Nepal- Week 2

I got back yesterday from 4 days in the field with two colleauges, visiting health posts and observing training sessions and technical support visits. It was about a 1-hour flight to the western side of the country, followed by a very long and bumpy ride in a red Land Cruiser 4x4, the kind I used to write waivers so my USAID projects could buy (since they’re not made in the US). I had eaten my usual large breakfast before leaving, so when we pulled off the road after only about an hour to eat lunch, I wasn’t thrilled. You know those commercials for sugary cereal where the announcer says it’s part of a balanced breakfast, and the shot widens and you see the kid is also having toast, eggs, fruit, juice, yogurt, and probably some bacon too for good measure? That’s what my breakfasts are like here, minus the bacon. It’s no wonder that the first words of Nepali I taught myself were related to getting people to stop putting more food on my plate: “full” (pugyo) and “I don’t need” (pardina). However, I was told it might be awhile before we’d eat again, so I had my own plate of dal bhat. We had driven through flat, green scenery on our way out from the airport, with people out working in the rice paddies now that the rainy season has started. Unlike most fruits and vegetables, which are significantly better the closer you consume them to their source, I learned that there is little to distinguish fresh rice from the dried, processed, supermarket version, other than the potential for encountering bits of gravel in your meal. Luckily I was able to avoid such a fate, though I made sure to chew carefully. We got back into the USAID-marked vehicle, which I affectionately, if not creatively, named “Ruby.” Ruby was a champ, as was our driver, taking us safely through streams, over rocks, across slippery muddy sections of road, and around steep curves that required a honk before turning as you never knew who might be coming at you from the other direction. After a couple more hours (and a sighting of about 20 golden monkeys crossing the road), we turned off the paved road to begin our shortcut. This involved some very steep, very rocky and winding roads up the mountain. Eventually we returned to paved road, but were soon stopped again, as the rains from the previous night had caused a landslide ahead. Bulldozers had been at work for hours trying to clear it. We waited. We drank tea. It rained again, in sheets, and when it stopped they had to start all over again. It was during this time that I learned a couple of things: 1) I have the power to "hold it" through sheer force of will. I draw way too much attention to go off and find a private spot to pee, plus, we were on a steep mountainside, and I was wearing jeans. So I held it for the three-and-a-half hours it took to get through the pass, and for another hour on the other side until we stopped for tea. I’m like a camel, only more stubborn. When I saw the available facilities, though, I wished for the relative cleanliness of the woods. 2) I also learned that Nepalis are great ones for hocking a lugie. I see it (and hear it) less in the capital than I did on this trip, but man was there a lot of expectorating! Men, women, and children do it freely and exuberantly. It’s quite surprising to the western observer. 3) I had already observed this before leaving the capital, but I’ll include it here anyway: friends in Nepal hold hands, or put their arms around each others’ shoulders, and it’s not unusual to see two men with their fingers intertwined. This reminded me of my time in Rwanda, where the same was true though I think to a lesser extent- there, I’d see people walking together along the road side by side with their forearms touching. It’s so rare in the US to see anyone holding hands besides couples or little kids, so it’s nice to witness affection between friends.

The district we visited, Salyan, is lovely, and being higher-up, we had much cooler temperatures and nice breezes. The morning views from the balcony outside my room were particularly beautiful, and we were sometimes literally in the clouds. The accommodations did leave a bit to be desired, but it was part of the experience and it did make me appreciate the relative comforts of the capital, so I’ll leave it at that. Except to mention that despite frequent power outages, every room had a TV. I found that amusing. We took a couple of morning walks around the village, admiring the mountain views. One morning we also got to see a goat drink from its own stream of urine under a poster depicting a poor couple telling a wealthy man how proud they are of having a latrine in their home, while he guiltily visualizes defecating in an open field. I tell you, you haven’t lived. At least the goat knew the source of his water. Sorry, that's in poor taste. (Groan. Somebody stop me.)

During my field visit, I toured the District hospital, as well as a sub-district health post and birthing center. I also observed a Technical Support Visit in which someone from the project field office goes over clinic records and discusses issues with the health worker, and a training class for Maternal and Child Health workers (all women) on the use of partograph during delivery. One of the most interesting parts of the visit was our encounter with some Rauti people. The Rauti are a nomadic tribe of only 500 people, who travel between three different areas in the west of Nepal. They spend much of their time in the jungle, and when they emerge they build temporary settlements (one of which we saw under construction) and sell or trade with the locals the foods they’ve foraged or the rough goods they’ve made, such as wooden bowls. They also make their own clothes, so they really stand out from other Nepalis who are usually dressed in western shirts and pants, except for adult women who often wear saris. Apparently, the Rauti people recently negotiated with the government and were granted a small amount of money per person, per month. They are often discriminated against. After seeing some of them on our way to the sub-district health post, a Rauti man showed up seeking care for joint pain. He wanted ointment, but the technical program officer conducting the support visit, the health worker, and my companions, convinced him to take a pill instead, and provided water. I guess Rautis are skeptical about taking pills, but he eventually did and then sat for a while, observing the dialogue, before moving on.

On the last day we made our way back down to the town near the airport (we took the long way around this time, avoiding the site of the landslide). We observed a Health Education and Adult Literacy (HEAL) class and a meeting of women who facilitate these lessons. The HEAL class was held in a communal-use building, and we were welcomed by the women attending the class. It was run by a Female Community Health Volunteer (FCHV), of which there are approximately 50,000 in Nepal. These women do an incredible amount of health service delivery and health education/awareness, despite the fact that many of them are illiterate themselves. We were given floral leis to wear around our necks, and the class finished up their group work, with one woman reporting for each group on their lesson. They were using course books that were half in Nepali, half pictures. Since these women are illiterate, and actually speak a different language from Nepali, (as do many in the terai districts), they worked from the pictures. Then they were asked to go around the room and each say something they had learned from the class. Responses included things like proper nutrition during pregnancy, the importance of clean water and antenatal care, not carrying heavy things while pregnant, etc. Then we asked them a few questions, and they had the chance to ask us questions as well. They had a lot to ask me, about how I like Nepal and how long I’m here for, and what I do in the US. Everyone was very friendly and curious. Then one woman made a comment, and everyone laughed. The supervisor translated for me- she had joked, “Since you’re speaking in English, you could be abusing us and we wouldn’t know.” I replied, “They could do the same to me, since I don’t understand a word anyone says.” That got an even bigger laugh, when it was translated back. We took some pictures and headed back to the car. We spent the night in a brand-new hotel near the airport that, despite being only 2 months old, had a lot of broken appliances. At least my room had a fan, though. Being very close to India, the food resembled more closely the type of food I’ve had from this region of the world before coming here. It was still dal bhat, but with a bit more flavor, and I really enjoyed it. The next morning after breakfast, it was back to the airport and back to Kathmandu! It was overall a good experience, and I’m glad I got to the field my first week in-country. In addition to being a great learning opportunity, it made the hot water, internet connection, and giant breakfast waiting for me at my host home even more enjoyable than before!