Thursday, December 24, 2009
Smallest buddhist in the house. Seto Gomba, Kathmandu.
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
Sunday, December 13, 2009
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.”
Friday, November 13, 2009
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.
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.
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.
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Sunday, April 26, 2009
All the evils in the world
Beware of acid rain, ozone depletion, middle age spread, the green house effect, toxic land fills, air pollution, climate change, global warming....
I like the way middle age spread fits in there juxtaposing all the 'big' environmental problems that we individually can do nothing about with one that can be resolved by having two mouthfuls less than full. And eating the right things of course.
An acquaintance, Alden Towler, has been researching diet in Kathmandu while on a Fullbright scholarship. His findings are as interesting as they are shocking.
According to a study conducted by the Nepal Diabetes Association, while only 3-4% of Nepal’s rural population is affected, 18% of Kathmandu’s urban population over the age of 40 has Type 2 Diabetes, and an additional 10% suffer from a pre-diabetic state called Impaired Fasting Glycaemia1 underpinned by insulin resistance.Children for a Green New Nepal have their work cut out when the people in charge are struggling to keep their own health in order. Read more of about Alden's study here: http://aldeninnepal.blogspot.com/2009/02/processing-polished-rice-reflection-on.html
Saturday, March 28, 2009
Earth hour: Vote Earth - your light switch is your vote. Ballot box rigged by Nepal Electricity Authority
Friday, December 05, 2008
Down in the dump: a visit to Kathmandu's rubbish hole
It was quite depressing. I walked around for some 20 minutes, feeling a little uncomfortable, taking some pictures and talking to people. They seemed resigned to the disgusting work at hand, slightly cheery in a ke garne (what-to-do) kind of way. But not happy.
Apparently 350 tones of waste is produced by Kathmandu daily. That results in around 50 trucks travelling the uphill then downhill 28km from the city to this rural area. 65% of the waste is organic meaning it could be either composted or used to produce biogas. That is, if it were separated at source.
As new trucks came and reversed down to the site, people waited to attack the new load before it was flattened out. Out of one truck came two fluorescent lighting tubes which a boy picked out, waved around and then promptly smashed, releasing their mercury containing powder into the air.
So what to do? What is the problem. If the problem is my being disgusted at people having to do this to earn or supplement an income, then perhaps I should be banned from going there. If it is because this work is hazardous - god knows what awful stuff finds itself among this waste - then perhaps these people should be banned from approaching the site.
Longer term, it makes sense to separate waste. Actually no, in the short term it makes sense, now. Here are the reasons:
- Of the 65% organic fraction of the 350 tonnes per day, if it could be used in biogas digesters, then ____ Rp of gas could be produced. (figure to come)
- If all of that could be sold as compost (unlikely), then its sales value could be up to 3,60,000 Rp (3,600 Eur)
- Reducing the truck journeys from 50 to 18 would save around 1,50,000 per day (1,500 Eur).
- Removing the organic fraction from the waste makes obtaining the recyclable elements much easier and slightly less unpleasant (if no less dangerous).
- Once some separation is started, it makes it easier to begin to separate the non-organic fraction into useful and non-useful elements.
Uneven load shedding
No load shedding We understand that the demand for electricity exceeds the supply and that the NEA has to resort to load shedding [the enforced shutting down of sections of the power grid to share out limited electricity supply]. The hours of darkness are getting longer. However, one wonders why some places never have load shedding even when the whole city is without electricity. A huge area near our house in Lazimpat never has load shedding. This is not fair! If it were a public facility like a hospital, we would understand. But it's just another private house. Why this discrimination? Rajendra Khadga LazimpatWell, I am embarrassed to admit that I am one of those living in an area with 24/7 power supply. I am no wiser than Rajendra as to the reason, although there was talk of one of the houses nearby once being inhabited by a VIP. Of course it is as unfair as it is wonderful for me. Load shedding is a great hinderance to the citizens of the city. Moving along unlit streets is plain dangerous. Trying to study or read by candle light is no easy task. The prominant industrialist Binod Chaudary noted this as one of the concerns of the business community while this government is apparently aiming for double digit economic growth. While I could turn the power off at the appointed times, I don't think I will. I will promise however to limit myself to one light at a time and power to the internet connection and laptop until this area joins the rest of suffering citizens. Saying this, there is a lot of work to be done here in terms of energy efficiency. More about this another time - when I have done something about it.
A small act of censorship at a Human Rights photography exhibition
The piece of card was about just 8cm by 6cm crudely stuck down with tape but big enough to make quite a mess of the UDHR60 photographic exhibition being hosted by the Russian Cultural Centre (RCC) in Kathmandu, Nepal.
On December 10th the world will celebrate the 60th anniversary of the Declaration of Human Rights. As this declaration was signed in Paris in 1948, the Alliance Française took the lead in developing a week long program of film and documentary screenings. The screenings were supported by a photographic exhibition created by the renowned VII Network, a photographic agency which comprises some of the worlds best contemporary photo journalists.
To quote the VII website:
“A total of 30 photos were chosen that best represent the 30 articles, or principles, contained in the Declaration of Human Rights. The images come from the VII and VII Network photographers - photographers who risk their lives on an almost daily basis to bear witness to the world's injustices and to document human rights abuses. That fight will continue.”
And the photographs are as tragic as they are excellent. Disappointingly, in complete contradiction to the spirit of the event and the content of declaration itself, the RCC, using this small piece of card and tape, carried out an act censorship.
The photo in question was taken in 2000 by Eric Bouvet to represent Article 9: “No one shall be subjected to arbitrary arrest, detention or exile.” The picture was captioned (in French) with: “A young Chechen female is imprisoned in the Russian Chernokozovo detention centre in the suburbs of Grozny, Chechnya in 2000.” Presumably feeling that this might show Russia in a bad light, the caption was censored by covering it up.
Article 19 says: “Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.” Hopefully this too should apply to Eric Bouvet?
According to a source at the Alliance Française, it was indeed felt by the Russian Cultural Centre that this picture might single out Russia negatively and that “there are no pictures of Guantanamo bay” for instance. Alliance Française offered to remove the picture completely from the exhibition but this was rejected in favour of covering up the caption.
On Friday at 2pm the picture was removed completely. At 4pm, as the exhibition was being packed away, it had been returned with caption intact.
Dr Vladimir Novikov the Russian Cultural Centre's amiable director said it was "a question of balance." He would have been happier if only one picture had been used per country and in the exhibition, Chechnya was featured twice. According to him it was the Alliance Française who covered the caption. According to Alliance Française, it was the RCS that requested that to be done (though this is not about appointing blame).
Many countries are depicted in the exhibition and a few are shown in a bad light, namely: Burma, Brazil, China, USA on tour in Iraq (3 pictures) and also this country, Nepal (a picture of a 15 year old crying as her wedding procession leads her to her new husband's home in Kagati Village).
The argument that the picture singles out Russia is a poor one. But still it is completely missing the point.
There are few countries in the world with a clean human rights record. The object of the exhibition is not about specific finger pointing. It is to remind us that we, the 'human family' as the French government aniversary website describes us, have a long way to go, that we need to re-read and keep these declarations in mind at all times and, most importantly, that we need to challenge contraventions, however small, wherever we find them.
The irony is that the presence of this captioned photograph in the exhibition didn’t reflect any more badly on Russia than the many other countries depicted or we the 'human family' in general. The fact that the RCC engaged in this small act of censorship, at such an exhibition, really does.
http://www.diplomatie.gouv.fr/Sunday, November 30, 2008
Impossible, nay improbable head-on colision.
We followed the green arrows to the x-ray room. We were seen immediately by a friendly (in a lukewarm way) radiographer. While the hand was x-rayed, I was directed to the pay the 300 Rp that it would cost. Along the way, I passed a person on a bed in the corridor who was either sleeping deeply, or dead. A blanket covered the face so it was hard to tell.
I returned to the x-ray room to see that the boy was having his head x-rayed for good measure (the collision was not strictly head on as his forehead hit my now swelling shoulder). Would be interesting to have a CAT scan too see if there was a brain in there.
We waited again on the bench with the clean floor underneath our feet and the boy fell asleep. I witnessed a thin and frail man on the bed in front of me having his genital region exposed and examined. Three policemen walked in and out again with a handcuffed pair of drunken youths.
After 15 minutes we returned to pick up the still-wet x-rays. Behind the counter most of the doctors were sitting huddled around an electric heater. I asked one doctor, probably rather abruptly, to please dry an x-ray for me. "Dry it yourself sir," came the reply. I can understand that it must have been difficult and frustrating for the doctors to do this work in such conditions and I could hear this in her voice.
Now it was over and we could return home. The hooded doctor gave the all clear, prescribing only strong pain killers for the wrist. Forty minutes in all, which was very speedy in comparison to the war zone of any English A&E department on a Saturday night.
We shook our uninjured hands and parted. I continued back along the road where we'd collided and reflected: tomorrow it would be perhaps a little funny and that it could, of course, have been much worse.
Wednesday, November 26, 2008
Bottle collectors revisited
I passed by the home of the seemingly happy bunch of plastic and cardboard collecting kids who roam the Thamel area looking for the waste they can turn into money.
http://www.flickr.com/photos/rpb1001/497368390/
Still we can't really communicate too much with the 20 or 30 words of each others language that we know. So not much to say, other than that the eldest guy's Nokia camera-phone / MP3 player was pretty amazing.
Friday, March 30, 2007
Transcendental Meditation practice in Kathmandu
Today I tried a Transcendental Meditation (TM) course in Kathmandu. It is a course in 4 parts followed up closely with a lifetime of twice a day practice. TM and Mr Maharishi Mahesh Yogi got a large boost of publicity in the 60s when the Beatles came to visit.
According to the TM organisation's website the technique is a simple as falling off a log, yet you can't learn it from a book, tape, video etc. To learn it you have to pay money. No open source approach here.
The first step was an introduction about what TM is. There was quite a lot of theorising about how TM is scientific in its nature. Well reaching a physiologically calmer state during meditation seems to have been proven, but I am not so sure about the link between that meditative state and the Unified Theory of quantum physics for instance.
One thing that appealed to me was the idea that as the body naturally tends towards healing itself, the mind tends naturally towards happiness - all you have to do is let it. A nice thought. The result of calming the thoughts in the mind, should be bliss (a fantastic word) which - I get confused here - is the point where the noise of conscious thoughts stop and pure ego-free awareness is experienced... something like that - sure there must be something on Wikipedia about it.
So the technique is really just sitting comfortably and using a mantra to focus the mind on as little as possible for 20 minutes. When distractions come, slowly repeating the mantra allow you to put those thoughts and distractions to one side.
Right now I should be doing my first mediation practice but I am writing this, don't have a cushion, am hungry, need to do any number of other things. 20 minutes is a lot of time.
But I will do it. In summary, I think if you take 40 minutes out of your waking hours to sit quietly, relax, breath gently, think of nothing and occasionally feel blissfulness, that can only be a good thing. The question is will I be able to notice benefits - what, how and when? And will the seemingly excessive cash outlay be worth it?
Thursday, March 29, 2007
The Dust
Sunday, February 25, 2007
karate tubes demonstration
If you have ever wondered what to do with old fluorecent strip lights, here is an option: donate to the Vashanavi karate club for one of their demonstration days.
I was invited, as a guest of honour it turned out, by Sunil, who I met a couple of weeks ago on the Nuwari marathon puja day which I will write about and backdate. The demonstration began at 8am and I turned up smelling very slightly of old Everest beer.
He is a karate teacher and runs the class that some of these students choose to take. They pay his travel and wages and by the look of things it is all run on a thin shoestring judging by the ragtag collection of outfits (and lack of) which cost around 6 euro each new.
Anyway, the results were pretty impressive given the circumstances. There were more girls than boys, 2 blackbelts and a definate can-do attitude. I has a front row seat, as a guest of honour and witnessed full body contact sparing between a couple of 11 year olds, smashing of roof tiles, the above destruction of old tubes and a motorbike ridden by a cool 'master' across the stomach of an unusually large student.
Afterwards we had tea and biscuits. Very civilised.
Sunday, February 11, 2007
Morning walking
I woke up at 5.30 am with a dry mouth, needy kidnies and no source of drinking water for an hour or more. I looked out of the window from my bed (in via via hostel) and watch the morning activity. People walking places, the occasional card or motorbike and the local baker steaming something making occasional hissing noises. All still quite quiet, dark and cold outside. Then two men with a red and green flag started to divert traffic from the main road, down a side road. It looked like something was going to happen, perhaps a political rally, I didn't know. But then came streams of people. A parellel centipede of people in their thousands mostly wearing traditional dress. Got up and took some pictures although it was too dark even to focus. Then a car came, stopped and lit the scene with its headlights. So you can see the line of Nuwari women in traditional dress. They are carrying large brass teapots filled with rice, sweets, biscuits to offer at temples.
Wednesday, January 31, 2007
Gulf air economy class Bahrain to Kathmandu
Odd to say but it was good entertainment to watch people going to the toilet from my near ring side seat (see the one empty pleace i the second row). The toilet doors on this 7something7 were fold in two, hinged in the middle to save space, I guess like on most planes but I have never really noticed or remembered. Most of the people on the flight were 'guest workers' in Middle Eastern countries. The guy next to me drove trucks in Oman; the guy further to the right was an ex-gurkha and worked for UPS in Baghdad airport. All going home to see family and take a break from their unenviable jobs. Midly astounding was the guy in row 5 who wore his pink woolly hat for the duration of the flight. But the toilets proved hard to get into. People twisted the lock of the cupboard next to the toilet containing the earphones and blankets, tugged on the long-unused aisle ashtray , placed their fingers gently on the vacant sign and pushed on the left side of the door (logically like you would any door) all to no avail. There was a small letterbox like insert in the door for pulling it closed fromt he outside. One man, having tried the above, flattened his hand carefully and inserted it, as if it might read his fingerprints. All to no avail. Without exception the confused toilet-goer wuold break into a sheepish smile and turn to the audience for help, which would be duely given with some laughter (laughing with, not at). And all these smiles reminded me of the place I was going to.

