Report for the health camp

Mobile health camp 2012 - An international volunteer’s perspective.

Ben McKinnel.

I was lucky enough to be invited to assist on a mobile health camp from the 29th June till 9th July 2012. The aim of these camps is provide basic healthcare to poor and marginalized areas of Nepal where these services are sadly lacking. The camp was organized by CDRA-nepal, a local grassroots style NGO with the Rotary club of Dhulikhel and was funded by the Goodwill Community Foundation. The team consisted of an eye team, a general health team, a women's health team, a dental team and a pharmacy team. There were also three international volunteers from New Zealand and two nursing students from Canada. On the 29th we all packed into our bus and headed off on the 14 hour bus ride to Tansen, in the Palpa reigon.

The first two days of camp were in Argali, a small village nestled in a valley around 1 hours drive from Tansen. The village is surrounded by steep bush-clad hills that would all be called mountains anywhere else in the world. As we arrived the hills were shrouded in mist and the cool peacefulness made a refreshing change from the hustle and heat in the city. We were officially welcomed into the small school that was to be our base for the next two days. The facilities were basic, with small rooms without electricity but clean and perfectly acceptable. All the different teams were assigned a classroom each to work from with the camp using all the rooms of the small school. For most of the camp I was helping out in the eye team, I have a small amount of experience in screening and assisting the opticians and felt that I could be the most use here. There were originally two optometrists scheduled to be on camp but one had to withdraw at the last minute due to family bereavement. Deniesh, the remaining optometrist did a sterling job seeing the multitudes of patients, often working through tea breaks. Many of the eye patients were elderly people suffering from cataract blindness and the local Rotary club of Tansen had arranged funding for 12 surgeries at the local hospital located in Tansen. Sadly this was no was near enough as we 25 cases of cataract blindness on the first day alone. Some other common eye complaints were children with very weak eyes, infections and allergies. The infections were referred to hospital for more in depth treatment and the children were prescribed glasses that were supplied at a highly subsidized rate. I think these glasses will make a huge impact on the childrens ability to learn and therefore their prospects for higher education. We were fed local food of Dhal Bhaat cooked by local volunteers and billeted in wonderful homestays for the night, where our hosts informed us that Argali has a population of around 9000 with only a local health post staffed by two nurses.    

After two days enjoying the wonderful hospitality of the folks in Argali we headed off to Butwal. Butwal is a large city located on the Terai or plains area of Nepal. Effectively an extension on the great northern Indian plains the Terai was sweltering in the summer heat, sitting at around 35 degrees Celsius with very high humidity. We were well looked after by the Rotary club of Butwal, in fact one of the strengths of this camp was utilizing local Rotary club as facilitators. The motivated locals were able to make local arrangements and mobilize their Rotary Community Corps (RCC) to help with the many tasks required to accommodate and feed a large team. We stayed in the city and headed out for two days of camp in two separate locations. The first was in the village of Saina Maina. Not far from Butwal and on a major road, therefore serving a large population. There are areas of relative wealth beside areas of absolute poverty. Many of our patients here were from the Dailit or untouchable caste. I touched several throughout the day and my hand didn't fall off or anything. The camp used one classroom block of a large school complex. During the lunch breaks we were swamped by school kids curious to see what was going on. We were able to screen many of these kids and pick up several who were in need of glasses. Many of these children would have never been picked up otherwise. The women's health team had a busy day on this day, However I kept away from their rooms  figuring that the last thing they needed was a 6 foot 3 foreigner making the patients nervous. By this stage some of the new volunteers were up to speed with the eye testing and I was able to get a look at some of the other teams. This was very interesting even if I wasn't very helpful.

The second of these days was at the tiny village of Amrath Kopibastu. This small plains village is located well off any main roads, we had to walk the last couple of kilometers as the bus wasn't going to make it over some very rickety bridges. The difference being on a main road makes was obvious as the community was noticeably poorer than the previous day with most of the houses being small mud huts with thatched roofs. We set up in a small school quickly as we had our systems well sussed by now. As word spread through the small community many people began to arrive, in fact this was one of our busiest days yet. The people are mainly from the Tharu caste which is a marginalized community in Nepali society. The Tharu people are among the original inhabitants of the Terai reigon as they have a natural immunity to malaria. As malaria becomes less of a problem due to pesticides and drugs, the Tharu are slowly being pushed off their fertile farmlands.  We had some communication problems as many of the villagers only spoke the Tharu language and not the official Nepali.  We really felt we were needed in this village as these people are often reluctant to seek medical help in town as they fear it will be too expensive and they are unaware of many treatment possibilities. There were many people keen for eye treatment as many people regard their eyesight as their greatest asset and fear losing it above all else. We were told by one local that they can make do with almost anything except the loss of eyesight and this is when they become a burden on their families. Eye problems are common here due to the massive amounts of dust and contaminates in the atmosphere. All the teams had a busy day and felt very appreciated. We sadly said goodbye to Gennie and Michelle, our volunteers from Canada and packed back up and headed up to the Dang area in our trusty bus.    

Dang is a poor area in the mid west Nepal, while slightly higher than the Terai it has a similar climate and is famous for its hot, sticky summers. We spent the first two days in Dang based in Gorahi, the main city for the area. From our hotel we went to the campsite, a large secondary school on the outskirts of town in the area of Narayam.  This school of over 2400 students didn't have any running water and the toilets were not for the faint of heart! The area is on the outskirts of town and therefore highly populated and we saw a mix of farmers and in town laborers. The monsoon caught up with us on these days and it was sad to see the patients lining up in the torrential downpours but not be willing to give up on their chance at healthcare.  We worked as fast as possible to try to keep the lines down but more and more kept coming. Still at least the rain kept the temperature down. On the second day here a woman who had been seen by the doctors collapsed shortly afterwards. It turns out that she had decided to take all the prescribed pills at once despite being expressly told not to. She made a full recovery. Sadly this attitude seems quite prevalent due to lack of education. Many people think 'if one pill is good then 10 pills must be 10 times better'. We were more vigilant about stressing the importance of following prescriptions after that. Another interesting patient was a young man with facial injuries after a vehicle hijacking. He was very shaken and taken to local hospital for x-rays. At the end of our time here Ashok made a generous donation of a water tank for the school on behalf of the Rotary club of Dhulikhel. This will help with the current water problem the school is facing. 

For our final two days we headed on a short drive to Tulsipur, the other large city in Dang. We were stoked to find our hotel for the next couple of days had a swimming pool, just the thing to combat the hot sticky weather. Our camp was located off the beaten track in another small village of Kashipur. Again this is predominantly a Tharu village with farming small plots of land the main occupation. There we had an unusual case of one man who tried some self-medication. He had been suffering from itching in his eyes and in Nepali folklore it is said that eating chilies is good for your eyes. This guy tried to bypass the eating part and rubbed chili paste directly into his eyes. This is not something he would recommend as it turns out. I also took the chance to attempt to plow a field in the local style with a wooden plow pulled by two bulls. I think the bulls didn’t understand English very well as the results left a lot to be desired. At least everyone had a laugh, even if I think next time I’ll stick to a John Deere. We located three cases in this village that we decided to take back to Kathmandu for further treatment. One is an eight year old boy with facial disfiguration and poor eyesight. He and his father came for the 17 hour bus ride home with us to see a specialist. He said he will perform the operation free of charge but they must wait until the boy is twelve for the muscles to develop. Another was a girl who had a cataract from a young age and had already received surgery. However the surgeon made a mistake and we took her and her father on the bus to see the specialist also. Sadly it was inoperable and the also returned home. The third girl had a large cyst on her abdomen that was immediately called life threatening by the doctors. As we were returning to Kathmandu the next day we took her and her father with us also. She is currently recovering post op very nicely in Dhulikhel hospital.