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Foggy Mountains

2016 - 2017 TRIP

In 2016, 2 teams in Project Aasha visited Bung and Gorkha in Nepal

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BUNG

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One  team was sent to Bung to study the healthcare needs of the villagers, with a primary focus on maternal health. The various healthcare services and facilities – a health outpost, a government clinic and a local clinic – were assessed. This team was accompanied by Dr Kumaran Rasappan.

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GORKHA

 

Another team visited the Himalayan Eye Hospital (HEH), our partner organisation for the surgical eye camp. We were pleased to meet with Dr Indra, who had been our point of contact who would be working closely along with Dr Rupesh, our mentor. With the end of our service at the surgical camp in Gorkha, returning to Kathmandu, and joining up with the group from Bung, we arrived at Tilganga Eye Hospital on the morning of the last day, the largest eye hospital in Kathmandu, to seek opportunities for further collaboration.

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BUNG

A LONG AND ARDUOUS TREK

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While the main team was sleeping soundly, a couple of us woke at 3am on the second day to head to Bung. This was a secondary team with the aim to study the primary healthcare in the villages, focusing on maternal health. The road was indeed quite bumpy and winding, and after surviving the bumpy ride we still had to continue to trek for a distance before reaching out resting place for the night. The Nepali porters certainly lived up to their reputation as those being in second nature up in the mountains. We were tremendously exhausted by our porter’s pace while trekking with all our equipment up the precarious slopes of Deepli. After resting for the night, we continued our trek to reach Sotang.

As we were all geared up to leave Sotang and embark on the second half of the trek to Bung, we are approached by a man holding his young son in his arms. The poor fellow’s right arm was immobilised and the father, tearing, lamented that the injury was serious and could not be treated at the health centre. He also lacked the funds to take his son to the hospitals at Kathmandu as it was quite expensive. After taking a couple of X-rays of the injury, the father was counseled and advised to send his son to Kathmandu for better treatment options. Our team also volunteered to bring the boy to Kathmandu on our return trip back in the jeep. Here we also met up with our local guide, Mr Shree, who was an invaluable resource in assisting us throughout our stay in Bung.

UNDERSTANDING BUNG

 

We visited the Edmund Hillary Clinic in the morning of Day 3 and were treated to a small welcome ceremony. We surveyed the facilities available and also interacted with the staff to find out more about healthcare coverage in Bung.

Word spread that Dr Kumaran was around and villagers thronged to the clinic and many villagers came to seek medical attention. The majority of patients seen were elderly suffering from chronic symptoms of pain and were taught basic exercise to work on their backs and knees, demonstrated by our team. We were also presented with a couple of acute cases, including a knee aspiration (we had to adapt and use a shorter syringe than the ideal due to constraints) and a head injury with sharp gash in the scalp and pus formation.

In the afternon, we met the local Village Development Committee with numerous important figures in the community, including the chairman and politician in charge of the district. The Women’s Co-operative Team, in charge of improving the lives of local women, was present too. Following the meeting where we discussed various potential projects we could partner them with, we conducted the maternal health survey with the women present to understand more about knowledge and coverage received by women in Bung with regards to maternal health. In the subsequent days, we continued to survey the villagers with the help of our interpreters, Mr Tarjen and Mr Shree.

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GORKHA

Introduction to the Hospital

 

Nepal: A country of mountainous land (home of the Himalayan range, with 8 of the 10 highest mountains in the world!) rugged people (Sherpas!) and deep spirituality (maybe somehow related to the Ancient One?) Expectant, as we would be when travelling to a new land, we arrived in Kathmandu at night and set off for Pokhara the next day. We came to the Himalayan Eye Hospital (HEH), our partner organisation for the surgical eye camp. We were pleased to meet with Dr Indra, who had been our point of contact who would be working closely along with Dr Rupesh, our mentor.

HEH is a trust hospital fully funded by NGOs. It conducts free surgical camps, but walk-in treatment requires payment, though the income is only sufficient to cover daily operations. The bulk of its revenue comes from Indian nationals along the border seeking treatment, which is used to fund its operations in the Himalayan areas. HEH serves the Gandaki, Dhaulagiri and Karnali zones in Nepal, where majority of the population are poor and underprivileged. Due to inaccessible mountain areas, about 40% of people could not get surgeries. As such, HEH goes down to rural areas regularly to conduct free camps, though NGO support is required for such camps.

This reflects the state of eye health in Nepal, where eye health is managed by private hospitals and NGOs, instead of the government, hence providing little incentive to reach out to rural areas. There are no government eye hospitals, and government funding is grossly insufficient (<10% of surgeries are sponsored by the government, and government support only started 2-3 years ago). Dr Rupesh then gave a lecture to the staff of HEH, exchanging ideas on surgical procedures and planning future areas of collaboration, such as: addressing the issue of cornea blindness and lack of corneal transplants, glasses for paediatrics patients, a mobile eye clinic, and screening camps for diabetic retinopathy.

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VISIT TO TILGANGA EYE HOSPITAL

 

With the end of our service at the surgical camp in Gorkha, returning to Kathmandu, and joining up with the group from Bung, we arrived at Tilganga Eye Hospital on the morning of the last day, the largest eye hospital in Kathmandu, to seek opportunities for further collaboration. For the community outreach of Tilganga, >50% of workload are in remote districts outside Kathmandu. There is the issue of integration of eye health with primary health in the community (in the form of health posts in local districts). Eye care services are lacking in remote districts (with only 14 district branches of eye centres), and the government has limited resources with regards to eye health. Patients have to refer to regional hospitals run by NGOs.

There are 32 eye hospitals in Nepal, with district eye clinics which are branches of regional eye hospitals. Each of the 75 districts has at least one eye health centre, which is still insufficient, and where lack of manpower remains a problem. Currently, Tilganga is involved in a project involving tele-medicine, where fundoscope images are sent from district centres to eye hospitals, before referring patients to the hospital. Further, Tilganga is rolling out an Electronic Medical Record (EMR) system as a pilot project that would be extended to other districts in the future.

On the topic of tele-medicine, Dr Rupesh suggested an online platform with an international panel of specialists to review complicated cases referred by local doctors (with ongoing work-in-progress), as well as providing the equipment necessary (such as fundus cameras) to district clinics. There would also be a need to train manpower at the district level with the relevant technology.

We ended off the meeting with such exciting opportunities in mind. The scope and impact our project could potentially be huge if expanded on a much larger scale. This gave us hope that our efforts can indeed go a long way, with its belief of strengthening, instead of competing, with local efforts and providing help where it is most needed.

VISITING HIMALAYAN EYE HOSPITAL

CULTURAL EXPOSURE

 

On top of discussing grand plans with the local health professionals, we were also very blessed to be warmly welcomed by them, and were hosted to several festivities celebrating Nepali culture. But first, some background:

One of the most iconic religious symbols of Nepal is the Kumari girl. The Kumari, also known as the living goddess of Nepal, is a mortal manifestation of the divine goddess: Taleju. Taleju is a goddess specific to Nepal, worshipped as the chief protective deity by both Hindus and Buddhists alike. The Kumari is pre-pubescent young girl carefully selected from the Newari community. Eligible girls must go through a rigorous examination process to ensure that the new Kumari bears all the listed perfections of the goddess. This bears close resemblance to the Tibetan selection of the Dalai Lama. When the present Kumari menstruates, it is deemed that the goddess has left her body. After which, a new Kumari will be selected and inaugurated to its position.

Within each district, the local Newari community will elect their own Kumari. Our host: The Lion’s Club Chairman of Gurkha District, was part of this community unique to Nepal. His only daughter was selected as the Kumari of the Gurkha District, and we were honored to be invited to his celebration. He explained to us that the girl must marry 3 times in her lifetime as the Kumari. The first, to a holy tree, then to a god, and finally, to a mortal that she loves. He believes that as the Kumari of the district, she has been blessed by the divine goddess to bring peace and wealth to the people of Gurkha. As such, his faith dictates that he must adhere to traditional practices. For example, 1 week before the first wedding, his daughter must be isolated in a room and prevented from meeting any boy throughout this period. Just like the famous Kathmandu Newari, she will serve her term will the goddess leaves her body at her commencement of her first menstrual cycle.

The celebration was a boisterous one: loud music, jolly villagers and scrumptious local food were part in parcel of this jovial occasion. This was indeed a rare privilege for us to learn more about the culture of our partners here in Nepal, an added bonus to our trip here!

Mountains in Fog

NOTABLE CASES

It's Not Just a Case of Age - Related Cataract

 

Male, 65 years old comes in with very poor vision on the right eye. His visual acuity test showed only hand motion on the right eye. That means that his vision is so blur that he cannot even count the number of fingers shown, and can only recognize that a hand is being waved in front of him.

 

This gentleman has come by himself from his home in Gurkha, Nepal to seek treatment for the progressive loss of vision on his right eye that started 12 months ago. He has left behind his wife, who also struggles from cataracts, to take care of the fields while he is away.

This case resembles a good proportion of the population that we have served in our project. Ophthalmic conditions are more prevalent in the Nepalese population compared to the world. The altitude exposes the people to higher than average amounts of radiation from sunlight, which progressive damages their eyes and leads to clinical presentations (e.g. cataracts) in old age.

 

Many patients who came to us share a similar background to this gentleman. They come from an agricultural background, with little to no medical knowledge of common eye care complications. That contributes to both the lack of prevention and the delay of appropriate treatments which could have effectively reduced the incidence of preventable blindness.

This is a frail elderly man who continues to work to make ends meet for his family. He had to leave behind his spouse, to travel alone to our free surgical camp to receive the treatment that otherwise he would have never been able to afford. For his wife, she would have to live with her progressive loss of vision for another 12 months till the next eye camp, before she can receive the treatment she dearly requires.

 

Project Aasha aims to extend the coverage of our project, to reach out into the isolated populations of Nepal where few other medical teams have been. We want to bring ourselves to the convenience of the patients, and intervene where help is most required.

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