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.