Journal of Elective 2004
Saturday, August 07, 2004
Day 31: Nagarkot
We went to see Mount Everest, but it wasn’t to be.Yesterday Leroy (from Holland) and I took a very bumpy bus ride to Bhaktapur then Nagarkot, a small village 30km from Kathmandu, on a ridge at over 2000m overlooking the Kathmandu valley. Lonely Planet describes the village as “very much a one-night stand... there’s not much to do in the evenings so bring a book”. And they were right.
Low season meant all the hotels were desperate for business, but this didn’t mean the same friendly welcomes of Thamel or other areas. Instead it felt more intimidating and unfortunately the standard of service at the hotels and restaurants wasn’t up to much at all. However, it was good to be out of the pollution again, and made for a good weekend escape. We ate fairly well at fairly decent prices, but were rewarded with a grand view of the surrounding valley to marvel at... and we even saw some of the Himalayas.
4km away there’s a viewing tower that allows a 360 degree view of the surrounding area... including the microscopically small summit of Everest in the distance. We were chancing our luck anyway with it being the monsoon season, but we were in hope of catching a glimpse of some big mountains by reaching the tower before sunrise.
That’s what we did, getting up at 4am this morning for the hour-long hike to the top (despite a minor, frustrating detour down into the valley by accident!). It was quite surreal with so much mist in the dark. The tower is in the middle of a military camp, and it was also quite bizarre waking up soldiers at checkpoints to ensure we weren’t intruding the wrong way into the camp. Such exchanges would consist of tentative “namaste”s, in our best, non-Maoist-sounding accents! Again it’s probably just the fact we’re not used to having guns in Holland or Scotland - and all the soldiers we met were really very friendly and chatty.
We got to the top, only to meet two other medical students from Krakow in Poland who’d already ascended the tower. But despite much conversation and hope, the clouds parted only briefly, and we conceded that we wouldn’t get the fantastic view which comes as standard with a visit to Nagarkot in September-November. Ah well.
We took breakfast in one of the equally dingy, quiet hotels on the way back, and packed up to walk down to Changu Narayan where Pam and Toby (an effervescent, very friendly med student from Germany... she’s just recently joined us at Kanti) were waiting for us having spent the night there. However, the brief walk turned into much more of a trek, and we had to call off the meeting because of the rain, longer-than-anticipated route and weary legs having been walking almost non-stop since 4am in the morning.
And now I’m back in Kathmandu, looking forward to Rama’s dal bhat this evening.
Namaste!
Sunday, August 08, 2004
Day 32: Hopeful Home
And where to start? Firstly, a moody computer wiped my entry for Thursday’s visit to Pashupatinath - the main cremation site for Hindus in Nepal. However, it was such an important and insightful visit that I’ve added it in chronological order. See Friday’s Day 30 entry for details.But now I’m back in Pumpernickel’s using coffee and chocolate chip ice-cream as uneeded sustenance to write today’s entry. I’ve just visited Hopeful Home orphanage, something I’ve really left longer to do than I meant. Yet, it appears the timing is perfect...
I phoned Dinesh, an inspirational worker at the orphanage this morning, to arrange a visit. By chance, he was coming to Kanti today with one of the children and so I met up with him at 11am following their appointment.
Hopeful Home is a two-year-old orphanage in the Swayambunath area of Kathmandu, and is home to 36 children from 3 to 14 years of age. It’s name reflects the ethos inside, and a tour this morning surprised me with the sense of homeliness and resourceful use of any donated books/equipment, to provide an optimistic, fulfilling environment. The children were at school during my visit, so it was particularly quiet (!), allowing me to ask Dinesh loads of questions about the setup. I have become interested in the health care of children in residential care in the UK (furthered by 5 weeks of study in this area in May) and so I was keen to compare the situation in the UK with Nepal.
In a nutshell, the Nepalese government is unable to provide financial support for such institutions, though it was explained that this is due to the problems of collecting tax in the first place. So places like HH rely on foreign organisations and individual donations. This works to some extent, though it is clearly frustrating that such unpredictable income is not conducive to long-term planning.
HH is involved with volunteer programmes, whereby foreign volunteers come for a period of time to trek, sight-see and give some time to working at the orphanage - helping with play, teaching English and general maintenance of the home.
The current 2 volunteers are away this week to see Chitwan, and so the home is running with basic staff levels (although it is clear that the staff are immensely devoted and committed to the children). And this is why it seems my visit was good timing.
Unfortunately it has been difficult to get very involved with practical help during my time at Kanti. It was therefore great that Dinesh was enthusiastic to my suggestion that I - perhaps with some other interested students from Kanti - come to HH in the afternoons each day this week to play games, teach some English (and no doubt be taught some Nepali) and generally share some fun time.
The visit also made me reflect on the dilemmas of opportunity cost. As I mentioned before, the costs of cancer care for one child can reach $3000-$4000+ at Kanti, a cause to which Bishop is impressively (and sometimes movingly) committed. However, the cost of a year’s accommodation, food and education of a child at HH is in the region of $300-$400. These are rough figures, and both organisations expressed reluctance to guess at an average figure. Yet, in (health) economic terms these are important questions. And personally, in my ideas for potential ways to fundraise back in the UK, it is a pertinent point to ponder.
But on an extremely selfish and fickle note, my ice cream is now finished so perhaps these are all points to return to later in the day.
Namaste.
Monday, August 09, 2004
Day 33: Oncology
It’s been another busy day. First, there were some serious goodbyes to say to Ashley, who left for the States today. Ash has been a great sport, always with a keen eye on the social scene amongst students, volunteers and tourists in Kathmandu... plus she had much more interesting mealtime stories of photojournalising Nepali events and people, which saved discussion from becoming too medical. Ash - please do keep in touch!Leroy and I joined the Oncology ward round this morning, and it was super to have some enthusiastic English bedside teaching on the way. Paediatric oncology is an area in which I don’t have much experience, and so I was keen to learn. Despite the budget constraints, a significant number of children make great recoveries. The ward seems to be really well run, and has benefited so much from collaborations with some of the leading international centres of expertise. One such example is Alder Hey Hospital in Liverpool - even the directory of the oncology service there has visited Kanti.
That said, serious limitations still exist, in terms of access to investigations (e.g. chromosome studies and cell typing), treatment (bone marrow transplants are impossible to do at Kanti) and participation in the big MRC (UK Medical Research Council) international trials. However, it’s clear from the medical records that standard, up-to-date protocols in accordance with the MRC guidelines have made treatment as effective as possible.
After the round, Leroy and I took a break for ‘Mountain Dew’ (similar to Sprite) but as the cafe had no vacant seats we found a quiet spot outside the Oral Rehydration Unit - no irony intended! A couple of kids started chatting to us and soon the disappearing hankie was on show. The sudden mass appearance of more children and parents was phenomenal, and we were both literally besieged. Some wanted to see the trick again and again, whilst others wanted to quiz us on our names, where we came from etc. There were more than 30 children at one point, and it clearly amused Bishop who stumbled across the chaos whilst showing some other students round the hospital.
In the afternoon I had a lazy wander around Thamel and Durbar Square. The streets really are like medieval scenes, with lots of small shops selling everything from kitchenware and hi-fi, to pashminas and fruit.
Soon I was on my way to Swayambunath to the orphanage - Hopeful Home. The route took me through very non-touristy areas of KTM, and I had to negotiate my way past some disgruntled looking bulls.
My arrival at HH couldn’t have been more welcoming! The children had just arrived back from school and their ‘namaste’ and excitement as I walked up the main path was particularly memorable.
Everyone was very keen to introduce themselves, and even more exciting was their reaction to the fact that I didn’t have a Nepali name. So now I am Binod, which is quite a common name in Nepal, although I had to keep reminding them to call me that instead of ‘Sir’!
And so developed an afternoon of balloons, magic and juggling with some homework help too. Plus one of the teenagers showed me some of his poetry in a very special book that he kept in his trunk of belongings. One poem, which he was particularly proud of, was about his life - that his father was dead and cannot remember much from the age of 2-8 years. I asked him if I could copy it down and with his agreement I’ll put it on this blog tomorrow.
Soon it was time to leave, as Dinesh encouraged me to go before dark (which is quite early in KTM) for my own safety. But I have committed to returning each day this week, and they’ve given me loads of ideas of things I can do including telling them about Scotland and showing some postcards of Scottish views which I have with me.
Tonight has been lazy with nothing in particular. Pam and Toby both have a dreadful cough, which they may have picked up from the hospital. And so it is with some guilt that my days are now filled with so much variety and interest, while they are recuperating at home.
But I’m pleased that my last week - which looked set to be a slow wind-down - is actually now piled full of great teaching, clinical experience and fun.
Namaste!
Thursday, August 12, 2004
Day 36: Busy busy busy
It’s been a while since my last entry, and the reason is the incredibly busy week I’m having. Yesterday Pam, Toby, Shaq, Leroy and I were even up and in Thamel for another 8am, 65 rupee breakfast at Helena’s Restaurant. The days this week have all included a great 9.30am ward round in Oncology, followed by our own following-up of patients and then lunch. In the afternoon it’s been a case of ice-cream, internet (if possible) then Hopeful Home before a great meal of dal bhat back at the Joshis.The most fun addition to the week’s activities has undoubtedly been Hopeful Home. Yesterday Toby and Leroy came too, and we bought 50 bananas en route... quite a sight especially as the route takes us near Swayambunath (‘The Monkey Temple’) and so there were some guesses that we were going to feed the monkeys!
The children at the orphanage are just amazing, more so because of their backgrounds and how much they have prospered since coming to HH. There’s a real feeling of HH being their own home, and volunteers being the visitors to their world... we’re very well entertained by songs, jokes, play and homework, but it’s enough just to be there and share in the activities to make it all seem worthwhile. So far we’ve had renditions of the Yellow Submarine and Drunken Sailor songs, much photo-taking (by the kids themselves), balloons and stethescope-listening. It’s a great way to end each day.
One of the children has had to receive some OPD-medical care at Kanti, and I’ve been a bit involved with his case too... including joining him and Dinesh when he came back for a follow-up appointment yesterday. It was very interesting to experience OPD from the patient side (with patience being the operative word) and watching what’s required to organise tests, drugs and all the rest. Admittedly, they did get seen slightly quicker and for slightly longer because of the stethescope that I had around my neck. Perhaps slightly unethical but then given the circumstances I really don’t feel that much harm is done.
There have been several other hospital cases which have made my eyes open slightly wider than they are normally over here - including a couple which have involved some sense of personal responsibility. Perhaps it’s good time that I leave on Monday, or perhaps it’s easier to take that responsibility in the knowledge that I am leaving the country. But the last few days have also consolidated my desire to return to Nepal once qualified... and bouncing this idea off several doctors has also met with encouragement too.
On the one hand, I’m sure I’ll see things from a different perspective once I’m back in the UK - I’m particularly keen to see Moscow, Cambodia and Lithuania in the near future. But then I do like the idea of maintaining links with a country like Nepal whilst practising in the UK, not least because there are so many lessons still to be learned from the developing world (and probably vice versa). I say it that way on purpose... I can’t help but feel that there is a certain amount of arrogance in classifying countries as developed and developing... as if developed countries have no more developing to do.
It’s going to stay busy for the next few days... the way I like it.
Namaste!
Baby Life
Ram Kaji Thapa, 14 years, Hopeful Home
My father
was dead
When I was in childhood
I did not get education
I did not get food
I did not
get education
I cannot write a letter
I did not get nice clothes
I did not get shelter
When I went
to
Grazing the goat
I got sorrowful condition
When I was walking on the road
Then I
wanted to read
But how can it be possible
Fortunately I came this organisation
Here I will get good education
I wanted to
read
But how can it be possible
I wanted to get good bead
But my days are full of pebble
I was
running on the street
Fortunately I got helpful man
He took me into this organisation
Here I will get good education
Saturday, August 14, 2004
Day 38
This instalment comes from the playroom of Hopeful Home. With so many students now departed and Kanti being so quiet, it was easy to set aside a day to spend here - especially as Saturday is a day of rest and play. But I was honoured yesterday, when the staff invited me to stay overnight, especially as this would be useful to Hopeful as the other volunteers don’t get back from Chitwan until Monday.This morning I arrived, all set for a day out as discussed with the kids when I was here yesterday. However, I was slightly bemused when there was the assumption that I’d just take a group of 15 children myself, up to Swayambunath! In the end, we limited the numbers to 8 children, and went on the trek up the hill to the stupa - taking a detour through a pine forest and stopping for Fanta on the way.
On reaching the top, we spend some time taking photos, looking through the telescopes and watching planes land at the airport. We got back down to the bottom 365 steps later, and went for lunch of Momos and more Fanta. On the way back we stopped to hire 3 videos (or VCDs, to be correct) with me relying on the helpful guidance of the shop owner on the suitability of the Nepali films chosen! Of course, no video night is complete without fizzy juice, crisps and sweets, so we made a visit to the local ‘corner shop.
And for this - a day’s entertainment and lunch for 8 children and me, plus a video night for 37 kids, the cost was less than 700 rupees. A big treat in Nepal terms, but less than 6 quid in the UK.
It’s one example of how much can be done with so little, a fact better exemplified by the work of the staff who look after the children here - some of whom grew up in similar situations to the children here. I have been deeply impressed by the opportunities that have been made to the children here through creativity, security and shear hard work. I still find it fundamentally difficult to understand why these children are parentless. The feeling from my time here in the last week is similar to running a Cub Scout Pack Holiday or PEAK week - but of course this is their day-to-day life. This is their home and family, and they won’t all go back to parents at the end of the week.
I do find it frustrating at this point not to have the skills of a journalist, as my ramblings are sure to lack a coherency and message that my experience here - as well as the last 5 weeks in Kanti and KTM in general - deserves. But if it helps to get some ideas across, I’ve realised the HH epitomises some of the many lessons that I have learned during my time here.
1. The first is the welcome and friendliness that is inherent in Nepali people, with even a hint of it found in those trying to give the ‘hard sell’ to tourists. Nepalis are clearly used to having lots of incomprehendable, money-flashing, sometimes downright embarrassing tourists. And in HH this has been especially true, manifesting in many ways from being invited to share afternoon chia with the carers at Hopeful, to being dragged (willingly) into prayers when it was noticed that I was slightly unsure of whether to join in or maintain a respectful distance.
2. Language and how the barriers can be overcome. Some of the children speak very fluent English - due in part to their education at a school where English is taught extensively. Others, for example those age 8 and under are less able to understand English (though less so than my own lack of Nepali!). But again, the lesson I learned in Poland came into play - being able to say hello, apologise and smile makes valuable ground in an otherwise awkward situation. This has been true of Nepal in general - but children are much less likely to have formed assumption about who you are (compared with Thamel where traders think that all white people have pots of money to spend on pashminas, mountain flights and trekking).
3. How fickle and pathetic we can be in the West, and how dangerous ‘quick money’ is to the economy. In the UK there seems to bean increasing number of get rich quick television and over-the-counter games. That breeds greed, and a majority of those attracted don’t understand the real odds. Anyway! Sorry, a bit of a diversion there... but sitting here I do find it immensely frustrating to think how much good could be done with so much money.
4. The amazing transfer of certain trends and ideas across the world - a concept explained expertly in Susan Blackmore’s ‘The Meme Machine’. The concepts of free health care, disposable cameras and toilet paper have not really reached Nepal and are difficult to explain. However, the Happy Birthday song, ‘Round and Round the Garden’ rhyme and David Beckham quite clearly have. The challenge to Nepal is what new ideas are adopted and which are discarded. (Admittedly this is true of more important ideas than rhymes and disposable cameras, but I hope I make my point!).
But now, my time has run out again to say all the many things that I want to. The film has finished, and we’re about to crack open the Sprite/Fanta/Coke and have a party on the balcony outside.
Namaste!
Sunday, August 15, 2004
Day 39: Final Farewell and a Promise
And I’m ashamed to say that despite the time being 11am, I am once again in Pumpernickel Bakery with ice-cream and Fanta!Last night was a ball, and it seemed like all the children and carers had a great time. There was Nepali dancing, music and a great atmosphere. Perfect.
After the party I retired to the ‘volunteers’ room’ which I soon discovered was being used for the first time. It was a slightly unusual arrangement, which I didn’t manage to work out - but basically the room was in one of the nearby houses belonging to a family who are not really involved with Hopeful. The welcome I got there was as Nepali as I could have imagined. The family spoke very little English but they still insisted that I join them to watch some television and did their absolute best to make me feel at home. I was still a bit unsure of the whole scheme (as well as knackered after the long day yesterday) and was a bit taken aback when the 3 brothers aged 22, 19 and 16 followed me into my room and sat down to make conversation. But it was soon clear that they were just being friendly and wanted to learn lots from their new Scottish lodger.
This morning I was back at Hopeful for 7am, to help with any last minute homework and again, just to sit around chatting in English and to pass the time before school. However, one of the teenagers there - Ram (whose poem I put on this blog a few days back) asked me if I wanted to see their school! This was a great privilege, moreso because I had another fantastic welcome from the Principal. He was also very quick to tell me about the high academic abilities of some of Hopeful’s children, and it was interesting that the names he mentioned were the same as those I had observed as being particularly bright and attentive during my time at Hopeful.
Before all this we had breakfast, and yet more conversation about when I would be returning to HH after my final departure this afternoon. I’ve discussed this with some of the staff too, and the answer is ‘as soon as possible’. I’m sure lots of people say that. But I am sure I mean it. And all the more so because Milan - a fantastic singer and a great achiever, like all the kids at Hopeful - said to me at breakfast “Binod, when you go back to Scotland please don’t forget us”. I won’t, and I really really feel that this is the kind of project I want to support in the long-term once I’m back in the UK. I promised I would return, and that’s a promise that I won’t be able to break.
------------------------
This is likely to be my last entry until I return to Scotland tomorrow. I’m
really grateful for all the emails and comments, and hope I haven’t bored folk
too much, especially if you’ve been visiting the blog regularly. There is a wealth
of stories, experiences, feelings, observations and views which I haven’t been
able to include here. But please do hassle me to see the photos, tell the
stories and come up to Yorkhill for some Nepali chia!
It will be a busy time once I’m back in Scotland on Tuesday, as I’ll have 4 days to prepare for PEAK and Germany (another 2 weeks of travelling), see as many folk as possible and catch up on all the routine things back in Glasgow like mail etc. However, I’m hoping to get loads of photos online when I’m in Edinburgh during these 4 days to see my folks, and so I hope visitors to the site won’t have to wait too long to see the magic of Nepal - especially as some of the photos have turned out to be really amazing.
Thanks too to everyone for their encouragement for seeing Nepal. Zubir, my cousin Andrew and Dr. Donald in particular for ensuring that I saw the Foreign Office website advice in perspective. Taking that too seriously could have made for a UK-based elective... I don’t even want to think of how much I could have missed out on.
And finally thanks to everyone here who’ve
made my stay so enjoyable and interesting. The Joshi family, in particular
Bishop and Rama, have opened their home for me and other students to give us a
real sense of security and perspective. Shaq, who’s patient translations really
enhanced the elective at Kanti. Dinesh for his enthusiastic trust for my time
at Hopeful Home. And all the other students, doctors and other individuals who
are too numerous to mention, but whose time and help is gratefully remembered.
For the last time... Namaste!
Tuesday, August 17, 2004
Day 41: Back home
I’m back home. Once again great service from Qatar Airways. There was lots of security around the airport - I was frisk searched on the way in to the airport, and also between transfer bus and airplane. But it didn’t seem very effective... when I pointed to my camera case and asked that it didn’t get put through the x-ray machine they just nodded in agreement and didn’t have a look at all. (If I pointed to it and said ‘bomb’ would they have reacted differently?).Then I had to completely unpack my hand baggage before entering the departure lounge. The guy kept saying ‘knife, sharps, gun?’. I had none (I left the AK47 in Glasgow for this trip) so instead he got to see my first aid kit, Chris Bonington’s autobiography, numerous cheap CDs and loads of photos (of all the things I wanted to go back to Scotland with, the photos are highest priority!). When I’m fed up like I was last night, I try to make the officials laugh. And it worked both times I tried it in Tribhuvan Airport!
Back in Scotland I realised that the culture shock that everyone was warning me about for Nepal, was actually going to happen on my return. Inverclyde Taxis tried to get me to pay over 14 quid to Yorkhill, so I phoned a cheaper firm who have a fixed charge. I’m still in the phase of ‘do you know how many children that could treat/families that could feed’ but I realise that the taxi rank of Glasgow Aiport is not the time nor the place.
I return to Scotland with a broadened horizon on what is possible to achieve, and with a greater insight on the areas which need such motivated support the most. I have a new-found compulsion to do my best to help fill this void - personally and professionally - and look forward to the endless new challenges that I hope it will bring in my life.
Namaste!