Sisaghat

Monday, 7. November 2016 1:16 | Author:

It is extremely difficult to put into words the last three days. On Friday afternoon we travelled to Sisaghat, a small village around 3 hours drive from Pokhara.

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Sisaghat has a population of around 1600 according to one of the locals we met, however it would not surprise me if this figure included neighbouring villages in the area.

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We went for our major health camp, to provide medical assistance to these people who are fortunate if they see a doctor once per year. There is a bus that comes through to Katmandu and Pokhara at least a few times per week, however most people have hardly ever left their village. The isolation did not mean these people were insular though and although we were a little bit of a novelty being from Australia, there were lots of questions asked and we were able to see so much.

We were greeted with garlands of marigolds and the traditional Nepalese horn.

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For such a small town there was a diverse ethnic mix with a Hindu temple, a mosque and a Christian church. Other houses hung Buddhist prayer flags.

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Our guide, a 21yo lad who was studying science in Pokhara but returned home for our visit, proudly showed us his home and we met his mother. They had goats, chooks and buffalo and we were able to watch the Buffalo being milked.

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The milk was heated over an outside stove and we were offered it to drink. It had a sweetness that was different to cows milk. We walked down paths and met children and our guide introduced us to his other mother and explained that his father took two wives.

We also saw some of the local crops including the millet which was ground and used for breads and also made into a local spirit which was, er, interesting!

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Dinner was back at our host families home and consisted of traditional dal bhat.

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The family had killed one of their chickens especially for us.

Sisaghat is in a valley of the Himalayas and in the morning it was cold and a fog had swept in. The temperature was cold enough for us to see our breath as we breathed out, however once the sun came up from behind the mountains it warmed up and we were hot in our shirts.

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Our host father cooked chapati for breakfast made from the local millet over the outside stove.

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The family kept goats, chickens and pigeons. We heard the goats baa-ing from early morning and eventually they were let out of their pen to graze.

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We were here however for the Health Camp.

 

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Doctors from the Fishtail Hospital travelled out to see over 700 people who had travelled from far and wide. Our job was to take the pulse and blood pressure of those who registered and direct them to the doctors. Many people thought we were doctors from Australia and our local guides had to explain that no, we were nursing students and even though we were white skinned, we didn’t know more than the local doctors! Whereas last week a lot of people had blood pressures that were much lower than we see in Australia (90-100/60-70), this week more people seemed to have higher readings. This was just one test and it could easily have been caused by anxiety at visiting a health camp when there is such little medical assistance usually available to them. We took it in turns taking vital signs and at other times sat with doctors.

I first sat with the doctor conducting ultrasounds. The machine looked like it had come straight from the 70s.


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I learnt later that the majority of people presenting at the health camp came with complaints of lower back or abdominal pain. This was mainly caused by squatting in the fields all day, or at their stoves, or at their toilets. Ultrasounds showed no major abnormalities on most patients, however I was surprised at the incidence of mild to moderate fatty liver that was found. These were fit, healthy people who eat dal bhat most days, eating very little red meat. I wondered if it had anything to do with alcohol consumption which appeared to be rather high amongst the men especially.

I also spent time with the obstetrician/gynaecologist who again reported women with lower abdominal pain from bending all day. She did tell me that in most villages there are trained locals who can assist with delivering babies, however the infant mortality rate is still quite high. The dentist reported pulling over 30 teeth for the day (I did not stay there long!) and the paediatrician comforted parents and grandparents worried about the runny noses and sore ears of their children.

My most interesting time was with the orthopaedic surgeons however. In Australia, MIML™ and I joke that psychiatry is the basket for all the ‘too hard’ cases in the hospital- if the medics can’t work it out they send it to the surgeons, who send it to psych! At this clinic, the orthopods were the dumping ground for the too hard cases. Yes, I did see men and women in their 50s crippled with arthritis from their hard work, and these consults usually took a couple of minutes with the doctors being very forthright and telling people they need to rest for a week or two and the people saying they couldn’t so the doctors telling them there was little they could do. One consultation took a good deal longer. A local came in and spent the consultation looking at the ground. The doctor spoke with them for several minutes. Afterwards the doctor told me that the patient was concerned that some mornings they wake up and want to sit in a corner and not speak to their family and yet other mornings wake up and want to run up and down the street and they can’t explain their behaviour and they thought something must be wrong. The doctor had listened and even though he told me he thought the patient had a classic case of bipolar disorder, he wanted them sent for a cat scan and for some thyroid tests. Although he was not a psychiatrist he did not mind talking to the patient and offering advice.

Over lunch, doctors talked with each other about what they had seen and bounced ideas off each other. The collegiality was really nice to see.

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At the end of the camp we went for a walk around the village. There is a wonderful suspension bridge over the river and we walked across it.

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We also came across some locals who had mixed reactions to having their photos taken.

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Coming into Winter the harvest is in full swing. Rice was being cut and left to dry on the ground before being piled into stacks.

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Corn is also hung around houses ready to be turned into cornmeal.

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This morning we said a tearful goodbye to our family and headed back to Pokhara.

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The self-sufficiency of the villagers really struck me. They almost live off the grid with electricity connected to the homes in order to run a fridge, a few lights and a small television. Water is not plumbed into the homes. The squat toilet is flushed by pouring water from a bucket down it. People bathe by pouring water over themselves, even in the cooler climate, however there was a fire near the water tanks where the water could be heated. The villagers loved having us there and appreciated the health care, but as one doctor told me the doctors feel like they can’t do a lot for people as they are predominantly healthy. In many ways it seemed an idyllic lifestyle- tending the land and feeding your family, however people grow old very quickly.

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I have to include this photo I snapped this evening- I went into a shop to look at scarves and came across this cat who seemed awfully happy with itself!

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Theatre

Friday, 4. November 2016 13:59 | Author:

This is an early post as we are heading out to our major health camp this afternoon and it is doubtful as to whether or not we will have Wifi. I spent this morning in theatre at the Fishtail Hospital. It was a fascinating experience and one that I will no doubt be reflecting upon for some time to come.

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The first case I saw was a total abdominal hysterectomy and bilateral oophorectomy. In Australia, my understanding is the majority of hysterectomies are performed vaginally. Here they have abdominal surgery because they lack the facilities for laparoscopic surgery. In Australia everything is disposable, here it is sterilised and reused. Regardless of the differences however, the patient received the best care available.

There were some minor procedures we also got to observe and then we were told there was to be an emergency caesarian section. Meconium was present so the procedure was rather quick. The father was not present in the room, however when the baby was checked and found to be fine he was taken to his father and grandparents who will care for him for the next 24 hours whilst the mother is in recovery. I will admit I find this a strange practice and as a mother I don’t know how I would cope being separated from my new baby for 24 hours, but this is a different culture and practices are different.

This afternoon we head out to our major health camp. We are camping there for two nights with a family. It should be fascinating, however I know I am rather anxious about it all. No doubt upon our return I will have lots of photos and stories to share :)

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Children of Nepal and TB

Thursday, 3. November 2016 23:52 | Author:

This morning we spent time at Children of Nepal. Here we took some education sessions around hand hygiene, toothbrushing and women’s health. Our group had a group of young women aged 11-22 who were really interested in menstruation and the puberty process. Material I had sourced from Sexual Health Cairns was very helpful in this regard.

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After the education sessions we spent time with the women and some of their young children enjoying tea and biscuits. It was beautiful seeing the children interacting with our group.

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Some of the work Children-Nepal does surrounds empowering women to earn their own money and not be reliant on their husbands. A lot of the work they do is sewing and they sell toys and other sewed items in a small shop and export throughout the world.

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After lunch we heard a really interesting lecture on tuberculosis. One of the main points I took from this was the way the Nepalese government (which changes fairly frequently!) is united in its mission to ensure every patient diagnosed with TB receives and takes appropriate medication. This is done through clinics where patients must attend and sign for their medication each day.

This evening another walk around the town. We saw a graffiti artist completing a new project

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and enjoyed a cocktail overlooking the sunsetting over the Stupa with the newish moon in the background.

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Random Stuff

Wednesday, 2. November 2016 23:02 | Author:

Today we again spent time at Fishtail Hospital. I shadowed a couple of consultants as they conducted outpatient clinics. Unfortunately the Neuropsychiatrist was not consulting this morning, but I had a great chat with one of the obs/gynae consultants. She had seen a patient who, after having two daughters, was desperate to have a son. We talked of the differences in culture and how in Nepal it is still seen as vital having a son as your daughters will marry and look after their husband’s family in their old age and not their parents. She said she tells her patients that she was educated in Nepal, studied Medicine in Nepal and went on to become a consultant in Nepal, married a Nepalese man and still believes she will help look after her parents when they age. Nepal is a rather patriarchal society so it was great to be able to talk to her about some of the differences with Australia. Some people still want children of specific genders, however it is usually not because of perceived gender roles in the family.

I have no photos today- I am conscious not to take any in the hospital as it is not something I would do on placement in Australia. The hospital was quieter than usual today as it was a public holiday as the President of India was visiting. Nepal has a lot of public holidays, however I do not believe workers get paid extra for working on them so a lot of places remain open.

I went for a long walk this afternoon and was able to watch some Nepalese children playing in the street. Since I have been here I have only seen one child watching their mother’s mobile phone whilst she worked- usually the children are gathered out the front of shops playing or talking or singing or encouraging you to enter. Whilst we find the food here relatively inexpensive, for Nepalese people eating out must be a real luxury. A nurse at Fishtail Hospital earns the equivalent of around A$200 per month. On the other hand, over 80 per cent of Nepalese people own their own home. It puts into perspective some of the spending I make at home. The other interesting thing in Nepalese restaurants is that they don’t have children’s menus. Children eat the adults food. We have visited the hospital canteen and always see children there eating Momo. Momos are a dumpling filled with chicken or vegetables usually and most often steamed, although some restaurants will fry them. We were told that for most children a plate of Momo is a real treat.

We are eating a lot of vegetables here. There is usually a plate of beans and carrots for breakfast available to us and the Nepalese diet is full of legumes with a little meat sometimes. On the other hand we have not had a lot of fruit and have to be careful because of the sanitation here. As travellers it is hard to peel apples to eat them and it is easier to skip fruit altogether.

Tomorrow we are off to the Children’s Home which should be a great experience. I have promised MIML™* that I will not bring home an orphan!

 

*MIML™ is the Man In My Life!

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Tibetan refugees and Dipawali Bhai Tika

Tuesday, 1. November 2016 22:25 | Author:

We are almost half way through our trip and I am still having trouble interpreting things I see. As I have said before things are not good or bad, but rather different and at times I really feel like an intruder into someone else’s culture.

This morning we visited the Tibetan Refugee Settlement where our guide and many other Tibetan refugees live. Hearing first hand about the fleeing that started in 1959 and how some people walked weeks and weeks in order to seek refuge in Nepal and how these people live exiled in their own community, however are not Nepalese and do not receive the same rights as Nepalese citizens, even though many were born here was really quite disheartening. I am trying to steer clear of news from home whilst away, and really am trying to avoid politics, however comparing the stories of these Tibetan people and thinking of the dreadful laws Australia has for those seeking asylum really highlighted my privilege in being an Australian citizen.

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We were joined for lunch with over 25 older Tibetan men and women who live at the settlement. For those asking for food pictures…

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After lunch, we distributed some of the woollen items I had collected from around Australia. The smiles and thanks from these people were so beautiful. One of the ladies at our table talked of her 5 children and we were able to give her beanies for each of her children. We will distribute more woollens at the Health Camp this weekend.

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After returning from the Settlement Camp, we dressed in cultural dress in order to attend the Dipawali Bhai Tika festivities put on by the local hotel association at a local orphanage.

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Here is where I am conflicted. I really enjoyed dressing in a Kurta and actually purchased two here and plan to wear them at home. The ceremony of Bhai Tika was something I probably would have preferred to watch rather than take part in as it was not my cultural beliefs. Bhai Tika celebrates one’s brothers as a sister prayed for her brother and gave him flowers and told the god that they could only take him once the flowers wilted and the flowers didn’t wilt. Now sisters venerate their brothers today by annointing their ears and head with oil, giving them a multicoloured tika on their forehead, laying a garland of flowers around the neck and giving them a present. We sat in a circle and participated in the ceremony. Whilst this ceremony was technically a ‘mock’ ceremony it just didn’t sit well participating in it knowing it was not part of my belief system and I question how I am respecting someone else’s beliefs by taking part in it.


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The flowers and shawl they gave us are lovely and the shawl will remind me of my trip. Again I am not sure if because these people were so willing to have us participate (we paid a small fee) we should accept their hospitality. This is something I will continue to reflect upon.

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Rest and relaxation

Monday, 31. October 2016 23:46 | Author:

Today was our second day off. After an early night last night I was awake for breakfast and then went for a walk with some other students. We headed towards the lake and after refueling on a coffee walked around the lake stopping to watch a snake charmer!

I am so not a snake person and should have held my camera landscape instead of portrait, but I think you get the idea. Please note the shadow of my left hand!

Walking around the lake gave us some gorgeous views of the mountains and also the boats and local fishers.

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We were game enough to hire a life vest and venture across the lake to a Hindi temple.

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Whilst the boat was rickety, I really felt for the chap doing the rowing as he does this 6 days a week! The island was a little touristy, however being festival time there were plenty of families heading over to pay their respects.

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The temple was quite beautiful and of course had lovely views.

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After returning Lakeside, I went for a leisurely walk along the shopping strip and planned what I would like to purchase in the coming 10 days or so. At one stage I came across a cow who I think had been nibbling on the apples and bananas people had left out as offerings last night!

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I also came across some people dancing in the street celebrating the festival.

After writing some more postcards (please let me know if you would like me to send you one- it’s cheaper than sending a letter in Australia!) a group went out for a pasta dinner at an Italian restaurant- it was quite nice not having spicy food for a change! All in all a lovely relaxing day, even if I did manage over 15,000 steps!

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Sunrise

Sunday, 30. October 2016 22:15 | Author:

Today was our first day of rest since we arrived so instead of sleeping in and taking it easy we headed to Sarangkot to watch the sunrise. The early rise was so worth it as not only did we see all the lights for Diwali/Tihar on our drive up but the views were spectacular. Apparently we were really fortunate as Cris mentioned she knew of someone who had to go up 12 times before they had a clear view. Apart from shopping, this was probably the first ‘touristy’ thing we have done and there were people there from all over the world, most suffering from under-caffeination! They say a picture tells a thousand words, well here’s thousands!

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After we returned to the hotel another traveller and I went into the city near the hospital we are working at. The taxi driver on the way over mentioned that not many tourists venture into the old market area and we did feel a little out of place. We had children following us for a while and lots of people staring! I was able to pick up some coloured powder which I will use to dye with when I get home and my Kurtas. We walked around for a while and still saw great views of the Annapurnas.

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This afternoon whilst others in the group paraglided and took a zipline down the hill, I treated myself to another massage. This time I went to The Helping Hands Spa, a spa run by an organisation that aims to give people with a disability, in particular those who are deaf or blind, a way of working to earn a living. My masseuse was deaf but still gave me the most amazing massage! I paid a lot more than I did in one of the tourist spas, but it was so worth it. Not only was it a great social enterprise, but the product was also fantastic!

This evening we have been for a walk to see some of the displays for Tihar. Flowers, fruit, incense and colourful designs greet doors surrounded by candles and lamps with coloured footsteps inviting the gods to bring prosperity to the household or business for the next twelve months.

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Our hotel also lit up for the occasion…

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For those wanting more photos, I did a bulk upload to Flickr today. Most aren’t labelled or anything, but tell a story I hope!

 

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Health Camp 1

Saturday, 29. October 2016 23:02 | Author:

Today we participated in our first health camp of the trip. It was the most amazing experience. The camp was at a village on the outskirts of Pokhara which we reached in a 30 minute bus ride. It was held in conjunction with the Pokhara Lions Club, Fishtail Hospital and CQUni. In 4 hours we managed to see over 700 men, women and children.

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I started on the observation station where we took people’s blood pressure, pulse and temperature. It was interesting that most people were on the lower side of normal or what we would term hypotensive (one as low as 85/60) however these people were smaller than a lot of westerners and are still fit and healthy.

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I then spent time in the makeshift pharmacy. There were limited medications available however there was a good variety. What was interesting was that whereas in Australia we would have multiple types of medications (for instance several different types of statins to control cholesterol) here they have one.

After this time was spent sitting with the paediatrician as he saw so many children. Most consultations lasted around a minute. Some children came because they just wanted to see the doctor like others in their family were- one child told the doctor that when he runs he gets a pain under his chest (a stitch!). Although some would see this as wasting the doctor’s time, it also showed that people were not afraid of accessing medical care when it was available. One gentleman was pushed about 3 hours from home by his neighbour in his wheelchair. Knowing what the roads were like really surprised us all as this was no mean feat.

Time spent with the obs/gynae consultant was also interesting. Although the camp was relatively close to the city, a lot of patients did not know what was available for them, for instance women with prolapses did not realise they could have them repaired for free. Sadly it was evident that the rate of hysterectomy was very high in the region as there is no other way to deal with gynae issues.

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It really was the most rewarding day thus far of our trip. I felt like I was making a difference and really helping people who needed help. The surroundings were gorgeous and the people so happy to see us.

Today was the first day of Diwali or the festival of lights.
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Hotels around us have decorated with fairy lights and candles and as I type I hear fireworks. Today was the festival of the dog where people venerate their dogs. When I dropped off my laundry and the shop a few doors down I had to snap a photo of their pet.

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Kurta, leprosy and downtime

Friday, 28. October 2016 22:40 | Author:

A brief post tonight and alas no photos. This morning I spent time in the obstetrics and gynecology ward. There were new babies and women who had had hysterectomies. Over here hysterectomies are performed through the abdomen as they lack the tools to perform them vaginally.

On Monday the Festival of Lights begins. We are going to celebrations as a group so I ordered a kurta, one of the traditional dresses of Nepal to wear. Others in our group ordered saris. The colours to choose from were magnificent!

After lunch we listened to a lecture on leprosy. Whilst it has been eradicated, it has not been eliminated from Nepal and the doctor speaking to us still sees several cases per month.

This evening we have gathered as a group for dinner and a few drinks. A great way to wind down before our first health camp tomorrow.

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Culture Shock

Thursday, 27. October 2016 23:35 | Author:

It had probably been building for a few days but the culture shock hit me today. We spent the morning on a ward at the Fishtail Hospital and things were done differently to how we are used to doing them in Australia. It is not that they were good or bad, but just different. I am trying to be especially mindful that I am in a different culture and I am not a wise woman from the east coming to tell others how things should be done, but rather an observer in a foreign land. I will admit though that processing all the differences at once was exhausting. One of the main differences was the ward had 15 patients with one nurse in one large Florence Nightingale style open ward. Admittedly every patient is also accompanied by numerous family members who take care of the activities of daily living (ADLs) such as feeding (they go and purchase food from the hospital canteen for the patients), wash them, toilet them and make sure they are comfortable. They also take the doctors prescription to the hospital pharmacy and pay for the medication before bringing it back to the ward for the nurse to administer.

The medications were slightly different to what we were used to in Australia with all patients receiving IV antibiotics having a small amount injected intradermally to check for a reaction. Cannulation was predominately between the thumb and wrist. Observations were taken using manual instruments (sphygmomanometer, thermometer with temp taken under the arm, and oximetry and pulse taken with a small portable pulse oximeter. Respiratory rates were not taken. Interestingly no patient had their blood sugar checked, even those admitted with pancreatitis and type II diabetes.

After lunch we visited Naulo Ghumti Nepal, an NGO set up to help people with drug addictions and/or HIV. They offer drug counselling, treatment and rehab programs of 3-4 weeks and provide community engagement with needle exchange programs and education aimed at reducing the stigma of IV drug users, people with HIV and those with mental health problems. Over 40,000 Nepalese people live with HIV with 37% of these people not using antiretroviral therapy. We were pleased as a group to present Naulo Ghumti with money we had raised prior to our visit which they will use to continue their efforts in Pokhara.

We then visited the Himalayan Eye Hospital where we were able to present the items we had collected for this hospital. Being at such a high altitude with people living way into the hills surrounding Pokhara, there is a high incidence of cataract of the eye. The eye hospital provides over 5000 surgeries each year and is responsible for restoring and maintaining sight in many Nepalese people. Our donations were very well received and we were promised will be put to good use.

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Tomorrow we are back at the hospital. I will keep observing and trying to make sense of what I see, however I think that a lot of this will not become concrete until towards the end of the trip or even once we are back in Australia.

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