Monday 21 November 2011

Exams, SPANDAN & a new baby for Lalit

Lalit, DFN's first sponsored student
now in his third year at medical school
Namaste!!

I hope you both are well and good.

My study of final year is going very well. I have to study the major subjects (Medicine, Surgery, Pediatric, Gynecology and Obstetric)  in final year. This year is vital to become a good doctor so I have to study and do good in clinical.
I have got my Mark-sheet a few days back for my latest exams and I have passed!

I became the EDITOR-IN-CHIEF of my college yearly magazine called SPANDAN. It is one of the important work during the study in my college. I have built the team to work for the magazine. The Principal and M.D. has given this responsibility to me.


Aruna, Lalit's wife and Alen, his daughter
with Dr Kate Yarrow last January


My parents and family in village are happy with my result that I passed. My brother is in Kalikot hospital doing a volunteer job after finishing his H.A. course. He is trying to find the job there.

My family in Kathmandu are also good. GOOD NEWS-Aruna is 24 weeks pregnency, she is healthy and good in Kathmandu in her father's house. Alen is also doing well, healthy and had started school.


Bye with lots of love,
Your Nepali son,
Lalit Jung Shahi




Lalits latest exam results for his 3rdMBBS

Wednesday 16 November 2011

What are the health seeking needs in Padampokhari by Meena

Meena, DFN's student, on her second community posting in Padampokhari VDC, 5 hours away from Kathmandu
Namaste,

I hope you all are fine. Nahakul and I am also fine here. Did you reach safely there? 
In our second community posting, I was posted at Padampokhari VDC of Makwanpur district. It is a 5 hour bus ride from Kathmandu. 

Understanding the health needs in rural areas is a cornerstone of DFN's work




The duration of posting was one week. Within that one week, we learnt about the educational level, health seeking behaviors, socio-economic and health status of people in community. It was really a great experience for me.




My formative exam result has also arrived and it didn’t turn out to be so good but now I am working hard for my upcoming summative exam which starts from December 11. I have been facing problems in computer and mathematics but I’m trying my best to improve.
Hope to keep in touch.

Yours sincerely,

Meena Kafle Chaulagain
Meena's fellow students on her second community posting

Monday 7 November 2011

Return to Patan Academy for Dr Kate Yarrow

Meeting the chairs of the Patan Academy at its 7th Consultative Meeting
I was honoured to be invited to Kathmandu in October to participate in the Annual International Consultative Meeting for Patan Academy over 5 days. This meeting is one of  many great minds from across the globe, composed by eminent professors and deans from a variety of worldwide institutions such as Harvard University. The panel was chaired by professor Cliff Tabin, professor of genetics at Harvard.

The aim of this meeting was to tackle the future training needs of the medical students in relation to the complex healthcare needs of rural Nepal.

The main outcome for DFN was strengthened links with Patan Academy, a better understanding of the dire healthcare situation in rural Nepal, and a clearer future for our aims and goals as a charity.

DFN's three students, Lalit, Meena and Nahakul with Dr Kate Yarrow and Rajesh Gongal, Patan's Dean
Accompanied by Lalit, our current sponsored student, I was also able to meet with our two new students Meena and Nahakul, both of whom, we are very proud to say, have now signed their contacts with DFN and Patan. I was also able to deliver a large batch of donated medical books and laptops to help them with their studies.

The delegates at the Annual International Consultative Meeting for Patan Academy

Saturday 5 November 2011

Nina, Mrinmayee, Abishek and Mark all sweat for Doctors for Nepal

On Sunday 9th October, four intrepid DFN supporters put on their running shoes to raise vital funds for our future doctors taking on the Royal Parks Half Marathon, a race which takes participants from The Green Park along the Thames, up to Temple Tube Station and back down to Kensington Garden through Hyde Park.

Between the three of them, Nina, Mrinmayee & Abishek have raised just over £1,500
We are very proud to say that our four runners, Nina, Mrinmayee, Abishek and Mark all completed the Royal Parks Half Marathon in, let's say it, near Olympic times!Mrinmayee finished in 2:30:00, Abishek in 2:28:46 and Nina finished in a record 1:58:14.

"I did it in a (personal best) time of 1.48.48 which placed me 2298 out of. 12000 so I'm quite pleased." Mark

Between the four of them, our athletes raised just over £2000 with donations still coming in, Mark raising £445 through his Just Giving page.

Taking part in similar events for DFN is a very effective way of fundraising and help us raise our profile. We are extremely thankful to those of you who take part in such events to support our students.

So, a big thank you to all four of you for choosing to support Doctors for Nepal. With two new medical students on board and thanks to your funds, we are one step closer to providing better healthcare in the remote areas of Nepal.

Saturday 24 September 2011

"Why I want to become a doctor", Nahakul, DFN's new student

 Before chosing Nahakul, we asked him why he should receive a DFN scholarship, and this is what he wrote:

"A scholarship is definitely what any sensible student would prefer. But, a scholarship is more than just a preference for me, because at my present state, it would be the one and only key to the gateway of my dreams. I belong to a society where people are only just managing to survive in the mouth of poverty. The day I decided I had to become a doctor was when I became aware of the fact that I could not remain blind to suffering. I realise I can no longer watch my people die of 'preventable' diseases.
 
There are many sources of underdevelopment, but the one that proves to be most fatal is the lack of adequate health care facilities. In my opinion, above anything else is everyone's right to life and this is what I want to ensure: survival, for every human whose existence is threatened by disease. In the case of my own country, being a physician, no political, religious or racial differences could stop me from fulfilling my duty and no matter where I went, I could be of use.
 
Amidst political turmoil and the growing divide between rich and poor I became seemingly aware of it in my growing years, I admit there have been times my weak financial status has made me feel most unfortunate. Yet, Nepal's, or for that matter, my own district's low literacy rate has made me think otherwise. I am both proud and priviledged to have been picked amoung thousands for a scholarship in one of the most reputed schools of Nepal, Budhanilkantha School ten years ago. If there's one thing my school has taught me, it's that the only true nationality is one called humanity.
 
Armed with this belief, in me I have the courage to make mistakes and the wisdom to learn from them, if you could call life a building, then yes, I have been to some of the darkest rooms, even lived in them.
Seeing so many faces like my own, I have learnt to reach past the dirt on people's faces and reach for their hearts. Now, I want to take one step further and reach beyond disease. I believe the right diagnosis is not enought to heal all the wounds a patient may be carrying, because not all pain can be derived from pathophysiology alone.
 
I have always followed my heart and that is why I write to you today. I have found my inner calling and one scholarship can unleash the path I know I was meant to follow. I know it will not be easy but I assure you, I will never fall too many times. If a career in medicine means I can, through my own bare hands, heal effectively and efficiently, to the satisfaction of us both, I know it will pay off, I know it will."
Nahakul, Lalit and Christine carrying out interviews for the Health Needs Assessment in Manma village during our trip last January

Tuesday 20 September 2011

Introducing...Doctors for Nepal's two new Nepalese trainee doctors

It has been an exciting few months for DFN, and we are pleased to announce that we have selected two new students to receive sponsorship from Doctors For Nepal.
 
Meet Meena

Meena is a 20 year old married girl from Jumla, one of the poorest and most remote districts in the far west of Nepal.

Selected through the Patan Academy of Health Sciences in Kathmandu with which DFN is linked,  she is to be the first recipient of our full DFN scholarship.She beat many other candidates to the place through a rigorous selection process which included thorough aptitude and psychological testing.

Meena comes from a family of 5 children. Neither her father, a farmer, nor her mother ever received any education, even at a basic level. She is incredibly keen to become a doctor, and we are extremely proud to have the opportunity assist her through her studies.


Meet Nahakul

Nahakul is a 20 year old young man from the Kalikot district in the far west of Nepal.

We met him on our visit to Nepal in January where he assisted us as we undertook the Health Care Needs Assessment in Manma. We were instantly struck by his deep understanding of the plight of his people, and were very impressed by with his eloquence and burning desire to study medicine to help improve the living conditions in Kalikot.
Luckily he succeeded at the entrance exam to Patan, and we are pleased to announce that we will be sponsoring half of his scholarship, as he will be receiving a partial scholarship from the Academy itself.

When asked why he wanted to become a doctor, he wrote a very compelling letter,click here to read it.


Training as rural doctors in Nepal

The Patan Academy in Kathmandu, where our students will both be training recently opened its doors in 2010. This new medical school focuses entirely on a community based approach, training its students to become doctors in rural Nepal, thus improving healthcare in these deprived areas, an aim equally championed by DFN.

In return for their scholarships, Meena and Nahakul have both signed agreements with DFN and Patan to work for a minimum of 4 years in rural Nepal once they have trained as doctors.

We are extremely proud to be supporting these students in such a fantastic new medical college.

Tuition fees, accommodation and food

The cost for DFN to ensure that the tuition fees, accommodation and food are all paid for is in excess of £6000 per year per full scholarship student.

It is vital that we are able to guarantee this support for Meena and Nahakul through the ongoing generosity and fundraising of our supporters. Please do continue to pledge money and directly aid the training of our future doctors for Nepal.

This is how you can help:

Your support is vital towards the success Doctor For Nepal’s students and our mission. With their training and your help, more than tens of thousands of people will finally have access to a doctor in rural Nepal.

Please give generously

With many thanks

Dr Kate Yarrow

Sunday 24 April 2011

Sweat, blood and tears in Brighton for Doctors for Nepal


Nina, Stephanie, Jim and Sandeep successfully raised over £5000 for Doctors for Nepal
On 10th April 2011 months and months of training was pulled together for the second ever Brighton Marathon. Four brave souls put on their running shoes and completed the 26.2 miles marathon in respectable times (3h 53 mins to 4h 38 mins). Stephanie Tilston and Nina Haefele (both DFN trustees) were joined by Brighton doctors Jim Cooper and Sandeep Sudan. Between then they raised an outstanding 3500 pounds. Huge thanks, and congratulations to them all.

Kate's home made cakes raised £160 for DFN




On the side of the road the Yarrow family (trustees) set up a stand selling home-made cakes to the masses, and raised 160 pounds from their efforts. Bills Produce Store Brighton and The Real Eating Company Hove both very kindly donated exceptional cakes for the stand, contributing to the success of the day (visit either of restaurant for more regular supplies of great food and cakes!). A passerby took such interest he later donated 1000 pounds!






Keep on supporting Nina Haefele 
in her bid to raise £3000 for DFN


The funds raised (nearly £5000) will go a long way towards supporting our new student through the first year of his or her studies. It is vital we are able to continue this support through every year of each of their studies, to ensure they are able to become Doctors For Nepal. The more we raise, the wider we are able to spread our work, including training other healthcare professionals in rural Nepal (for example in family planning skills), and supporting healthcare projects in the field.

Thanks to Stephanie Tilson for running for Doctors for Nepal








The dedication (from months of training through to cake-baking) shows what potential there is to raise funds from participating in fun events. We are constantly in need of more funds so if you think you are able to participate or run an event - please do get in touch. We have bought four places in the Royal Parks Half Marathon in October and are looking for runners (call or email Kate if interested). The Brighton and London Marathon are already open for 2012 places. Setting up a Justgiving page to raise money is easy - so do please consider ways to raise money and help us continue to help the desperate people of rural Nepal.

With many thanks,

Dr Kate Yarrow



















Big thanks to Bills Produce Store Brighton and The Real Eating Company Hove  for their delicious cakes.

Sunday 27 March 2011

Education levels in Kalikot: Male 64% vs Female 20%


The aim of our expedition to the Kalikot District in the far west of Nepal was to understand the reproductive behaviour in the region, and the use of family planning methods. The reason for choosing this particular area of healthcare is because maternal health has such a huge impact on the rest of the family; large numbers of children leads to a higher infant mortality, malnutrition, and lower levels of education. For the mother, there are also significant risks attached to having large numbers of successive pregnancies.
We interviewed 100 men and women within the reproductive age group from various villages within the district.  We managed to collect a large amount of data, which has been painstakingly analysed, and is in the process of being written up for publication.


One of the most striking findings was the large number of births in the district. If you look at Graph1 you can see that for every decade of reproductive life, women have approximately 2 children. If family planning were being used when families were complete, you would expect to see the graph tail off much lower. This indicates little or ineffective family planning.

Graph 1 - Average parity in each age group
Many of the families had experienced an infant or child death – 15% of our sample. The commonest causes were preventable such as chest infection, diarrhoea, and malnutrition. But most often, people did not know the cause of death, unable as they were to get to a doctor before the child died.

Graph 2 - Causes of childhood deaths
Knowledge of family planning was mixed, however a 30% of women had never even heard of family planning – a shocking figure when you consider the importance of its use.

Graph 3 - Knowledge of family planning
When we looked into education levels, it became clear that education has a direct impact on knowledge of family planning, and the incredibly low level of education in this area has had an impact on the use of family planning.

Graph 5 - Levels of education

These findings are just a few of the mountain we compiled, but show a huge need for improved family planning in the area. I plan on presenting the overall findings to the Nepalese Family Planning Association (NFPA) in late March, and we hope to raise more funds this year to help train healthcare workers in the area specifically in family planning techniques.


If you are able to offer a donation, your money will affect thousands of lives, by empowering women to take control of their family size. To donate please go to  

Kate Yarrow, Doctors for Nepal Founder and Chairman of Trustees

Saturday 26 February 2011

"I'm terribly sorry, but survival is three days away", by Dr Kate Yarrow

Doctors for Nepal's team preparing to interview patients in Manma Hospital
Whilst we were doing the family planning assessment in Lalit's village, there being no doctors around, Lalit and I were summoned to the health post to see a sick woman. Given the complex nature of her illness, I could not offer her any treatment in the small shack we were sitting in. I advised the family that she was very ill and if she was to have any hope of survival, she needed to be taken to the closest hospital - 3 days travel away. Her family are unlikely to have the means to be able to fund her transport or treatment and I think it likely that she would have died at home or en route to the hospital.

Nepal is one of the poorest countries in the world and this is reflected in the health of the population. Life expectancy is much lower than that in the West - it is currently 59 compared to 85 in the UK. People die younger, of treatable conditions such as pneumonia or diahorrea.
Dr Kate Yarrow and Rebecca Brady interviewing a women in Mugraha
Most of us on our trek to Kalikot experienced some gastro-intestinal disruption of one kind or another but we were lucky enough to have access to our own medicines; we are also well nourished meaning a few days of diahorrea would not kill us.

Dying from this kind of condition is reality for many Nepalese. The data we collected in Kalikot revealed that 15 percent of the children born had died in infancy or childhood; mostly from treatable conditions. There is only one doctor in the district which counts 123,000 inhabitants. For a majority of the district's population, this doctor is many days' walk from where they live. By the time the patient reaches the doctor, he or she is often too sick to be treated and dies.

Too many children often stops parents from providing adequate healthcare for them children.
Patients often do not access health care as they are so poor that they cannot afford the simple medicines to treat them. Another problem they face is, that with so many children to care for, there is no one to take sick children to hospital so they die at home before help can be called.

Maghraj acting as translator for our interviews
Whilst trekking these last two weeks, I have seen how tourism has brought money into rural areas. The health posts I have visited are impressive examples of what money, education and dedication can do to improve rural health care in the Khumbu (Everest) region. 95 percent of pregnant ladies, for example, are accessing ante-natal care thanks to tourists' donations. However almost every other region of Nepal is lagging far behind.      

Dr Kate Yarrow and Christine Bottine interviewing a woman about her use of family planning
Doctors for Nepal cannot overcome the geographical difficulties of Nepal nor change health seeking behaviour of the country as a whole. We hope that by providing scholarships to medical students who will then work in rural areas, some of these families may go on to live healthier and longer lives. By donating to our charity you will be helping young student doctors to achieve their goal. You will also be supporting health care projects in remote areas.

I hope that by reading this you feel inspired to make a difference. Please donate generously

NEXT:
The Results: Education levels in Kalikot: Male 64% vs Female 20%

Saturday 12 February 2011

Tikka here, tikka there: Welcome to Mugraha, Nepal, by Christine Bottine


It’s a long day’s walk that awaits us as we set off from Manma Hospital at 9am, only 1hr late on schedule. The house has been paid for, the wash buckets have been returned, the final exchanges about DFN's future cooperation with Manma’s DHO have been had­, our neighbours the buffalos have been patted one last time , and we’re off heading into the hills again.


Today, we are heading for Lalit’s village, Mugraha, where he grew up and went to school. He hasn’t been home in 6 months and the light skip in his step betrays his growing sense of anticipation; eager that he is to see his family again and introduce us all to them; making the two ends of what is now his life meet for the first time; his Nepali family and his English family. 


After the next hill, there is my village, he tells us. And sure enough, as the next bend unwinds, Mugraha appears in all its glory, its small houses disseminated across the hill's green, paddy covered flank. We have been walking for over 5h30 now and our legs are starting to tire, so spotting our final distatnaion feels  tremedously uplifting.  But suddenly, a new reality dawns upon us: we are one side of the valley and the village we are trying to get it is on the other; between us a 400 metre drop down to the river that we have to climb down before climbing back up again.

This constant rise and fall is typical of Western Nepali landscape and makes travelling in a straight line a frustratingly impossible endeavour, when “as the crow flies” generally means at least over two hours of walking.


As we’re standing there, dismally contemplating the last leg of our journey, we hear, coming from across the valley, a beat, the beat of a drum in the distance, booming out of a miniscule cluster of houses. They have spotted us, they have spotted Lalit and they are welcoming him home.
And so, after a quick interview of the local health post worker, we begin our descent, hurried by the beat, our dusty 5hrs weighing down on our knees, our heartbeat pounding to the sound of the echoing drums.


As we reach the crack in between the hills where the river flows, we are greeted by our first welcome committee, Lalit’s 12 year old sister and four of her friends. They look at us and giggle before bounding straight back up the sinuous path they have just run down, showing us the way.

We begin our ascent slowly, pacing ourselves as we walk, trying to brush the scarlet red from our burning cheeks. As we climb, more and more heads pop out from behind rocks and trees, peering out at us from behind enormous dark brown eyes, scrambling over the rocks to get a better look at this strange procession of white people with red cheeks. Soon, our convoy is outnumbered by our followers as we, ourselves, turn into those following. We know that we are now approaching the village, escorted by this army of small children running around us, nearly tripping us up as we go.


Finally, ­­­­­we reach the paddy fields where we are greeted by the adults of the village, gathered around those whose music has been guiding us up across the valley. Swirling dancers, hypnotic drumming, wailing songs, gitfs and an appraisal of Lalit’s ancestors throw all our Western preconceptions and judgment aside, leaving us at the mercy of this spellbinding hospitality and generosity.


By that point, any pain or exhaustion has been completely forgotten, as we know that what we are receiving is a spectacular gift of friendship and respect. We drift up the hillside, as if carried by this myriad of smiling and inquisitive faces, each receiving a tikka, red rice placed onto your forehead by the elders of the village and dozens of mala, beautiful, hand-made flower necklaces to welcome us.


Tikka here, tikka there, tikka really everywhere, everyone wanting to welcome us to their village. None of us expected such a welcome, and we are all left speechless, smiling both bemusedly and excitedly at each other over the heads of our newly acquired friends.

When we reach the stone courtyard outside Lalit’s parents’ house, the drummers and  the singer are already there waiting for us, specially commissioned by the family to play for us to celebrate our arrival. We are all sat down in plastic chairs, set out like thrones around the courtyard and given a very welcome cup of steaming massala tea under the gleaming eyes of well over 100 people dangerously amassed above our heads.


The ceremony carries on well into the night. We are given 1hr to relax, get changed and let this most surreal experience sink in. Lalit’s family cook for the entire village, offering us a feast of exquisite dahl baat, with delicious sag, alu gobi curry, homemade basil pickle and rohti (a special type of chapatti).


Over the course of our two day stay in Mugraha with Lalit’s family, we were treated with tremendous generosity. They housed, fed and even nursed us; Lalit’s mother sitting by Maia as she was bedridden for a day with a stomach bug. They also proved essential in helping us with our interviews, keeping the inquisitive crowds at bay and enabling us to carry out over 50 questionnaires in one day.



When we left, the family gave us another tikka ceremony and then accompanied us part of the way, Lalit’s youngest sister skipping over the muddy puddles in her plastic flip flops. We know that we now have friends in that valley, stuck in the middle of nowhere, a place where we will always be welcome.


Hospitality is a concept that they have mastered and preserved to perfection, one which puts our own to shame. And it was, with our hearts in our mouths, that we waved to them one last time from across the valley, hearing their chanting fading away into the distance, indelibly printed into our minds and hearts.

Monday 7 February 2011

How many women do you know who have died during childbirth?


How many women do you know who have died during childbirth? This was one of the questions we asked men and women around Kalikot. Around Manma hospital, more often than never, the answer was "many" followed by the terrible accounts of sisters, mothers, aunts who had died whilst giving birth.

Why? Often they don't know, like often they ignore the causes of their own children's deaths. Bleeding, poor hygiene, disease; the reasons are numerous and to us, with our Western technique and modern equipment, sound easily manageable. But in Nepal, in a mud hut, the reality of giving birth is completely different.

We came across Subina Shrestha, a Nepalese filmmaker who whilst she was herself five months pregnant set out to find out why so many mothers are dying in childbirth in Nepal, making this amazing documentary.

Feels so close to home to us, as the women we spoke to are the same women.

Monday 31 January 2011

Manma Hospital from a Western midwife's perspective, by Rebecca Brady

Spy Manma Hospital in the bottom right hand corner
My first impression of Manma District Hospital was a bit of a shock.  Coming from working in the UK, I don't think you can ever be prepared for this, as really you are so blessed with the luxury and availability of seemingly inexhaustible resources in a flat favourable urban environmental setting. 

Manma Hospital. hanging to the side of the cliff above the Karnali River
The 3hr steep climb straight up to Manma from the River Karnali in Gite should have prepared me, but good old naive me, what did I know.  The initial shock was not for the lack of staff, skill, technology, modern comforts or lack of bedside televisions and readily available, hot, (arguably) mediocre but regular meals, but more the sheer remoteness of the cliff edge environment which only reinforced the obstacle-like conditions which seriously limited the long term management, transfers and availability of care for the community.

The hospital itself is perched on a steep mountain cliff side, in good repair and fairly well presented; appearing organised with an outpatient and inpatient department facilities of 15 mixed surgical and medical beds.


My biggest shock was seeing the delivery room for obstetrics; initially I thought, fine, ok, bed, light, equipment, smell of bleach, lovely, just like the UK - until I started to ask questions: How do you manage a major obstetric haemorrhage? and caesarean sections? sorry? you have to transfer to Surkhet, an 12hr journey by bus or stretcher down the perilous road of landslides and sheer drops into the river? As our guide said, it is just not possible, we do not have the trained staff to perform this.

The sluice room, interesting sanitation for those who are in the know...
And what about pre eclampsia and eclampsia, I asked? The same, he said, and with this I became so angry, mostly at the injustice this district hospital faces and what the women's journey into motherhood must be, as if coming in or out of giving birth was an emergency in a rural setting. Most women are okay, but the minority suffer a heavy toll.

The delivery room, the place for imminent delivery after a bumpy bus ride
 What made me angry was that some people in the UK are so completely ungrateful for the things they had at their fingertips, when  here, they make do with little or nothing. Through the assessment in Manma, almost all of the people interviewed had known a family or friend who had died in childbirth.

The male only ward, a mix of medical and surgical beds
It appears to be a way of life - when women actually travel miles into hospital on basic and treachourous transport after a long first labour, or have bled a lot postpartum and you cannot help - this must be the most horrible and difficult thing to face as a health care professional in these settings, as well as the heart weighted angst and responsibility one feels after the prospect of losing the life of a mother and/or child in circumstances beyond your control. 

The last left overs of MSF's prolonged stay here
All over the delivery room were posters of contraception, availability and methods in all shapes and sizes, which only highlighted the fact that maybe, we can save many lives through some foreward planning, education, enlightenment and ultimately empowerment, giving the gift of choice to women and their families.

Although this weighed heavy, I was very impressed with many other aspects of the hospital.

The autoclaving room, where instrument sterilisation happens
The highlights were an amazingly well organised and stocked antenatal clinic in which the nurse midwives provided care within a four antenatal appointments system, with family spacing and some health promotion with contraception, nutrition and infant care with vaccinations.There was a good evident system of a birth and death register, as well as a log of all appointments attended for the women.

What you see on your way out of the delivery room, thank you US Aid
The wards beds were clean, organised although basic and the nursing station was pristine and organised. The nurses shone with pride in their roles and I had the privilege to meet one amazing one when I helped the bus driver involved in the bus accident over to be assessed at the hospital. Later, when she had us over for dinner on our last night, she laughed at my physical Nepali signing attempts and pathetic lack of Nepali to convey 'bus accident'. She understood - my mime was apparently effective as she called the on call doctor quite quick...
Manma's hard working nurses who help keep the hospital going
My favorite was a brilliant laboratory sufficient with well staffed skilled lab technicians in microscopy, culture and most blood work with most bedside HIV and Hepatitis B kits provided from the Ministry of Health. Coming as a 'inexperienced newbie' straight from a six month tropical nursing course, I could happily manage in the lab and the lab technicians and assistants were very well informed and happy to answer with ease and humour with all my rapid fire questions.
My favourite bit, the lab!
Slowly I could see the health needs being mostly met; with the bigger challenges being sanitation, location, location and location; and a steady lack of resources namely being skilled doctors to be retained to pass on the baton of knowledge in the District Hospital, as well as the cultural boundaries that will always need to be respected and considered.

NEXT:

Tikka here, tikka there: Welcome to Mugraha, Nepal, by Christine Bottine