The Spa at Bayalpata

On Saturday Nardi, Bryan and I pampered ourselves at The Spa at Bayalpata, a not-so-full-service spa where we chose the Deluxe package.  We started with the steam room (just step outside onto the veranda), received our hot bandanas, and got our beard and hair trimmed by the specially un-trained staff.  Nardi filled the role of cosmetologist extraordinaire, but manicures and pedicures were self-serve. Alas, we were out of lemon wedges -  to cover the eyes, and the pool is all dried up.  But we feel a lot more human now!
(post publication note -cucumber is much preferred to lemon - thank you Sandi- but we were out of those too :-)

Before

During

After the Spa at Bayalpata Deluxe Treatment

The International Rotary Club - they're not just pancake breakfasts

Let me put in a plug for actually visiting my blog site on blogger for those of you who read these posts by email.  There are cool websites to check out, a map of where I'm working, and a neat background photo of the hospital.  Click here to visit the website on your mobile, tablet, or computer.

One of the links on the website is for the Nepal Rotary Club.  I have to admit I think of the Rotarians as the folks who have pancake breakfasts and put signs advertising their meetings at key intersections in towns in the US.  I know they do service, but had no idea of their reach until I visited India and Nepal.  Today, out here in Achham province, which, let me remind you, is in the middle of, well, somewhere, but is REALLY remote (10 hours by jeep from the nearest airport), a Nepali man in a suit and sporting a rotary pin came all the way from Kathmandu to deliver a digital x-ray unit for Bayalpata hospital.  As Dr Cam (second from left) said, it's hard to overstate what a visionary, thoughtful, and impactful gift this is to the people of Achham province.  It means that

• doctors here can share x-ray results with specialists around the world in complicated cases.  
• better quality x ray images
• no more film to buy, store, and dispose of
• no more chemicals that get into the environment

There are Rotary clubs, and projects, EVERYWHERE here.  Their reach, and their impact is really, really impressive.

What's your pleasure?

I've been thinking today about how the things that I take pleasure in have changed since I got to Achham. One of the wonderful things about getting out of my comfort zone has been re-discovering forgotten pleasures.

Things that I'm taking less pleasure in:
-Food - we have enough to eat, but there's no comfort eating here
-Starbuck's coffee (although I have Via - a marvelous product for the traveler)
-Getting in the car to go someplace (no car, few places to go)
-Movies (don't got 'em)
-Sleeping (it's hot and the bed is hard)
-Running
-Nice clothes (I know this is hard to believe for some readers, but from my present vantage point I realize how much pleasure I took in putting on clean clothes)
-My belongings - there's nothing like NOT seeing my things every day to help me realize how much seeing all my things every day (house, car, lawn, garden, ...) gives me pleasure and comfort

Things that I'm taking more pleasure in:
-Talking to my wife (boy do I appreciate something more when it's limited)
-Emails and texts from my kids (hint!)
-Music
-Other people's kids
-Sunsets
-Stars
-Cool breezes (did I mention it's HOT?)
-Conversations with Nardi and Bryan
-Seeing how my work is or will help the hospital function more efficiently
-my gifts, and those of my colleagues (it's fun to realize on this small team with limited resources what each person, including myself, is capable of contributing)

So, what forgotten pleasures have you re-discovered recently?

Human connections

My job here is to help Bayalpata Hospital with its logistics challenges.  But my mission is broader than that.  It includes connecting with the people here on a more fundamental human level.  This is challenging for me in at least two ways: I don’t speak Nepali, other than a few words ("Philip, my name is."  "Egg, is there?") and I’m an introvert.  So I’ve been thinking and praying about ways to make human connections beyond the traditional greeting, “Namaste,” which is so regularly uttered as to easily become routine and mindless.

I was blessed with such an opportunity when Abishek “interrupted” my day.  The first time he did this was when I saw him sitting on a bench outside the office where I was working.  His mother is a community health worker (CHW) who had come to the hospital for a weekly meeting at which the coming weeks work plan is hashed out.  It happened to also be a new mother workshop, so there were lots of infants around.  

Attendees of the new mother workshop at Bayalpata hospital.  Community health workers encourage new mothers in their communities to attend the workshop.

Abishek looked bored, so I rustled up some crayons and paper which he happily accepted.  An hour or so later I was working on my computer when I noticed my cursor seeming to move around on its own accord.  Looking to my side I was surprised to see that Abishek was moving my mouse around, turning it upside down, and generally inspecting it to see what fun things could be done with it.  This was my signal to end my work for the day and get down to the real business at hand.  So I went to the dorm to get my soccer ball and heard the first and only English words from Abishek – “yes, yes!”

We spent about 20 minutes kicking the ball around together, and were joined intermittently by some of the other CHW kids.

Abishek is the one with the bandaged head.  I never heard how he hurt himself but he was pretty energetic!

Bayalpata Hospital - Filling a Critical Need in the Community

Possible Health, which is the new name for an organization more popularly known here as Nyaya (pronounce Nee - AYE- Ah) Health, was started by a group of medical students who responded with compassion and action to a desperate shortage of medical doctors in this remote region following Nepal's recent civil war (1996 - 2006).  Byalpata Hospital is a public private partnership - the land and buildings the hospital operates in were provided by the government, and Possible Health operates the hospital, raising funds to pay for equipment purchases, salaries, and most medicine purchases.

The hospital fills many critical health needs in the community, including:
-maternal and child health
-communicable disease treatment
-emergency treatment for trauma

It does this through its emergency and outpatient departments, which treat approximately 300 patients per day, a 53 bed inpatient ward which is about 80% occupied, and an active community health program, which sends community health workers into the field to encourage safe birthing in hospital, to provide patient follow up, and to conduct health literacy campaigns.

This is a busy time at the hospital.  Last night the hospital staff conducted a Cesarean section, one of several births this week.  It is cholera season in this part of the world as the rainy season starts, so ensuring a robust supply chain to the essential medicines is one of our tasks while here (we were able to provide a thorough inventory assessment to the Bayalpata hospital director on arriving here last week).  And every day we see children with casts on arms or legs -  needed for broken limbs sustained while working, or just walking, in this place where stepping off a path often leads to a punishing fall.

The doctors, nurses, and community health workers here do their healing work with great teamwork and grit - facing chronic shortages of power, manpower and properly maintained equipment.  I'm honored to be permitted to support them, and will share more about these amazing people and their work in future posts.

Sunday at Bayalpata

I'm happy to report that I've been blessed to encounter two Christians at work here at Bayalpata hospital. The Bayalpata fellowship at this point consists of SP, a Nepali-American who is operations director-Nepal for Nyaya Health Nepal / Possible;  Marina, a Nepali medical student, and me.  We had a great time Sunday evening enjoying the beauty of Nepal, sharing stories, the bible, prayer and song.

"For the beauty of the Earth!" - the view from our hilltop perch during our Sunday meeting

The Trip to Achham

On Tuesday, after meeting with the government regional stores inspector in Dhangadhi to pick up supplies of medicine, we began our journey to Bayalpata Hospital in Achham province.  The journey is 276 km (170 miles), over winding roads through the hills of western Nepal.  We made three strategic food stops chosen by our driver, which was a tour of the roadside offerings of Nepal.  Yes, we were careful to avoid meat and eat only fully cooked items.  Well, except for our first stop, where our driver introduced us to the delectable Kafal berries which grow in Nepal.  Ours were picked by two smiling women waiting on the side of the road for just such a car to go by.

Kafal berries on offer along the road to Achham

Khir being prepared over an open fire

We also stopped for Khir (a rice pudding prepared in buffalo milk) in a smoky house with a pitch-lined room and an indoor wood fire, and chow-chow (Ramen noodles fried with egg and onion).  We arrived at the hospital at 9:45 PM, a journey of almost 10 hours.

The road to Achham is a 1 1/2 lane road, where vehicles traveling in either direction ride roughly in the middle of the road and pass one another as they approach.  There is a lot of horn beeping around blind curves.  Our typical speed was 30 km/hr (19 mph), but its a nerve-wracking experience at times.

We arrived to find three folks already in the dorm, Michael, a doctor from Vermont who comes to Achham to volunteer his time twice a year for two weeks each time, SP, the hospital operations director, and Jess, the finance director, and three open beds.  We drew straws to assign beds and bunked down, so happy to have that long journey behind us!

One of the three rooms in the dorm

Thanks to my teammate Nardi Odijk for providing the photos!

Phase 1: Benchmarking and Supplier Interviews

The Richard T Clark fellowship program is designed to promote the sharing of expertise between Merck and small non-governmental, non-profit companies engaged in Global Health improvement activities.  Our job for Possible Health involves (among other things) streamlining processes and improving procedures related to the entire supply chain for medicines and medical supplies, including whom to source from, how to ensure quality, and how to get the best prices.  Some of these medicines and supplies come through private distributors and some are procured and supplied through government channels to the hospital.

To do this, we decided early on that we wanted to make the best use of our time in Kathmandu, where most importers, large private hospitals, and government agencies are located.  So our schedule has been full of meetings.

Here's one example:
The National Tuberculosis Center provides TB treatment throughout the country.  It's supply chain practices have been very successful.  We spoke at length with the director about the key factors in their success and the challenges they face maintaining good quality at low prices.  We also shared traditional chiyaa tea, a common custom when meeting with visitors in Nepal.

Philip, Pradip, Bryan and Nardi at the Nepal National Tuberculosis Center 

After our meeting with the director

 

Second leg: Dhangadhi, Nepal

Yesterday our team of three arrived in the western city of Dhangadhi after a one hour plane ride on Buddha Air. The terrain is much flatter here, south of the hilly region, than I expected to see in Nepal. This area is known as the Terrai, the flatlands. The monsoon is expected to start in the next week or so.  Pre-monsoon weather is HOT and humid; yesterday's temp reached over 105 F.

It is a blessing that this journey has proceeded in stages. From US to Kathmandu, to Dhangadhi, to Achham, the comforts from home are reduced in stages, the climate and other challenges increase, but we have time to adjust to the changes. 

We stay in Dhangadhi for two more nights before heading to Achham by jeep. We have several meetings with hospital suppliers over the two days. 

Missing home, but holding up well!

Getting to DHangadhi on Buddha Air

In the air between Kathmandu and Dhangadhi

Outside of Dhangadhi

Kathmandu - first stop

After a 20 hour plane ride (where I spent the first 9 hour leg to Istanbul in a mercifully provided exit row seat, and next 7 hour leg from Istanbul to Kathmandu stretched out over five middle seats on a big, blessedly empty plane), I arrived at Kathmandu on Tuesday morning.  

My colleagues Nardi and Bryan and I are well situated at the very comfortable Summit hotel in Kathmandu for a few days where we are benchmarking hospital supply chain operations at Grande hospital (big, western, caters to the wealthy) and KTM Model hospital (smaller, run by an NGO, caters to the less well off), and a few other organizations on behalf of our client, Possible Health.  We met with the head of the Nepali government's AIDS ministry for dinner and a far-ranging conversation.  Among Dr Hemant Ojha's many insightful comments was this one: "going to Achham will change the way you worship your God."  I am quite sure he's right!

I also met the fabulous Esther Laxmi of International Needs Network, Nepal, who is leading a Christian ministry among the poor in Kathmandu and outlying regions.  IN Network sponsors children, providing food and education support in concert with the public education system, and also provides vocational training and guidance to young women from around Nepal as part of its "Lydia" program.  We discussed the possibility of identifying candidates for this program from the Achham district.

Here's a blast-from-the-past Youtube link shared by my friend Jen to get you in the Kathmandu spirit.

I'm really grateful that we're off to such a strong start on our project here in Nepal!