There right next to the micro bus stand for Tokha, bathed in the golden, dusty dawn light was the Korean Cock stand. To me the phrase Korean Cock brings only one image to mind and this stand, manned by a young woman, could not possibly be selling it. It turns out to be an imported Korean waffle machine turning out some rather tasty looking waffly fish with chocolate coated heads for a reasonable 10 Ruppes [sic] each. Why cock then? “Cake,” says the boy to the right. That’s a really, really bad and lazy spelling mistake, I think to myself. That or Kathmandu’s advertising industry has taken a great cynical leap forward trying to lure in the returned South Korean female migrant workers market. I explain the meaning, to the two loitering guys, and it takes a good ten seconds before they will let themselves crack up. Bahini, the stall manager, does not want to be in the picture.
Hats off to the staff of Mandala Book Point. Not only did they have the apparently fabulous Robert Bolaño book 2666 in stock when it was not to be found elsewhere in Kathmandu, even if it was a little bit grubby, but they made it gift-worthy.
Rather than trying to scrape off the unstickable sticky-glue price-sticker on a 650 Rupee book that might not be liked, or even read by the recipient (as was the case), upon suggestion they replaced it with something much better – a sticker of much higher value.
With much mirth, the labeller was set to the highest value, and out popped a lakh – or just a Rupee short. Rs. 99,999 which at about 1000 Euro exchanged is surely enough to please the most critical recipient of a birthday book.
The Internet is a big place. It’s rather like Kathmandu in some respects. While busy and colourful, there’s lots of needless noise, there’s a lot of rubbish everywhere, a lot of time can be wasted getting from A to B, it’s pretty disorganised and no-one is really in control. And then every now and again you discover a small quiet courtyard of the main super highway / gulli. In this place its neat and tidy, thought and consideration have been given in ample proportions and you find it’s a place you want to visit time and again. This place is http://nepa.li
Well that all sounds a bit sycophantic and over the top, and it is, but it’s too late because I’ve typed it now. Anyway, take a visit and see what I am talking about. It makes a great antidote to reading the Nepali press. Try:
It’s no secret that Kathmandu will be visited by an earthquake sometime soon. But only in the last week have I started to think about it a lot. And it gives you a lot to think about.
A geophysicist I met recently in a café posted an invitation to a lecture on the topic of Nepal and Earthquakes on a Kathmandu events mailing list.
I was ill so didn’t attend, but met her in a café the following day. The conversation ended with her saying, “I didn’t mean to scare you!” The first sobering thing that she mentioned was that she tries to avoid Thamel as much as possible, a place I frequent often. The reason why, “There’s nowhere to run”. Thamel is Kathmandu’s shoddy but decadent district where most of the bars, restaurants and tourist hotels are situated. It’s buildings are densely packed, as you’d expect in a place where money is to be made. The build quality can’t be vouched for however. As the saying goes, ‘earthquakes don’t kill people, buildings kill people’. In Thamel, there are too few open spaces to run to to avoid falling pieces of building that could kill you. And if not immediately bricks, tiles and concrete, then it will certainly be raining large plant pots with their struggling foliage that line up along balconies of restuarants and the edges of rooftops.
The second sobering fact was that she carries around with her a bottle of water, a torch (flashlight), a swiss army knife and some food in her bag whenever she goes out.
I learned several more things in the time it took to drink a cup of coffee. For instance, that a section of the Himalaya from Gamgadi in west Nepal to Kathmandu has had a deficit of earthquakes in the last decades compared to the areas either side of it. The tension is building up. And a final piece of information, the coffin-nail in my day, was the fact that the floor Kathmandu valley is sediment from an ancient lake bed surrounded by firmer hills. Tap your teacup and watch the waves to get an idea of what this means. The waves reflect from the edges back into the centre time and again. The energy takes much more time to dissipate, the ground keeps on wobbling, and thus the damaged caused is vastly greater than it otherwise would be. Not only that, but the silts’ resonant frequency is low compared to rock and similar to that of shallow earthquakes, which means, well look up resonance here.
The following day, I received an email saying: “You shouldn’t be afraid of earthquakes, just be aware of the risks and be prepared… Sorry if I scared you but remember, the next big earthquake could happen in 100 years!”
Well maybe, but I disagree with this. An earthquake is something to be utterly terrified of. And with regard to the 100 years, yesterday and earthquake of 5.4 was detected in Tibet 40 miles north of Namche Bazaar. This morning san aquiantance claimed: “tiny tremor of an earthquake this morning in ktm – i totally felt it, did you??”
I didn’t feel it and I am glad about that. However, I’d already started imagining the room swaying, the windows breaking, plaster exploding from the walls and ceiling, and wondering where I should move to, if should I grab my boxershots on the way, go out the front door or through the window on to the balcony. That’s at home lying in bed in a house that will hopefully hold up, though I have no evidence whatsoever for that.
Now I am sitting in a cafe with 5 floors above me. Who was the architect, who were the builders? It’s 20 m run to the front street or a jump to the rear over a spiked fence. All the time the ground will be violently shaking, the world will be falling apart. It will be unimaginable, although I am trying. And that’s imagining in the daytime. In the blackness of night, with no moon, during a period of load-shedding would not be good (but then of course, the lights would go out anyway as already leaning rotten electricity poles crack and tumble.)
And then what?
Well then it really gets terrifying as you pinch yourself and realise you are in the hell on earth that you knew would one-day come. From Geohazards International‘s estimations:
- More than half of the city’s bridges would be heavily damaged.
- The entire water system, sewer system, telephone system, and electric power system would be disabled.
- Six in ten buildings would be seriously damaged. The city has seven fire engine brigades.
- The homeless would number somewhere around seven hundred thousand.
- Deaths would number somewhere around forty thousand. The dead in Nepal are usually cremated. Each cremation uses more than a ton of wood.
- Injuries would number in the hundreds of thousands. Kathmandu has about 2100 hospital beds in twelve hospitals. Half of these would be unavailable due to damage (actually 80%). Kathmandu has 700 doctors.
- The airport is almost surrounded by land subject to liquefaction. This would seriously hamper the arrival of outside aid.
And this is 8 years out of date, before Kathmandu’s real urban expansion really kicked in. For instance, according to a friend, Kathmandu’s last working fire engine gave up the ghost recently. But as others have pointed out, fire engines would probably be trapped in their fire station behind jammed doors, and the roads will either be broken or covered in rubble.
As another guy I know put it, “When the earthquake hits, it will be every man for himself,” meaning the government will not be there to help in any meaningful way, shape or form. He is busy building a steel cage inside one room of his house. It is interesting to wonder how society will deal with the situation too. Will there be a kind of connecting ‘wartime spirit’, or will it descend into anarchy. I hope for the former, but given what I have seen of people’s behaviour here, I am assuming the latter.
So, given the enormity of the impending situation, what is being done in terms of preparedness? As far as I understand, a lot of groups are doing a lot, but when the day comes, and the weeks and months after the day, all the preparation will have had little impact. I should be sure of my facts before making sweeping statements, but, sadly, I would bet everything I have on being right. Roger Bilham of the University of Colorado wrote more generally about earthquakes and big cities: “We know where the problems are. We know what to do. We know how to fix it. We just need the political will.” And there is a great shortage of that here.
And to finish off this depressing post, it is worth considering the chances of it happening:
Nepal ranks eleventh on the list of nations at risk from earthquakes. Of all the cities in the world, Kathmandu faces the highest risk, according to seismographic studies.
People say it is a small world, and then refuse to walk anywhere beyond the corner shop. It’s a very big world. And on this very big world, I am living in the city slated to be the next to be turned to rubble. It has taken a long time for this fact to dawn on me.
If we accept that another Big One will strike Kathmandu within twenty years, then for every day you spend in Nepal you have a 1-in-7300 chance of being there at the wrong time. If you stay for ten days, which is probably less than the average for most Western tourists, that gives you a 1-in-730 chance of being there. If lotteries operated with that kind of odds, a lot more people would be buying tickets. If one in 730 airplane flights crashed (or one in 730 passengers died, which is the same thing), there would be fewer frequent fliers.
Very worth reading this post from Seth Sicroff – it’s well informed and also depressing, but at least it has got some pictures.
So you’d imagine the earthquake would be on everybody’s lips and preventative actions and drills would be happening everywhere. In another post I might wonder about why that seems not to be the case.
So preparation. Tomorrow is Holi so no chance I will be going outside of the house. Monday is shopping for knife, muesli bars, a strong water bottle, a torch (I have) and iodine tablets for water purification and a lighter. Then it’s to the British Embassy with a copy of my passport and longitude and latitude of the flat.
Smallest buddhist in the house. Seto Gomba, Kathmandu., originally uploaded by rpb1001.
I am lucky. I complain about a lot of things, but life for me is interesting and life for me is good. This evening, Christmas eve (although this has little meaning for me), was spent as the fourth attendee of a Buddhist wedding. The other three were the bride, groom and their young daughter.
The wedding took place under the auspices of a particular Ringpoche (name escapes me) in the Seto Gomba, the White Monastery, near Boudha in Kathmandu.
In this picture, the wedding is over and formalities are being completed in the office. Every monk in the house, and all employees too, are receiving a 100 rupee gift from the groom from a rather thick wad of cash managed by Tenzin Chopel (hand outstretched, right).
Here, hesitantly comes the smallest monk of the Gomba into the office to receive his money.
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.”
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.
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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Below is a picture of a wall painting seen on a school wall near the Indian embassy in Kathmandu. It is done by a group run by a guy I know, Children for Green New Nepal.
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:
What to say? Just heard this on the FM4, an Austrian internet radio station, about Earth Hour. “We’re encouraged to switch off all non-essential lighting for one hour”.
“VOTE EARTH: your light switch is your vote.”
Welcome to Kathmandu, where Earth Hour has been going on for many years. Currently the zealously green government has been giving the citizens of Nepal an enforced buy-one-get-16-free option on these votes and stuffing them in the ballot box for on their behalf.
Every day, for 16 hours the government turns all of your switches off – both inessential lighting and everything else with it. Additionally they topped up the Earth Hour manifesto with turning off non-essential street lighting, traffic lights, mobile phone company power supplies, all industrial machinery, my local bakery’s ovens, power supply for kidney dialysis machines, ECG machines and anything else you can think of that has a cable with a plug at the end somewhere.
Long after the world switches its non-essential lighting back on and starts wasting energy again like there is no tomorrow (and that is looking increasingly more likely), we here will be sitting in the dark. Either that or burning Olympic-size swimming pools of imported diesel in generators to keep normal life going.
The irony is that the power we are missing would be hydro-power. But due to years of incompetence, rampant theft of power and some dry weather, the system is more than a little creaky.
Here’s a tip for all Earth Hour participants: at 8.30pm, go the whole hog (not the half hog), flick that big red switch on your fuse box. Enjoy!
Yesterday I visited Sisdole where Katmandu’s rapidly filling rubbish dump is located. It is what you might expecte of a rubbish dump: a lot of rubbish, a sickly smell, pipes ventilating gases from putrefaction, trucks delivering more booty at regular intervals, bulldozers flattening it out across the dump. The setting was a bit incongruous: all this among green wooded hillsides and terraced fields. What certainly was not be expected was the 25 or so men, women and children walking around on top of it trying to supplement their income from the recyclable waste they could recover.
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.
I returned home from Sisdole to a cup of coffee and organic breakfast. I stank. Even my camera when I held it to my face to take a picture stank of the waste. Later in the afternoon I became ill. Either from the breakfast from the cafe I have visited numerous times, or something else. I retired to bed. Later, the familiar bloated feeling that lasts several hours before eventually vomiting came. I lay in bed reading and then decided to look at the days photos. Just seeing a picture of the steaming waste was enough of a psychological catalyst to make me reach for the bucket.