olddog60s

[olddog60s]

Our Lives

In the first picture you can see the hospital, with the blue rooves. The building next to the river cliff is the accommodation where we lived. There are four upper and four lower rooms. We had an upper rooms as our kitchen living room and we slept downstairs. The buildings are breeze block construction with concrete floors. At least the floors/walls were painted. There was no heating, but you could cope with that because Chaurjahari has a relatively mild climate .In winter it never gets below freezing and in summer you get average temperatures in the mid to high 30 C’s.

We had luxuries in our accommodation. A gas cooker fuelled by propane, solar panels for electricity with a battery back up system. A shower, flushing toilet and we had the luxury (actually the necessity for us) of large containers of bottled water which we boiled and then filtered through a large, high quality, Swiss made, water filter.

Jamuni was our housekeeper and cook. There is a picture of me with her and her son, Yam. They ate with us each day which was a way of supplementing Jamuni’s wages. I would have liked to pay her more but we weren’t allowed to. It would have led to problems in distorting the local economy. We found other creative ways to help her and Yam. Jamuni’s husband deserted her years ago.

Strangely enough, we were never ill in Chaurjahari, but we both had stomach bugs a number of times when we visited Kathmandu or other towns!

Belinda’s work was as Nurse Trainer. She did a really good job in teaching the nurses good practice and implementing systems in the hospital. Many of the facilities were basic. For example, instruments for operations were sterilised in pressure-cookers. Belinda spent a long time training the staff the procedures to do this correctly. She also helped out with operations and generally oversaw the nurses.

When we were there there was only one doctor. There is a team of doctors there now. There were however a class of medical staff called CMA’s. They were I guess like nurse practitioners and could even perform simple surgery and anaesthesia.

I was there to help to improve the hospital administration, and come up with an action plan for marketing and fundraising. I also did what is called a SWOT analysis with recommendations. My role also involved having input into the spiritual care of the staff and patients. I also helped in the local church.

[olddog60s]

Health

Chaurjahari hospital was started as a Christian Mission Hospital. It serves a vast area. There is a state run hospital in a town about five miles away but the quality of services is poor. That is because Nepal is a poor country with few tax payers.

Chaurjahari has an excellent reputation. It provides simple operations and health care and medicine. There is an emphasis on mothers and babies and many children are born in the hospital each year. Because there are no roads, people have to walk or if they are too ill to walk, be carried by family/friends on stretchers. People walk for days to get to the hospital. The record whilst we were there was a family who had walked six days to get there. Their loved one was treated and recovered.

The hospital runs solely on charitable donations and funds from charitable trusts..Patients who can afford to pay, pay for their treatment. There is a sliding scale of payments and those who can’t afford to pay have all their costs met by the hospital charitable fund. A high number of patients benefit with payment in part or full from this fund for their treatments. 

Care is availabe 24 hours/7 days/ every day. Here is a paragraph from the webiste of the Nepali charity which now runs the hospital. (This is an adapted form of something I wrote for their website when we were in Nepal).

“CHR (Chaurjahari Hospital Rukum) is situated in one of the most remote and rural regions of Nepal. It is located in the centre of three districts (Rukum, Jajarkot, Salyan) in the mid-western region of Nepal. The aim of the hospital is to mainly provide quality and affordable medical services to the underprivileged and marginalized communities of people of Rukum and its surrounding districts.

Rukum was one of the centres from where the conflict flared up, CHR faced many challenges during the 10-year long insurgency.  CHR was initially operated by TEAM but with the rising tension between the government and locals, CHR was completely shut down and could no longer operate due to political unrest. HDCS was requested to manage and operate CHR, the situation was risky but HDCS saw the urgent need for CHR to reopen since it was the only hospital in that region. HDCS successfully reopened CHR and continued serving the people. Even with the end of the conflict, there were many other issues the hospital worked to fight against.

Being in a remote area with limited modern advances, the hospital struggles to change the mentality of people regarding health care. Lack of education has allowed locals to hold on to false beliefs and superstitions. For example, many people seek help from traditional healers for physical ailments and only come to the hospital as a last resort. CHR along with PHP is working to educate communities about health issues and to bring positive social changes.

In this way, CHR efficient services and many life changing procedures has established the hospital as a place where HDCS can give quality care for minimal costs.”

Just to give an idea of the problems Nepal faces because poverty means there are few taxpayers, therefore the government has little money to spend on services, I’ll share this experience.

The Nepali health system has doctors, two grades of nurses (fully qualified and ANMs) and CMAs, who are doctors’ assistants. CMAs assist doctors but are also trained to perform simple operations which don’t need anaesthetics. They can diagnose issues and prescribe treatments and drugs.

On one occasion one of the Nepali administrators (he was a competent English speaker) took me to visit a Government Health Post in the area which was run by one CMA. It took us two hours to walk to the village and when we arrived the CMA was sat outside the health post with a school type exercise book to keep his records. There were swarms of flies in the air. He told us he had had two patients that day. When my colleague told him we were from Chaurjahari hospital the CMA allowed us to look inside the health post. I immediately understood why he was sitting outside and not inside the building. What I saw shocked me. The inside of the building was literally like a ghost town is portrayed in an old Cowboy Western. The rooms were filthy. The shelves and the medicine containers and equipment on them were covered in thick cobwebs. Another picture sprang into my mind...like something out of an early twentieth century Hollywood horror film. The health post literally looked like a film set. It was surreal. That is the tragic situation of a country which doesn’t have a functioning economy. The government provides some services, but in rural areas, they are pretty much services in name only. 

When we were there, Chaurjahari was a 38-bed hospital. There was one doctor, but he left after the first six months and for about another six months there was no doctor. We had one fully trained nurse and five ANMs who were not as highly trained, but in practice performed the same work. There were six CMAs, a couple of which were experienced and highly competent. There was also an X-Ray technician and two trained Lab technicians. They were the medical staff. Belinda’s function was to help with the ongoing training of the nurses and to implement better systems in the hospital.

In reality, she was often called upon to use her skills and experience to intervene in difficult medical situations. Belinda often assisted in the Operating Theatre when there was a doctor there. We also had a highly motivated retired, French doctor who worked for TEAM. He used to come maybe three times a year and stay for 6-8 weeks. During that time, he trained the doctor and other staff and he performed operations each day. 

One incident I remember well was during the time when the French doctor wasn’t there and there was just the Nepali doctor. One night, Belinda and I got woken up by the Security Guard. “The doctor needs Belinda to come to the Operating Theatre straight away, and he wants you to come too.” It was maybe 2 AM. We got up quickly and walked across the volleyball court to the hospital.

The doctor was dealing with a difficult birth. The mother had been in labour for a couple of days. Instead of coming straight to the hospital, her family had secured the help of the local Shaman (traditional healer). Only when his help produced no results did they bring the lady to the hospital as a last resort. The problem was that the family were all at the hospital. They knew the woman was in a life-or-death situation, but there was an expectation that the westerners would save both her and the baby. The doctor told us all this and said he was very worried. He knew he could only save one of them ... and that this was going to create problems with the family. 

He wanted Belinda there to help him with the difficult birth, because he knew she had the required skills and experience. He asked me to come because he wanted me to pray. That was quite a humbling request as the doctor did not have an altogether positive attitude towards faith. He also wanted the moral support of another man. As it turned out, he and Belinda delivered the baby and saved the woman’s life, assisted by the ANM nurse. At the point of delivery, the ANM who was reading the instruments, was told by the doctor to come and assist himself and Belinda in delivering the child. He then told me what to do, but I had to read out the blood pressure and oxygen level reading from the monitor and say them out loud to the doctor. 

The child was delivered but was sadly dead. Then the doctor and Belinda and the ANM made sure the mother was stabilised and she survived. That was my first ‘hands-on’ experience of death. The ANM wrapped the dead baby in a blanket and the doctor asked me to take it and put it on the table whilst they worked on the mother. Holding a dead, new-born baby in my arms was a shocking and humbling experience. But for medical staff, sadly, it is something they often face and just must live with.

Once the mother was stabilised, she was put on the ward. Then the doctor had to break the news of the death of the child to the family. They were understandably upset because there was also an expectation of western medicine being invincible. This led to accusations of the doctor being incompetent being made by the family to local politicians and leaders over the next few days. Thankfully, the two Nepali Hospital Administrators who I was working with, were both well respected in the community and amongst the representatives of all political parties. They managed to smooth this issue over. The reality was that the child died because the family should have brought the mother to the hospital 48 hours earlier, rather than going to the village Shaman (healer) for remedies. The poor doctor carried a heavy weight of expectation. To be the only doctor made that a heavy burden to bear.

And Belinda too had high expectations on her. When there was no doctor, she was looked to as being the last line of defence in difficult medical situations.

[olddog60s]

[olddog60s]

Chaurjahari 4

Water has to be brought from the river each day for many villagers. It is often young girls who do this work. The containers they use weigh about 20kg when full and it is about a 30 metre descent on a rocky path to the river.

Since we left and electric pump has been installed to pump water up to the village, to a tap near the hospital. As is often the case, things start out well but often fall into disrepair.

The locals drink and cook with river water, and they bathe in it. Their animals do the same. Water borne diseases are common.

Most houses don’t have toilets so people go into the bushes to do their business.

There is electricity. It is hydro generated from this small dam. The electricity supply is intermittent, especially in the dry season.

[olddog60s]

These pictures show what life is like in the villages for Nepalis. They live in simple houses and usually own a small plot of land by their house or nearby. They grow what they can on their plot and there are communal fields for rice and other grains. All households keep animals, usually under/next to the house. Water buffalo are useful for ploughing, and to eat eventually. Pigs and goats are kept for meat. They are slaughtered and what one family can’t eat is sold to neighbours or family and friends. Chickens are also popular but they and the goats are pretty gaunt and don’t have much meat on them.

Cooking is on open fires inside the houses. There are no chimneys but the smoke goes out of the windows which are just window shaped spaces with no glass. A close look at the wall in the cooking picture above will illustrate why respiratory diseases are so common amongst Nepalis. Many of them also smoke heavily.

Wood for cooking fires has to be collected, often by women. Children too get involved with animals and working in the fields. Look how young the girl with the scythe is. She can use it safely and competently and knows how to bind sheaves. Children also look after and milk the goats.

Anything which can’t be grown has to be gone without. The shops in the Bazaar sell cooking utensils, matches, torches, batteries and some spices. There are also lots of cheap eateries where Nepalis can get their staple diet of rice and daal, with vegetables if they are available. Meat is a luxury for most villagers.

[olddog60s]

Chaurjahari 2 There was another way in/out. Yes, that is a ‘donkey train.’ There were no roads so food which couldn’t be grown in the fields and other things like clothes and vital supplies arrived by donkey. Some of the goods came from China on a series of ‘trains.’ Our diet, like all Nepali’s consisted of Dal Bhat twice per day (daal and rice). Whatever vegetables were in season were added. Meat was an occasional luxury, maybe once/month when a local killed a pig/water buffalo/goat. We could also ask for chicken. It was fresh. Arrived on our balcony alive and one of the locals despatched and plucked it for us to eat that same day.

[olddog60s]

Chaurjahari 1 Chaurjahari Hospital lies around 325 km (200 miles) west of Kathmandu, the capital of Nepal. Belinda and I were there from January 2007 until May 2008, when we returned to Europe. Chaurjahari is very isolated. When we were there, the only way in/out was by plane from Kathmandu. When I say plane, I mean a Twin Otter propeller plane. This is the plane we flew on. Those are the Himalayas you can see out of the window. The other pictures are of us unloading when the plane landed and Chaurjahari airport :)))) It is actually a field. You may wonder why the airport buildings are so delapidated. Chaurjahari lies in the heart of Maoist country, and in the civil war against the King, which ended in November 2006, with the peace accord, they attacked it and burned it down. Nobody was killed in the attack, they emptied the buildings first. When we were there, there was just a radio room where an operative had contact with incoming/outgoing planes. There were two flights per week. One in/out for Kathmandu and one in/out for another town.