Nepal summary

Hi

I can not begin to thank God enough for your prayers over the last 3 months. Without a doubt it has sustained me in the toughest of times trying to make sense of the local situation. I often wonder why I've been given the opportunity to grow up so privileged. For that, I must thank my parents for taking the bold step in venturing out of their stable environments to a new land in hope of a better life that they have only heard about. Indeed you can argue that there are many benefits to living in North America - one of them being quality child healthcare, without which I probably would have been dead several times over due to severe asthma as a child.

I'd also like to thank my parents for the blessing to travel back to a place that resembled their roots - a place that they left in hopes of not having me go through the same things that they had to endure. But for that I'm grateful that they have given their blessing for me to travel, see and experience firsthand life in the developing world. The experiences gained here have been engraved into my mind and helping me understand humanity. It is often in these "unbearable situations" that we find our real self.

In a nut shell, I'll try to share the multitude of life lessons in this thank you email. (you should have all received a physical card in the mail - if not it may be still coming in the mail - or might just be lost. You can never tell with the Nepali post system. But isn't that true of life as well. Some people say that Calgary weather is schizophernic in it's unpredictability; but to be honest, we're not much better at predicting weather out in Toronto. The thing is, we'll never know for sure... and so it is with life. What we control is our attitude. 

Lesson the 1: The value in living connected

One of the most wonderful parts of life in Nepal is that you are connected with the environment. With a lack of isolated environments (ie. insulated homes), people know what is going on outside.    In the south, I would pass out everyday from 1100-1500 cause it was just so hot. And once in the mountains it was frigidly cold. With a limited supply of wood above the treeline, you learn to cherrish each moment the fire and hot tea is available. People are connected to the earth. They are aware of the seasons. It's neat to see the change in fruits available at different times of the year. And there is a profound sweetness when the mangoes come into season for maximal enjoyment. Patience is one of the fruits of the spirit.

This physical connection parallels the need to be connected to God (John 15:1-17)

As branches, we need to be connected to the vine in order to thrive. How often it is that we are found trying to graft into other things that will give life only to see that it hurts us. But when we are tapped into him, we are only then able to bear fruit and be a blessing to the others around us. Lord help us to be connected and remain connected to you that we might not be picked up and thrown into the fire and burned.

I am trying to find the living with the benefits with artificial environments (ie. my workplace where I know that the air temperature and humidity are servo controlled and will remain constant and where I don't worry about where the electricity comes from or whether or not water will come from the taps). Trying to investigate the cost of these conveniences has really uncovered some brutal realities... 

One of the most liberating things I've been doing since coming home is finding excuses to go ride. Roaming around the countryside on a bike really allows you to get the full feel of what is going on around you. You can smell the air, feel the bumps, see the sights, taste the dirt.

Lesson the 2: The value of Community

Stimulated from some thoughts while reading Jean Vanier's "Brokenness to Community": All my life I've been taught to excel in school, climb the corporate ladder, be the best I can be. While healthy competition exists, if channeled in the wrong places can construct an attitude of elitism. Which Vanier warns is the sickness of us all. Healing begins by naming our fear and addressing our less than worth feelings with compassion and without judgement. For me understanding elitism and my tendency toward exclusional living has been tough to stomach, but liberating as well. But herein lies the struggle on how to be living inclusional lives when really there are some people I could really care a less for. 

As I journeyed into rural Nepal and intruded on land which others occupied, I was shocked to be greeted with a hearty smile and welcome rather than a shotgun in hand and a cross look (Consider property line signs in North America - 'trespassers will be shot'). Even the least educated person on this earth can identify a human and realize that there is something profoundly unique. Perhaps it is ingrained into the Nepali people for their greeting नमस्ते (Namaste - means I greet the god in you). Perhaps in our pursuit of 'higher education' we have sacrificed ourselves. During my visits, I was given choice crop to consume, a family's plastic sheet when I had to go into the rain. Makes me wonder whether I see the God in each life (Matt 25:31-46 - and I'm using this passage in a selffish context out of fear for being labelled a goat.)

So the challenge here is to live simply and together valuing each other and not things. To be not be a sheep after doing a cost/benefit/risk analysis; but to be a natural proverbial sheep. Sharing openly whatever I have and encouraging others to do as well. Consider Phil 2:1-11. Lord in your mercy, help us to live in community with You as our one head (Eph 4:1-16)

Lesson the 3: God is good and sovereign.

Having just come back less than 2 weeks, I'm thrown right back into the swing of things. Working in a hospital, I see death all the time, and many times it is unexpected of people of all ages, races and societal status. Death and taxes are inevitable. Carpe diem, seize the day, do something with the life God has granted. The very fact that I wake up from my sleep is confirmation that God wanted me alive for just another day. I hope that He is pleased with His investment in the life He has given me. 

Prayer items:

- gratitude and humility to accept God's strength for each new day

- a grateful vs a guilty attitude as I readjust to life in Canada

- digesting experiences in Nepal and sharing with others before it becomes stale (organization of thoughts for sharings - there will be an opportunity to share with the respiratory therapy society in the fall, pray that Christ is made known)

- stability of the faith that drives missionaries in Nepal

Please find the following link to the top 100pics I took in Nepal album.

link removed: please contact me directly if you want this link.

In the race,

e

Hebrews 12:1-3

The whole world in His hands.... and other songs...

So in the travels today, I got to visit my sister and little niece today. She's actually smiling more now and ridiculously cute as per being a baby.

 

But while vaccuuming the loft, I non-challantly picked up my niece's little playmat - "her world". And then I realized that "I" have her whole world in my hands! To be honest it was a bit of an ego stroke - to hold an entire world in my hands to be able to turn it literally upside down if i wanted to change things around in it...

 

Then I realized that God who 'spoke' the world into existance has the whole world in His hands and that was a humbling thought.. ... ... Having just been at the foothills of the Himalayas, then to the south flatlands of sustainance farmers, to the excessive lifestyle of my native roots, back skiing in May in my homeland - the land of the free, to land of Cowboys and now back home in B-town, to know that there is someone watching over me who sees the world as a little spec is actually quite comforting. All the complaints and things of this world grow strangely dim in the light of His glory and grace.

 

* I would have liked to provide references for these. If anyone knows, please do share.

 

Thanks!

Verge Magazine submission

My experience in Nepal has without a doubt gripped my definition of life. Landlocked between China and India, Nepal is the home to infamous Mount Everest, Himalayas and also one of the most unstable governments. As a result, despite the exceptional potential for hydroelectric power generation and economic boost from tourism, it remains one of the world's poorest countries.

 

Born and raised in Canada I could not fathom how one could live on less than a small Tim Horton's coffee a day. I reluctantly went after being coerced by my friend to put myself in further debt to investigate life in one of the poorest countries in the world. (According to WHO's World Health Statistics 2009, 54.7% of Nepal's ~28million people live on less than $1 a day)

 

Departing from the shelter of the airport terminal, I was quickly introduced to the chaos of a developing country that some locals refer to as democracy in the jungle. With no traffic lights or road signs, I was pleasantly surprised that I actually arrived (and alive) at my desired destination. After nearly hitting several pedestrians, cutting off countless cars and running over a dog, I finally arrived at my host's middle class 1 storey flat in Lazimpat – the embassy area of the capital city of Kathmandu.

 

Over the next 2.5 months, I would learn firsthand what it meant to live a simple yet fulfilled life from the Nepalese people. Nepali's generally eat 2 meals of Dhal Bhat (lentil paste mixed with rice) and maybe a vegetable mix, at 10:00 and 19:00. In the rural areas, where ~83% of Nepali's live, the return on produce is very low; but with that comes a astonishing sense of community. Despite living an ear shot away, neighbours are all quite familiar with each other's families. Education is limited but from the way foreigners are treated, there is much to learn from their simple way of life.

 

Stumbling in the rain in a mountain village near Kodari, a Sherpa family spotted us and emphatically invited us to consume the first of their stash boiled potatoes and milk tea – a simple yet satisfying meal especially with nothing around. Through limited communication, we learn that they have never left the mountain and live like bears hibernating during the winter months of snow trying their best to gather wood with a pair of worn sneakers to stay warm until the next planting season. It's truly incredible how these people survive and yet are SO generous with what little they possess – including a contagious permanent zygomatic smile.

 

Returning to Kathmandu, I splurged <1USD on 1kg fresh mangos. At home, I realized that my host would never purchase these fruits whose prices were inflating astronomically due to tourism. (A tourist's definition of 'dirt cheap' was infinitely more than what a local could afford.)

 

So the challenge begins as I return home tonight and process how to live in light of these and many other experiences. Thanks for the opportunity to share.

 

Ponderings in a stable environment

Was having conflicting thoughts about returning back to the developed world. On the one hand, I was really glad to depart from a world of absolutely unpredictability. On the other hand, I realized that perhaps that is the thing that makes life so much more enjoyable.

 

Having been born and raised in a developed country and only heard stories of unpredictable and hostile living conditions. It was quite sad, yet sobering to experience life in a developing and politically unstable country. I have some very interesting footage of riot-like behaviour. I find it quite interesting how groups of people can have such an impact. Sociology is a very interesting field of study indeed.

 

Back to coming back to work in a developed country. Electricity doesn't ever go out. Water is all over the place and I can even drink out of the taps too! I always have whatever supply I need - and some more.

 

I do hope that I never take for granted the excess of supplies and resources that we have. But one day when things start running out, the people with nothing - that have learned how to make do with limited resources will suddenly have those critical skills to perform; because they understand where the bottom line lies. The way that we are producing trash and wasting unnecessarily, it can't be too far away.

 

Nostalgic to walk through the bowels of the very hospital that I trained at. Seems like a very sterile environment indeed. Swiping to get through, the technology that I take for granted is all around me. As well, security so that I can operate without worry. I finally get to my locker and my memory fails. My shoes are behind a locked door. Spoke too soon about security being a good thing.

 

So the struggle now is how to adjust. How to share the experiences I have had in a challenging and meaningful way. I can tend to be quite negative and must work on being positive and encouraging. Been learning a lot and trying to figure out where I am to spend the limited time I have.

 

But a couple of ideas as to what to focus on. Had been listening to a lot of lecture series on what it means to be rich. And seeing first hand what it means to be poor. I'm convinced that to have water, electricity and not have to worry about WHETHER food will be served for dinner. I mean if my biggest concern is WHAT I'm going to eat - then I'm probably really well off. The challenge is to get out of the rut of thinking that to be rich is to have just a little more. Need to ponder more.... Eyes want to close...

3 different worlds...

Finally had some time to consider all that has gone on and now I'm more confused than ever.

 

Having mixed feelings leaving Nepal. I was immediately thrown into the chaos of Hong Kong - a world of drastic change in lifestyle, infrastructure, values, standards, etc.

 

Arriving in HK, I thought I was in some sterile institution with not a spec of dirty anywhere on the airport express train and with it operating so smoothly. I wasn't sure if I was dreaming. Not a bump to be felt or the sound of the locomotive running - only a pre-recorded voice informing me of my destination. The funny, thing was, I actually missed feeling the bumps in the road, the rumble of the engine turning over, the vibrations of the vehicle and the shouts of the bus boy informing me of my destination and my how much I needed to pay. No one talked on the train, the environment seemed sterile. But once I exited the building the natural elements got to me, it was stinking hot and humid in HK and a clear reality that I was alive hit me again. But during my time in HK, every car, bus, building I would walk into became just another micro-ecosystem on it's own totally oblivious to the true reality of the heat outside.

 

Throughout my week I would soon realize that the family unit for most consisted of a live-in maid who came from a poorer country (e.g. indonesia, philippines, etc) who would come to work for ~3500-4200HKG/month. Children grew up spending more time with the live-in maids than with parents. This type of lifestyle is also present among the rich in Nepal, but seems so much more pervasive here in HK. The affects that has on the family unit you can only imagine.

 

With meals easily costing 5x what they would in Nepal. It was hard to coughup the cash for a meal knowing full well the purchasing power parity of dollar. What made it easier was seeing old friends who reminded me that we are not actually in Nepal anymore and there's a different standard here. whether good or bad, not sure...

 

Returnign to home soil was perhaps the greatest thing ever. That being said, the 8.75$ it cost to get downtown from the airport nearly knocked me off my feet. Can't complain cause my classmate had arranged a bike, car and home for me. Vancouver is great, being able to ski in the mountains was quite refreshing. I was saddened when my $20 prescription glasses from Nepal were broken during a yard sale on the slopes. Luckly, I came out ok. But seeing and exploring the mountains on skis in my home country was definitely a delight. On Sunday, we say "Hear our praises" for the 2nd sunday in a row in 2 different countries. Having been to the mountains and trekked and skiied through the valleys, the petition to have praises rise to God from the mountains to the valleys really put a whole lot of perspective and weight. i only wish that i understood more of what I sang and say. Analogies and words are heavily loaded if we seek to understand the depth of them. Perhaps my respect for explorers increases.

 

Ah yes, phones..

 

So in Nepal, a SIM card could be recharged for 200NRps (less than $3CAD) and used for about a month

In HK, a SIM card costed me 38HKG (~$5CAD) and used for more than 5 days no problem

In Canada, a SIM card cost $5, but activation costs 35$ and minimum amount was 15$; so the alternative was a CDMA phone (with GPS, camera, video and all these other features) for $55 with $15 credit on the card. Essentially in order to remain connected, the cheapest option was the buy the entire phone. Interesting how different societies operate...

 

Anyway, life continues. Trying to contemplate and digest all the differences in life in different places.

 

May my thrist for truth remain constant longing...

Back in civilization

So the past couple days have been fantastically interesting as I'm trying to refind my place in this world again.

Ever since coming to Hong Kong I've been severely confused. I'm almost not sure what to do with constant electricity and H2O. I'm finding myself taking a nice warm shower with good shower pressure and also not having to worry about charging batteries only at night. although i think some paranoid habits have been formed in order to have backups for everything.

Still trying to figure out the balance to have for life in order to make the most of every opportunity.

Had the privilege to share my experiences with 3 classes of grade 9 students today. was grea tto have someone to share with.

anywya, more to come when i figure out what i'm actually thinking. HK and Nepal are very different. speechless really... can't wait to be back on canadian soil tomorrow!

Update

Back in the city after the ridiculous strike that went on. Have some footage of the demonstration that went on during the first day before things got too violent. But the city is once again buzzing with excitement. The political conflict remains unresolved and everything in flux.

My time is now very limited and feeling the pressure of tying up loose ends. My days are starting @ 0600 every morning and usually teachings throughout the day and eventually leaving the hospital ~2000. Just a ton of things to do and further ideas to explore.

A bit frustrated too by the tardy computer. I think the little things that didn't bother me before now do cause I am reminded of how fast things run in Canada.

We are just spoiled. Trying constantly to record the sensory overload that I feel here. It's getting real tough, cause everyone wants your time and the things you want to give time to often get pushed aside. Feel like I can't really get a grasp on what I feel - think I'm just numb now... Hopefully sort out some thoughts in HK.

Anyway, trying to get back to work for a presentation today.

Peace,
e

Mahendranaghar

http://maps.google.ca/maps?f=q&source=s_q&hl=en&geocode=&q=Mahendranagar,+Far-Western+Region,+Nepal&sll=28.962228,80.147743&sspn=0.069389,0.143852&g=Mahendranagar+Airport,+Mahendranagar,+Mahakali,+Far-Western+Region,+Nepal&ie=UTF8&hq=&hnear=Mahendranagar,+Mahakali,+Far-Western+Region,+Nepal&ll=28.796546,80.101318&spn=2.223801,8.789062&z=7

Visiting a friend's family from ENPHO. So awesome to be in the presence of a local family and getting to know the life of a local in the far-west. Very different than the rest of the country.

Arrived after the overnight bus ride. It's hot here, but definitely enjoying a break from the chaos of the valley. Lots of time to think and digest all that has been going on.

To be honest, my original goals have kind of been altered drastically as I came to realize limitations of infant flow CPAP compressed air sources in Nepal. That being said, I've also been able to see the endless possibilities of development through a different approach in starting bubble CPAP at various locations through spare parts brought over.

I've also refocused a lot to focus on relationships with people as the primary objective - so that continued support can happen while on the other side of the world. It's been a very fruitful time in Nepal learning a lot about how other people are living without electricity and water. But most importantly indulging in the community spirit in all things. E.g. at post office, stamp seller involves me stamping envelopes to increase efficiency (so we work together). After leaving my water bottle behind at the post office, the customer is found drinking out of it. With water in shortage everywhere, it seems that if there is a need people just fill it. Other examples are on buses, old lady just asks for water from a younger teenage boy and he gives her water. They really know how to stick together and endure the hardships that they face together.

Also being in close quarters makes conversations with your 'neighbours' a necessity. It's quite different than in Canada where it often feels weird to strike up conversation with the person sitting next to you on the bus...

Nepal is a beautiful place and lots learning here. OK, gotta go, hopefully, this goes through... electricity has been cutting out very often here..

update

Heyo people,

Sorry for the delay in writing.

Lots happening in the last little while.

The last week was perhaps the busiest and most fulfilling wk of my time in Nepal. Had been scheduling talks/labs/etc on mechanical ventilation at 2-3 hospitals per day from Sunday to Th when I was scheduled to return to Tansen to put together the final touches on a CPAP unit for them.

Lots of teaching and many positive responses from physicians, residents and med school students who all very new to mechanical ventilation. Don't realize how privileged we are to have all these conveniences.

Then TH came and while upstairs seeing some pts my laptop got taken. Unfortunate as the circumstance was, I really saw the community lifestyle that people here live. I think people at the hospital were more concerned than I was about the stolen laptop. I think they believe that it reflects on the people and the hospital. I also didn't realize how much information I had on it. Pretty much everything I've been working on in Nepal was here along with contacts. Nevertheless, I was reminded that I should be more careful, but that information is temporary and that relationships matter most. The ironic thing is that that morning I had written a email that morning about how I really find it hard to blog, because most of the things I have to share are personal and in relation to certain people. I was going to send this out to people so that they might not just read about issues, but react to circumstances. 

I hope that in reading this update that you might be able react in whatever way you feel prompted.

lesson from the laptop takage: information sharing is valueable, but relationship sharing is invalueable.

My next supercool event happened that evening with some expat missionaries inviting me over for dinner to refocus my time left in Nepal. Then as I cruised home in the dark, my chain broke. And again testament to God's watching over me, I was able to coast literally to the hospital where I was spending quite a bit of time. The security guard recognized me and quickly helped me figure out what went wrong. I'd need a new chain link so he helped me package it. As I was going to walk home, the receptionist came out to tell me they called the ambulance to bring me home. I decided to walk though, cause I actually like walking back.

5 lessons from 5 boys on the Sabbath

The bike posed further problems even after they put a new chainlink on it. The chain tension was a bit off and it kept on slipping as I was riding to church on Saturday. As I fustratedly got off my bike, 5 boys came running toward me and without hesitation pulled the grease covered chain back on. They continued to follow me down the road where it happened again and then told me I'd need to get my wheel set back a bit in order to increase the tension in the chain and to ride slowly. I now realize why Nepalis ride the bike the way they do. but the 5 lessons

a) They knew their gifts

b) They were in their 'mission field'

c) They ran to the need

d) They humbly and sacrificially drove right in dirtying their hands 

e) They followed through - provided advice and made sure I knew how to permanently fix the problem. 

I often wonder whether or not these 5 attributes are in my life. If I know what I'm gifted in, if I actually spend time in my 'field', if I run to the need, if I act humbly and sacrificially and if I follow through...

Praying for all you at home as well!

Off to Mahendranaghar in the far west after 2 days in Palpa tomorrow. Back in valley on 10th for more demonstrations.

in the race,

e

hebrews 12

Back in the Kathmandu

So after a week at the United Mission Hospital (UMH) in Tansen, Palpa, Nepal, woke up early this morning to catch the UMH buck (half bus, half truck - a bus whose back 4 rows was converted into a storage area to transport goods). To my surprise, the bus took off promptly at 0600 not waiting for anyone. Reminded me of the GO trains back at home and refreshing to know that I had not been late for this one. The buck does a weekly round trip leaving Wednesday morning for Kathmandu and returns the following day. Got to see a fantastic sunrise as it slowly crawled lazily over the hills and illuminated the beautiful landscape that surrounded. A noticeable haze filled the air from small garbage fires and crop fires as locals prepare for the monsoon season soon to come.

 

The thing I love about travel is that there is always something interesting to see. As soon as we started to leave the relatively smooth pavement of town, all passengers were issued a small black plastic bag. Passengers took this readily in the expectations of the undesired. Only a few brave souls declined. And so the trip began at first on newly paved roads that twisted and turned along the narrow ridge leading down the hills toward the Terai (lower 1/3 portion of Nepal where the land is flat and sun is unrelentingly hot). It was as if we were playing a game of hide and go seek with the sun. As we careened down around another hill, we'd loose the sun only for it to find us again just in time as we made the next turn. Despite the blind corners our skilled driver would unleash our comic polytonic horn to alert the world that we were coming around the corner at break-neck speeds and not going to stop for anything. I think drivers here to more reckless when they drive on the mountain side of the ridge, cause if someone will get bumped off, it'll be whoever is driving cliffside. I didn't think much of this at first, but before our 10hr ride back into town was complete, I saw, 1 bus tipped over on it's side, 1 truck halfway down a steep hill (how it stopped I know not - although, when we went by, there were 3 steel cables leading down to the marrooned vessel), and another half truck on the road with it's tail embedded into a roadisde house. And I was only awake for 2hrs of the entire ride...

 

On the bright side there is lots of development going on around here. Although it's arguable whether if that is best for rural Nepal. Most of the roads seemed like they have been paved within the last 3yrs, cause they really didn't look that good last time I visited Nepal. That being said, much of the roads in the hills had sunk in sections or were totally obliterated due to landslides. Roads in the Terai are actually quite decent. About 1hr east of Butwal, I saw a procession of a sweeper, followed by 2 stencil holders and then a painter with a yellow brush painting a dotted yellow line on either side of the roadway. A white dotted centreline was already present but hardly acknowledged by everyone from pedestrians, cyclists, rickshaws, micros, cars, buses, trucks, motorcycles overtaking each other with just inches to spare. I wonder whose I idea it was to paint the lines... Things run very differently here but they do function. I think that's part of the excitement in travel - seeing how people live. To an outsider, the transportation system seems chaotic but it functions; and they don't traffic lights, which would fail whenever there is a powercut.

 

Anyway, our driver skillfully maneuvered the traffic and roads to return us back to Kathmandu.

 

At home now. We hit up a flower shop with Sandip, potted some plants and now hanging out. The electricity came back early so we're getting an update on news and cartoons. Apparently the Maoists are planning a bandha (strike) of some sort but so far no one knows when yet.

 

Teaching hospital is back at full tilt after practically not seeing patients for 2 weeks. Although reading the paper the other day it seems that they are still having issues with the unclaimed bodies of 20% of all the atopsys they do...

 

Time at UMH was encouraging to see that people were trying to make the best of the situation. A constant stream of expatriate physicians and surgeons are always there to share their expertise and passion to serve the people. And it's affecting local medical officers and interns as they realize that there is more to life than the pursuit of material wealth. And with that, continue to live each moment as if it's your last. Carpe Diem. Soli Deo Gloria

 

 

update from Tansen

So been here for just over 24hrs and I think I've been regenerated as I feel as if I'm actually contributing. Today started with a ridiculously good rest (as always indicated by drool)...

 

0700 up and got some reading and praying in.. was actually up earlier too

0745 doctor's group devotions at the hospital followed by doctors rounds with a paediatrician from the states. Helped with inhouse NRP training and running through scenarios was fun and refreshing seeing people gain skills and understand the reason for doing what needs to be done in an effort to save lives best - as we know so far.... Day was done @ 1715 and went out to the city to explore and roam with my aunt. dinner for cheap and good...

 

coolest reading today: Mark 5:21-43: presents a medical case of and lady with idiopathic symptomatic hemorrhaging persisting for 12yrs. The text says that she endured much at the hands of physicians and had spent all she had and was not helped at all, but rather had grown worse. This comes at a fitting time where I am seeing a lot of people with diseases that persist far beyond any reasonable time. Nevertheless, this lady is instanteously cured through her physical act prompted by faith. Make me wonder whether my faith or belief in what I do can help address the hemorrhaging that is going on in the world today. Is that what it means to have faith?

 

The other interesting thing is that this story is encapsulated in a larger story of a 12yr old child who is 'resurrected'. Interesting how the use of 12yrs is used again. For as long as one person was alive, another was hemorrhaging. So while we may seem to be hemorrhaging for a lifetime, there is still hope. 

 

Thank you to all who have written words of encouragement as I try to make sence of all that my senses are trying to process. It's tough, but finding so solice being away from the craziness of Kathmandu in a quieter place where I can breathe and begin to think a bit more. 

 

Hope you are all well... 

 

peace,

e  

Tansen, Palpa

Arrived safe and sound after a crazy adventure of 13hrs on a Nepali bus. (For any amount of time it's an adventure, but when you're on for so long you really get to knwo the ppl around you quite well)

 

I've journalled this and hopefully will post sometime, but just a quick note so that you know that we've arrived safely. Meeting @ 0745 tomorrow. so hitting the sack early.

 

all the best to ppl back in Canada!

update

So it's been exactly 3wks since my departure and so far things at the hospital remain somewhat the same. Progress seems unfortunately slow in this country, but also can be quick at times.

 

Update on IFCH hospital

- donations made

- still waiting on an infusion pump and then the Dental room will be ready for usage. The pulse oximeter came in handy.

- still waiting on an air compressor. Despite multiple offers, vendors have still not shown up with anything physical. So we wait... soemthing I am finding it harder and harder to do..

 

Other:

- I was given the opportunity to talk at the Nepal Paediatric Society conference this year. My aunt was also able to attend this interesting conference that illuminated many of the challenges/frustrations that physicians faced in this country. I particularly was saddened by some of the comments made during an engaging panel discussion on whether or not neonates should be resuscitated. Eg. physicians try to their best to save a newborn and finally the child is stabilized and the parents need to discharge in order to get home. Their child is stable but still in critical condition. Their rationale for leaving - a child they can always have another; but their cow, if they loose it, it's over for them and the rest of their family.... It was fitting that the conference theme was "social determinants of neonatal health". Medicine is a very different ballgame here. I was able to share a bit about BABU's initiative to launch an infant flow CPAP program. It was well received, but now to follow through

- My aunt is here with me and we'll be travelling to the United Mission Hospital tomorrow for an intense teaching 7-8day teaching schedule. It'll be fun though cause I actually know what I'll be doing vs. trying to figure out how to be best utilized. The way mission hospitals are run here are so effecient. It's quite encouraging in a country of shear chaos.

- I've had the opportunity to meet with a lot of ex-pats in the area and sharing time/thoughts with them. It's nice to have a fall back community to speak to that I know understands me.

- Just dropped off 2 of my Canadian friends who came and successfully volunteered in the hospital and also at ENPHO (www.enpho.org)

- Will have a lot of contact to follow up with on return from Tansen. There are a lot of people interested in seeing how an RT can be useful. I'll be investigating this cause apparently my chances of getting into the country and contributing clinically are slim. The best way would probably be to come as an educator which seems to be in high demand.

- going through the Mark Series with the Mens group has been great.

- found a good ex-pat church to attend on sunday's at KICC school in Patan.

- load shedding continues - waking up at strange hours of the night to use internet

- petrol shortages seem to be more often now seeing longer lines.

- water shortages are as per normal. We are really fortunate to now have a well. Just finished last week. Now we have water, but the quality unsure. So far nothing funky from dish washing and my 1 shower that I've had in 6days. We'll try tooth brushing with the water soon. Someone came over today to visually sample the water... No one seemed quite concerned. Was tempted to get the ENPHO guys to run their full gamit of tests on the water, but havent' had a chance to get a sample out to them.

 

I pray that things are well with ppl back in Canada. Miss it a lot these days especially since I'm trying to fight an upper respiratory tract infection from all the pollution I've been inhaling. But I'll be out of the valley for a good week, so looking forward to that awesome contrast.

 

Well, gotta get packing, up tomorrow by 0400.

 

peace,

e

start of a new day

So, up this morning by 0630 by the daily contemporary music of performance of chaos by dogs, roosters, chicken, construction and anyone else who wants to contribute. I usually do contribute with a toot or two.

Breakfast consists of bread and deep fried shrimp chips. Very basic foods here lacking nutritional value.

Walk out and find my safa tempo (electric three wheeled vehicle with a small front cab that fits 3 then 2 benches that fit a snug 10. The thing is, vehicles here look SO banged up rust everywhere. I realized that regardless of how well ppl dress, they are bound to get dirty. So everything looks dusty. Anyway, things are as per normal rubbing up against the damp bodies around me. Then the tempo suddenly stops, the driver was taking a call on her cell. This is quite interesting cause we just implemented a law in Canada banning cell phoens and driving. I should have congratulated her. But yesterday I saw some guy dialing and talking on a motorbike, mad skills that i'd like to master some day...

Finally get off and pay the driver for my trip up, only to receive some very damp change. i don't even want to know what that paper is soaked in. Sweat? urine? i wouldn't be surprised by any of it. holding it by the corners i'm not sure whether to just throw it out (and for me to throw out change it's gotta really bad) or not. I get to the pharmacy to buy some more metronidazole and to my surpirse is it's exactly 10NPRs, my change for 10 tablets. The trees have just been trimmed and in the process half the electrical wires have also come down with it. ke garne? what to do...

a day in a life.... and for some the last....

Here at the hospital, the PICU continues to be constantly overflowing.
 
The doc's day started here at 0630 (after leaving the hospital well after 2100 last night) with a surgery then a constant flow of patients streaming in through the doors. Everyone from the underprivileged pt who only has the shirt on their back and hope that this thing called a 'hospital' can make things better for their child to the carefree diplomat.
 
everythign is a lack.
 
Power outages: Are a dime a dozen in this place. It's as if this place is gets a shot of adenosine at random intervals. Lights, computers and all electrical equipment gets momentarily suspended... the generator kicks in but ppl don't know to reset all the electrical things like the AC.
 
A child comes in reporting that a surgical consultation at the only Internationally recognized hospital in Nepal was 12,000NPRs. They were promptly turned off and checked in at another hospital that charged only 50,000NPRs for the consultation, surgery, recovery and entire hospital stay. It's brutal times for healthcare in this country.
 
Note: a good salary in this country is 5,000NPRs/month.
 
Mechancial ventilation 3,000NPR per day at the government hospital
mech. venitlation 10,000NPR per day at private hospital
Congenital Heart defect sx free.  up to 14yrs, but the problem is qualifying them for Sx. recurrent infect'ns prevent them from being candidates.
 
another ER case turns into a disaster as i learn of what standard protocol in a country where wppl dn't know better is. due to the lack of resources and knowledge certain procedures are left not even sure what i'm to write. you'll just have to come and see for yourself. i'm just appalled at the situation. doesn't make sense at all the things you see here.. today was quite depressing, see that body.

 

but i guess situation was bound to come since a diagnosis was made in utero already, but due to non-compliance with medications, lack of knowledge, lack of facilities, this child dies. perhaps death isn't as bad as the process of death...
 
should i be telling their entire stories or are these stories best left untold? perhaps i liiked things better not knowing what can be done or what's going on

 
don'tknow what to think/do... but it guess that's wat keeps you going...

 

somewhat depressed tryign to find hope.

 

i have a presentation to make at the Nepal Pediatric Conference in 4days. . You can pray for good content and clarity. Theme is social determinants of neonatal health. please feel free to fire me any thoughts.

 

it's hard to think after trying to digest what happened today. this country needs help.

 

update

Hey crew, sorry it's been a whil since updating, I'm goign to need some
approval for some expenses incurred. At the current moment I've spent
15000NRps for duty fees in getting all the donated supplies across the
boarder. The boarder rep was originally asking for 25000, but I arbitrarily
asked for 15000. When the final bill came out, I realized that only 1700 was
required by the government our boarder rep pocketted the rest...

other potential requests are
- air hose y-connector,
- screening for windows to prevent flies from entering the hospital wards
-

still trying to setup a bank account

So a typical day. Woke up at 0530 and saw off 2 friends at a bus station.
Went into the hospital early to get a head start only to be greeted by the
most ridiculous time waster exercises. E.g. physically cleaning ethernet
connection in the back of the computer to connect to hospital network. So
frustrating spendingso much time on things you know should take a fraction
of the time. It definitely teaches patience though. So finally finish a
draft for donation list for the charity and a coupon draft for free
pediatric consultations at the hospital. There's still a ton to do for the
conference which is in a week and the CPAP machine has yet to be setup due
to some connectors that still have to be obtained.. Things are slow in this
country.

Anyway, rounds today are a bit less depressing as most of the patients are
decently managed. But it's overkill for the director who rounds twice on
every pt in the hospital while doing outpatient services from 0800-2000
everyday. I remember the first day tha we rounded, there was pneumonia case
in the NICU intubated and ventilated on PC 25/5 FiO2=1.0, RR=60bpm. Modelled
and let's just leave it at that. Goign through charts, it seems there are
enough cases of kids who come to the hospital a bit too late. Perhaps
reflective of the fact that only ~19% of Nepal's births are attended by a
skilled birth attendant.

Integration

@515

twelveth month and 4th day of year 2066 in Nepal. (Mar 17, 2010)

So the plan was to come and integrate into the Nepali way of life here. I believe I'm living quite differently but trying my best to figure out how to be as organic as possible.

 

Up @ 0430 by phone call now, it's still pitch black... and someone is over by 0445 asking if we need more water. It's pitch black now cause of load shedding. we were lucky enought o have some electricity last night (hence able to charge laptop and download emails - way to go offline gmail!)

 

couldn't get back to sleep cause of crazy dogs barking their heads off.. now the roosters are going....

 

But yes, this is Kathmandu and what I'm hoping to integrate into so that the time here can be enjoyed and productive. I'd say my body is still adjusting to dry dusty air, but not as bad as anticipated. More on integration to Nepal life later. I need to investigate the area under the curve of my blanket.

 

just as i say that the birds are now rhythmically chirping away and the dog on the roof running circles..... as the Nepalis' say, "Ke Garne?" meaning ' What to do?'

 

 

Kathmandu update

2215 march ten, two-thousand ten.

Landed uneventfully in Nepal and collected all 12 checkin boxes. Boxes slightly bruised, but nothing spectacular. Somehow loaded onto 2 carts by a zealous porter looking for a good tip. Tried to push past in the express line and stopped by customs people. The papers that I provided didn't seem to satisfy the customes person so had to keep all the check ins in holding. So I was taken to a customs holding area where the stuff was being held until the customs officer could come deal with it in the morning. It was a good thing, I've been here before otherwise, I'd have a lot of trouble accepting the fact that the only colateral I'd get was a ghetto sheet of recycled grade paper that had my name on it. My name which they thought was Canadian/Canadienne as per my passport. 

 

So I exit the terminal and greeted by Dr. Shakya, Nat, Justina, Sandip. Although previously warned by my mother, not to worry, I was diappointed that all this stuff was held up. After meeting a Nepali person we walk right back into the terminal and start asking everyone around what can be done to reclaim the equipment now. I think part of this tactic is to ensure as much ppl know about the equipment that has been heldup as possible so that the ppl that seized the equipment would not be able to secretly make off with the equipment which has occured in the past on countless occassions. It turns out that nothing can be done til the next day. Go back to hospital and hang out catch up for a bit til 0100. By this time, I don't think i've slept over 10hrs in the last 3days.

 

Back at the hospital in the AM 0830 to figure out our tactic for getting equipment back. Return to customs cargo area to reclaim baggage with hospital administrator. Enter into a dicey, dusty warehouse were TONS of suitcases, cargo is kept in holding. we are first greated by a bargaining representative who makes us wait for about 30min and then asks for 600NRps. Apparently this is standard procedure.  I'm ushered in 2ft past the restricted access gates by our bargaining rep to take a look if I cansee my baggage. not able to see much, i reply no. so the next step is to locat luggage, the photos i took and the room where they were held is shown to them and they collect them. another 1.5hr later, the luggage enters the restricted access zone. i'm asked to sign papers and then the boxes are pushed out ofthe restricted zone by eager porters. all the while boxes, andskidsof other held up materials are beingpushedand carted out of this area - everything from treking equipment, coputers, animal anitbiotics, clothing from china are found inthis area. I am now told that half theprocess iscomplete. Here I was thinking that it would all be over. But the bargaining has just begun. I am told that they want us to pay 25000NRps for the goods. Talking with the administrator we decide ona bargaining goal of 15000NRps. We're told to wait.

 

Meanwhil the floors are slowly becoming cleaned with the plethora of boxes being pushed along the floors. It is also important to note that fragile although spelt correctly on boxes is clearly not comprehended. "Breekbaar - Fragile" with the universal glass symbol can be seen on some items that look like they just came out of war. My boxes are in decent shape with minimal holes and scratches; but have definitely been tossed around. In order to increase unloading efficiency, porters load skids to approximately 10 feet with whateer they can take out on the pump cart. a trail of the product they are shipping follows like a crumtrail of a young child enjoying a cookie. In this case, the crums are flat screen monitors. They are kicked along to their unlaoding destination where the 10ft stack is promptly toppled over to create a big pile flat screen monitor rumble. the pump cart is returned while a group of eager porters reorganize the product in their own personal way. stacks of 5, 3,1exist in whatseem to be a formation to create steps. Not sure if they were just bored. As the stack gets taller with subsequent skids that come out, the formation of hte steps start to make sense as these are actually used as steps to get product tothe uppermost part of their piles unreachable on ground.

 

About 2hrs later the bargaining has completed with the bargaining repfinally agreeing to 15000NRps. Theequpiment like every other box inthe cargo area is ripped open exposing it's contents for the scavenging of local authorities for approval. Since we clearly made know our donations were for charities, there wasn't toomuch trouble caused in the search.

 

We finally made it back to the hospital 6hrs after with all the goods in hand with  15600Rps in damage. We find out after the transaction that customs duty only charged us 1695NRps. But this is the way this country works.

 

today we opened all the equipment and had the Capitol Enterprises rep come to help out as well.

 

really ipressed by the International Friendship Childrens Hospital with many clients lining the doors for good consultations. many depressing things to report, but ppl are trying hard here to make things work. It was also nice to see my buddy's donated head lamp still in use for oral exams.

 

Anyway, it for now. next week will be imprementing all the equipment and donating the rest of the stuff to ENPHO and UMH. Been a long week with never more than 6hrs sleep but so much to do.

 

Dogs are awake @ 0530 so better get some shuteye. more later...

Hong Kong

Arrived in HKG 50minutes early just before 0500. The deplaning process was just as quick as the planing process. Quite impressed by the little things dones to optimize the flow of passengers. E.g. separating the boarding pass checkin process to 2 steps, thereby allowing the passenger to walk straight through without stopping until they get to their seat.

 

So I roamed the airport a bit until I found a quiet spot and then tried their WiFi. And it worked! The entire airport is WiFi accessible even the airport express train (but not free there). Caught up on emails and then boarded the Airport Express train. This has got to be the smoothest, and quietest ride I've ever been on. There's just no way of describing a ride on the clouds.

 

As I deboarded at the Hong Kong train terminal, I got into an equally modern looking terminal and proceeded to explore it all before figuring out to get out of this convoluded place. For some reason after about 16hrs of the plane, I totally lost all ability to navigate properly. When I did get out. I started roaming the streets to hopeully hit a couple of sites I saw on a map of the place.

 

ended up at this biological park in the middle of the city with crazy monkeys. Then proceeded up step streets to hopefully hit some type of peak.

 

Met these Philippino house helpers and talked to a bunch of them in the park as they were walking all the dogs of owners. It's very interesting and humbling the type of lives that they lead. More thoughts on this later perhaps. Then met this well-traveled retired highschool physics teacher. I ended up hanging out with him for about 3hrs as we walked to the peak of the city to see the tourist sites. He ended up treating me to a McDonald's breakfast (I had to break my McDonald's boycot; but I think the time that we spent together was well worth it) There is lots to learn from lives of the people that have gone before you. Oh yeah, also met a Nepali security gaurd in HK as well. It's interesting to hear of all the adventures and life lessons from people that have so much life experience.

 

I finally got back to the IFC mall where the train station is and roamed around the harbour trying street food. The craziest system for ordering food.

 

- walking down street full of chinese dried goods, including octopus on street

- go down dark alley where ppl cooking food.

- see somthing i want to eat and order it. told to order with someone different and 2mins later some person who i haven't talked to at all has all my food prepped. had no idea how their system worked, but the food was fantastic. lubriacated esophagus very well with all the oil used.

- crashed at airport

- flight very itneresting meeting a German textiles expert on route to Bangledesh for work.

-fight to KTM uneventful

On a jet plane

So finally after years of conviction, months of planning, weeks of soliciting, days of packing, hours of security clearance, minutes to walk through the gate to the plane, I'm finally off to Hong Kong. The moment is here and now flying over Chita now.

 

In the last couple days rushing to get things together. I realized that this moment now is no more important than any other moment in life. And my time is no more important than any other little child. Each moment is a privilege and to be used optimally. Life is shorter than we all know and I challenge you to treasure each moment doing what you desire. Just watched (more listened) Revolutionary Road while responding to emails where people challenged me to consider what I'm doing. Whether I've slotted myself into a mold or truly doing what is fulfilling.

 

And to be honest, after investing so much time/money into my education, it would seem almost irresponsible not to pursue something related. But is that truly what I'm to do? I've come to conclude that seeking God is first and foremost of importance for from there life convictions originate and true joy and peace occur when those convictions are lived out. Signing off from ~31,000ft. Over and out.

Just about ready

It's the eve of departure day. To say that I'm excited is an understatement, but to say that I'm apprehensive is also an understatement. 

It seems as if the weight of the world is on my shoulders. I feel as if I'm lining up at the marathon startline. Part of me is excited and another part trying to comprehend what ever possessed me to take jepardize my job, take a pay cut, all to go out into the unknown....  But then I come back to the root motivation - realizing that this is a burden that has been placed on my heart. Something I probably can't live with if I just walked on by after seeing first hand the pain and suffering of those in such a beautiful country.

Confirmation came today from my church pastor praying for me in the congregation. I knew then that the church was behind me. It meant a lot; and when he extended open arms to hug me, I think I was still overwhelmed by the privilege it was to represent the finger reaching out to scratch an itch in a hard to get at place. I'll need the help of the other parts (ie. arms, forearm, etc) to get me there and it was nice to see everyone come on board. Additional confirmation came from a friend who came out from Waterloo to send me off. It was nice to also see my uncle and aunt come by to send me off and pray for the trip. Reflecting on all the support, I'm reminded of the immeasureably more than we can ask of imagine that lies ahead...

For a long time it felt like a long uphill battle with countless rejection letters or no responses from vendors/hospitals unable to donate equipment due to legal issues. It has now culminated in almost 10 packages waiting final sealing (ran out of tape). With the help of an ex-beer store worker to help teach the finer details of shrink wrapping packages to be secure, I'm sure that they'll be safe to travel... A special thanks to those that have offered up their vehicles to transport all the goods as well.

So, with less than 22hrs to go and still a bit more to pick up. I'm excited and hopeful.

Wish you were all coming with me to see this awesome country.

Thanks for all your support!

exactly 4 days left...

It almost seems surreal, that I'll be returning to a place where my heart burned to return; yet I feel a bit lost still trying to hack together presentations for people there.

 

But I'm reminded, that I'm there not to impose ideas or things on people but to journey with them. I just pray that all this preparation is going to the reconciliation of man back to peace.

 

With all the donations coming in. I'm feeling the pressure of delivering and making good with the support I've been given. It would be a horrible shame to see this flop. But a reminder that God judges the heart. I just pray that my motivation is pure and work is driven by God.

 

Yeah can't think too much now but figured I should be updating. More later when reality strikes...

 

 

Whew....

Another long day. Planning for this trip has been quite an intense yet satisfying task. I actually feel as if I'm working towards something vs. sustaining something. I think men were created developers...

It seems that it takes me forever just to get through emails and presentation creation is constantly on the go, but never very productive. That begin said, please see prayer items for updates.

a) Praise for the many respiratory therapists that have volunteered their past presentations for my recycling usage which saves me a TON of time
b) Praise for the company of 2 more siblings that will be in Nepal at the same time I will be there. They are taking a Sabbath year to travel and see the world. I had the unique opportunity to see and pray with them today which was super cool!
c) Request: for the donations to get to Nepal and then to clear customs. Working on getting exemption papers now, but with the dynamically changing political climate in Nepal, God only knows, so please join me in a plea to Him.

Feb 20 update!

My apologies for not updating more currently. The goal is to be updating at the end of every week and I'll start that now.

So to bring the logistics up to speed. My scheduled departure is now March 09, 2010 @ 0010. Cathay Pacific, my newest favourite airline, has generously decided to allow me 10 checkins at no extra cost. I'll be in Nepal for 9.5wks departing May 15, 2010 @ 2315.

My time is Nepal will be split several different ways. Goals include
1. Re-establish ties with Sandip - my host -,  his friends, local Lazimpat community people and fellow local brothers and sisters.
2. Support and affirm the work of Drs. Shakya and Shrestha at the International Friendship Childrens Hospital. This where neonatal infant flow CPAP program will be launched.
3. Support and affirm the work of the Environment and Public Health Organization, both old employees and new employees
4. Establish new links the the medical community within Kathmandu (ie. Teaching Hospital) and attend the 15th annual Nepal Pediatric Society conference Mar 25-27.
5. Establish new contact with physicians @ the United Mission Hospital in Tansen, Palpa. I hope to do this trip with my aunt who is a retired RN/midwife when she comes in late March-early April. I've established ties with a Christian physician there whom I've been very encouraged by in our conversations over email so far. I'll be bringing in some equipment (1 Infant Flow Driver/1 case Generators/Blender/O2 analyzer,etc) and also do some teaching int he 1.5wks that we hope to spend there. We're going at a time that should be well before Monsoon to prevent any travel issues that may arise.

Support has been steadily rolling in the form of equipment and finance. Prayer support is still lacking in my opinion.

Prayer items:
1. More prayer partners: especially for Tuesday --> Friday.
2. Need focus to finish off presentations. There's a ton more work than I orginally anticipated that goes into this...
3. Logistics: Customs letters for getting all the equipment through.

Weekly update

So spent a lot of time going through some lectures by Randy Pausch - author of Last Lecture who was basically giving a lecture on how to live your life for his kids after he was diagnosed with pancreatic cancer. Lots of good honest truth in what he has to say. It's just a shame that we as a society think that we are so safe and free from the clutches of death in our earlier years. I pray that Christians might live with the Spirit's energy in such a way that leave people undoubtedly knowing that they have had an encounter with the presence of God.

An update on the trip so far. This trip has been continually haunting me. On the one hand, I feel as if failure is highly probable given the craziness of this undertaking. But on the other hand, I realize that all things are possible shoudl this be something that God desires. I've been very blessed with the accountability of some people pushing me on (e.g. BABU buddies). This week has also been extremely awesome for a couple of milestone markers.

Below are update bulletins
a) Infant flow driver obtained. It is currently being shipped to Canada now from some company from the states who picked it up not knowing what to do with it. It's costing more to ship than the actual purchase. It should be here on Feb 08 for inspection. The thing is, they aren't sure whether this thing will work or not...
b) Infant flow nasal canulas: Just gotten confirmation from one of my super cool work places that deals a lot with neonates and they will be donating spare unused supplies, both a bulk set + will continue to keep spares for us. My super cool employer has been wonderfully supportive since I joined them back in July 08.
c) Still need some supplies, but leads are going well. I also received some correspondance from another company that is considering donating a unit capable of providing bilevel positive airway pressure! super cool, but no confirmed donation yet!
d) Presentations: These are slowly coming along. I need to sit down next week and really go through some material to pump out some documents.
e) The abstract was sent last week for the NEPAS (Nepal Pediatric Society) 15th annual conference. I hope to present there. No news back yet.
f) Another super cool company has secured at least 1 and maybe 2 humidifier pots for donation. This is super cool!
g) airline tickets seem decently priced.
h) Presentation booked for Sunday at church
i) Pending presentations at hospitals.
j) My society has volunteered to publish help in their newsletters. They are awesome!

It for now. I'm tired and need sleep

Worthwhile investment!

So I've been looking into investments recently, here are some numbers to convince you to consider investing in Nepal...

Your chance to sponsor the inaugural neonatal CPAP program in Nepal!

The Facts.
The Situation: Making sense of the numbers.
The Opportunity.

The Facts
All data taken from the World Health Organization (WHO) Statistics 2009 available online @ http://www.who.int/whosis/whostat/2009/en/index.html. Unless otherwise noted, all statistics are from 2007.

Global Health Indicator	Canada	Nepal	Statistical notes
Mortality and burden of disease
Neonatal mortality (deaths within <=28days)	3	32	per 1 000 live births
Infant mortality (deaths within 1yr)	5	43	per 1 000 live births
Under 5-mortality	6	55	per 1 000 live births
Health service coverage
Antenatal care coverage: at least 1 visit	No data	44	% 2000-2008
Antenatal care coverage: at least 4 visit	No data	29	% 2000-2008
Births attended by skilled attendant	98	9	% 1990-1999
	100	19	% 2000-2008
Health workforce, infrastructure
Physicians	19	2	per 10 000 population
Nurses	101	5	per 10 000 population
Dentists	12	less than 1	per 10 000 population
Other health service providers	no data	2	per 10 000 population
Hospital beds	34	2	per 10 000 population
Demographic and Socioeconomic Statistics
Living in urban areas	77	9	% in 1990
	79	13	% in 2000
	80	17	% in 2007
population living at less than 1$/day	no data	54.7	2005
Cause-specific mortality and morbidity
Access to improved drinking water sources	1	0.89
Access to improved sanitation	1	0.27	45% urban Nepal and 24% in rural Nepal
Health Expenditure
Total expenditure on health	10	5.1	as % of GDP (2006)
Government expenditure on health	17.8	9.2	as % total government expenditure (2006)
External resource for health	0	15.7	% of total expenditure on health (2006)
Per capita total health expenditure	3917	17	in US dollar amount (2006)
Per capita government health expenditure	2759	5	in US dollar amount (2006)
Out of pocket expenditure	49	85.2	as % of private expenditure on health (2006)

The Situation: Making sense of the numbers
Considering the statics above and having journeyed there to better understand the situation, it is clear that neonatal and pediatric healthcare in Nepal is severely lacking. Neonatal mortality is a key indicator of child and maternal health according to the WHO. With a neonatal mortality rate of over 10x the national Canadian average it is quite concerning.

Around the globe, neonatal death accounts for ~20% of the <5 year old deaths. Nepal’s statistics suggest that neonatal deaths account for almost 60% of the <5 year old deaths. According to the WHO Nepal mortality fact sheet 2006, prematurity accounts for 20% of neonatal deaths.

Within the last 2 decades, Nepalis have been relocating to urban centres at a rate of greater than 4% per decade. As urbanization occurs, clean water, improved sanitation and education becomes more accessible to the general public. The capacity of healthcare facilities is feeling the strains now with the increased number of patients. With only 2 hospital beds per 10 000 persons in the country, that is 17x less than what is available in Canada. There is also a need for doctors as only 2 doctors are present per 10 000 people. Within Nepal there exists only one government pediatric hospital (Kanti Bal Aspital). A second private hospital just opened last year (International Friendship Childrens’ Hospital – http://www.ifch.com.np/) effectively doubling the number of PICU/NICU beds in the country overnight.

The Opportunity
There is a unique opportunity for your organization to help out this promising hospital with necessary equipment for them to provide essential services to a population in dire need. Your equipment will be managed by Bringing About Better Understanding (BABU), a Canadian charity dedicated to improving the level of child healthcare in Nepal. Additionally, any donations made out to us will be able to go a long way given the purchasing power parity (PPP) of your donation.

Thank you for your interest in helping out. If you have any questions, comments, queries or advice. Please feel free to contact me @ Eric@ideas2implementations.org. I look forward to hearing from you soon! Peace.

Abstract: http://www.ideas2implementations.org/nCPAP.doc
General letter: http://www.ideas2implementations.org/Nepal.doc

Motivation...

Wow, whoever thought doing development work would be this difficult. Beyond organising ideas and thoughts, parsing through data from the Central Intelligence Agency's World Fact Book, World Health Organization and United Nations Childrens' Fund.. It's quite draining and depressing going through all the data... Much easier to develop policies and procedures for best practise... Going to try and sleep it off...

Sponsorship opportunity

Hi,

Thank you for your interest in this exciting return trip to Nepal. I had the privilege to travel there 2 years ago and found that healthcare in the developing world was very hard to stomach. Please see my thoughts from my visit in the RTSO Spring 2008 newsletter - page 3

Through the help of mentors and SickKids, I was able to bring a pocket spirometer to Environment and Public Health Organization (ENPHO) and conduct a pilot lung function study with the traffic police in Nepal. I am happy to say that it is still in use by researchers investigating various factors affecting lung function on people in rural and urban centres.

Upon return, I partnered with other likeminded people to start a charity. We’re proud to say that Bringing About Better Understanding - BABU which in Nepali means baby boy – is now a registered charity with the Canada Revenue Agency! BABU exists to improve the level of child healthcare available in Nepal. We achieve this through a) public education and b) empowerment of physicians and surgeons through knowledge share and quality equipment donations. We currently work through the newly founded International Friendship Childrens' Hospital (IFCH - http://www.ifch.com.np). We have sent 2 people there last year for the opening of the hospital. One has returned for the 1^st year anniversary and to do more needs assessment. I will be returning in March 2010 for ~2.5months to launch the inaugural neonatal nasal CPAP program. We are still looking for a sponsors to champion this initiative by donating 2 variable flow CPAP systems. Please see abstract. They are also desperately in need of syringe pumps, ultrasound and non-invasive/invasive ventilators for their Neonatal/Pediatric Intensive Care Unit.

If you think that you might be able to help in any shape or form that would be greatly appreciated. Through BABU, you can be certain that any donation will get to IFCH and be used to service those in most need. During my first visit, equipment that my friend and I acquired for the only government pediatric hospital in the country went mysteriously missing in less than 2wks. We have learned our lesson and we now have a formal process to manage all donated equipment to ensure that it a) does not grow legs and b) remains in use.

Please feel free to forward my contact information to anyone who may be of help or is simply interested in global healthcare. Thank you for your time and attention. I appreciate any thoughts, comments or suggestions!

Hope you are having an excellent start to the new year!

Eric Cheng

eric(at)ideas2implementations.org

Reactivation!

It's time once again. I'm so excited to be able to return to Nepal. It's more of a necessity in that being there last time really just tore my heart open. It was the first time I was in a developing country and saw the injustices and shear lack of common knowledge getting people into lots of trouble - much of which involved unbearable pain and even death.

So I've wrestled with what type of world I live in in North America, where I can learn about the troubles of the world, but yet still be very removed from it. After meeting some rural families in Nepal, I realized the futility of the lavish North American life and learned about the simplicity and beauty life offers just on it's own lived in harmony with the people around you. I vowed to go back and discover more about this way of life and also to contribute some of the things I picked up in school and living in Canada. I love Canada!

So the struggle begins, to get time off here and return. People think I'm mad, but to me there is something mysteriously revitalizing about hanging out with people and simply enjoying each others company. I was challenged by this in a sermon. To value people and use money rather than using people and valuing money.