The Halfhog tries an ultra-marathon

“An ultra-marathon is just an eating and drinking competition with some exercise thrown in.” In case you were wondering what an ultra-marathon is, there you have a definition from famed US sport nutritionist Sunny Blende. I though of this as I, a vegetarian, stared at the noodley chicken soup on offer at the first checkpoint of the 2010 Annapurna 100 ultra-marathon race.

I took the water on offer and slipped over to a small pasal for a packet of Parle-G, the world’s biggest selling (and consequently most littering) glucose biscuits.

My first ultra-marathon was going to be a long, slow chicken-soup-less day out full of eating and drinking with a backdrop of the immense Annapurna range. No racing, just keeping moving, enjoying the scenery and just keeping smiling, however forced that smile might need to be at times. And more or less alone – 71km split between a field of 40 doesn’t suggest a jostling pack.

The race starts in Pokhara and runs all the way to the famed Poon / Pun Hill view point and then a good part of the way back. In between runners are treated to a 2050m climb part of which clambers up 3080 stone steps. All in all there’s of 3584m of up and 3346m of down. This challenging physical aspect along with the Himalayan views and the sultry, blushing-blooming rhododendron forests make the race a truly unique event.

Annapurna-100-ultra-trail-race-january-1st-2012

Click to download our race brochure PDF thing (1 MB)

The race started at the centre of hotel-strewn Pokhara lakeside at 6.30am. The majority of the runners sped off as if free ice-cream was on offer at the end of the street. Within a kilometre or so the tantalising morning view of Machapuchare (Fishtail mountain) had disappeared behind the foothills and the hotels thinned out to reveal real lakeside lake and local residents going about their business. The flat jogging ended abruptly with a turn up to Sarangkot, 700m higher than the lake and the first checkpoint. Already at this point, the leaders were already 30 minutes ahead. A woman wished, ‘best of luck!’. A small boy shouted, ‘you’re last!’

The race was first run in 1995 with a collaboration between, artist Jan Turner and ex-Ghurkha Ramesh Bhattachan and some help from British cricketer-turned-walker Ian Botham and some money from Nike. Only two other races have since happened in 2000 and 2009 due to the political upheaval in the country and subsequent difficulties in finding sponsorship for such an offbeat sport.

This race was the 4th Annapurna 100 race. The 100 refers back to the previous races’ distance of 100km, and the name stuck as it sounds pretty catchy and there was a website domain to consider. A big change this year was that distance was reduced to 71km to ease difficult nocturnal logistics and the burden on the runner’s legs (who apparently actually complained last year). Next year it will be back to 100km.

Additionally, a lot of the route was shifted onto trail from road. This was down to Roger Henke, director of the Summit hotel in Kathmandu who stepped in at the last minute to provide the sponsorship to make the event happen. Henke is himself a keen trail runner and is very familiar with the tourism industry and the potential niche tourism markets that Nepal is able to serve.

“I wanted to develop the race and turn it into a trail race because I believe that trail running has future from an adventure tourism perspective. So I convinced my board to sponsor this year’s event – to make it happen – and use the experience as well as the visuals and contacts for designing a better event next year, with much better international exposure.”

This years event had around 40 competitors, mainly drafted in from police and army sports clubs though running-novice locals from villages along the route entered too. Consequently the race had a wonderfully intimate atmosphere among the runners and the volunteers and villagers at the frequent refreshment stations. There were a number of international runners, including Jo Schoonbrood, the over 55 world record holder for distance covered in six hours.

At the second station at around 15km, there was a little fatigue to be felt in the legs, but just a little. The bananas were hard, but the noodles plain, thus edible. The path undulated and local residents looked on bemused. With most runners probably in one and twos, sweating profusely, it probably looked like a jail break as in Nepal, running is generally for thieves.

The trail markers thinned out here and directions had to be asked from locals. The route, to my dismay, headed downhill along a road. Down now meant up later. At around 25km, the soup lost its noodles an became spinach soup, well known for its high calorie content. Four kilometres further on after a clunking down hill to a river, we’d reached Birethanti, arguably the real start of the race.

Here was race organiser Ramesh Bhatterchan with an enthusiastic pep-talk and a bottle of water while the TV cameras, filming for Transworld sport, rolled.

This was the 31km in the bottom of a river valley and surrounding hills towered above, which implied that our destination of Poon Hill would also be towering above somewhere.

I caught up and ran for a while with a local boy called Santosh entering in his first ever running race (he finished in around 12 hours). Together we started the steps up to Ulleri. This was a meditation. Keeping a manageable rhythm, not stopping other than to drink, and deliberately keeping happy (‘Wow, look at the view!’). Being local, Santosh lagged behind having to talk to all the people he met and knew. I caught up with a man called Nand and we continued together. At Ulleri checkpoint we asked ‘How much more up?’ The reply came, perhaps a fundamental of life in this area, ‘Everything is up!’

This stage of the race enjoyed one of the big attractors of Nepal which is the rhododendron forest in bloom. Through this knotted forest we stumbled, across waterfalls of clean, clear water – things utterly foreign to the Kathmandu resident. The canopy glowed red. A rumour has it that some of the arboreal inspiration for Lord of the Rings came from this area long ago. The Mothers’ group representatives of [name forgotten] gave tikka and a Malla of Rhododendron flowers and the red power immediately mixed with sweat and dripped from the end of noses. In such surroundings, it seemed wasteful to dwell on the condition of the body, which actually, after a hill ridden marathon distance, felt surprisingly good.

There are a growing number of scientists who will tell you that we are born to run. Being able to run for long distances after prey (who became exhausted before us) gave us our competitive advantage over Neanderthals. Our foot is designed as the ultimate shock absorber (and our comfy running shoes do nothing but to make our feet weaker and encourage injury). Our lungs, not connected to our gait like many quadrupeds (front feet down, innards slam forward, lungs squeezed empty) allow for regulated oxygen supply for long distances (man always beats horse over 50 miles). Our success in finding meaty protein however lead to our big, highly-developed brains which told us to conserve energy (be lazy) whenever possible.

Still, marathon and ultra-running have grown rapidly in popularity in recent years. American research has shown that interest in running rises most during times of difficulty such as recession or after a disaster. Since 2001, ultra running has become, at least in the west, more popular than ever.

The Annapurna region attracts over 70,000 visitors per year to its trekking trails, with some creativity and adequate marketing, the Annapurna 100 should be able to attract a sizable field for 2011, which is the Nepal Tourism Board’s fingers-crossed-for-tourism year. But such a race doesn’t only offer something for tourism. A much bigger prize is the realisation of sporting potential.

“I believe that a bigger better race will have much more chance of attracting bigger sponsors, which will make the prize money pot bigger and thus support local athletes training,” says Henke.

Yes, Nepal might one day have an ice-dance champion, but in the meantime, a mountain running champion should surely be a no-brainer. There is world class talent here worth getting excited about.

“To be able to run that fast, at that altitude, up those steps and just keep on going, in that time – and still look good and fresh at the end – I think it’s spectacular,” offered British athletics coach and ultra-distance adventure Rob Cousins.

Rob Cousins originally came from the UK to train athletics coaches with the Nepal Olympic Committee. Unfortunately the offer of free, professional help proved too much for the NOC to accept. Now he has teamed up with Annapurna 100 race organiser Ramesh Bhattachan to train a two promising mountain runners for the prestigious Davos ultra-marathon race in Switzerland, the Nepal of Europe*.

Cousins believes there is potential that has not been properly exploited. “After two or three months I think I can get them faster,” says Cousins. “I was out with some of the army running team before the race. They were doing things I was doing when I was aged nine on the rugby pitch. I think their training is probably making them slower and so I think there really is potential.”

The athletes confirm, “We train mainly on track and road as most races are on road,” says 4th placed Raiwat Dhahal also of TAC, “we train just one day a week on hills on the Trisuli road.”

Ethiopia might not be the dominating force in distance running it is today had a Swedish coach, Omni Niskanen, not been in the right place at right time with his then state-of-the-art training knowledge in 1946.

But Nepal is not the blank slate that Ethiopia was then. Nepal’s trail running future is perhaps just around the corner. Last year’s 100km Hong Kong Oxfam Trailwalker event was convincingly won by the Nepali, Ghurkha-linked Group 4 Security (G4S) team. The team of four, including Khatri, won in a record time of 11.42 minutes, a full two hours before the second team’s arrival.

With some tailored training, including nutrition, core strength and race strategy, there are more potential victories waiting to be seized. But here Nepal’s international trail running potential remains just potential.

The stick wielding, khaki-clad leader of Tribhuvan Army Club, who was reluctant, as you sometimes should be, to be on record, demonstrated enthusiasm but limited vision. He said that while his men train every day and they win everything – but only in Nepal. He’d be proud if they won a big mountain race abroad, but then “but I don’t think they would get that opportunity.” So what are they training for?

One exception is Dacchiri Sherpa who now lives in Switzerland and also represented Nepal in the Vancouver 2010 winter Olympics. “Yes some Nepalese take part in races sometimes but not regularly, and yes in Nepal the people they have big capacity but there is limited investment for the sport, and there is not much support from our country”

Dacchiri Sherpa showed stunning strength to win the 1000km Himal race from Annapurna basecamp to Everest basecamp in 2002. This was a 23 day stage race through rugged terrain with 38,000m of ascent. Born into this terrain, runners like Dacchiri have a definite advantage, as annual Sherpa record breaking antics on Everest attest.  But the support of a coach, and a club or a nation are necessary to compete internationally these days. Time will tell if Rob’s training programme bears fruit.

At the summit of Poon Hill the mountain view was obscured with cloud and a chilling wind was blowing. Mallas were presented (earlier seen discarded in trees lower down), photographs were taken and biscuits were stuffed into pockets for the decent. The warmth of the (relatively) frozen checkpoint volunteers was admirable. They were truly excited to be part of this small running event in which there were far more volunteers involved than runners.

With the knowledge that the hard work had been done, the 20km run home, which would itself normally be a rather long run, seemed like it would be a piece of cake to be savoured and enjoyed.

I think few understand about ultra-distance running. Few understand running come to think of it – its what we’re designed to do after all. In such a race, it’s really just about keeping moving, enjoying the scenery and keeping smiling. And eating and drinking too.

“Khanus! Khanus!” ordered a very senior member of Ghorepani mothers group offering biscuits,  Chinese apples and hot noodle soup. Ah – of course mothers understand everything, even the necessities of ultra-distance running.

* 15th April 2010: Scant news just in from the Everest Ultra Marathon which finished yesterday in Lukla.  To quote Rob Cousins:

“what a story for the winner!  A local porter who decided to do the run the day before, had to run to the start, then beat the Army team hands down!”

Read a shortened version of this waffle here:

http://nepalitimes.com/issue/2010/04/14/Nation/16976

And see trailrunningnepal.org for some pictures and reports in Japanese.

Magar woman from Pyuthan, Nepal


Magar woman from Pyuthan, originally uploaded by rpb1001.

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

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

View On Black

Kathmandu: the earthquake is coming. I’ve just realised.

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.

Next steps? visit http://www.eqknepal.com/ or this Facebook group.

 

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

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

Transparency and technology and Nepal

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

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

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

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

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

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

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

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

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

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

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

Any thoughts on this anyone?

Dil Bahadur Kidney Transplantee – an update

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

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

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

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

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

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

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


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

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

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And now the doctors are going on strike…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Smallest buddhist in the house. Seto Gomba, Kathmandu.

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.

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

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.”

Gadhimai Mela, Nepal

Gadhimai Mela, Nepal, originally uploaded by rpb1001.

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

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

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

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