Magar woman from Pyuthan

Magar woman from Pyuthan, originally uploaded by rpb1001.

I visited Pyuthan recently. Where is that? See here: en.wikipedia.org/wiki/Pyuthan_District. Five hours drive north of Butwal on dusty roads brings you to a very beautiful valley. It is spring now so the wide valley floors are completely green and visually very appealing.

This woman is a Magar. I liked her nose-ring.

View On Black

(Trekking) Map of Nepal: It's kind of interactive and good quality

This is the best map of Nepal on the entire Internet. Well Google maps is there but currently there is very little information about place names or trails on that. This maps gives an excellent overview of the mountain geography of the country. The map has been made by Himalaya Map House to show the Great Himalaya Trail route as proposed by Robin Boustead. See http://www.thegreathimalayatrail.org/ for more about the long distance path, or long distance trail which extends across the Nepal Himalaya.

Anyway, enjoy the map. Click below and give a few seconds for it to load.  

Nepali coffee and how to prepare it

I've just imported some espresso coffee making things from China. I still don't really know what to call them. I say "Coffee pot" but they also go by macchinetta, caffettiera or moka pot. I heard that every home in Italy has one of these in its kitchen, though some of these will now be packed away now that electric espresso machines have become so affordable. Still, such a coffee pot is probably the cheapest, simplest way to make good coffee at home. If more people can make good coffee at home, won't the home market grow just a little bit more benefiting farmers in rural Nepal? So this is the attempt to add a little caffeine boost to the wider public in Kathmandu and beyond. 

http://coffeepotnepal.com/

This mission started in Langtang after 10 days of Nescafé in a country with some pretty good coffee being produced. In these trekking areas all lodges have to have fixed menus and fixed prices set by the local tourism committee. While it stifles culinary-creativity somewhat, it stops price wars and thus tries to focus the lodge owners minds on keeping the lodge looking tidy and its bedrooms clean.

Still, with competition rampant, it was hard for lodges or tea-shops to differentiate themselves from the next one along the path, or rather, the one big fancy one that all the guides assumed their clients would want to go to. Perhaps a bit of real, freshly prepared coffee would be enough to attract people to a smaller, less conspicuous (and less successful) lodge?

This has not been proven yet as it took around 8 months from placing the order to getting them to Kathmandu. In the coming months, some good Nepali coffee should make its way up to Langtang. Let's see how the tourists like it.

Ok, I'll bite - Make Money Blogging Free eBook review

A week or two ago, I visited Gulmarg in Kashmir to snowboard. A few days before arriving, there was an unusually big storm which left somewhere between one and two meters of snow lying around. And naturally some of it wouldn't stay put and, in one particular case, a huge and record-book making avalanche hit an army camp sadly killing 18 servicemen.

While everybody's concern was with the victims and those being rescued, at the same time, people were desperately waiting for the gondola (the longest in the world no less) to open so that they could head up onto those dangerously avalanche prone slopes. This is how people are of course.

Gulmarg, like any ski-resort, has a snow patrol that monitor the safety of the slopes. It is headed by Brian, from New Zealand. On several occasions he came out to address the waiting crowds before the gondola station. Dressed in tighter-that-usual, all-black ski gear, with neatly cropped ginger facial hair and aviator specs, he cut a dashing figure and thus commanded great authority. As a consequence, no-one seemed to mind too much when he gave the bad news, that, for the time being, the slopes would remain closed.

To move on to the point of this blog entry, he ran a blog on snow safety (which has a fantastic header image) which you can check here: http://www.gulmargsnowsafety.com/. It looked like a nice simple site and I thought the template might be worth using again some time. At the footer, the origin of the template used is always shown. In this case: http://www.dailyblogtips.com/wordpress-themes/. To get the themes you have to sign up to the newsletter which seemed like a worthwhile exchange.

As part of this exchange, I got a free copy of "Make Money Blogging Free eBook" which I read. I blog, so could I ever make money from it? If you own or manage a website then I recommend that you get a copy of it here:


http://www.dailyblogtips.com/make-money-blogging/

I don't think I will ever make money blogging, I'd still like more people to read what I write however. For that to happen, I need to do a few things differently. One is to write more often, and be useful, unique while I'm at it. Importantly I need people to link to this site, and I need to link to those who link to me. These are some of the simpler things I learned from the eBook, and this is why I am writing this post. My quote: "It's changed the way I blog"

Transparency and technology and Nepal

I have little idea what politicians do here in Nepal. I read mainly negative things about them, perhaps due to the fact that the press report mainly negative things: a slap of a civil servant here, an attack on a doctor there, a trip to a hospital in Singapore for treatment at the tax payer's expense; a bit (or a lot) of nepotism and obviously some corruption (because its a perk of the job).

But then if the subject of politicians is raised in conversation, reactions range from frustration to rage. Their reputation among the public (that I speak to) is poor. There is a little praise reserved for a couple of young hopes: Gagan Thapa is one who is often mentioned.

Nawaraj Silwal, Siddhartha Rana, Ashmi Rana, Ashutosh Tiwari, Santosh Shah

I attended a conference around a month ago. It was hastily organised apparently, the audience was stuffed with students from one of the speaker's hospitality college. The questions from the youth audience were limited and required to be 'brief and to the point' while the speakers were allowed to waffle on, off the point.

With one bright exception (though I missed the first speaker). One of the speakers there was Santosh Shah. He is well known in Nepal for his Today's Youth Asia initiative which comprises of a TV show, magazine run by youth and an education program which has trained hundreds of teenagers in personal development. The theme of his talk was institutions. His argument was that a) institutions are important, obviously, but b) that no individual should be, or think themselves bigger than an institution.

And this is the case with many Nepali politicians, some seem to believe themselves to be bigger than the institution that they work for.

As someone with a background in web development, one organisation I admire is MySociety. One of their collection of websites, it called 'They work for you'.

Essentially it aggregates information about MPs in the UK using some clever technology which 'scrapes' published documents, such as Hansard, and collates information in an accessible way.

I have seen the fruits of this on several occasions where a journalist has asked a question of an MP who's answer is flatly contradicted by the evidence available on the site. It's powerful.

Could something like this work and benefit the public and journalists in Nepal? Possibly, but it would be quite different. The main reason would be that information could not be collated automatically.

But perhaps something could be done as a collaboration between journalists. If journalists reporting on politics and events could post information on a site and categorise it simply, perhaps a public picture can be built up of that politician. Logging where they go, their public comments and public promises, the slaps, the assaults and the gaffs should be easy. Assimilating information on their performance, how they vote, how often they turn up to work, their expenses and outside business interests would be a little more difficult. Perhaps the website would encourage whistle-blowers to bring new information to the table. Perhaps some kind of scoring system could rank their performance and distinguish the wheat from the chaff. Possibly it would be difficult to keep the postings impartial, but not impossible, and who would manage that?

Any thoughts on this anyone?

Dil Bahadur Kidney Transplantee - an update

One of my hobbies is trying to get people to laugh on photos. Its pretty easy in Nepal I think. While having your photo taken is becoming more common, as there are many snapping mobile phones about, having photos printed is relatively expensive and, if not a luxury, something reserved for serious applications to officialdom.

If you can imagine pictures of your great, great grandparents when the world was still sepia coloured, or your youthful great grandparents when the world had turned black white, and then if you can picture the serious scowls they wore on their faces, add colour some colour and you have an idea of how portrait photography is most of the time Nepal.

Anyway, during the few seconds of overbearing stress while waiting for the photographer to click the button, its is really easy to make people explode into laughter.

There you go. Laughter therapy is free. The straight face behind the mask is Dil Bahadur and this tells something of our relationship. For him, because of the donations that have been collected, I am his (small g) god - a term I hate. But given the context of a culture with millions of Gods, I can see where he's coming from: out of the dust and smog comes someone who agrees to help you (by asking his friends and family to part with some cash). But this luck has just been the cherry on the cake. Dil has done more than his best to get to this point: a great deal of fund-raising in his home town, representation in the press (Journo seeks support) and support from his colleagues, his family came to Kathmandu to help him through dialysis (and his wife donated a kidney), and recently becoming one of the very lucky few in Nepal to reach the operating table in Bir Hospital (which incidentally celebrated one year of successful transplantation on the 12th December 2009).

Back to the photo. Among the family there is a palpable sense of relief, but with Dil, constantly wearing a mask to minimise the risk of infection with his permanently weakened immune system, he knows this is a long term thing. He faces up to the cost of his treatment every time he goes to the pharmacy and parts with cold hard cash. So far, generous donations brought in around 1,300 Euro. This has paid for one of the (two recommended) doses of chronically expensive Zena-pax which increases organ acceptance by up to 40%, plus the initially high doses of immunosuppressants. So far so very good. Still another 600 Euro would required to get to a maintenance state, where the daily dose of drugs becomes much cheaper and (more or less) manageable.

After that the challenge changes: to earn enough money to feed the family and pay the pharmacist. Its possible. A group of patients are looking at a programme where they set up their own specialist pharmacy to cut out the middleman and save around 15% of the cost. A group of people connected with UNDP are planning a training course on how to "Start and Improve Your Business" so that families can improve their income to cover their increase expenditure. Its early days, but there must be some way found to make this self-sustainable otherwise transplantation remains only for the rich.

So, nearly there, nearly out of the woods. Thanks very much indeed for your support to get to this point.

---

Donations already received can be seen here: 
http://spreadsheets.google.com/pub?key=tdOFgjwTUeKCSow9L40a0qQ&single=true&gid=2&output=html

If you wish to contribute, please do so using this button below. It will take you to a secure Paypal site where you can use a credit card to make a donation. The account used is my own, it is currently empty and I will publish (anonymously, dates and amounts only) at a later date. Alternatively, Account name: R. P. Bull Bank name / Address: ABN AMRO / Leidseplein 25, Amsterdam; Account No: 519969626; IBAN: NL44ABNA0519969626; BIC / SWIFT Code: ABNANL2A. Thanks for your support!

If in any doubt the screen you should see on clicking the button above looks like this: Paypal screen

And now the doctors are going on strike...

“My life is under threat now,” says Dr Nil Mani Upadhyaya, registrar of the Nepal Medical Council (NMC).
On December 15th, two men were waiting for him at his gate on returning from work and attacked him with a khukuri knife. Dr Upadhyaya is lucky to have suffered only minor cuts. The men then fled on motorbikes and could not be followed.

Why was he attacked? “That is the main question for me,” he explains, “I have no single enemy after 25 years of practicing medicine. There has been no demand for money. There has not even been a bad conversation on the telephone.”

“Part of our role at NMC is licensing doctors. There are some people who have trained outside Nepal, in Russia, or India who have failed the licensing exam to practice in Nepal. Some have failed so many times, up to 14, 15 times. Our guess is that it might have come from that group – but we really don’t know, we’re just speculating.”

The attack was a trigger for the NMC’s sister organisation, the Nepal Medical Association (NMA), to threaten a one day bandh on 28th December unless their demands were met. The NMA represent the interests of medical professionals in Nepal. The bandh will result in a voluntary stopping of work in all departments except emergency.

Dr Kedar K.C., president of the NMA explained that the primary demand was for measures to increase safety of doctors in the workplace. Apparently there have been up to 40 attacks on doctors in the last 2 years across Nepal. Bundled in with this are a call for increased health budget, increase in the number of doctors, better equipment, abolishing 5% tax on salaries (which is anyway passed on to the consumer) all the way to setting up Bir Hospital as a centre of excellence and the foundation of a new medical university.

This is a worthy list but already the NMA’s strategy has fallen apart before it has started. Firstly it has diluted the issue of violence against doctors with many other complicated issues, including some self-serving ones (tax reductions, increase in private hours allowance). It could be perceived as using the frightening attack on a senior doctor to force through an increase in their benefits.

Secondly it is using the thuggish tactic of the bandh. While this could be justified in extreme cases, and after all other options have been explored, here the NMA is offering the public punishment as a kneejerk reaction to an event of 13 days earlier that additionally didn’t happen in a hospital. In calling a bandh, while not blocking roads, it puts itself in the same camp as all of the other flag-waving, violent, tyre-burning, unwilling-to-negotiate rock-heads.

What does the head of the NMC think about the bandh? “From a personal point of view, and that of registrar, I would not support it, but then I am a victim too. From a medical ethics point of view, I should not support it. It is a very crucial question for me.”

If Dr Upadhyaya has his reservations, it would seem unlikely that the long-suffering public are going to be offering their unswerving support. And there is the third point – never call a strike of a public service unless you have built up firm public support for your case beforehand.

How does Dr Upadhyaya he see the best way to improve the protection for medical staff in Nepal? “It is very difficult question. If the whole country is going in one direction, how can you protect [anything]. We are in the same direction as Afghanistan; there is no law and order here.”

“The home minister said about a year ago ‘I cannot safeguard my own life, how can I safeguard the lives of others?’.”

So then what good is this bandh going to do? Let’s wait and see. Perhaps the government will shrug their shoulders and call their bluff.

The NMA has missed a great opportunity for developing public relations. It could have detailed the terrible cases of violence against doctors, the dedication that medical staff show, the long hours, awful equipment, weak management and the fact that hospital budgets are lower than WHO minimum recommended levels. They could have played on the fact that ministers often use the public purse to get treatment overseas. Or wheeled out some happy, satisfied patients to rally support for doctors. It could have managed the expectations of the public, that doctors always do their best for patients, but that they cannot work miracles and sadly some patients will die.

It could have opened a conversation with the public about why doctors (and society at large) are suffering violence and what should be done. And then, importantly, show that they’re actually listening and thank them for engaging.

Instead, tomorrow, doctors will further loose favour with the public and strengthen the choking culture of the bandh as the only way to fix problems. In many ways, they will have just made the problem worse.

Smallest buddhist in the house. Seto Gomba, Kathmandu.

Smallest buddhist in the house. Seto Gomba, Kathmandu., originally uploaded by rpb1001.

I am lucky. I complain about a lot of things, but life for me is interesting and life for me is good. This evening, Christmas eve (although this has little meaning for me), was spent as the fourth attendee of a Buddhist wedding. The other three were the bride, groom and their young daughter.

The wedding took place under the auspices of a particular Ringpoche (name escapes me) in the Seto Gomba, the White Monastery, near Boudha in Kathmandu.

In this picture, the wedding is over and formalities are being completed in the office. Every monk in the house, and all employees too, are receiving a 100 rupee gift from the groom from a rather thick wad of cash managed by Tenzin Chopel (hand outstretched, right).

Here, hesitantly comes the smallest monk of the Gomba into the office to receive his money.

Best viewed large on black, click here

Dhaulagiri & top trumps

A photo I once took of Dhaulagiri is now on a German set of top trumps called "Mountains of the World". Mountains get rated on the following: Höhe / Erstbesteigung / Schartenhöhe / Dominanz / Besteigungen / Todesrate = Height / first ascent/height of col / dominance (distance from other comparable mountains I think) / number of ascents / death rate. Something like this anyway.

Finally mountaineers' pub debates over the difficulty of various mountains can now be settled in a civilised card game.

http://www.quertett.de/index-Dateien/page0007.htm

Die, Nepal Bandh, die

Pasted from facebook group of people wanting an end to the bandhs...

Looking forward to the coming 3-day bandh? Looking forward to the fact that a few big egos with no-one's interests at heart but their own, will oppress you for three long days with the real threat of cheap several-hundred-rupee-per-day-hired-violence. Who benefits from this? Can bullying create lasting change? After 15+ years of bandhs, does it have the power of shock and awe any more? Or is there only the sorry, stale whiff of an unshaven thug's day-old armpit about it. It stinks. It's terrorism on the street corner and the masses lie down and take it as a part of life in Naya Nepal. The more things change, the more they stay the same. But wait a minute....

• Its not my job to stop it
• I am helpless to face up to it myself, what can I do?
  
  and
  
  
• So what, its just a few days, I can wait it out
• Uh, what, I'm asleep.... zzzz

Is there really *nothing* we, you, I, me, he, she, they can do? Aren't you feeling helpless, pathetic, angry? What? You don't care? Go and take a long, hard look at yourself in the mirror right now maybe? Wake up?
Here's a suggestion. Instead of looking for the nuclear bomb that will wipe bandhs from the face of history tomorrow, let's take it slowly, be creative, be surprising, reject the shouting, chest beating old-school ways, and have a lot of sneaky fun. Sounds like an ideal romance, no? Let's start by giving a hint of the steam in this youthful pressure cooker. Start by making small cracks in the wall of nonsense surrounding the rulers of this country, the ruling caste.
START THINKING!
Time to start brainstorming on this wall and discussion forum. There is no hierarchy here. You have a good idea? Share it. You think we're all stupid? Please let us know. Have a terrible idea? Inspire someone else to improve it. Its open to all. Get thinking. Discuss with your friends.
What has come up so far? Only a few can be published (let's be a bit subtle) and there are some good techno-ideas.

1. "What about 'Flash Mob'"?, asked a few people - showing the strength of the silent majority without violence. Know what it is? An sms alert brings a huge mass of people together at short notice at a specific location with secret instructions. Then disperse immediately after the action is over.
2. "Exposing faces behind the mob", suggested another. Get snapping pictures of bandh enforcers, and start posting pictures on this and other forums. This is one small way of empowering ourselves and see the faces behind this destructive forms of protests.
3. Phone jamming - "if you get 1000 people to call every party head office and express their opinion on bandh, would be fun no?"
4. Email the editors - "Mass send emails to the editors of the mass media in Nepal. 'Please publish on letters page: Dear Sir/Madam, I am 23 from Lalalalitpur and I want to express my view on the bandh culture which is a hand at the throat of this nation....etc etc'", suggested one of you. "If they don't read or publish every letter, at least they get the message from a constipated in-box."
5. "A bandh day football tournament on tundikel, mass random cricket competition in the streets, a cycle rally for the hard-core orwhat the hell - let's just get people, lots of people together. Otherwise its pathetic, isn't it?", brainstormed yet another.
6. "Eggs, eggs, eggs - or should it be shoes?", asks a foreigner. "Where is the dissent in this country!?"

Ideas abound, actions, er, well, limited. Safety in numbers is key - isn't that why we want to make the group as big as possible? As a group, we'll work on what you have said. Is this dumb? Could it be better? Let us know now.
We have got some secret underground plans on the way. We are looking for activists like you! Let us know if you want to be a bit more hands-on in removing the culture of bandh from this country. If you feel you want to remain hands-on-keyboard and contribute ideas, please feel free to send us ideas (however simple they might be) in the discussions forum in this group. If you want to do so anonymously, please email us at: zerobandh@gmail.com
Get out, take pictures, listen, look, talk to people about their view of bandh, listen hard, ask them more questions, listen, listen, and report your stories.
"If you think you are too small to make a difference, try sleeping in a room with a mosquito." Some wise person said that. You all know its true.
We'll be in touch soon regarding the above. Be ready to bite.
http://www.facebook.com/group.php?gid=60117778340

Kathmandu's Bir Hospital celebrates first anniversary of successful kidney transplant.

Dr. Pukar Chandra Shrestha, transplant surgeon, Bir Hospital, Kathmandu, Nepal, originally uploaded by rpb1001.

12 December 2009

Today, the 120 year old Bir hospital in Kathmandu celebrates the anniversary of its first successful kidney transplant.

Bir’s renal transplant department was the brainchild of surgeon Dr. Pukar Shrestha who spent six years training in UK. In his last role he was a senior registrar at the Freeman Hospital in Newcastle before choosing to return to Nepal over promotion to consultant.

“I was thinking, ‘Nepal needs me’,” he recalls. “In the UK there are many like me, but here in Nepal every patient needs doctors like me.”

In the past 12 months 16 patients have been given kidneys donated from family members. “16 is good success over 11 months, however we used to operate on up to 15 patients every week in Newcastle.”

The department’s target is one transplantation per week. But there are major obstacles to achieving this. For instance, the department has no operating theatre. “We have to borrow the theatre from cardiology or neurology and this is a big limitation,” says Shrestha. Additionally there is no facility for tissue cross matching in Nepal and samples need to be sent to India which is both costly and takes 4-6 days. “On the positive side,” adds Dr Shrestha, “we have a really capable and dedicated team here. We’re also lucky to have strong ties with organisations outside Nepal such as Freeman Hospital, Transplant links and Health Exchange Nepal who are helping us with training.”

Previously the only option for those with Chronic Renal Failure (CRF) was to go to India. While there is no official data, it is thought that up to 100 people cross the border every year paying upwards of 8,000 Euro, sometimes purchasing an organ there.

Now Nepali’s have the option of both Bir Hospital and Tribhuvan University Teaching Hospital (TUTH) which had its first transplant success in mid-2008. While the average cost of a transplant in the USA for example is at least US$ 50,000, both hospitals charge less than 3,500 Euro for a transplant using the best available drugs. “I was trained in the UK and want to work in the same way,” says Dr. Shrestha.

Dr Rajani Hada, Associate Professor of Nephrology at Bir is enthusiastic about transplantation. “Over 50% of patients are below 30. With a transplant they can go on to lead normal, productive lives.”

It is estimated that annually 2800 people suffer from CRF in Nepal. Dr Hada believes that while transplants save lives, the most effective way is early screening and thus prevention. “In my ideal world I would screen all children at school. It costs just 25 NRP (23 Euro cents) for a urine test, and we could catch problems early and treat them. We could eventually reduce that number significantly.”

Present at the short ceremony at the hospital is Dinesh Thapa, 22, who was transplanted seven months ago with a kidney donated by his mother. “We have a new life. For us, the transplant is a miracle,” says Dinesh.

The immunosuppressant drugs he takes daily to stop the body rejecting the kidney cost around 150 euro per month, an amount that is equivalent to a good government salary. “We sell our land,” says his mother when asked how they finance this cost. He is studying journalism and in two years hopes to be able to have job and be able to cover this cost himself.

While operations themselves have been very successful, the cost of medication is a major stumbling block. Some organisations such as UNDP are looking into income generation programs to help transplanted patients and their families afford the drugs. Dr Hada called for the government to remove taxes from immunosuppressants and even offer a subsidy to patients.

“We need to do something for these people,” says Shrestha later, “Dinesh is not working, how long can he sustain these costs?”

“We can’t make an emotional bond with patients or we’d end up in a mental hospital,” says Dr Hada. “Making good decisions for all our patients is the best we can do.”

Kabir project Kathmandu: Mahesh Ram & troupe

Kabir project Kathmandu: Mahesh Ram & troupe, originally uploaded by rpb1001.

Mahesh Ram & troupe (Meghval Folk Music, Rajasthan, India) This was my first introduction to 'Kabir'. I believe Kabir was a 15th century poet in India. From the little that I know of it, his poetry seems to confront religion as external actions, offerings, chantings, temple visiting etc. God is within - something is within at least. Its refreshing to hear and read this after attending last week's ritual sacrifice for a deity. Many folk artists across the Indian subcontinent play this poetry in a mesmerising, rhythmic style. The band above was part of a festival in Kathmandu - the Kabir project which showed four documentaries by the organiser Shabnam Virmani and others. See: kabirproject.org/ and see also www.youtube.com/watch?v=suWaoJOb1ak for Pakistani qawwal style Kabir. Not sure if this is the same track as on the CD I bought. That, by Farridudin Ayaz & Party was certainly some of the extraordinarily tranquillising music I have ever heard.

Gadhimai Mela, Nepal

Gadhimai Mela, Nepal, originally uploaded by rpb1001.

Last week I attended the Gadhimai Mela. Mela means festival in Nepal. For me it was like another world entirely. The Mela has gained some notoriety internationally because of the ritual slaughter that takes place there. Approximately 12,000 male buffaloes are ritually sacrificed there and many thousands more are slaughtered in the 5km zone around Gadhimai's temple.

I am writing up this experience for the interested to read. Is hard to get a flavour of how it was from pictures alone, but then I don't guarantee that the text will make it that much clearer.

Meanwhile, see the photos here. Some are bloody but please put your squeamishness to one side.
http://www.flickr.com/photos/rpb1001/sets/72157622780160303/

There is a great reflective piece on this here: http://sushma.blogspot.com/2009/11/are-we-civilised-yet.html

Indra: one kidney lighter than a few days ago

Indra: one kidney lighter than a few days ago, originally uploaded by rpb1001.

This is Indra and she just donated a kidney to her husband. It is interesting that each of the three doctors I have spoken to (two nephrologists and a surgeon) have mentioned that 'rich' people (in Nepal) don't want to donate kidneys. They prefer to buy them from someone, somewhere in India with all the risk that that might entail. It is only the poorer that have family members donate. There is obvious necessity there - they have no choice financially - but equally it is never an issue to find a donor within the family to make this very selfless contribution.

Having said that, in poorer families, it doesn't rule out duty to family before self and pressure from the family hierarchy.

Anyway, a key point here is that you don't have to be biologically related to the recipient to be a live donor. The other point is that donors can and do lead a fully normal life after donating a kidney.

Death or financial ruin, or both.

It’s around midday as I wander through the maze of dark, grey corridors in Bir Hospital in Kathmandu. Outside it is busy and colourful like a bus station as people sit crammed together on covered benches as if they were waiting for a journey to commence. But they have all arrived from ‘the village’ (the collective term for rural Nepal where over 85% of the population lives), potentially many days away, to get treatment or to accompany family members. Where does everyone sleep?

I am looking for bed number one in the ‘special ward’ where transplant patients wait. Well, there is only one patient at the moment. A sign points to the visitors’ waiting room. Through the window I see his family sitting patiently in this small, bare room. They smile their best smiles when I enter, and I sit down with them and ask where their son is.

Dil Badhur Shahi looking pensive as many Nepali's do on photographs

I met Dil Badhur Shahi, a 28-year-old journalist, in May this year as I was trying to burrow through some bureaucracy to get a journalist’s visa to extend my stay in Nepal. While waiting for several hours on a collapsing beige couch for a bureaucrat to return from lunch, we talked a little in his ramshackle English and my shameful Nepali. When all the talking that could be done was done, we exchanged business cards and said goodbye, both giving up on the chance of the bureaucrat’s return.

Eldest daughter Monika

Youngest daughter Melina

Several weeks later he called me asking to meet up and we met next to the Bhimsen tower, a white phallic structure in the heart of Kathmandu which, at 50m tall, pokes just above the smog and allows you a breath of almost clean air (which in itself is worth the ticket price) as you gaze over sprawling, choking Kathmandu. I couldn’t really remember who I was meeting until I saw his face. I’d only agreed to meet up with this caller because the mention of a ‘kidney problem’ awakened my curiosity.

I’d once been involved with a friend’s project called Tackers, which brought children with organ transplants together for a week in Switzerland. There I learned a little of the world of organ transplantation: the emotional rollercoaster ride of hope and heartbreak, the patience and resolutely positive outlook required; the daily, colourful heaps of pills to be swallowed; the incredible level of expertise involved and accompanying cost. It could only be interesting to see how the situation compared in Nepal.

Over a milky tea we talked and I learned that Dil Badhur means ‘brave heart’; he’s from just west of Pokhara, where he runs a small district newspaper; that he has two young daughters, Monika and Melina; and that he has kidney failure from undiagnosed hypertension. Life had changed from being an accepted normality to being organised around half-day dialysis sessions twice per week in Kathmandu and finding the money to pay for it. He didn’t laugh that much but given his circumstances, I could see why. “Can you help me?” he wanted, not unreasonably, to know.

I agreed to try, but since then I am ashamed to say my efforts to help have been half-hearted at best. While I wished him well, he seemed to be in a hopeless situation. But then I was discounting his will to live and his will to not leave his young family fatherless.

The bottom line is of course that kidney failure is untreatable. Dialysis is needed, ideally, three times per week just to keep alive. But while dialysis maintains life, it kills financially. It costs around 20 Euro per session and perhaps up to 30 Euro by the time lab tests, equipment and consultations have been taken into account. There are very few jobs in the entire country paying salaries that could sustain these outgoings for long. These fees get paid from savings, from collections among friends, family and community and eventually selling any possessions, property and land owned.

The only escape from dialysis is a kidney transplant. Previously, the nearest hospitals performing transplants were in India and the operation would cost upwards of 8000 Euro that is, if you have a compatible kidney lined up to receive, or someone to buy one from. For many this amount poses an insurmountable barrier and this is the real tragedy.

The top dialysis organisation in Nepal is the National Kidney Centre (NKC) headed by chief Nephrologist Dr Rishi Kumar Kafle. He was an inspiring man trying to save as many lives as he could in the face of impressive adversity: scheduled power cuts of up to 16 hours per day; getting enough clean water in dehydrated, polluted Kathmandu; a general lack of funding and the difficulty, universal to all patients, of affording to stay alive. He is well aware that not many of his patients will ever get a transplant, but some do and that’s the point – from his centre around two people per week have been making the journey to India.

The head of nursing at the NKC told that a number of her staff had resigned, as they can no longer emotionally handle the heartbreaking stories patients routinely have to tell. They’ve funded their own dialysis for as long as they could and when all of the savings were gone, valuable possessions pawned and the family’s house and land were sold, then their only remains the inevitable and a literally impoverished family left behind.

The hurdles don’t stop at a successful transplant. For those who can find the means to get a transplant, there remains the life-long need for immunosuppressant drugs to stop the body rejecting the foreign kidney. The cost of these Swiss or Japanese drugs can, depending on which combination of drugs is prescribed, outstrip the cost of dialysis. While generics are available from India, the cost can still reach 200 Euro per month. To put this in perspective, that’s more than the monthly salary of Nepal’s only qualified transplant surgeon. There’s certainly work to be done here in the medium-term to reduce costs through tax exemptions and bulk purchases.

Several days ago I was surprised to get a text message from Dil Badhur saying that he is booked in for his transplantation operation in the government-run Bir hospital. His wife, Indra, will be the one donating the life-saving kidney. Nothing is impossible, it seems, if you try hard enough.

The cost of the operation is a bargain, if you can call it such, at 3,500 Euro. Just 1,000 Euro of this is the hospital fee while the rest pays for medical equipment and state-of-the-art drugs for during and the days immediately after surgery.

He’s already paid as much as he has been able to raise through contributions from family, friends, his journalists’ union and his home community. Still 2,500 Euro has to be found, and it will be.

For most kidney failure patients in Nepal, as time rolls on, the final outcome will be either death, or financial ruin and likely both. For some though the outcome will be life, despite the unrelenting, exhausting financial burden. Without insurance to fall back on, survival becomes a question of ingenuity, resourcefulness supported with, if some luck is there, others' goodwill.

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I am passing the hat around. I’ll contribute how I can, and I hope if you can make a small contribution, then, with enough people’s help then this life, and the family it is part of, can be prolonged.

Thank you. I’ll keep you posted on how it goes.

If you wish to contribute, please do so using this button below. It will take you to a secure Paypal site where you can use a credit card to make a donation. The account used is my own, it is currently empty and I will publish (anonymously, dates and amounts only) at a later date. Alternatively, Account name: R. P. Bull Bank name / Address: ABN AMRO / Leidseplein 25, Amsterdam; Account No: 519969626; IBAN: NL44ABNA0519969626; BIC / SWIFT Code: ABNANL2A. Thanks for your support!

If in any doubt the screen you should see on clicking the button above looks like this: Paypal screen

Swine flu's travel itinery

click to view large

After more than a month without posting anything, this is just a post to end the drought.

On re-entering Nepal this at the end of September, this banner hung over a window just after entering the airport after crossing the runway. For anyone who has been to Nepal before, despite its serious message, it is a wonderful welcome back to the country. As well as country's names, the banner has ad-hoc and impromptu written all over it which is quite a prominent feature of life in Nepal.

It is also interesting to see how swine-flu has been vacationing: Belgium then Thailand, Kuwait then Iceland - quite some hopping about.

Smart solar - what kind of smart?

I was visiting a garden centre the other day. Don't do that too often as I don't have a garden, nor a house. Was a day out for granny. Wandering around from gnomes to expensive chindogu I saw a leaflet entitled "Renewable Energy: Worried about global warming?" Mmm, maybe.

In short, the panel and inverter costs a hefty £7999.  The government gives a grant of £2400 for this bringing the price to £5499 with a further £100 discount for applying online.

So what do you get for this, your small electricity generation plant in your garden or roof?

Well, under the grey skies of the UK it will generate up to 1000KWh (Kilo Watt hours) (or units) per annum. Currently the cost of a unit is about 11p - though it varies. The average electricity consumption per household is anywhere between 3,000 for a single resident to 5000KWh for a family of 4. 

How much will it save? 1000 x 0.11 = £110 per annum. That's really not very much given the initial cost of the system. An incorrect but ball park calculation suggests that the payback time would then be 50 years - half a century! By which time the inverter might need replacing - it has an estimated lifespan of 20 years, and indeed the panel itself who's effectiveness decreases with age. This does not even include the decrease in the value of money due to inflation and so the payback time would be in actuality even longer. 

Smart Solar, who make and market the system, manage, on their website, to get the payback time down to 16 years given that the price of electricity goes up at 15% per annum, a figure which would see your electricity bill double every 5 years and have the masses rioting in the streets. 

So, unless you have money to burn, forget it. If you think in future Solar power is going to save the world, think again. Cuts in carbon dioxide emissions need to happen now and at this price, it is not a viable solution. 

The system will be 'carbon neutral' after 2-5 years of use. Still, there are much faster ways to have a positive benefit on the environment. My old college, I am very happy to see, has been (or was) running a sustainability project.  They added up the amount of electricity used by appliances left on standby. It shows that just by switching of all of the appliances when you are not using them could save you in the order of £75 per year - of the same order of magnitude as the solar panel. There are even devices to help you do this. Then of course you can change your light bulbs to CFL, order your shopping online, improve insulation, stop buying crap, 

There - that just saved you £5500.

So now I am just left wondering how something that is such a poor investment could a) be on the market at all and b) attract such a fat wedge of subsidy from the UK government. Is there nothing better that they could be spending it on?

Love story

Love story, originally uploaded by rpb1001.

These Asics trainers standing on the platform in Zurich have a story behind them. For seven years, since a trip to Paris, they've been worn by a pretty, dance-loving Swiss girl called Stephanie.

Walking along a Parisian street with her ex-boyfriend, she heard a fully fledged lovers' argument from a window high up above. The trainers flew out of the window and landed on the street. She took them.

Now it is seven years later. Even if they're kind of stolen, they're still comfortable, they still work, they're still trainers. Perhaps otherwise they would have already reached the dump many years ago. Heartening to see a reason to wear something that is not simply about appearance or fashion.

I suggested, when she finally decides to part with them, that she go back to Paris, find the street, the window and the owner and return them. Would be interesting to close the loop.

2/3 chocolate, 1/3 waste of fuel

The picture at the top of the page is a cereal packet, shipped to Kathmandu from somewhere in India. Open the box and the first thing you find is 1/3 air. This means that for every 3 chocolatey truck-loads, a fourth journey could have been made unnecessary. It is, in theory, a pretty huge saving.

What's at stake is the box real-estate, the in-store advertising to the thirty-something kiddies walking buy. Its hidden waste, not like a dripping tap, a light left on or the heating on with the windows open.

For me, reading the press frequently, it seems like we (who are we) have come a long way in terms of awareness, things are changing but dreadfully slowly. Habits change particularly slowly, few want to downgrade their choices or put effort into changing behaviour: doing the right thing is often trumped by the easy thing.

Having said that, there are opportunities to improve scattered around all over the place. You just have to look carefully to see them, and then do something about them.

If you want to do something now, you could email Kellogg in India and ask them briefly why they are transporting so much air? Let me know if you get a reply. 

nutrition.india@kellogg.com

Images of Everest Basecamp and the Himex Expedition 2009

Namche Bazaar at night © Alex Treadway

If you have 5 minutes spare that you can split into 30 seconds and 4 minutes 30 seconds, then take 30 seconds to download Alex's amazing images from Everest basecamp this year. Click the picture or the link below and download the PDF linked to the lower left of the page. 

http://www.alextreadway.co.uk/photography.asp?sid=32&oid=360

Alex spent over a month at the camptaking pictures for his and Billi Bierling's Everest Changes People project. 

If you are lucky, you can get the PDF to give you 4.30 of slideshow - not sure how you do it, just give it a try. If you know anyone who has been to Everest basecamp, forward them the link now.