Home > Health > 5 Weeks in Nepal’s Remote Far West, By Dr Dilys Noble

Dilys Noble, PHASE Trustee and GP from Sheffield recently spent 5 weeks in Nepal mostly in the far west. Bajura, Humla and Mugu are the only 3 districts in Nepal that have no road access! Dilys writes…

“Landslides, unlike lightening, often do strike twice. It took just 20 minutes of torrential rain last May to destabilise the rocks above Kolti in Bajura, and to send them crashing down on top of the clinic again. A nurse and child were trapped inside, they were rescued, frightened but unhurt. Sadly there were casualties further up the town and a family of 3 died.

Fortunately, much of the amazing progress made since my visit in February 2014 had not been undone, although the clinic did have to function out of the other local government offices whilst the clean up took place. The curtains I made in January to try and provide some element of privacy in the consulting room had allegedly been looted amongst a host of other things. The dispensary now has a self contained wooden hut inside the main clinic building enabling the drugs to be kept safe and dust free however possibly the greatest advance is the nearly continuous HEP electricity supply with some large photovoltaic cells to power batteries for back up. There is now a functioning laboratory with a PHASE trained and employed technician, Kisore. The lab, though basic can test for TB; Typhoid; HIV and do basic urine and blood tests. There is also a deep chest fridge for vaccines. The fridge is vital as it provides a link in the cold chain allowing the clinic to provide childhood immunization and to act as a hub for distribution to villages within a 2 day walking radius using cold packs.

Children in Humla

Rugin and Wai are 2 of the 4 new outreach clinics PHASE has opened since February 2015, in part using a grant we have received from the UK government through the Department for International Development. Rugin is a strenuous 2 day walk from Kolti along the cliffs above the jade Karnali river, Nepal’s longest. Life there is very basic – subsistence farming of the high middle hills of Nepal. Millet is the staple food with a dearth of any vegetables or fruit and the only protein being lentils and beans. Surprisingly it’s the only village I have worked in where there was a complete absence of any poultry running around. They just die, according to Karan, Rugin’s PHASE livelihood enhancer, who has plans for solving that and also promoting kitchen gardens and proposing apple trees as an economic venture.

A Mother and her Children

Unsurprisingly all the children and a substantial proportion of the adult population are undernourished leaving them lacking energy and prone to infection. The diarrhoea project, involves house to house visits by the PHASE “diarrhoea nurses” endeavouring to explain the causes and change behaviour; clean water, hand washing and use of toilets in preference to the open defecation habit. We saw a 5 year-old girl in clinic with severe dysentery and visited her in her home village a few days later. Outside the house was a bowl of fresh bullock dung mixed with water and the forecourt and doorsteps still glistening wet from being freshly painted with bright ochre coloured paste. “Village Cleaning”. Inside mum was vigorously kneading dough for millet roti and the small child lying beside the cooking fire looking very much better. It is probably the only time in my life I have refused roti. Dung, Dough, Dysentery. Changing behaviour isn’t easy but as logic holds limited sway over tradition.

Whilst in Rugin I was present at a delivery of a healthybaby to a patient whose 4 our of her 5 previous children had died. The reasons were not at all clear but delivering with our skilled birth attendant present has given the new baby an excellent chance of survival. The birthing centre provides a clean environment for delivery, sterile blade to cut the cord, clean clothes for mother and baby and all importantly advice about prevention of disease and malnutrition. Knowing there are nurses in the village with whom she has had a positive relationship at the time of delivery make women more likely to seek help if their children do become sick in the future.

Wai is another village about a days walk from Kolti where I spent a week mentoring our nurses in clinic. I was really baffled by a 15 year old boy who had a pain in his right hip and was unable to walk. After finding he had marked paralysis of the other leg of recent onset but he couldn’t find words to describe the problem I realised that this could be a new case of polio. Nepal is supposed to be a “polio free country” but the specimens sent to Thailand for examination may tell a different story. According to the WHO infectious disease control doctor, there have been a few cases recently in Bajura. This means the refrigerator is an even more important asset and hopefully with better vaccination coverage Nepal will really be Polio free.

Dilys between villages

I gave a short talk on the work of PHASE to a local Rotary group in Sheffield before I came away to Nepal and was asked at the end if I thought PHASE was in danger of destroying a culture. Is preventing children from dying before they even get to school or becoming adults unable to contribute their society through ill health destroying a culture? I leave that answer to you.”

At PHASE we believe that someone who is born in a very remote and inaccessible corner of Nepal should still have the right to access healthcare, education and livelihood opportunities. As we can’t build roads to these villages or re-settle the communities, we rely on YOU – our generous supporters – to bring these essentials to them. 

Becoming a PHASE Sustainer and making a regular gift is the best possible way to ensure that we can continue our vital work… and even a small amount can make a big difference. Just £10 per month could provide health care for 60 people! – to find out what else your donation could support click here. 

To set up a regular gift to PHASE please – Click Here