Best Monsoon Trek Ever! - Part 1

Our time at Bayalpata Hospital has flown by, and we're already past the halfway point.  It surprised us to realize that we had been working at the hospital for six weeks with only two days off.  We needed a break!  So we took advantage of a week's leave to go to Kathmandu (Nardi) where wife Marja was traveling on her way to India, and to Pokhara (Bryan and me) to get some rest and relaxation.  Bryan and I met up with a fantastic gentleman named Dinesh, who turned out to be the CEO of Helping Hands, about which you'll here more in a future post.  Dinesh became our guide, friend, and connection-maker during our week in Pokhara. 

Based on the advice of some of our coworkers at the hospital, we decided to go on a four day trek into the Annapurna mountains (part of the Himalayas).  It's a risky time of year to go, because it is monsoon season throughout the Indian sub-continent.  We were told that it was likely that we wouldn't have views of the snow-capped Himalayas, that our trip might be dampened by rain, delayed by mudslides and hampered by leeches, but that the trip would be beautiful regardless.  We decided to chance it.  The saying is that God can't steer a parked car, and my heart told me that if a miracle was to happen, we needed to put ourselves in a position to experience it.

We met up with our guide, Mandan, in Pokhara and drove to Nayapul, our starting point.  It was raining, but we had purchased head-to-toe rain gear, and brought plastic to cover our backpacks.  After one hour the rain mostly stopped, and that turned out to be nearly all the rain we'd experience while walking during our trek.  It rained in the afternoon and at night, but when we walked it almost never rained (other than a few sprinkles). 

 

Philip and Bryan at our first rest stop,  and the first foot bridge over a monsoon-swollen stream

After climbing what seemed like thousands of steps, we made it to the town of Ulleri, where on a clear day, we were told, the snow-capped South Annapurna and Himchuli peaks are clearly visible.  This day, though, there was nothing but clouds.  We settled into our rooms in a tea house, where we were the only guests.  I kept stealing glances down the gorge towards the Himalayas.  Towards the end of the evening, we began to see, revealed through the mist, pieces of the mountain and its snowy summit lit by the sunset.  We were so excited! 

But even better was to come!

Our first glimpses of the Himalayas (the peak is Annapurna South) through the evening mists, from Ulleri after our first day. 

Thankful for safe travel

Bryan Nardi and I have been working at Bayalpata hospital for six weeks with two full days off. We decided to use a week allowed by the program for some rest and relaxation. 

With the monsoon gaining momentum several roads are washed out north of us, but our biggest challenge turned out to be leaving the hospital driveway, for which we needed a tractor tow.  The rest of our 12 hour jeep travel to Nepalgunj and on to Pokhara (for Bryan and me) was uneventful. 

Nardi meets his wife, who is traveling in the region, in Kathmandu. We're very relieved and thankful this morning for her safe arrival in Kathmandu given that her flight departed at roughly the same time, from the same origin, and a route that was too close for comfort to that taken by the Malaysia Airlines flight that was downed.  

Please join me in prayer for the families of the lost and the many victims from around the world. 

Weekend!

Nepalis have a six day work week; their one day off is Saturday.  My sense is that this extra day of work compared to the West doesn't result in proportionally more productivity, though. 

Last night we ate at our favorite restaurant up the hill in Bayalpata village, affectionately known as "The Hookah Bar," even though the restaurant has no Hookah. The rumor is that they hope to buy one and named their restaurant in anticipation of the event. Our regular patronage will surely help!  For $12 we had a biryani with chicken that would rival the best Indian restaurants in Philadelphia, easily. 

On the way up (30 minute steep climb) we noted how the recently brown fields have been sown with rice. It's been rather dry for the monsoon season, so farmers are betting on a change to support their rice. We've had a rash of injuries from farmers' encounters with bear and wild boar here  - more of the hazards of this beautiful but very rugged and challenging place. 

Box Kite brings joy in Nepal

We've had a "box kite," a three dimensional (not flat) kite that we've taken to the beach and various windy locations since Maggie and Spencer were small.  Box kite has turned into our version of "Flat Stanley" who has been having quite an adventure.  Latest installment - Nepal!
Yesterday we had a windy afternoon here and two kids who live nearby and hang out at our dorm pretty regularly to play came by.

I think you'll agree the attached video is worth watching!

BPH Anniversary Celebration - the Goat, the Baaahd, and the Ugly!

Bayalpata Hospital celebrated its fifth anniversary on Saturday with a staff party. [ In retrospect, since it has rained non-stop since Sunday, it might have been more advisable if we'd all pitched in and built an ark.  The monsoon has finally arrived in all its fury.] Instead, starting at 7 AM we had a friendly football (soccer to you Americans) game with the Nepal Armed Police.  Yes, that should make you nervous - when we arrived we found what looked like a regiment of Palace Guard troops heading the ball to each other in near perfect synchronization.  Here they are lined up to walk the field and clear it of debris. This is an even more important task than you might think as these guys play barefoot! Yes, the picture is taken in front of a control tower.  This is the site of the old Sanfe Bagar airport, which was bombed in the civil war a few years ago and is not currently operational.  We were told that the airport will resume operation in a few months.  We'll see...

The Nepal Armed Police - players in blue

Spectators enjoying the match

A little American football on the sideline

The final outcome assured Bayalpata hospital a robust ongoing defense from the Nepal armed police, while preserving the dignity of its own: 1-0 in favor of the police.

We packed a jeep (24 people in and on a vehicle the size of a Range Rover) and headed up the hill for an afternoon of food prep, eating, dancing, kite flying and coloring for the children, and singing!

Lunch

Stirring the (vegetable) pot

#Nepal #Bayalpata

Recapping the Adventure so Far - My Merck blog

Well as promised, dear readers, here is the first blog I sent into Merck as required by the Richard T Clark fellowship program - for your reading pleasure!

At Merck we’ve often talked about the importance of “walking a mile in our customer’s shoes.”  Well, what if we took that idea a few steps further – from walking in their shoes to living among them, working, and even playing with them?  The Richard T Clark Fellowship for World Health is giving me and two MMD colleagues Bryan Baylis and Nardi Odijk the opportunity to work, live, and play in a place where the challenges to delivering health care are among the most difficult in the world.

Philip Kuhl, Pradip Bagele (Possible Health, Nepal), Bryan Baylis and Nardi Odijk in Kathmandu before a meeting at the Nepali government’s National Tuberculosis Center

What are those challenges?  In two words – poverty and remoteness.  The average per capita income here in remote far western Nepal is about $0.50 per day, the chief business is agriculture, and many heads of household travel to India to get jobs to support their families.  How remote is this place?  To get here to Bayalpata requires 10 hours by jeep over a partially paved road from the nearest city with an airport.  For most residents in this region, travel is by bus or on foot.  The nearest towns, which require a 40 minutes’ walk in either direction on the one road in this area, are small hamlets stocking the barest essentials in tin-roofed roadside stalls.

We live and work at Bayalpata hospital, a public-private partnership between the Nepali government and Possible Health (www.possiblehealth.org), a non-profit (they prefer the term “for impact”) company of physicians, nurses and community health workers that runs a regional hospital and its community outreach operations including ante-natal, hospital birth promotion, and chronic disease management programs.  It has 53 in-patient beds and serves 300 patients a day in its outpatient department.  Its community health operations span fourteen village development committees throughout the surrounding district of Achham.

Bayalpata Hospital, in Achham, Nepal.  The Merck RTC fellows live in the white building under construction in the back right of the picture.

 We’ve seen the effects of the challenges of poverty and remoteness on medical rounds at the hospital.  Last week we encountered four infants suffering from malnutrition, two young girls with fractured legs (people walk a lot on narrow paths through the mountainside, and falls are punishing), and a case of leprosy, an ancient disease that has been eradicated in most other parts of the world.  The two deaths here last week – a premature infant and a 60 year old man with a collapsed lung, would likely have been avoided if transport to a larger center were economically and logistically feasible.  In this environment, choices about how to spend resources – time as well as money – have life and death consequences.  The three doctors and the rest of the staff here face these questions daily; there are no easy answers.

It’s fitting that three Merck supply chain experts should be deployed here in Achham province, Nepal, where so many problems boil down to logistics.  We have two areas of focus – optimizing the external supply chain that delivers medicines and other needed supplies to minimize cost while ensuring quality, and organizing and streamlining internal operations.  The internal operations include management of hospital stores and pharmacy dispensaries and development of simple operational management procedures (for example, what happens when a shipment of medicine arrives by public bus in the middle of the night during the monsoon)?  My MMD colleagues and I will share more about the details of our work in future posts – we hope you’ll stay tuned.

You might be wondering – what do you do for fun out there?  We’re far from friends and family, and there are no western-style entertainment establishments within hours of Bayalpata (although the world cup reached us, much to the joy of my Dutch football fanatic colleague Nardi, who you’ll hear from next in this blog series from Nepal).  We take hikes with some of the medical students doing research here, we take in the beautiful scenery, and we connect with the workers, the patients, and their kids.  Yesterday I took a break from work to play a little soccer with two boys whose moms are community health workers (CHW).  The CHWs had come to the hospital to review progress and get assignments for the coming week.  Abishek, pictured below, was also a patient, having suffered a superficial head wound in a fall.  He’s got spunk, and likes to pose for pictures!  These are some of the most precious moments in our fellowship – the opportunities to connect on a human level with the people we aspire to serve.  It makes whatever sacrifices we’ve made getting here and working here worthwhile.