Thursday, December 3, 2009

Can you recognize this song before the chorus?

I have arrived in the US for home leave and will be here until mid-February. Have had a few re-entry issues this past week since arrival (AM/PM swap-jetlag, bronchitis and gastro resettlement), but things are getting better now. It is such a wonderful gift to be able to visit with people personally, look them in the eye, hear their voices and talk with them (and, of course, hold their babies). I can now exploit the high speed internet available in this country to post videos and pics from the last year!

This first installment is a clip from a leprosy research conference dinner held in Fukuoka, Japan in July. We were in a small boat when a couple of street singers happened to come by. I did not recognize the song until the chorus.

Wednesday, December 2, 2009

Monday, November 23, 2009

Annual staff picnic pics


Friday, November 20, 2009

"AIDS, malaria eclipse the BIGGEST child-killers: Diarrhea & Pneumonia

Sometimes it is difficult to understand the reality difference between what media portrays as epidemic health problems in light of what preventable deaths are occurring in populations lacking similar wealth and power (which generate media volume).


By MARGIE MASON (AP) – 22 hours ago

HANOI, Vietnam — Diarrhea doesn't make headlines. Nor does pneumonia. AIDS and malaria tend to get most of the attention. Yet even though cheap tools could prevent and cure both diseases, they kill an estimated 3.5 million kids under 5 each a year globally — more than HIV and malaria combined.

"They have been neglected, because donor or partnership mechanisms shifted their emphasis to HIV and AIDS and other issues," said Dr. Tesfaye Shiferaw, a UNICEF official in Africa. "These age-old traditional killers remain with us. The ones dying are the children of the poor." Global spending on maternal, newborn and child health was about $3.5 billion in 2006, according to a report by the Bill & Melinda Gates Foundation. That same year, nearly $9 billion was devoted to HIV and AIDS, according to UNAIDS.

Pneumonia is the biggest killer of children under 5, claiming more then 2 million lives annually or about 20 percent of all child deaths. AIDS, in contrast, accounts for about 2 percent. If identified early, pneumonia can be treated with inexpensive antibiotics. Yet UNICEF and the World Health Organization estimate less than 20 percent of those sickened receive the drugs.

A vaccine has been available since 2000 but has not yet reached many children in developing countries. The GAVI Alliance, a global partnership, hopes to introduce it to 42 countries by 2015.

Diarrheal diseases, such as cholera and rotavirus, kill 1.5 million kids each year, most under 2 years old. The children die from dehydration, weakened immune systems and malnutrition. Often they get sick from drinking dirty water. The worst cholera outbreak to hit Africa in 15 years killed more than 4,000 people in Zimbabwe last year. The country recently reported new cases of the waterborne disease, and more are expected as the rainy season peaks and sewers overflow. Rotavirus, a highly contagious disease spread through contaminated hands and surfaces, is the top cause of severe diarrhea, accounting for more than a half million child deaths a year. A vaccine routinely given to children in the U.S. and Europe is expected to reach 44 poorer countries by 2015 through the GAVI Alliance.

"Every child in the United States gets it, even though they have access to clean water and hygiene," said John Wecker, of the Program for Appropriate Technology in Health, a Seattle-based nonprofit that is part of the vaccine alliance. "The only effective way to prevent these deaths is through vaccination." Diarrheal diseases received more attention in the 1980s and 1990s, he said, but interest has waned or been diverted elsewhere, allowing them to creep back. "How did the leading killers end up at the bottom of the global health agenda? I don't know," Wecker said at a recent GAVI meeting in Hanoi. "We've got the tools. We're not looking for the next technological breakthrough. It's here now and it's not being used."

Death can often be prevented by giving children fluid replacement, a simple recipe of salt and sugar mixed with clean water to help ward off dehydration. Yet 60 percent of children with diarrhea never receive the concoction, according to a WHO and UNICEF report released last month. "It is so preventable," said Dr. Richard Cash, a Harvard University expert who helped develop the oral rehydration therapy 40 years ago. "Preventing the deaths is at the very least what we should be striving for."


Tuesday, November 17, 2009

The recent slapping incident

“PM 'trying' to make Begum apologize, Civil servants demand Begum's arrest, apology within five days” KATHMANDU, Nov 15: Prime Minister Madhav Kumar Nepal has said he is working to make Minister of State for Agriculture and Cooperatives Karima Begam apologize for her mistreatment of Parsa Chief District Officer Durga Prasad Bhandari, a high-level government source said. The prime minister said this during a meeting with senior bureaucrats at his residence Sunday who met him to discuss the matter. Nepal Government Employees Organization (NGEO), which is close to the ruling CPN-UML, on Sunday issued a five-day ultimatum to the government to arrest Minister of State for Agriculture and Cooperatives Karima Begum and make her apologize for beating up the chief district officer. The organization submitted memorandums to this effect to the Office of the Prime Minister and Council of Ministers through the District Administration Offices throughout the country.

A group of government employees led by NGEO-Kathmandu President Ganesh Thapa handed over the memorandum to Kathmandu CDO Bhola Shiwakoti. NGEO has threatened stringent protests if the demand for arrest and apology are not met within the set deadline. Government offices in Parsa that were closed for five days in protest of the minister´s misbehavior opened Sunday. All government offices in Parsa remained closed for five days reopened Sunday keeping in view the plights of the ordinary people seeking government services. The offices were opened after eight different associations of civil servants on Saturday made a decision to this effect.

Last Tuesday, Begam accompanied by about 50 of her supporters had beaten up CDO Durga Prasad Bhandari at his office allegedly for sending an old vehicle to pick her up at the airport. Begum represents the Madhesi People´s Rights Forum. After the minister faced strong criticism from various sides including the government, she changed her statement and accused CDO Bhandari of misbehaving with her and "not doing people´s work".

The District Police Office, Parsa has already issued arrest warrant against Begum and sought support from police in Kathmandu Valley following a formal complaint by Bhandari´s bodyguard. Begum is in Kathmandu but police have not arrested the minister saying it is unaware of such arrest warrant.

Nepal slips in corruption index

Kathmandu, Nepal. November 17. Transparency International (TI), the global anti-corruption watchdog, said the level of perceived corruption in Nepal worsened in the year 2008. "Malaysia, Nepal, the Maldives and Afghanistan, on the other hand, saw their scores decline, representing worsening levels of perceived corruption," TI said in its annual report released globally on Tuesday. Nepal was ranked at 121 position of the index in 2008 but this position slipped to 143 position in the corruption barometer in 2009, according to TI. Only war-ravaged Afghanistan is behind Nepal in the index among the South Asian countries. Afghanistan ranked at 179 position has highest level of perceived corruption. (Neighbouring India ranked#80)

Sunday, October 25, 2009

Oct 24, 2009 Lamatar Medical Camp

Yesterday we performed a free medical camp in a small village area in the hills on the other side of Kathmandu valley, approximately 2 hours from Anandaban. We set up in a combined school/health post building in the area. Compared to other camps, fewer people came (<200). It was a smaller community than others we’d previously targeted but there were people there in need. Many of the first to arrive were children and orphans. Some were so small. Nine year old boys that were the size of a properly fed Nepalese 4 year old. (I asked several times and checked with an adult nearby.) In our team for the day, we had several foreigners that work here in Kathmandu – a Swiss nurse, a retired pharmacist, an Aussie pediactric nutritionist - plus a Nepalese dental assistant and a couple of Nepalese doctors that were in town who’ve served for years in more remote outposts, besides some of the Anandaban clinical staff (doctors, nurses, pharmacist). There was also a Aussie couple that is volunteering at Anandaban for 3 months (GP and occupational therapist). We collect clothes during the year for these camps and we never seem to bring enough for the kids. An older local boy (maybe 12-14yrs) in a school uniform helped to distribute the clothes with us. For most of the morning while the clinical people tended those who came, one of the Nepalese women in our team talked with the kids, clipping their fingernails. Some of the orphaned kids were managing to live with extended relatives but were supporting themselves by working odd jobs (no schooling). Child labor is common here with estimates that 42% of children 5-12 years old are working. I could not get much information on how they had lost their parents. Life here is hard. The hills are steep, falls and injuries occur with little access to or money for health care.

Early on, we found a woman needing cataract surgery in both eyes. We made arrangements for her to get checked in KTM and potentially have surgery (1-200 USD). One tiny elderly women hobbled in for gynaecological consult. She had a prolapsed uterus about the size of a grapefruit. The nurses helped her onto a couple of school desks arranged back to back in order to give her an exam. The Swiss nurse was stunned at what they saw. The woman had been in this condition for 5-6 years. Unfortunately, the demands of life here make this an all too common problem. This woman had been living for years hauling water and bags of supplies up and down hills, planting and harvesting rice and other crops, hand laundry, tending the animals and family in this condition. I do not even know how she could sit much less work. The medical staff discussed what to do. As there were no lights in the room and the windows had to be closed, I stood to block the door from others coming in while also trying to not block too much light so the doctors could see (Seth’s flashlight once again was most gratefully appreciated). A nurse tried to explain what the doctors wanted to do (push things back into place and something to hold things back in place). The tiny woman got very nervous and wanted her husband. One of the nepali doctors walked to the hill behind the building to get the husband who agreed to the procedure. It was over in a few minutes (performed on the desks pushed together). They gave her some Tylenol and water to drink. She sat there shaking. After 5-6years, in a room full of strangers, it was traumatic. Aftercare and provisions for further problems were explained – she may still require surgery. They were given some clothes and she quickly went home.

The medical team told me that they had done 3 of these at a previous camp – but as I had not helped in the OB/GYN room, I’d been unaware. With hundreds coming in a day, I can only glimpse some of the cases. The dental team stayed the busiest, extracting 28 teeth. A maoist motorcycle rally was going on for a couple of hours a few hundred meters downhill. As we were finishing the clinic, one of the kids that had been running about all day appeared again waving the red communist flag that someone from the rally must have given him.

As we packed to leave, someone mentioned that there was a tent resort area nearby with great views. We visited it on the way out. There was simple restaurant with a number of tents spread out on the steep hillside. But the view was stunning: the breadth of the Kathmandu valley with the crowning white Himalayas becoming visible in the clouds above the surrounding dark foothills. Afterwards, we drove back for a couple of hours downhill on roads that are mostly only wide enough for one vehicle. If another vehicle is encountered someone has to backup up until a site is found where one can squeeze past the other. I really appreciate the Anandaban drivers!

I’ve tried to post some of the pics from the camp below. I’ve now figured out how to compress photos making them easier to post with our internet issues.

These can be difficult places to work – but the need is great. It is a privilege to be given the opportunity to do something here. I hear stories from others that have been placed abroad to work. Horrible tales, unfathomable need. And the problem is that what we see is not isolated – it is all too common. But common does not dull the pain. Lift up your eyes. There is just so much that needs to be done.

Lamatar camp: clothes distribution

Sorting donated clothes and then passing them through a window to people standing in line. The kids graciously helped one another to sort which pieces fit which kid best. The boy in the blue school uniform (maybe 12-14yrs old) helped the entire time to sort the clothes to the other kids, many of whom were orphans living and working in the community.

Lamatar camp: team arrives at the school building

Lamatar camp: Dr. Indra discussing plans for the day

Lamatar camp: view from behind the school

Kathmandu valley is behind the hill.

Lamatar camp: prepping vegetables for lunch

Lamatar camp: Jwala and Sally picking stones from the dahl (lentils)

Lamatar camp: one of the doctors seeing patients

Lamatar camp: Dr. Indra and Sylvia providing info for cataract surgery

Lamatar camp: checking for malnourishment

Did you know that 49% of the kids in Nepal are malnourished? One of the most obvious common effects is stunted growth.

Lamatar camp: playing hide and seek with my camera

Lamatar camp: dental workers (and surgeon) in action

It was a slow day...only 28 extractions!

Lamatar camp: signing up at registration

Lamatar camp: Sylvia with patients

Lamatar camp: Jwala clipping nails and talking with kids

Chatting at lunch with Sylvia, the Swiss nurse


One of the kids after receiving donated clothes


Hill top view of Kathmandu valley with white himalayas behind in the sky


Rice Fields ripe for harvest

No comments please on this picture not being level!!!

 1. Level places are not common.

2. It is difficult to take level pictures while riding in a bus on these roads.  J

Thursday, October 15, 2009

Reese's Peanut Butter Brownies

This is a recipe that has been tested in my kitchen here (using a “miracle oven” over gas stovetop). Therefore, it comes out in a form slightly like a 2-tone bundt cake. It has been field tested here on Aussies, Brits, Scots, Irish, Dutch, Nepalese, Americans, etc. with favourable reviews!


Reese's Peanut Butter Brownies


3/4 c Butter or margarine

3/4 c Reese's creamy peanut butter

1 3/4 c Sugar

2 tsp Vanilla extract

4 Eggs

1 1/4 c All-purpose flour

1/2 tsp Baking powder

1/4 tsp Salt

1/4 c cocoa 


Recipe slightly adapted from:


1. Heat oven to 350 F. Grease 13x9x2-inch baking pan.

2. In saucepan, melt butter. Add peanut butter; stir until

peanut butter is melted. Stir in sugar and vanilla. Add eggs; beat well with spoon. Add flour, baking powder and salt; beat well. Pour about 1/3-1/2 of the batter into the pan.

3. Mix cocoa into the remaining batter left in the mixing bowl or pot. Pour on top of the other layer in the pan.

4. Bake ~30 minutes or until brownies just begin to pull away from sides of pan. If you want your brownies American style, take it out “just” as it becomes cooked (don’t over bake). Cool completely in pan on wire rack. Cut into bars. About 36 brownies.

Friday, October 9, 2009

Update Oct 9, 2009

The monsoon rains just keep coming and coming and coming. They normally have tapered off by now. Since the rains keep the rivers flowing and the hydroelectric power running, there is a useful side to it. However, they are also saying that continuing rains will damage the rice that is ready for harvest – knocking the ripened grains to the ground. Food prices have already shot up from general shortages. Their reduced yield of crops from the late start of the rains this year. This is the season when many are trying to grow enough to sustain their family for the rest of the year.


The temperatures are also beginning to fall. I wore a sweater today for the first time this season (cardigan for non-Americans J).


With the weather report finished, what has the hospital been up to? Well, the Dashain holiday has officially finished. Tihar happens next weekend and part of the following week. During that festival one day is spent worshipping each of the following: crow, dogs, bull, and then sisters worship their brothers.  Dogs get a tika (red forehead dot) and sometimes a garland on their day. Have I ever told you about the street dog population here? J


Similar to the Christmas season in other countries, longer term patients here (who are able) request to go home for the holidays and then return afterwards. Others will delay seeking treatment until after the holidays are over.


The other day riding to town in a the hospital jeep, an ambulance with sirens blaring overtook us. One of the staff told me about the patient inside that ambulance that had arrived at Anandaban just minutes before we had left the hospital. The man’s leg had been struck by lightning 3 days before deep in the steep hills south of Anandaban. For about 200,000 people spread out for many hours drive in those hills, we are the nearest hospital. And many of those people live many hours walk from the nearest road. It had taken that man 3 days to get to Anandaban. He probably had to get someone to carry him partway until they could find a road and then some form of transport. By the time he reached us, the leg was infected. Although we have a general ward and an emergency room, this case was too critical and had to be referred to a hospital in Kathmandu... which meant that he had to ride another hour over rough roads. As we sat in the traffic jam listening to the wailing siren stalled ahead of us, one of the staff mentioned that maybe after 3 days the nerves were damaged so badly that maybe he would not be in serious pain anymore at this point...maybe...   


Other current events: A church group from the UK has come to help out for a week. Dr. Hugh Cross (Leprosy Mission Country Rep for Nepal) and his wife Diana are here in Nepal for a month. They will be working with various groups, leprosy organizations across Nepal, visiting Lalgadh Hospital and having meetings with the staff here. The first free medical camp is tentatively scheduled for later this month. Next month there is a UK specialist hand surgeon coming to have a surgical camp here and at Lalgadh. The camps are especially good. We line up patients from across Nepal in need of specialized reconstructive surgery as well as interested nepali doctors that need to learn the specialized techniques. Then the surgeons team up for all day surgical marathons! It is amazing to watch people “operate” in their gifting with joy and excitement. They pray before each one. The doctors wear themselves out giving and the is such a blessing to even see them receive it. It can make such a tremendous difference in their life to have a hand somewhat functional again and not be so obviously disabled in a stigmatized culture. Also, a Japanese surgical nurse who “happened” to visit last year alongside the UK specialist team has decided to come again to help out.  More news later...


The surgery pic is from a hand camp last year around this time. Dr. Indra and Dr. Donald (guest UK hand specialist) work on a boy’s hand. In the other photo, a few weeks later, I was able to get a picture of some of the surgery camp patients around the hospital (they have to stay for a couple of months for recovery and specialized physical therapy). One boy is holding his cast out of view while one of the others is trying very hard to resist smiling at me! Please pray for the patients here at the hospital. Many come from far or remote places. Due to the difficulties of life here, sometimes families cannot spare someone to be with a child patient during a long hospital stay.  










Wednesday, October 7, 2009

Leprosy Article Excerpt about Perspective

  • Below is a portion of an article written by an MD comparing funding amounts of wall street executives, war initiatives and public health campaigns. He uses leprosy to prove one of the points. the whole article by Dr. Tom Engelhardt is here:
  • When Curing Millions of Leprosy is "Failure"
  • ...But wait. Aren't some of these public health campaigns wasteful failures? Sure they are. Let's look at one public health failure: The drive to eliminate leprosy.
  • Caught early enough, leprosy can be cured today with the antibiotics dapsone, rifampicin, and clofazimine. Over 25 years -- courtesy of Novartis pharmaceuticals and the Japanese Nippon Foundation -- these medicines have been handed out for free, and have cured more than 14 million people of the disease. They work so well that the WHO now recommends integrating the world's 250,000 known leprosy patients into primary-care settings, just like those with any other illness.
  • Treatment is so effective, in fact, that several years ago the WHO launched a campaign to eliminate leprosy entirely. Ultimately it sank 15 years and about $200 million into the project. (I cannot find a link for the $200 million figure, provided to me by WHO officials in e-mail correspondence.)
  • But there's a logistical nightmare when trying to eliminate leprosy. Other targets such as smallpox, polio, and Guinea worm exist in one reservoir only: sick humans.
  • Not so with Mycobacterium leprae, a bacterium that attacks skin and nerve cells. Even today, we don't know everywhere this bug lives. It has been found in the oddest places: in armadillos in Louisiana and Texas, in the noses of healthy people in some parts of the world, and even in some soil samples.
  • Such a bug was never an easy target. Even so, in 1991, the World Health Organization vowed its "elimination" -- and then defined "elimination" to mean less than 1 case per 10,000 people. At such a low background level, it was hoped, the disease might dwindle into irrelevance. It hasn't worked. That 1-in-10,000 target was arrived at via politics and hopeful thinking. It was achieved worldwide in 2000, putting the WHO in the risible position of claiming "elimination!" and then seeking more money to, like, eliminate it some more.
  • The organization was bitterly criticized. Earnest, indignant treatises have been written noting that there is too little money to go around, and accusing the WHO of risking the credit of the more promising drives against polio and Guinea worm.
  • So, the anti-leprosy push was a $200 million failure.
  • Because it didn't eradicate leprosy.
  • It only cured 14 million people.
  • Of leprosy.
  • For half the price of an Alaskan bridge to nowhere.
  • Oddly enough, $200 million is reportedly the tax deferral enjoyed by former Goldman Sachs CEO Henry Paulson -- he of bailout infamy -- when he joined the Bush cabinet as treasury secretary.
  • So there you have it, finally: For $200 million of public money we can take a walk in the footsteps of Jesus Christ himself, curing millions of leprosy. A truly inspiring future is, as always, easily within reach, if we choose it.
  • Or we can just give Hank Paulson a tax break. Maybe throw in a credenza by way of thanks.

Sunday, September 13, 2009

another favorite goat pic

This animal was totally calm.

Riding the goats in Kathmandu


Sept 13 Update

Namaste. It’s been busy. The power outages are beginning again to cut into the days – but at a mere ~4hrs per day right now, that’s manageable! Tuesday, I depart for Karigiri Leprosy Hospital ( outside of Vellore (Tamil Nadu, India). Dashian, the biggest festival of the year is coming in a couple of weeks. Look it up: . Many goats will die – but then again, many turkeys will soon die in my own country.  Although the festival lasts for ~10 days, Anandaban will just have a 4 day weekend. Almost everyone travels to their home village for related rituals, etc; therefore, practically EVERYTHING in the nation closes…newspapers, public transport, all shops, etc.  Many of the patients will check out of the hospital to go home and then come back. In leprosy, they may not feel the pain and this is the most important religious festival of the year.


A couple of med teams left to go to some districts in the far west region that are experiencing cholera epidemics. They’ve now returned and given presentations on their trip. I hope to post some pics and stories from that soon. Those areas are so remote and the terrain extremely difficult. Far, far from roads. Days of walking or mule trains into steep, steep hills. Many of the people there have never seen a vehicle. During one health education session the doctors held with some village kids, they asked, “Who has a toilet?” No one did. The teams split up into two districts and walked days between villages. In total, more than 3000 people were seen by doctors etc in the camps. These areas are so difficult to reach and to live in that few educated health professionals want to even go through the effort to get there, much less live there to provide health care. The med teams found buildings that had been built at district headquarters some time in the past, but no doctors.   

Wednesday, August 26, 2009

Around the house pics

I'm not sure which order these will appear. My personal laptop went blind
(screen lamp dead) and there is no treatment available in Nepal. Therefore
it has taken some time to get some of my files etc retrieved from the hard
drive for posting to the blog. So, the white cement house is my home: No 4
Hansen House. Hansen was the Norwegian scientist that discovered the leprosy
bacteria. My friends may also have heard it before, since I worked at the
US National Hansens Disease Program in some capacity for around a decade or
so. J Looking up from my home on the right, there is the two story guest
house. There are 5 rooms with capacity to host a total of 11 people
comfortably. Higher up on the left is a small "canteen" on the edge of the
hospital driveway. I buy my eggs there, which are carried up in a crate
from the valley village below, Tikabhairab. Right now the going price is
roughly 10 cents an egg. The other pic is a current favorite: looking up
through the pines on a not-too-monsoon day, there is a rainbow about the
sun. J

It's that time of year again...

The monsoon rains make the grass grow. It can take days to cut a patch. In this picture is the largest stretch of flat space on the entire compound. So, even if someone had a lawnmower, it’s not as if it could be easily applied to the other 98% of the compound. But I think the method is maybe not so great for avoiding the leeches which stand on their tails and wait with gaping mouths for anything to pass by. Because they inject anesthetic first, you usually do not know unless you look or until they are finished and the blood just flows (from blood thinner) after they’ve gorged themselves. Pretty disgusting. Someone told me that tobacco juice wards them off, but since I do not spit…I keep to the clear areas as much as possible.

Wednesday, July 22, 2009

Eclipse in Nepal



This morning was the 96% eclipse of the sun here in Nepal (~6:42AM). Elisa and I tried to get good pictures of this “once in a lifetime event”; however, monsoon clouds protected us! Nevertheless, as you can see, the valley below Anandaban is beautifully green as it should be this time of year with rice fields.  The pics are during, after peak and then later as it was brighter. The last pic shows a small dam set up in the valley. Although the monsoon rains have come and the fields are green with rice plants, you can easily see that the small reservoir only has a minor stream compared to what it is designed to catch. Monsoon is definitely less this year and it will be reflected in the crop yield.

The leprosy clinic at Patan in KTM was the quietest I have ever seen. Schools and govt offices were closed. There are strong cultural traditions here regarding eclipses (  We also heard that there were two bandhs going on in different parts of the valley.


Sunday, July 19, 2009

Crow talker man threatens to halt Nepal's airport

STAFF WRITER 16:21 HRS IST Kathmandu, Jul 18 (PTI) A man who claims to converse with crows and gather thousands of them by his command has threatened to paralyse Nepal's only international airport if the government does not help him get his name enlisted in the prestigious Guinness Book of World Records. Gautam Sapkota, 27 who has reportedly got the unique skill could not get his name enlisted in the Guinness World Records due to financial problems, though he has already initiated the process of registration last year. Speaking at a press conference in eastern Nepal town Dharan yesterday, Sapkota gave three month ultimatum to the government to help him get his name registered in the Guinness World Records.


Saturday, July 18, 2009

why sheep? pt3

Why does a developing world hospital keep sheep onsite? Blood. Lab people often seem the vampires of the hospital. Have you ever given a blood sample for lab testing? Blood is one of the easiest things to get as a sample to reveal a lot of information for a doctor to use. Ever heard of a petri dish or an agar plate? Well, in order to test body fluids for bacteria that eat or destroy blood cells, a little bit of blood is mixed into the agar gel in the plate. Usually this is 5% sheep’s blood because that is easy. If the bacteria are staph or strep from a throat swab, it will grow on the gel and “clear” the red blood color as it consumes it (see pic or visit  
There are families of bacteria that thrive on the iron in blood. These tests, a microscope and a good lab technician can help in diagnosis so that the doctor can prescribe proper treatment.


So, the well fed handful of sheep act as regular blood donors to help patients receive proper diagnosis. The lab people told me that it is common to also use out-of-date human blood from the blood bank when available, so nothing is wasted.  In more developed countries, blood agar plates are just another item to place on order from a science supply catalog. The sheep are housed elsewhere.


Should the next trivia question be easier? J

Wednesday, July 15, 2009

Why would a hospital need sheep pt2

Well, the answer is not:


  1. to cut grass – this would make sense to people who have to cut weekly. Here, though, animals aren’t fenced in – cattle roam the streets anyway. Plus it may not rain 9m/yr. So, if the grass does need cutting for cosmetic purposes (very rare & not a high priority), it’s done maybe 2x/yr.
  2. Scare off monkeys – I wish.
  3. Milk – have not heard of that one. Water buffalo is the staple here.
  4. Meat – Nope. A handful of sheep wouldn’t do much for a hospital of 200 beds.
  5. Bait for wild animals that would otherwise eat the humans – Nope. There is an uncontrolled street dog population available.


There is a “scientific” reason. Those who have lab experience, even microbiology lab class, have an edge. Although, I did not figure it out. Someone told me. J And it was spoken as if it was the most reasonable and obvious thing for a lab person to know. This is way more hints than I had.

Monday, July 13, 2009

Why would Patan Hospital in Kathmandu keep a few sheep roaming on the grounds?

There is a good scientific explanation. Give me your best answer. J

Saturday, July 11, 2009

090712 Blog Update

Do you recognize the two trees on either side of the outpatient clinic sign? They are both native in my hometown and one is my state tree. J This morning when I walked outside it sounded like a pet shop. I hard time trying to see them in the trees, but it sounded like a good sized flock of happy parakeets had decided to descend on compound.  The power outages are at the annual minimum about now. We just heard that we are down to 1 “scheduled” hr per day off. It’s a pity that this extra energy cannot be stored properly against the other 9 months of the year when rain does not fill the rivers with hydroelectric power.   


The past few weeks have been spent writing grant proposals and evaluations. This coming week, two of our Masters students from Tribhuvan University are hoping to have their final thesis defense.  They both worked hard at Anandaban for almost 3 years on a project investigating strain typing for tracking short range transmission of leprosy. It was a lot of work! There are also several sets of government paperwork that need to be submitted this week and next. Next week, a project auditor from the US will come to check on the skin test project paperwork. At the same time, Dr. Hugh Cross, our TLM national rep, will be here for strategic 5yr planning meetings for the hospital. Doesn’t everyone enjoy back-to-back all day long intense meetings?


The week after that… I leave for Japan and Hong Kong. In Fukuoka, Japan there will be an NIH US/Japan cooperative Leprosy and Tuberculosis meeting. Scientists will present their latest findings for discussion. It’s a great opportunity to learn, meet with collaborators and see friends and colleagues! After that, I’ll fly to Hong Kong for a biosafety and good clinical practices training workshop specific for leprosy and TB. The last time I attended a workshop hosted by this group, we were in sessions essentially from breakfast til evening – lots of information. This trip and workshop is funded by the US National Institutes of Health. So, US tax payers, this is something that you are funding. Many sincere thanks! Two of us from Nepal are receiving the training as well as another Leprosy Mission lab staff from Cebu. Hopefully, the training will help us maintain the best levels of lab procedures in handling human samples for hospital testing and research.   


By the way, working in a developing country diagnostic laboratory makes for special opportunities. Yes, my office door is right next to where samples are taken for lab testing. How often do people bring their sputum to you in bottles like this? This patient had shown considerable thoughtfulness to carry this with him on his journey to Anandaban. Ishwor promptly added Lysol. I think we prefer our sputum samples freshly hacked on site.


The internet has slowed again of late. Oh well, when you notice that I don’t post as much it is most likely due to power, internet and/or workload issues. It is never, ever because there is a lack of things going on! If I have good internet access in Japan or Hong Kong, I will try to find time to post pics and maybe even video.



Friday, July 10, 2009

Dozen Daughters in Pursuit of a Son (A baby's gender considered a woman's "accomplishment" or "fault")

CHITWAN, June 28: She used to be sprightly and had an aura among her peers in the neighborhood. But a dozen failed attempts at a son later, 47-year-old Krishna Maya Latoula looks like an elderly. Physically and mentally exhausted, she now lives on medicines to support her ailing body that has taken the toll of her indomitable pursuit of that elusive dream and the nightmarish fallout of her failure. Wed to Dashrath of Kumroj-6 while just 15, she has spent 27 years of her married life pursuing the ultimate dream of a Hindu woman. But she had to finally surrender to the ever-ticking biological clock and have not been able to deliver after the youngest daughter Joshna five years ago. Ironically though, the final blow has brought with it a sense of relief for the mother of a dozen daughters. “I take solace in the fact that I no longer have to go through his physical abuse and snide remarks for failing to conceive a son,” Krishna Maya says with misty eyes. “I endured everything for the son but…,” the emotions take over and she fails to complete the sentence.

Living in a joint family with Dashrath´s mother and brother, who ironically has two sons, Krishna Maya has had three of her 10 alive daughters married. The eldest Kala has given a grandson, who lives with Krishna Maya, but that is no consolation for Dashrath. “I had hopes that the son would look after me through my old age, make my name in society and get me across Baitarni (a filthy river on the way to heaven described in Hindu mythology that can only be crossed after rituals performed by a son) but my hopes remain unfulfilled,” Dashrath complains. But Dashrath´s octogenarian mother Laxmi—who still actively heads the middle-class family that owns two tractors, two bigaha of land and a small shop—surprisingly has a different perspective. “There is no difference between a son and a daughter,” Laxmi believes. “Even though I harbored hopes of a grandson, I had advised Dashrath to stop after five. But he did not listen,” she reveals. Dashrath, to his credit, has not neglected his daughters despite being paranoid about having a son. Chanda and Jamuna, like the eldest Kala, have been married while Leela and Sita are studying in the 12th and 11th grades respectively. Ram Maya is in the eighth grade, Shova in seventh, Rama fourth, Durga second and Joshna in kindergarten. “Despite having many daughters, he (father) has never left us short on food and education,” the seventh daughter Shova says. "But he still craves for a son," Shova adds. Krishna Maya knows that craving and empathizes with Dashrath, and even looks to have that feeling of having let him down despite all his criticisms and abuses. “I could have died peacefully only if I had a son,” she completes her earlier sentence. (Sometimes a new wife is obtained in an attempt to resolve this issue, further solidifying the first wife as a failure in the community or leaving her abandoned.)


Sunday, July 5, 2009

Monsoon & Rice Planting

Monsoon means rice planting season. Flooded patties in the valleys and steppe fields cut into the hill sides are everywhere possible. Rice is the daily staple for most Nepalese, so this season is important for the year’s food supply. EVERYTHING is done by hand (or water buffalo). The rains have come late and little so far. People are trying to flood the patties artificially from valley streams to get things going. The temps could begin to fall again before the crop yields.


(Late monsoon brings fear of food shortage in Nepal


Further up into the Himalayas, where people cannot get rice, they eat a thick play-dough like mix of barley meal and water (it lands like lead). The first time that softball sized lump came on my plate, someone recommended that I hurry up and eat it while it was still hot and pliable – because it would only get harder as it cooled. I tried for awhile pulling off pieces like taffy with my hand to dip in lentils; but then my friends had mercy and gave me some rice (which they had all requested – serious hint there). Rice is the preferred food when available. By the way, a leopard has been sighted on compound twice within the last week, at least once in daylight. I haven’t heard of a leopard attacking a person around here. Tigers have a different record within nearby village areas. It’s difficult to tell though sometimes as the word “leopard” is mostly used here for both. Remember Bagheera the black leopard in The Jungle Book? The word here is bagh. The monsoon rains have also helped to ease the water shortage here in this high altitude valley. Here is a sample of today’s tap water. I had just got back from KTM and needed a shower. J All water for drinking has to filtered and then boiled for 5-10 minutes; but a lot of people don’t do it. It costs fuel to boil water like that for daily use in a household.

Late monsoon brings fear of food shortage in Nepal

LALITPUR, Nepal (AFP) — Every year, Nepalese rice farmer Ratnakaji Maharjan celebrates the arrival of the monsoon rains by attending a centuries-old festival in this historic town near Kathmandu. The annual event, in which a huge chariot said to carry the Hindu rain god Machchindra Nath is pulled through the streets of Lalitpur, draws crowds from across the Kathmandu Valley to celebrate and pray for a good monsoon. But this year, Maharjan's mood was more subdued than celebratory as he queued to worship before the wooden chariot. "The monsoon is almost a month late," complained the 35-year-old, whose family has farmed here for five generations. "The weather patterns seem to have changed, and we don't know how to adjust."

Nepal's long-delayed monsoon finally arrived in the Kathmandu Valley on Monday, allowing local farmers to begin transplanting their seedlings to the waterlogged rice paddies after weeks of anxious waiting. But there are fears the delay could prove devastating for this year's rice crop, and experts say the increasing unpredictability of the weather is causing huge problems for farmers in one of the world's poorest countries. "The monsoon this year started around three weeks late," said Krishna Prasad Paudyal, senior scientist with the government-funded Nepal Agriculture Research Council. "This was a major setback for rice planting, which requires lots of water. The delayed monsoon meant a lot of young seedlings died, and even those that could be planted won't have time to mature enough to yield a good crop." Rice accounts for almost 50 percent of cereal production in Nepal, which is particularly dependent on rainfall because less than one-third of its agricultural land is irrigated. The delay to the monsoon came after the landlocked country suffered its driest winter for 40 years, resulting in a fall of 20-25 percent in the production of wheat, Nepal's second-biggest crop after rice.

-- Serious food shortages looming --

Three years after Nepal's decade-long civil war came to an end, the World Food Programme (WFP) says many people are still living in near-crisis conditions, with 41 percent of the population undernourished. Almost one in four Nepalese people live on less than a dollar a day, and around 2.7 million depend on WFP food aid. "There are 16 districts that are highly or severely food insecure as a result of the drought and underlying factors like high food prices and poverty," WFP country director for Nepal Richard Ragan told AFP. "WFP has food-for-work projects in these districts, but we are rushing to include people living in drought-affected villages not covered under our activities." Ragan said the latest drought was particularly devastating because it followed more than 18 months of high food prices and years of poor crop production in many areas. "Many people have used up all of their food and cash reserves and are now forced to take drastic measures to survive -- like skipping meals and selling off agricultural assets," he added. Some local officials are predicting worse to come if this year's rice harvest is poor. Balgobinda Pathak, a government agriculture official in western Achham district, said he was expecting serious food shortages later in the year. "Last winter, food production was down by 60 per cent decrease due to erratic weather and some floods," he said. "This year, 50 per cent of crops have already been destroyed due to lack of rainfall. We will see a massive food crisis later this year." Experts say Nepal is unprepared for the changing weather patterns, and will have to do more to adapt to rising temperatures and increasingly erratic rainfall. "What we have seen lately is not just a change in the weather, but extreme variability in weather patterns," said Pitamber Sharma, a professor and expert on urban and rural planning. "These kind of erratic weather patterns will have a huge impact on farming and cultivation."

Thursday, July 2, 2009

Headline news in Nepal

Nepal sees only 12 days free of strikes in 6 months

KATHMANDU, June 28 (Xinhua) -- Nepal's statistics showed that in the past six months only 12 days were free of any kind of strike, local media reported Sunday. According to a report of The Himalayan Times daily, strikes or bandhs have lasted for 166 days in the past six months, disrupting traffic and shutting down government offices, business establishments, hospitals and bazaars. All days in January, February and April saw a strike in some part of the country. Except for March 18 and June 13, strikes were recorded every day in the two months. In May, 46 bandhs were recorded, while June has seen 57 bandhs and strikes so far. The statistics, compiled from incidents reported by mass media across the country, also reflect that the Unified Communist Party of Nepal (Maoist) (UCPN-M) has been using bandh as a tool for protest after it stepped down from the government in the first week of May, according to the report.  Organizations affiliated with UCPN-M enforced 22 bandhs and strikes in June and 17 in May. The party enforced bandhs for 69 such programs in the past six months. Other parties are also not far behind when it comes to enforcing bandhs. The Nepali Congress and the Communist Party Nepal-Unified Marxist Leninist organized 15 and 17 bandhs respectively in the last six months. Not only the political parties, even locals have started enforcing bandhs to fulfill their demands. In the last six months, the locals organized bandhs and strikes across the country for 175times. They mainly blocked roads demanding compensation for the families of accidents victims.

    Armed outfits and Terai-based groups in southern Nepal enforced such programs 145 times while the transporters and traders enforced bandh 92 times in the period. According to the daily, the increasing culture of bandhs is severely affecting the poor's ability to feed themselves, forcing many to skip meals and scavenge for food or borrow money and sell off assets to survive, the United Nations World Food Program said in a bulletin. The Federation of Nepalese Chambers of Commerce and Industries also informed that the nation loses revenue worth 7 to 14 million U.S. dollars on every bandh day. According to the police, bandhs and strikes were recorded on 254 days in 2008. The strikes were carried out by political parties, ethnic groups, students, labor groups, journalists, traders and teachers, among others.



Sunday, June 28, 2009

Just how unpredictable are strikes & protests (bandhas) in Nepal??

Bandh = everything closes, no public transport available (very few individuals own a vehicle), with tire-burning road blocks that threaten to enforce retribution on those that violate the bandh; can be called at any time by practically anyone, but most commonly by protesting people & political groups making demands that are not being otherwise met…in other words, kids get a lot of days off from school, tourists may find themselves walking from the airport to the nearest hotel and the availability of supplies coming into the valley to support millions is more often under threat than not.


Soothsayers fail to put their finger on the date

Kantipur Report

KATHMANDU, June 2 - How could the meticulous calculations go wrong? Or is it that the genius soothsayers simply miscalculated. However, in Kaliyug anything can happen, some say, at least to find some solace. On Monday afternoon, renowned astrologers from around the world gathered in Kathmandu for an international conference on astrology. They were heard whispering whether their science malfunctioned. The event was scheduled for June 1 terming it the best day after rigorous calculations, but it seems none of them could put their fingers on the right tab. A general strike called by the ethnic group Newa Mukti Morcha brought the capital city to a standstill, leaving the astrologers red-faced.  While scores of national and international participants were stranded at Thankot, the entry point to the valley, several others in the Capital could not make it to the venue due to the strike. And those who managed to had another problem: how will they go back? The august gathering that was to see at least 700 astrologers of international repute was to discuss ways to make this ancient science more accurate.  Ironically, the banda threw cold water on the programme. Though not raised by any participant, a question that must have been hovering in everyone's mind was: How could the astrologers fail to fix a hassle-free date for an international event? Organisers agree that a mathematical error might have led to the wrong astrological calculation. "We had earlier chosen May 30 for the event, but had to reschedule the event to June 1 owing to some problems," said Lok Raj Poudel, chair of the Astro-Council of Nepal and one of the organisers.

"We are no gods," said Dr. K. Divakaran, another veteran astrologer from India. "Astrologers cannot be accurate all the time." However, Kim J. Baaden, a participant, said this question had popped up in his head. He quipped that astrologers might have organised the event on the very day of banda, thinking people would have ample time to participate in the conference in a big way.  However, some have different excuses. "June 1 is the perfect date by all means, including lunar position, but predictions generally go wrong in Kaliyug," said Dubindra Serma, an acclaimed head guru and astrologer in the Kiranti community. Astrologers prophecise things as per the message of God but  God is also facing problems these days, says Divakaran.

The two-day conference aims to promote astrology as a science, initiate collaboration between Eastern and Western astrologers and modernise the traditional science. Interestingly, the conference also aims to sort out problems of inaccuracy in astrology. "Our astrology still predicts that one will have 12-15 children. Nobody believes such predictions however accurate the calculations astrologers claim to be," said Poudel.


Saturday, June 27, 2009

Toenails and fellowship

A couple of months ago, we had a women’s retreat. The entire thing, except for some activities, was in Nepali. Have I mentioned that I speak about toddler level? I know very much what it feels like for a child to sit in a long meeting as people use unrecognizable words for hours. Really, though, it was very good. We did play some nice games later involving hula-hoops, makeup in a bag and blindfolds. J J  We also had a toenail painting session. In the photo, L-R: Elisa, Laxmi and Chanda.   

Thursday, June 25, 2009

Two stories

God moves so much in the everyday. Glimpses and gleams. Yesterday, we had the regular weekly outreach leprosy at Patan hospital in Kathmandu. Because we are recruiting for a very big study, the research group has been working in a special separate room from the other hospital staff. During the morning, we were very busy – every station had patients and staff working on different bits of the study. I remembered that Dr. Indra, our senior surgeon who does not come for satellite clinic every week, had not yet seen us in action yet for this particular project’s recruitment. So, I went and told him to maybe come and see when possible. He was busy and said he could maybe get time in the afternoon to come see. We continued to work right through lunch. We were expecting 22 people to come for follow-up that day, and not everyone in the study is a leprosy patient. By the end of the morning, one of the lab staff counted the files and saw only 19 had come. So, the lab staff began making reminder phone calls. One was a young woman. Later in the afternoon, Dr. Indra walked in. I began touring him around the different stations set up for the study. The young woman walked in – at which point, one of the lab staff recognized her from the morning and began to apologize. We’d made a mistake! She had already come earlier that day, and so we did not need to see her again. She sat down at one of the desks with the staff to talk a bit. But Dr. Indra was standing nearby. The woman has a very badly disfigured right hand from a burn injury – no fingers and angled sharply to the side. She manages her scarf carefully to cover it some. Dr. Indra is an orthopedic surgeon; and because many leprosy patients require hand surgery, we do a lot of that Anandaban. Someone spoke to Dr. Indra. He turned to look at her hand. They set a date for her surgery this fall when a UK plastic surgeon and hand specialist will come to perform a week of hand surgeries. J So was it a mistake that one of the staff known for details, mistakenly recalled the young woman to come back? And that she happened to come in the room when an orthopedic surgeon experienced in hand surgery would stand only a few feet from her? J

This evening, we had fellowship at the hospital. Several patients came. There has been a sweet little (and I mean little, maybe 60-70lbs) old lady staying at the hospital for some weeks now. She barely comes to my shoulder. She is blind in one eye. She has no fingers and her feet are not so good either. But she hobbles about at her 80 years, gentle and uncomplaining. Tonight, when we asked for prayer requests, she told us that she is scheduled to be discharged tomorrow to go home. Home is in the Okhaldunga area– which by any standards is remote. There is a flight to that area maybe twice a week – but often cancelled due to low priority and weather. Once she gets there, she will have to walk two days into steep hills to get home. She had tears flowing. She spoke of known bear attacks in the jungle hill paths. Often here, younger men in families will carry the elderly or people can be hired to carry others in baskets on their backs. These hills are steep. I had a very hard time trying to catch if she has any family to meet her along the way, but it sounded like maybe not. No one is coming here to get her. Someone is meeting her in KTM tomorrow, but they aren’t flying with her. It’s highly unusual for a woman to travel alone. There are women in the hospital who can’t go home until someone comes – because they have never been outside their village much before, aren’t educated (most women can’t even sign their name) and do not know how to get home by themselves. So, for this 80 year old to be going by herself…maybe there is no family. Maybe there is no way to get word to them. Maybe because it is now rice planting season, no one can be spared to meet her. How would she get word back to us to tell us she got home safely? I do not know how she will walk two days on her disabled feet. And how without fingers can she manage money to safely pay for things along the way when she is by herself? There are so many stories like this. And it still hurts. Please pray for her. Maybe that someone will be there going to her village to travel alongside her and help her to get home. That there will be no bears and she will not be afraid. Two other elderly women patients walked beside her after the meeting to help her back to the female ward for the night. What to do? Do you know that according to national standards, she does not even qualify as disabled…because it was caused by leprosy.

Monday, June 22, 2009

Leprosy Research out the back of a truck

One of the studies we’re currently performing compares the skin reactions of people with leprosy to those who do not have it. Hopefully, this will someday aid in making an easy test to detect early leprosy in people who do not yet have major signs of disease. Therefore we could potentially treat them before major nerve damage and disability occur. But for right now, we are pretty busy trying out the prototypes. In this picture, we are spending Saturday morning in the parking lot of Patan Hospital in Kathmandu. Dr. Min Thapa is checking the temperature etc of a couple enrolled in the study. His younger son and wife, Sagar, watch beside him. Sagar is a CMA serving as a nurse in Anandaban.