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.