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We are sitting now on a local bus in a beautiful spot up in the Nepalese hills, surrounded by fields and trees. We are free to wander the local paths at will, and the climate is perfect, if a little warm now at midday. This is a Nepali traffic jam. I have no idea why, but presumably a road is blocked somewhere. Never mind, it is peaceful and pleasant, and we are heading back to Kathmandu a day earlier than planned, having walked down from ‘my’ village in 2 rather than 3 days. The journey on this local bus should be 8 hours (with no traffic jams), from Aarughat, in Gorkha province North West of Kathmandu.

Our party at the start of our trek up the Gandhaki Nadi valley

We have both had an amazing time so far.  After 3 pleasantly touristy days in Kathmandu, during which arrangements were discussed in the PHASE (Practical Help Achieving Self Empowerment  www.phaseworldwide.org) office, and we waited for our permits to allow us into the upper Gorkha conservation area, we set off on a very similar bus to this one, from Kathmandu to Aarughat. There were no traffic jams but it was a lot more crowded and uncomfortable, not helped by a diesel generator on wheels, which started the journey at the back of the centre aisle, progressively compressing everyone sitting in front of it, until after a couple of hours someone thought to tie it down. Fast food outlets in Britain could learn from the Nepalese version; the bus stopped at a designated roadside spot, where local ladies had ready prepared vast pots of rice (Bhat), Dhal (lentils), and vegetables. We were all fed and back on the road in less than half an hour!

Anthony making bread

With us were Bob and Anne Rivett, retired GPs from Somerset who were also going to spend time at separate health posts in Upper Gorkha, Susan Sharma, a 21 year old Nepali ‘staff nurse’ working as a supervisor with PHASE, and 19 year old Urmila, going to teach in a (more than usually) remote village high in the Gorkha valley (also employed by PHASE).

We were met in Aarughat by the delightful Pema Lama, PHASE’s own porter/ guide, and 2 other porters. After a fairly short walk Susan found us a small guest house to stay overnight, and enjoy the last shower we would see for some time. After a 7am breakfast, we were picked up by a jeep for the next 2 hour leg on exceptionally rough road. There were plenty of people already in and on the vehicle, but they had kindly left the back seat for Bob, Anne, Ant and myself (a space somewhat narrower than the width of 4 Caucasian pelvises).

Pema (PHASE porter guide) makes tea in his own home at Chumling

We were quite pleased to see the end of this bit and start walking at last. Very shortly we stopped and were given Dhal Bhat, while the porters scratched their heads over the quantities of luggage. Urmila had 2 large cardboard boxes of books for her school; these proved too much and were left behind, to be subsequently dispatched by mule train. So we were off, and walked for several hours (with breaks) in an averagely upward direction (though the path, mainly along the side of a steep river gorge, resembles the south west coast path in its up-and-downness). Night stop was at Machekhopa – another adequate guest house. Susan and Pema looked after us wonderfully all the way, and by this stage had discovered that nothing pleases English people more than a large flask of tea (black, with sugar – we took to it rapidly). The Dhal Bhat kept coming….

There was some debate about how far we should aim to go the next day – they were still assessing the fitness of the 4 ancient Brits – and told us initially we would just go to Tatopani, a mere 3-4 hours walk. But after a long rest and lunch there, we agreed we were happy to walk further (therefore missing washing in the ‘hot springs’, which is what Tatopani means). We spent the night in a delightful and hospitable remote farmhouse on the crest of a rise. The loo was a bit of a challenge, involving a scramble up a rock round the back of the premises. We all took care to drink little that evening…

The next day’s walk took us all the way to Sridibas (otherwise known as Filim or Philim), my destination village. I had been a little sad to know that I would be the first to stop, while the others all continued to higher villages. Anne, Bob, Susan and Urmila left the next morning; Anne and Susan to go for another day and a half to Prok, Bob to go on for a further day to Lho, and Urmila up a separate valley to Chumling. Ant stayed another night with me, to look at the Sridibas turbine, which hasn’t functioned since a landslip 6 years ago washed away the water source pipe. The turbine was securely padlocked – but he was able to take photos through a window. As it was a Saturday – the one ‘holiday’ of the week, I was able to go with him. The next morning he went off with Pema and Ragita – (PHASE’s education supervisor, who had been loaned to him as interpreter) on a wonderful journey to higher hill villages, looking at the turbines, in Bihi, Chumling and Chumchet.

Anthony photographing the turbine at Sirdibas - with audience!

So there I was in Sridibas… I had a wonderful time and felt it was a real privilege to live and work among local people. I shared the PHASE rented property (really one room, with a partitioned off small bedroom, and a small kitchen with open fire on the balcony) with Sita, a 28 year old ANM (auxiliary nurse midwife) and her 18 year old cousin Bageshwori, an ‘on the job trainee’ who has done 2 years of her college course already, and hopes to qualify as an ANM in a few months. Both are really delightful ladies and looked after me wonderfully. Their English was limited, and my Nepali non-existent – but we got by! After Ant had left I was allowed to join them for meals in the ‘kitchen’ (though never to help!). There we could sit on wooden 2 inch high stools, making life for the English knees a bit easier than always being on the floor.

Sarah with Rogita and Sita

One of the principles of PHASE is that their health workers should integrate as far as possible into the community. Hence they obtain their firewood and do all cooking on open fires, and obtain water and wash at the communal tap, as do the locals. On my last evening I met the government health worker (who had been away on holiday / in hospital after a motorbike accident / on a course). I asked if he too had to cook on an open fire – but he told me he has LPG gas brought up specially by mule! The girls told me a number of times how the locals say they much prefer the PHASE workers to government ones. They work together as much as possible, in the government health post. PHASE was founded in 2005 to try to raise the standards of health care in the remotest Nepali villages. Many of these had government health posts which were either not staffed, or staffed only intermittently and without enthusiasm. The prime aim of PHASE is ‘tactfully’ to raise the government standards of care by putting PHASE workers alongside them for a few years to get the health post up and running properly. This is already having some success in the first area in which PHASE was involved.

Our days consisted of tea at 7am (in bed if I was still there – I was truly spoilt!), and then some nice leisure time for me (during which I often went for a walk) while the girls worked hard to cook our first meal for 9am (usually Dahl Bhat, as was the evening meal, but with variations such as different vegetables, potatoes, chapatis, occasionally pasta and once meat – thought this is discouraged to Europeans in Nepal because of infection risk – I had a small amount for politeness. ).

Work consisted of alternate days in the health post, and doing home visits, or going to one of 2 ‘outreach centres’. Either of these latter options I thought were wonderful, since they would involve 2-3 hours walk each way in wonderful scenery, interspersed with invitations into local houses to be given tea, with or without a large pot of potatoes specially cooked in a darkened and smoke filled room with delightful and very friendly people!

The highlight of my time had to be a home delivery at 3am! The father banged on our door about 2.35am, and the baby was born at 3am, so we cannot complain that we were called too early! Luckily the home was close by. It was a typical home – all the family living in one very dark room, with an open fire which was part of the room. The mother lay on the floor beside the fire.  Two smaller children were sleeping under blankets; an older sister was watching, and three local ladies were there to help.

Next day - mother delighted with her baby's PHASE blanket

All went very smoothly, thank goodness! But just when I thought our work was done and we could go back to bed, there was a lot of discussion (which of course I could not understand).  The husband was involved; Sita made him sit on the floor opposite her, and talked earnestly to him. Then I was involved. It seems the parents had decided the baby should not be breast fed, since they thought this was the cause of the severe disability suffered by 2 of their 3 other children (both had the same disability, which was clearly genetic). Happily Sita won the day, and when I left the baby was still being breast fed! There is really no alternative unless the father travelled for several days to obtain powdered milk, and the hygienic conditions of bottle feeding could be alarming.

The clinic days were sometimes not so dissimilar to British general practice, with plenty of coughs (which on the whole the girls treated as we would, avoiding antibiotics where possible), and also a lot of gastritis, probably related to the spicy food. Our first clinic got off to a slow start because the patient had brought down an axe on his knee, and had managed to walk for over an hour to the health post! With some supervision from me, to remind her to suture the underlying tissue layers as well as the skin, Sita made a good job of stitching him up, by the torch from a mobile phone!

We saw one new case of (almost certainly) TB in a 15 year old boy. TB is not uncommon here; all those on treatment have to walk to the health posts daily to get their treatment, but new cases have to go to hospital to confirm diagnosis and start treatment. We told him to do this, and can only hope he did so.

On one of our home visit days we came across a man in his late 60s with a month’s history of weight loss and weakness. He was unable to walk to the health post (2 hours), let alone to a hospital (4 days), which was what was required for investigation. People not infrequently die for this reason, and accept it; it is more difficult for Western health workers to do so! On our initial walk in, we passed an old lady being carried in a basket by her family on the journey to hospital.

Sick lady being carried to hospital - 4 day journey

Meanwhile Ant was having a wonderful time romping between mountain villages, and spending every night with 4 (or 5) lovely young ladies. Two of the turbines he looked at were non functioning following landslips affecting their water supply; one of these had been locked up and was still in perfect condition; the other had not been and was missing vital constituents. One turbine was working and well loved by the villagers, but had a leak which they had not known how to fix. He took it apart and showed them (successfully), so they can now do this themselves. Hopefully his reports will prove useful.

We have now made it back to Kathmandu (the road block lasted 4 hours, hence this has gone on a bit – sorry!). We have had a pleasant couple of days with friends John, Lis, Andrew and Julia (not to mention some hot showers!). Tomorrow the 5 of us leave on the tourist part of our adventure – a trek round the Annapurna Circuit.

To view all the photos that go with Sarah’s story go to –https://www.facebook.com/media/set/?set=a.580609378638728.1073741829.162142530485417&type=1&l=875a63ec21

Sarah and Ant

Easter Saturday, March 30th 2013
Kathmandu

Sarah at outtreach Centre