Painted red : Farewell to the Tamghas Hope Centre

The night before we left the Hope Centre there was a formal farewell by the staff , Treasurer Tara ,and the landowners son . We were painted with a red tikka by each person and draped with flowers . They then presented us with two photographs of Tamghas mounted on board as a thank you for the contribution we had made whilst at centre. Then there were the photos, everyone posing for the camera and vying for position .Everyone loves having photo's taken .





In the evening Ganga’s Aunty came over with her 10 year old daughter and cooked a scrumptious chicken curry . Kedar bought 2 bottles of beer and some local whiskey which I tried in a beer as recommended by Kedar . Traditionally you drink the alcohol when snacking on the meat prior to the main meal, which is as always, dhal, rice, pickles and fried curried vegetables ( yes Dhal Bhatt again) . We danced Nepali style , some better than others eg Radhika and her niece . I was dressed in a traditional red Saree , nails painted red, black eye liner and red bangles . The girls had lots of fun dressing me, everyone contributing and laughing as they wrapped me up in 5.5 metres of cloth and arranging my hair . It was very special day.

Accessory or Need ? Umbrellas- a much needed 'accessory'

Thank goodness for umbrellas!. With the sun beating down whilst walking for 1/2- 3/4 of an hour when I am visiting homes in the village it gives me some shade and reduces the amount of time before I turn into a sweat ball.

Whoever said woman perspire and men sweat lied!

You can even get them repaired for 5-10 rupees!

Private hospital -User pays in Tamghas

Tara the treasurer of the Tamghas Hope Centre and local business man, has recently opened a new private hospital in Tamghas. There are 20 beds at present. $150 rupees a night . 24 hour lab, modern diagnostic equipment , beds and meals can be provided ( bought in from a local 'hotel') if you have no one to provide them for you .

We were in Tamghas during the opening and visited the following day. They offered two days of free assessment and treatment , hence the long lines of people.

The radio station and abortion clinic are housed in the same building but are to move to make way for more facilities and beds.

Radio station

Tamghas hospitals - Government

Delivery suite
Spare beds
New initiatives
Recovery room

We visited the local hospital and was escorted by a GP on a scholarship who was the head of staff. he was introducing new initiatives . The have a family planning centre, HIV clinic, lab( staffed part time) and they undertake cesareans and simple day surgery. ( No GA's as they dont have an anaesthetist.

You have to look past the building and amenities.

15 beds, no linen or food provided. You usually take a family member or caregiver in with you so that they can wash you and monitor your status as there are few nurses or care assistants to provide cover. They also bring food in for you. A generator for back up power due to the many hours of power cuts

Our pathway to Nirvana-Hinduism or Buddhism

Our reality ;

I relate more to the Buddhist philosophy and you could perceive what we are doing as a ‘suffering’ considering how we live in NZ . Many all our familiar pleasurable desires, including those sensual are now extinct ; supping on fine wine ( in detox since being in Nepal) , eating French cheese, turning on the stereo at the end of a day’s travel and then sharing an intimate moment with each other ( we are still newly weds you know! ) Now.... At night time after a day of deciphering the language, wondering what you have ordered to eat and if the cup of water you have just been offered is safe to drink , finding a toilet and managing not to pee on your feet, surviving the transport near misses, the changes in climate and extreme heat , all our your energy depleted we crash into “bed” or a very hard version of one without a mattress ( more like a table) , exhausted ! Add to this cocktail of romance a cold shower , the sweet music of the mosquitoes buzzing around your ears , instead of my husband’s loving words , and the only thing crawling around the bed is a bug or two! Romance takes on a new meaning and sleep is a much more attractive option ! Untouchable, definitely, however Nirvana is in sight,........ we hope!

What is Buddhism ?
Buddhism is not a religion since it is centred not one a god but a system philosophy and code or morality .It was first founded in northern India on about 500BC when a prince called Siddaratha Gautama achieved enlightenment . He was actually the fourth , the birth of the first Buddha was actually in Nepal. Buddha believe that enlightenment is the goal of all beings and eventually we will all reach Buddhahood.

There are 2 main Buddhist schools.

The Theravada ( Doctrine of the Elders ) or Hinayana, holds the path to Narvana the eventual aim of all Buddhist, is an individual pursuit. In contrast the Mahayana school holds that the combined belief of its followers will eventually be great enough to encompass all of humanity and bear it to salvation .( some people call this the ‘soft option” ! ) There are other versions of Buddhism found in Nepal one is l called the Tantric Buddhism of Tibet .

Buddha taught that all life is suffering and this comes from our sensual desires and the importance of these . He initially renounced material life in search of enlightenment but as this did not lead to discovery he developed a more realistic rule “ Moderation in all things”. Thats me! By following the ‘eightfold ‘ path our desires will be extinguished and a state of nirvana will be reached where our desires are extinct and we are free from our delusions . There are also as series of rebirths . Karma is the cycle that takes you through a cycle of births : your actions in one life determine the role you will play and what you have to go through in your next life.


What is Hinduism ( 80% of the population in Nepal )
This is the predominant religion in Nepal. This religion extends back 1000BC. The foundation of Hin dui philosophy explained in the holy book called the Vedas, the devine knowledge. Hindu’s believe that we all go through a series of re births or reincarnations that eventually lead to moksha, the spititual salvation that frees one from the cycle or rebirths .With each rebirth you can move closer to or futher away from eventual karma which is literally a law of cause and effect. Bad actions during your life result in bad karma , which ends in a lower reincarnation. Conversely , if your deeds and actions are good you will reincarnate to a higher level and be one step closer to the eventual freedom from rebirth. Dharma is the natural law that defines the social, ethical and spiritual harmony of your life.

There are 3 categories of Dharma.
1. External harmony that involves the whole universe
2. Dharma that controls castes and relations between castes
3. Moral code that follows that an individual should follow.

There are 3 main practices in the Hindu religion.
1. Puja/ worship.
2. The cremation of the dead.
3. Rules and regulations of the caste system.

There are 4 main castes
1. Brahmin /Chhetri or priest caste ( 65%)
2. Kshatriya or soldiers and governors
3. Vaisyas or trades people and farmers
4. Sudras or menial workers and crafts people .

These castes can then be subdivided although this is not taken to the same extreme as in India Beneath all castes are the Harijans or untouchables , the lowest caste casteless class for who the most menial and degrading tasks are reserved . You can not change your caste but if you choose to marry below your caste them according to Kedar you go down to that caste forgoing your previous higher caste status. From discussions we have had with local people the discrimination between the castes is lowly being ‘diluted” .

Ref: The Lonely Planet and Internet

Nepali toilet

Well what can I say ! Needs must! We are trying to master the art of toiletting Nepali style, wash with the left hand ( no toilet paper). The toilet systems( I presume a type of septic , actually I haven't even gone there to ask where it all goes down that hole) are very basic. No flush. You have a bucket in the room with a small jug in it and a tap . You wash yourself first and then attempt to wash your doo do's down the hole. Some are cleaner than others . We have started rating them!

In a few places, hotels and guest houses we have had European toilets but still the bucket and jug .
People with disability have the challenges of trying to squat and maintain balance Hopefully they then have hand function , left preferably, to wash yourself . ( the right hand is used soley for eating)

A 55 year old Brahmin woman who suffered a stroke- CVA

This was my first home visit. Initially she came to the centre with two family members. She is 6-8 months post CVA ( Stroke with left hemiparesis) and is walking independently with stand by assistance. Kedar did his physio treatment working on passive movements of her arm and leg and walking technique . I asked if she could sit on the floor and get up to stand ( important functional skills in a Nepali home . We encouraged her to start using her hand to eat food which she demonstrated as we shared fresh cucumber topped with salt and chilli ( Nepalese people don’t use utensils so the hands are very important, usually the right hand ) . I didn’t have the courage to venture down the track of toileting, having only just formed a relationship with her ( cultural practice is that the left hand is used to clean themselves after toileting . I suspected that she could still do this given she had enough hand function to make a good attempt at this or had adapted.) When I visited her home which was down a muddy dirt track ( we accessed this by motor cycle) with a very slippery steep path up to the main home ( I slipped down this when leaving and thankfully slid into Kedar who stopped me descending further! So who has the disability!) The extended family lived in 3 houses on 3 levels, the communal kitchen (photo) on the middle level and her home up another steep muddy bank with a few concrete steps at the end. (What funding would be provided in NZ by ACC or MOH to make this home accessible?) . At present her family walk beside her to ensure her safety. We encouraged her to start making roti again, doing a few household chores and not to enclose her arm in her Pashmina when walking but to let her arm swing free. She had a very cheerful disposition and seemed to enjoy our visit but was keen for us to leave so that she could attend the monthly local women’s committee meeting where Kedar and Ganga say all sorts of things are discussed, even down to mistreatment of women by their husbands. The committee have been known to send a representative to sort him out. Neighbourhood watch takes on a new focus. Could be a good thing to adopt in our culture ....maybe?

The kitchen . A clay oven and a gas ring , mud floors cleanly swept copper and aluminium or stainless steel cookware , jugs , plates and cups . You sit on the floor on the rice mats to eat .

A special girl-Niru

“Niru is a 8 years old girl from Arbathoka Gulmi. She has one younger sister and father and mother. Niru` family is little bit educated and not so very poor.” (Kedar).



This delightful 8 year old girl with CP was carried up to the centre every day for a week whilst I was at the centre . Her mother carried her in a shawl on her back and a friend walked with them to share the carrying. She lives a few hours away and was staying in the village in order to bring her daughter for treatment to the centre. She does not attend school as she is unable to walk and there is no other means of transport to school besides carrying by family or possibly paying a porter? There is no provision for additional assistance such as teachers aid whilst at school and no equipment . So many obstacles to accessing education which we take for granted in NZ. Her mother when asked stated that Niru wants to go to a school where she wears a tie. ( all the children wear uniforms at school and at the private boarding schools they wear a tie) . She was immaculately dressed in European clothes with hair tied in pig tails and a spirit and desire to learn that I so admired. She walked in the parallel bars and was assisted to walk with an adapted rolator walker . Her determination and smiling face was a delight to see. Kedar focused on passive movements and I attempted some occupational therapy . There were no toys, play equipment, books pen or paper, corner seats or any adapted equipment, so we improvised . I eventually purchased some pen and paper, balls, pegs and metal cups , anything I could source in the local village centre. Niru was supported the chair at the front desk with pillows and a small stool to rest her feet on and we played encouraging her to use her hands. Mark came along and initiated some informal testing by hiding a ball under one of the 3 cups and moving them around to see if she could find it. Bright girl... she located the ball most of the time . She concentrated intently on all tasks from writing her name , squeezing the pegs , stacking cups and putting balls into cups. . She loved moving the plastic rings around the wire frame, the only piece of hand function equipment in the centre ( photo) .

The next day we had just picked up a standing frame from a local workshop which I discovered you could sit in when it was turned around. I made some play dough which Niru kneaded , cut ( I adapted a plastic knife by building up the handle with some plastic tubing found in the spare room ) and she formed 8 round balls which she patiently rolled out with a rolling pin to form roti . She knew exactly what to do, probably from having observed her mother . She did not stop until all the dough had been rolled which took about 45-60 minutes.


Oh to be able to get this young girl into school. It takes money, resources , acceptance of the school in regard to disability , motivation and parental support. Even then when educated locally there are few job opportunities especially for woman who tend to either not go to school or leave early to tend the fields an animals and care for immediate and extended families. . The men have other options which have challenges. In the majority of village families at least one if not more of the men go overseas to work and send money back to support their families. Saudi is recruiting workers for menial jobs offering the chance of earning money that can not be earned in Nepal. We have read and heard stories about the exploitation of these people which is of a real concern but a fact of life for many . Some of the men are away for 10 months to a few years before they can come home.

It costs 4000- 8000 rupees a year to send a child to private school.

We are so fortunate in NZ to have access to health, services rehabilitation and education.

Our flatmates whilst at the Hope Centre

GangaThe Team
Mark and Kedar(Physiotherapist)

Radhika in her school uniform. ( usually she wears a kutha when not at school or skinny jeans! )

Fashion Shopping with Radhika in Tamghas village

It doesnt matter where you go in the world and how much people earn there is always woman's fashion!. These photographs are of the traditional Nepalese outfits I had made by one of the many local tailors in the village.( 1200 rupees for material and 200 rupees for making, $28 NZ total ) Is is called a kutha . You select the material , bargain for the price and then take it to the tailor who measures you and sews it on a treadle machine( no electric machines due to the many hours of power cuts in this country, you would go out of business).
Radhika , Ganga's 17 year sister lived with us at the centre and did most of the cooking( prior to and after having gone to school for the day ) was so enthusiastic about taking me shopping, showing me all the styles and colours. We has so much fun. We walked arm in arm through the village bargaining and laughing. She is my new adopted daughter! I always wanted a big family.


The tailors and a woman with oh that middle age spread!

Case histories.

These case studies have been taken from the Hope Disability Centre October Newsletter which we have had just completed.

Sumitra
The Hope Disability Centre (HDC) receives an endless stream of very complex and complicated cases. Finding the best solution can be challenging and each solution is unique depending on the needs of the individual.
Many children live with their families in remote and inaccessible locations of rural Nepal. Sumitra is one such child from a remote location of Nepal whom HDC has assisted in
many ways to regain mobility and independence.
Sumitra is a 16 year old girl from Gulmi District in Western Nepal. She has one brother and
3 sisters. Her parents are subsistence farmers and do not own a house of their own. Sumitra's family is very poor and no one in the family has received any education. When Sumitra was four months old she fell into an open kitchen fire in her house and both of her legs were severely burnt. Sumitra's parents did not know where to take her for treatment. Not long after Sumitra suffered her burns her mother, due to associated stress, was unable to look after her child. Also Sumitra's father died, leaving Sumitra in the care of her sister in law. Sumitra's sister in law did not know how to look after her and there were problems in caring for Sumitra.
In 2009 an Eye Hospital camp visited Sumitra's village. Sumitra went to the camp for an eye check up and was referred to HDC by the Eye Doctor after he saw the extent of her disability. At this point in time HDC Tamghas consisted of 2 small rented rooms in the town. We decided to refer Sumitra to Butwal where there was a visiting medical camp from Model Hospital Katmandu.
Both of Sumitra's legs were operated on at the camp. The damaged part of one leg was amputated. The other leg had a contracture and this was surgically released. After one month Sumitra returned to Butwal for a follow up. After the completion of the operation in Butwal Sumitra stayed for a year at HDC Tamghas. The centre provided lodging, food, exercise, wound dressing and other necessities to rehabilitate Sumitra. Sumitra was also enrolled at a local boarding school.
After Sumitra was fully returned to health she was referred to Green Pastures Hospital in Pokhara for the fitting of prosthesis leg. Sumitra stayed at the Green Pastures Hospital for four months to mould and ensure the prosthesis fitted correctly Sumitra also had training and physio so she could walk. Sumitra has prosthesis for one leg and after the contracture of the other leg had been released and a shoe fitted she is able to walk.
Sumitra has now returned to her village where she lives with her brother. She is attending
school and can now walk around the village where she is now accepted. HDC hope that
Sumitra will eventually work in the field of fabric painting so that this will generate income for her.
The total cost for the operation and rehabilitation for Sumitra amounted to 104,000 rupees; around $1,420 US dollars. This is small price to allow Sumitra a life of walking.

Fully recovered, Thank you ALTSO.

Sunita
Sunita is a 6 year old girl from Dubichour Village Development Committee (V.D.C.) Gulmi District. She has eight people in her household. Sunita's family is very poor and are not educated. Sunita came to HDC last year she have osteomyelitis, which is inflammation of the bone and bone marrow and we referred her to HRDC hospital in Katmandu. She was admitted to the hospital and surgery was conducted and Ilizarovs Technique was applied to lengthen her leg and she spent a month in hospital in Katmandu. Now Sunita is fully recovered and walk completely normally and now is attending school.
Sumita was able to walk after never being able to walk after the small investment of $493 US.

Take
Take is a seventeen a year old boy from Musikot 3 Gulmi. Take has clubfeet from birth. When Take was 4 months old his mother died and Take did not receive adequate care and nutrition. He was not boght in for treatment until he was seventeen years old. Take came to the HDC and he was referred to HRDC Hospital in Katmandu where Take was operated on to correct the right club foot. After one month Take is to return to HRDC Hospital in Katmandu to have the left clubfoot corrected.
The cost of the correction for the right leg has been around $580 US. This amount is needed to coorect Take's left foot.

The examples above show how a small amount of support from donors can make a powerful change to someone's life. The cost of transport, medical attention, dressing and accommodation costs are very low allowing donors funds to achieve a great deal. In most instances the cost of surgery is free thanks to Manipal, HRDC, Model and other hospitals in Nepal.