May/June 2017

Mike and Fiona returned to Pokhara at the beginning of May. At that time there was still no certainty of a work visa, however Mike was pleased to be able to take leave from his locum at the Queen Elizabeth University Hospital in Birmingham in order to see the on-going work at the Ear Centre and attend an ear outreach camp.

Mike had passed one hurdle, with a letter from one Nepali ministry confirming that he should have a work permit, however there were further delays because of a change in passport during the waiting period.

Soon after arrival he was able to help with some difficult surgical patients, including young children with extensive mastoid infection and a lady with a paralysis of one side of her face due to a damaged facial nerve, that required grafting.

A street in Jumla, pre monsoon rains

In the run-up to the monsoon season there were some heavy rain-storms and also some very clear days. All around he hospital flowers are in bloom and the grass growing tall and bright green. The snow level on the mountains lowered so they look spectacular.

Packing ready to leave the Ear Centre for the camp

About 10 days after arrival Mike and the rest of the INF team from the Green Pastures Hospital Ear Centre headed off on a marathon road journey to Jumla. We were joined by Dr Fredi Bacchetto as a representative of SON the Swiss donors. Sadly Dr Lukas Eberle of SON remains seriously unwell. Fredi’s wife Christine stayed in Pokhara and spent time with Mike’s wife Fiona. This was our 5th ear camp in Jumla, spaced over many years; the last was two years ago. On that visit the presiding memory was of being very cold, especially the poor audiologists, working in a windy dark corridor! This time the temperature as we crossed the Terrai on the Nepali border was very hot and humid, approaching 50 C, but then as we ascended into the hills it became very pleasant.

A section of road on way to Jumla

The hill roads have to be seen to be believed, apparently they featured on a TV programme as one of worst roads in the world! It took three long days of about 12 hours each in the 4WD vehicles to reach Jumla. One land-rover developed a broken gear box and had to stop and wait for an alternative vehicle. They then missed the police road curfew and spent a night in a rather primitive hotel before joining us.

The 4WD breaks down!

After a day setting up the theatre and out patients and meeting the local doctors we were ready to start the next day, but that evening we had a call about an emergency. A lady who also happened to be deaf and dumb had fallen from a tree. She was probably cutting fodder for her animals. She had a very nasty cut across the whole face, just below each eye, cutting her eye lids and going deep into the nasal cavity, with further cuts to lips and tongue, and a broken wrist. The local doctors were happy to have an ENT team arrive, so we cleaned the wound of grass and mud and repaired the lacerations and nose. We were worried she may get an infection or have eye damage, but the swelling subsided and she did well, going home a few days later. Because both she and her husband could not hear or speak it was hard to know how she felt, and it must have been very frightening for her. The pictures are rather gory, so we have not included them!

Operating theatre in Jumla

Trimming a graft to reconstruct an ear drum

As it is a short farming season in Jumla, and people were very busy with planting out rice seedlings and harvesting wheat, we were unsure how many would attend the clinic. Also we were a smaller team than usual, so we did not advertise. Nonetheless, we saw nearly 500 out patients, did nearly 40 operations, 200 audiograms and fitted 50 hearing aids. There is a local man who has worked with us for many years; he will help with follow-up and hearing aid supplies. Two men walked two long days from Mugu for hearing aids. Most surgical patients had infected perforations of the ear drums, some had more extensive cholesteatoma disease of the mastoids, though these were fewer than usual. Mike and the team did a teaching session to about 25 final year nurses from the local nursing school.

INF team with many of the surgery patients

Mike teaching final year nursing students at Karnali College of Health Sciences in Jumla

When it came to leaving, the team were very keen to take a side trip to visit Lake Rara. This is famous in Nepal as a beautiful remote place. The road was even more extraordinary, crossing vast cliff faces, entirely unmade-up and with numerous small landslides. At the end of the road journey we walked three hours through pine woods and lovely meadows full of sweet smelling flowers, then round the lake to the far side to stay in a rather basic lodge. It was an amazing experience. On the return journey the truck developed fuel and electrical problems and broke down twice. So they took four days to reach Pokhara.

The road to Rara

Carpet of flowers in meadow near Rara

Preparing fish for lunch

On our return, we were delighted to discover that there were four audiology trainees on a one month attachment to the ear centre, from the Teaching Hospital in Kathmandu. We were invited to a dinner by local ENT doctors and were able to discuss the EAN bursary candidates. We will make a final decision at our EAN trustee meeting in the UK in June. One of these will receive sponsorship to attend an ear related course abroad and an attachment to an ENT unit for two weeks. We also talked about other trainings we hope to arrange in Nepal. On this visit Mike was able to take a lot of medical textbooks paid for by EAN and also return several audiometers that had been recalibrated and repaired in the UK, again paid for by EAN. He also took a large batch of hearing aid batteries donated by RayoVac.

Mike and Fiona return to England in early June, thankfully with the work permit finalised. Then they will finish Mike’s locum in Birmingham and hopefully return to Nepal in late September or early October, just before the festival season.

We remain committed to further ear camps and to volunteers coming as teachers to the hospital. We are still awaiting the final health agreement that we depend on, between the government and INF. The minister has just signed it, so it should not take long now. Once that is in place we believe it will be possible to facilitate short permits for interns, students and other volunteers, and also their medical registration, to respect all local regulations. We are told that a large number of clinics and hospitals have been closed down by the authorities for failing to follow appropriate rules. Thank you to the many professionals and others who have supported us and who have offered EAN to come as volunteers and for your continued patience.

Rara lake in the evening