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Finally in Phortse and the Khumbu Health Care System

22 Mar

I’m finally writing from Phortse. It has taken almost a week to get to this remote village in the midst of the Khumbu valley at the start of the Gokyo trek. Surprisingly, the 3G internet connectivity here is faster than that in KTM. I can’t say the same thing however for the normal mobile phone connectivity which gets disconnected every few minutes. Phortse is an isolated village at an elevation of 3810m atop a spur projected into the Khumbu valley. The locals live on terrace farming of potatoes and buckwheat – all that grows on this barren sandy earth of the Himalayan highlands. I’m living in the company of Danaru Sherpa, a 53 year old, who’s a 9 time Everest summiteer. I met him during last year’s Cho Oyu expedition when I climbed with IMG. Similar to how no one recognizes Clark Kent with his thick black spectacles, its funny how these Sherpa superheroes engage Everest during spring and become potato farmers in winter. No one would even take a second look at these tiny men as they plough their land planting potatoes as the hordes of trekkers wisp past the village. The humility and strength of these great men is far beyond one can perceive.

Danuru Sherpa, 9 times Everest sumitteer and father of 3 holding up a plaque presented by Sir Edmund Hillary

Climbing Everest is just a job for these Sherpas. No guts nor glory involved. Its something that has to be done, so that they can feed their families and send their children to school. When you ask them why they suffer and risk their lives to climb, their simple reply is “I climb so that my children do not have to climb”. When one does the Everest Base Camp trek in the Khumbu valley, they will need to stay in teahouses from day to day. There, they will notice, hung proudly on the walls, will be the photos and certificates of the children of the owners of the respective teahouses. The fathers climb, the mothers look after the teahouse and their family land and with whatever that is earned, the children are sent to the best schools all around the world. They risk their lives to provide the best for their children. Photos from Australia, US, UK and the degrees with which the Sherpa children graduated from, line the walls. The Sherpa are simple minded family oriented friendly people. I respect them for coming from no where, working hard and self educating themselves with the necessary skills for entertaining tourists/trekkers/climbers and making a living out of it. Most importantly, I respect them for recognizing the value of education and wanting to give the best for their children despite all the hardship. With all that said, its still sad to know that the average Sherpa climbing guide, earns less than the average Nepalese citizen.

 

Sherpa children along the trek

My last piece of luggage arrived in Lukla by noon on Friday. I was thrilled with that until I opened my bag. 2 of the Motilium medication bottles had broke and 500ml of the sticky liquid had coated nearly all of the equipment inside. Further more, the broken glass had damaged some of medical equipment and my duffle bag as well. So much for having chosen a waterproof duffle when in fact, it had prevented the liquid from quietly draining out of the bag. I had to spend 2h cleaning the stuff inside. The cardboard boxes holding the rubber gloves and the surgical masks were all soaked and had ripped open. I had to duct tape all of it back together. At the end of the day, it looked totally unpresentable and unacceptable as medical equipment. I had to condemn some of the boxes.

 

As we walked uphill in the terrible terrain to Kunde hospital to meet Dr Kami from Namche, I recollected this amusing incident that happened in Lukla when I landed. I was waiting for my other pieces of luggage to arrive when this tall lanky man dressed in a rather formal attire (for trekking) with a thick British accent deplaned and stood by his luggage waiting for his porter to arrive. His baggage turned out to be a Samsonite suitcase with a handle and rollers for easy transport … in an environment like a hotel lobby that is. Obviously he had never trekked in Nepal before and went onto ask his porter why he was tying the suitcase with ropes (the way the Sherpa porters carry loads with their heads). He pulled up the handle and innocently asked “why not we just roll it along?”. If only the poor chap knew what he had gotten himself into and the terrain that lay ahead of him.

 

The majestic Ama Dablam seen from the village of Kunde. Never getting sick of it even after seeing it a million times.

We reached the village of Kunde, with the magnificent view of Mt Ama Dablam in the distance. Looking at it for the umpteenth time now, I was still awed at its beauty and couldn’t believe that I had summitted that majestic peak. I and my 3 porters marched into Kunde hospital bearing gifts of medical equipment for Dr Kami and his hospital staff. There Dr Kami explained in detail the health system in the Khumbu region.

 

The medical gifts that we bore to Kunde hospital

Dr Kami and team delighted to receive our equipment

The Kunde hospital was set up in 1966 by Sir Edmund Hilary. This was after he climbed Everest and saw the plight of the Sherpa people in the region. He 1st set up the school in Khumjung before the hospital. After many trials and tribulations, the hospital still stands strong today with funding by the Himalayan Trust, a non profit organization based in Canada. It recently set up out reach clinics in 4 nearby villages, Thame, Monjo, Phortse and Pangboche. They trained some of the locals from these villages in KTM for 16 months before they were made to run each of the clinics as health care assistants. These outreach clinics were intended to help the locals seek medical attention for simple conditions and to allowed them to collect medications for chronic diseases instead of having to walk 1-2 days to the Kunde hospital. All this looked very good on paper but things were very different on the ground.

 

When I first visited Phortse in Nov 11 after climbing Ama Dablam to reccee the clinic, I found out the actual situation. I linked up with the health care worker and she was describing the common symptoms she sees and the medications that she prescribes. There were very basic medications in very small quantities available. In my opinion this was not enough to run a basic clinic even for a small population of 400. Some antibiotics were at her disposal without her knowing the indications for prescription. There were simple surgical instruments lying around waiting to be brought to Kunde hospital for autoclaving (sterilization), the tap and the sink didn’t work and in general, the whole place didn’t look like a clinic to me. The locals didn’t really trust the system and chose to go to Kunde hospital (a day’s walk away) to seek help from a real doctor. Somehow the perfect system that was set up didn’t seem to have as much a positive impact on the locals as it was intended to be.

 

The whole remote village of Phortse seen from Mongla. Not many people visit Phortse as it lies away from the main trail of the Everest Base Camp trek as well as the Gokyo trek.

I came in with the mission of setting up a proper clinic in Phortse with new medication and equipment and to adequately train the health care worker such that she is more competent in rendering medical help to the villagers. Basically, I was trying to get the health care worker confident in using more medications and seeing slightly more complicated cases and at the same time to gain the trust of the people to trust the system such that everything was more sustainable once I left. However the stars had planned otherwise.

 

Dr Kami informed me that he was pretty upset with the health care worker in Phortse. She had married a man from Kathmandu and often took long vacations from the clinic to visit her husband. Recently she had gotten pregnant and chose to deliver at KTM instead of Kunde hospital (where there are adequate delivery facilities available) as even she herself did not trust the system. She had to undergo a Caesarian section and was staying in KTM till she recovered fully. This meant that she left the village of Phortse in Jan and was not going to be back till May. Even the villagers in Phortse, whom with which I spoke to later, were unhappy with her as she left them with a white elephant medical facility which was going to be locked for half a year. The 1st person I came in contact with in Phortse was a lodge owner who was sleeping wrapped up in blankets when I entered the lodge. He was ill and was still nice enough to receive me with a cup of hot milk tea. When I told him that I came to Phortse to set up the clinic, he was furious and went on rambling about the health care worker who had been chosen for medical training for the people by the people but had left them in the deep end of the pool ever since she had married the man from KTM. He had to chosen to wait out his cold rather than take a day’s walk to Kunde hospital for treatment. This seemed to be the plight of the villagers of Phortse- suffering in silence. Even Dr Kami said that the funds that they had spent on training her had been wasted. So there went my hopes of making the health clinic in Phortse sustainable by educating the health care worker. I now also had to grapple with the situation of not having any translator at the village for my clinic.

 

Cleaning up the Phortse clinic after the dust filled 3 months of lock up

Dr Kami also went on to explain that this was the similar situation in the village of Monjo. Coincidently both the healthcare workers in Monjo and Phortse were females and had conceived around the same time and had gone to KTM to deliver and had C-sections performed for their delivery. They were both recovering in KTM and thus both Monjo and Phortse had no one rendering medical assistance. Even Kunde hospital was facing a crisis. There are usually 2 doctors in the hospital at any one time thus the doctors were able to relieve each others duties when one had to return home for a short while. This time, the other doctor had so called ‘resigned’ without adequate notice and Dr Kami was stuck in Kunde hospital the whole time. He had not returned home (to his village of Thame which is 1 day’s walk away from Kunde) for more than 4 months. The whole healthcare situation in the Khumbu seemed to be in disaster during this time.

 

My assistance in Phortse clinic was received with open arms by Dr Kami. He gave his full support. Now, I and Dr Gayathri had to discuss on how we could maximize our time in the valley by trying to plug as many loopholes in the system as possible. The plan was as such. I will establish a proper clinic in Phortse and run it for 2 weeks and get the adequate contacts in the region. Dr Gayathri would then come down while I left to climb Everest and take over my duties in the clinic. Since she has a month here, she would rotate to the different villages with the different out reach clinics and educate the health care worker there (if available). She would also conduct basic health education sessions, women’s health and post natal care lessons to the villagers to establish a foundation for primary health care and make things more sustainable once we leave. Dr Gayathri might also take over the duties of Dr Kami in Kunde hospital while he retuned to his home town after a long time. There is so much that can be still done for the locals and plans are still very malleable.

 

I opened the clinic in Phortse on Monday and have been running it for 3 days already. Things are looking extremely good. I’m seeing about 18 patients a day in a span of 3h which is overwhelming for a village with a population of only 400+. The news that a doctor is in town is spreading like wild fire across the region and locals from even outside Phortse are coming to the clinic. I feel like my time here has been extremely fruitful so far and I will continue to look forward to the many more days I get to run the clinic. My experience so far will be in my next blog update.

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Posted by on March 22, 2012 in Uncategorized

 

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