A couple of months ago, we had a women’s retreat. The entire thing, except for some activities, was in Nepali. Have I mentioned that I speak about toddler level? I know very much what it feels like for a child to sit in a long meeting as people use unrecognizable words for hours. Really, though, it was very good. We did play some nice games later involving hula-hoops, makeup in a bag and blindfolds. J J We also had a toenail painting session. In the photo, L-R: Elisa, Laxmi and Chanda.

Two stories

2009-06-25T10:57:00.002-05:00

God moves so much in the everyday. Glimpses and gleams. Yesterday, we had the regular weekly outreach leprosy at Patan hospital in Kathmandu. Because we are recruiting for a very big study, the research group has been working in a special separate room from the other hospital staff. During the morning, we were very busy – every station had patients and staff working on different bits of the study. I remembered that Dr. Indra, our senior surgeon who does not come for satellite clinic every week, had not yet seen us in action yet for this particular project’s recruitment. So, I went and told him to maybe come and see when possible. He was busy and said he could maybe get time in the afternoon to come see. We continued to work right through lunch. We were expecting 22 people to come for follow-up that day, and not everyone in the study is a leprosy patient. By the end of the morning, one of the lab staff counted the files and saw only 19 had come. So, the lab staff began making reminder phone calls. One was a young woman. Later in the afternoon, Dr. Indra walked in. I began touring him around the different stations set up for the study. The young woman walked in – at which point, one of the lab staff recognized her from the morning and began to apologize. We’d made a mistake! She had already come earlier that day, and so we did not need to see her again. She sat down at one of the desks with the staff to talk a bit. But Dr. Indra was standing nearby. The woman has a very badly disfigured right hand from a burn injury – no fingers and angled sharply to the side. She manages her scarf carefully to cover it some. Dr. Indra is an orthopedic surgeon; and because many leprosy patients require hand surgery, we do a lot of that Anandaban. Someone spoke to Dr. Indra. He turned to look at her hand. They set a date for her surgery this fall when a UK plastic surgeon and hand specialist will come to perform a week of hand surgeries. J So was it a mistake that one of the staff known for details, mistakenly recalled the young woman to come back? And that she happened to come in the room when an orthopedic surgeon experienced in hand surgery would stand only a few feet from her? J

This evening, we had fellowship at the hospital. Several patients came. There has been a sweet little (and I mean little, maybe 60-70lbs) old lady staying at the hospital for some weeks now. She barely comes to my shoulder. She is blind in one eye. She has no fingers and her feet are not so good either. But she hobbles about at her 80 years, gentle and uncomplaining. Tonight, when we asked for prayer requests, she told us that she is scheduled to be discharged tomorrow to go home. Home is in the Okhaldunga area– which by any standards is remote. There is a flight to that area maybe twice a week – but often cancelled due to low priority and weather. Once she gets there, she will have to walk two days into steep hills to get home. She had tears flowing. She spoke of known bear attacks in the jungle hill paths. Often here, younger men in families will carry the elderly or people can be hired to carry others in baskets on their backs. These hills are steep. I had a very hard time trying to catch if she has any family to meet her along the way, but it sounded like maybe not. No one is coming here to get her. Someone is meeting her in KTM tomorrow, but they aren’t flying with her. It’s highly unusual for a woman to travel alone. There are women in the hospital who can’t go home until someone comes – because they have never been outside their village much before, aren’t educated (most women can’t even sign their name) and do not know how to get home by themselves. So, for this 80 year old to be going by herself…maybe there is no family. Maybe there is no way to get word to them. Maybe because it is now rice planting season, no one can be spared to meet her. How would she get word back to us to tell us she got home safely? I do not know how she will walk two days on her disabled feet. And how without fingers can she manage money to safely pay for things along the way when she is by herself? There are so many stories like this. And it still hurts. Please pray for her. Maybe that someone will be there going to her village to travel alongside her and help her to get home. That there will be no bears and she will not be afraid. Two other elderly women patients walked beside her after the meeting to help her back to the female ward for the night. What to do? Do you know that according to national standards, she does not even qualify as disabled…because it was caused by leprosy.

Leprosy Research out the back of a truck

2009-06-22T22:50:00.000-05:00

One of the studies we’re currently performing compares the skin reactions of people with leprosy to those who do not have it. Hopefully, this will someday aid in making an easy test to detect early leprosy in people who do not yet have major signs of disease. Therefore we could potentially treat them before major nerve damage and disability occur. But for right now, we are pretty busy trying out the prototypes. In this picture, we are spending Saturday morning in the parking lot of Patan Hospital in Kathmandu. Dr. Min Thapa is checking the temperature etc of a couple enrolled in the study. His younger son and wife, Sagar, watch beside him. Sagar is a CMA serving as a nurse in Anandaban.

Christians in Nepal defy extremists' demand to leave country

2009-06-19T21:36:00.000-05:00

Kathmandu, Nepal, Jun 10, 2009 / 03:44 am (CNA).- Hindu extremists in Nepal have demanded that the country’s one million Christians leave the country, prompting churches to reject threats of violence. They emphasized that their mission in the country will not change.

Last week militants bombed the Catholic cathedral in the Nepalese capital of Kathmandu, killing several people.
The extremist Hindu Nepal Defense Army (NDA) took responsibility for the attack in a statement distributed during May 31 public demonstrations organized by the Church, CISA reports.

“We want all the one million Christians out of the country,” their statement said.

Members of local churches make up about 2.4 percent of the Nepalese population. There are about 7,000 Catholics in Nepal.

The Catholic Church in Nepal is involved in social services with the poor, the sick and the marginalized and is generally well-received by the people.

In response to the threats the Christian community, with the support of local authorities, has alerted its members. Christians have taken security measures, with guards being organized to protect their churches.

The NDA since its inception has been fighting for the return of the Hindu monarchy which ruled Nepal for centuries, CISA says. They are protesting the democratic secular system and the rise to power of former Maoist groups.

The extremist group has already carried out several attacks on Muslims and Christians. Last year, Salesian priest Fr. Johnson Moyalan was killed in an attack.

2009-06-15T19:32:00.001-05:00

This is a link to an article about a social studies teacher that is coming to visit Nepal on a Fullbright scholarship. http://www.hometownlife.com/article/20090615/NEWS20/906150314

The line I like best is: “She said the group has been cautioned that electricity is intermittent, and to stay away from certain foods, like milk and cheese, and water.

“It will be an adventure,” she said.”

No lie. J

A "bandh" means "closure", usually of roads, businesses, schools...pretty common stuff

2009-06-15T19:09:00.001-05:00

Nepal's Maoists shut down Kathmandu with strike

Mon Jun 15, 2009 5:09pm IST

KATHMANDU (Reuters) - Nepal's Maoists brought Kathmandu to a standstill on Monday, forcing vehicles off the road and shops to shut in response to a general strike to protest the death of a local Maoist leader, police said.

Carrying bamboo sticks, activists from the Young Communist League (YCL), the Maoists' youth wing, burned tyres and torched vehicles of drivers who defied the shutdown. The strike also forced schools and factories to close.

The former rebels demand the government find the killer of YCL leader Rajendra Phuyal, who died last week.

The strike is the latest in a series of protests and strikes the Maoists sponsored since they quit government in May amid a row over the sacking of the country's army chief. The Maoists ended their decade-long civil war under a 2006 peace deal.

Moderate communist Madhav Kumar Nepal was elected new prime minister but he is yet to name a full cabinet due to wranglings among allies for positions, leaving the country in limbo.

2009-06-05T09:38:00.000-05:00

Asna will be one year old in July. She is the firstborn of one of the staff (Abidan and Muna) and lives on the compound! We were in the hospital bus on the way into town. The regular bumpy road to Anandaban is closed for widening (not paving). Therefore, we are using a bumpier, steeper, alternate road around the other side of the hill. I very much appreciate the drivers here! She eventually fell asleep. J

2009-06-03T06:29:00.000-05:00

Nepal 'church bomber' arrested

2 Jun 2009, 1924 hrs IST, Sudeshna Sarkar, TNN

KATHMANDU: As relatives grieved and the body of the third victim of the Nepal church bombing was consigned to flames, police said they had arrested the Nepali woman who had planted the bomb that killed three people at prayer and injured more than a dozen.

“We arrested Sita Shrestha nee Thapa, a 27-year-old woman, who confessed she had taken the bomb to the Assumption Church in her handbag and hidden it in the prayer hall,” deputy inspector-general of police and spokesman of the force Vinod Singh told TNN.

Shrestha, a resident of Gyaneshwor in Kathmandu, was arrested from a different place — Baneshwor — at 3am Tuesday after investigation. Soon after the blast on May 23, the new government of Prime Minister Madhav Kumar Nepal had formed a three-member team to probe the attack.

Calling a press conference in the capital Tuesday to disclose the arrest, police said Shrestha would be kept in custody till investigations are complete. She would be produced in court in due course, police said.

While the arrested woman reportedly confessed she belonged to a group called the Hindu Rashtra Bachao Samiti that aims to have Hindusim back in Nepal as the state religion, it was not known immediately if she was a member of the shadowy underground group Nepal Defence Army (NDA), which claimed responsibility for the bombing. “She said she was motivated by the NDA,” Singh said.

Shrestha is alleged to have carried a pressure cooker converted into a bomb in a bulky handbag. She went to the prayer hall of the church, pushed her bag under a floor cushion and then went out, saying she was going to the toilet. She never came back.

Around 9am, the bomb went off, killing 15-year-old Celeste Joseph, whose father Balan Joseph is from Kerala, and 19-year-old Deepa Patrick, who had come from Patna with her husband Vikash four days ago for their honeymoon. On Monday, after fighting for life for a week, Celeste’s mother Buddha Laxmi Joseph died of haemorrhage, throwing the family into fresh paroxysms of grief. The 45-year-old mother of three was cremated in Teku Tuesday after her last rites in the same church where she died.

The NDA, headed by Ram Prasad Mainali, has in the past bombed two mosques in the Terai, killing two people during prayer, and a church in Biratnagar in eastern Nepal. They also took responsibility for a blast at a meeting of the major political parties last month and one more near the International Convention Centre last May where the newly elected constituent assembly held its historic first meeting to abolish monarchy in Nepal.

Doubts however would remain about the police claim. In the past, police claimed a wellknown journalist was involved with an armed group from the Terai and arrested him on the basis of “confessions” by two other journalists. However, there are reports that journalist Rishi Dhamala was framed for activities that embarrassed the earlier Maoist government.

Free wheelchairs

2009-05-06T23:35:00.000-05:00

A few months ago, a group called the Free Wheelchair Mission donated 10 wheelchairs to the hospital. This picture is of (right to left clockwise) Dr. Indra, Dr. Ponkaj, Dr. Shudan, Head Nurse Neru, Training Unit supervisor Gopal and Administrative Assistant Aathen unpacking of the first box. These are much needed and appreciated. Leprosy patients tend to develop recurrent or persistent ulcers on their feet – sometimes wearing through to the bone and resulting in infections requiring amputation. It happens because their nerves no longer function properly to direct their feet how to work. The pressure points change and the feet become deformed and worn in unusual areas. When they come to the hospital, Dr. Indra can perform some surgery to restore some function; but most often, the patient has to be taught new life skills as the nerve damage is permanent. They also sometimes have to stay weeks or months in the hospital while their wounds heal. This is when they need the wheelchairs. So, this kind donation will be put to much use!!

Electricity update

2009-04-20T21:22:00.000-05:00

The Nepal Electrical authority (www.nea.org.np) has announced that power allowances will be increased since glaciers in the mountains are melting. Since Friday, I’ve seen 3 different power schedules issued, but none are being followed yet. So at present, we are getting some bonus hours of power – just not on a schedule that we know of. They say we will be taken down to only 12hrs power off per day (versus the 16-20 we’ve been experiencing since January). It will seem almost luxurious.

This photo is of a couple in the wards. The woman is a patient. Often in this culture a spouse will leave when there is a diagnosis of leprosy, but this husband is special. He visits her daily, bringing things to eat and sits with her.

Stupid monkey eating my trash on my wall in my yard

2009-04-16T20:49:00.000-05:00

I had to leave to go into town overnight for a meeting a few weeks ago. Moments before leaving, I had heard the familiar rustling on my back porch. I had shaken the sling shot at him, so he backed away from the trash can maybe 20-30 feet. Then he ignored me as he took his time and enjoyed whatever it was he’d stolen. I knew when I left in a few minutes, he’d just go back. It made me so frustrated, I drug my outside trash can into the kitchen and locked the door. On a compound, however, it did not take long for someone to notice that the trash can was missing from behind my house and rumors started that it had been stolen. Someone broke the news to me the following day. Such is compound life. It’s way tighter than any neighborhood watch program. Don’t ask about the wet spot on the wall. These past few weeks he’s been missing. He showed up with a companion just as the kids were released for a month’s holiday. The boys (and guys) like to practice their slingshot skills. He just climbs up high in the pines out of range. Maybe he has moved on until next season, maybe…

It has been 2 years since April 14th 2007

2009-04-15T07:29:00.000-05:00

April 14, 2007 was 2 years ago. Aubrey celebrated his first birthday party in the Chandler home. That was the day Ms. Donna said, “Maybe it is time for you to go on the mission field.” The next day google in a matter of seconds unexpectedly led to a shocking job description. A week later, I found out about friends who’d dreamt dreams about things it was impossible for them to have known. Two weeks after that, an application was emailed to TLM. In July 2007, I interviewed in London and then began the blog. By September, I’d left the US. By mid-December, I was in Nepal. It still blows my mind sometimes to wake up here, to see some of things I see, do some of things I do and to be with the people here. God definitely is an awesome story writer, has a great sense of humor and obviously has longsuffering patience for those kept clueless. He’s the best of managers.

This picture is of Anshu (for Americans, pronounced more like aung-shoe). Her parents moved onto the compound at the beginning of the year. Her mom is the pastoral counselor in the hospital. She will be 4 in June. This pic was taken when she stopped singing and dancing in the rain long enough for me to get a straight shot. Sorry you cannot see the dancing video. J

Shanku med camp

2009-04-07T09:22:00.001-05:00

Lunch in a nearby home

2009-04-07T09:22:00.000-05:00

What else? Dahl bhaat and tarkari (rice, lentils and mixed vegetables).

Shanku med camp pics cont.

2009-04-07T09:09:00.000-05:00

Hill top view from Shanku

2009-04-07T09:00:00.000-05:00

Pics from the med camp in Shanku

2009-04-07T08:53:00.000-05:00

For this camp, we drove a couple hours south into the hills – waaaaayyyy up into the hills. A couple hundred or so people came. The dentist was extremely popular. We had 50 women signed up to see the dentist within the first two hours of opening. I did door patrol for that room most of the morning – trying to keep little ones from watching other people getting shots in the mouth and extractions. Kids who were in line to be next did not need to see that. As it was, one little boy resolutely refused to open his mouth in that room no matter what his mom or the doctor said. Some things are the same everywhere!

We were so high in the hills, and the hillsides so steep, that we could not see the valleys below between the jam packed hills. One of the vehicles broke down on the way because the roads were so bad (and steep). It and another jeep ended up at the mechanics afterwards. We drove 3hrs back on a different road with better inclines for the down journey. I have much, much respect for the drivers here. “Someone” of our group purchased a live chicken on the way back. For some reason, that bird ended up not in his vehicle, but in ours for the rest of the journey home. But, I will have to say, the bird in the box under the back seat handled the bumpy road pretty well. We just heard a low disoriented cluck every once in a while. When we finally returned to the hospital, one of the doctors told everyone to go home, take some ibuprofen and go to bed. I think everyone was sore from the long bumpy ride. At least with a horse, there is a rhythm to the bouncing.

People who work the brick factories

2009-04-07T08:33:00.000-05:00

The children’s hair should be shiny jet black, but unfortunately is not always so here. The hands belong to a boy, who I would have guessed to be maybe 12. I haven’t gotten used to the fact that some kids here just don’t know how old they are. The people who work all day to form bricks from the clay have scaly, darkened hands like this. I even saw it in toddlers.

Pics from the Bugmati Brick Kiln Med camp (March 25th)

2009-04-07T08:14:00.000-05:00

Just over three hundred people attended this recent free med camp that we performed near a brick factory about an hour’s drive away. We also had some people from the surrounding area. Dr. Indra said some of the people working the brick factory make maybe 50c a day. It is hard work and bad living conditions - basically whatever lean-to shed you can fabricate on your dirt patch to make brick clay. It wasn’t uncommon for our nepali docs to diagnosis malnutrition related issues in the kids. Some of the youngsters working there had come from far away (other side of Nepal) without their family to just try to earn some money. These are always difficult places to visit, but we do what can do when we are there. We had a couple expat doctors volunteer to help that day and several visiting med students from a couple organizations came to observe. We did find a woman who had been recently scheduled for necessary surgery elsewhere, but she had never gone because she did not have the money. She will now have the surgery. This first pic is still in the set up stages and mostly has our med staff and volunteers. You can see Dr. Indra in the middle giving out preliminary directions.

My friends behind bars (no seats in the back of the taxi)

2009-03-16T21:04:00.000-05:00

walking gangs of revelers

2009-03-15T01:28:00.000-05:00

Baljit offers Saraswoti protective clothing for her walk home during the festival

2009-03-15T00:42:00.000-05:00