Last post

Well it's been quite a trip but for now I am going to sign off this little blog.  Am back to the world of fast net connection, piles of post, hot showers etc and enjoying catching up.  I expect I shall have some more time to reflect on the trip soon.  It really has been great and I felt so supported out there by all of you.  This blog doesn't cover everything but I hope it gave a slight flavour of the trip (and was a good way of sharing photos).

Many thanks indeed for being there.  I hope we have let something of value for the people of Far Western Nepal.  There are many changes that would help.  The situation there reminds me of the UK not so long ago - a high involvement of the NGO sector.  It'd be good to transfer some of that time and investment into more frontline staff in the clinics as ART becomes more available.

I digress.  Back to work on Monday so am going to enjoy the weekend.

Very best wishes and many thanks again.

If you have any further questions please do email me.

Hugs
Tristan xx

Final Day

Amazing final day and well deserved day off.
The pictures are all I can post for now.  Thanks heavens for the MacBook it has been amazing whilst here.
Got to dash - loads of email and not packed yet - hope to post a final message to this blog when home.
An amazing trip thank you all for being there Txx

Bhaktapur

Bhaktapur was great although quite a lot of hassle to purchase things....  Right - am off for a massage!

Done?

Final presentations given, final reports in.  2 sleeps til hometime!

Return To KTM

Briefly - good final days - leaving lunch at Bell's, tea with Parvej and his family - a friendly guy who has always said hello to us on the street, dinner with Dr Rajya and her son, then goodbye to the Saathi Boys and a safe trip back to KTM - in full strike mode.  Police at the airport covered in Kevlar and looking like Robocop (no pics taken!).
Presentations tomorrow and a full working day then a little R&R - first days off in 5 weeks.
Hope you all have an excellent week Txx
ps - many thanks to Marie and all the Global Medic Force staff for a very kind write up in the latest "Reports from the Field" (not yet available online)
pps - recommended new album from Mr Wayne G - has lightened up some dark and dingy hotel rooms for me in Far Western Nepal!  Thanks a lot mister hope you're safe on those NZ waves xx

Nearly back to Kathmandu

Just Sunday left in Dhangadi before returning on Buddha Air to Kathmandu.  IT looks as though our presentations may have been brought forward - FHI feedback on Monday and then I am presenting at Teku Hospital on Tuesday.
This should then give us a well earned couple of days off (we haven't had any since leaving Kathmandu really as even Saturdays have been office days).
Intention is a bit of (self funded) health club use at the Radisson, possibly dinner and a cocktail at Dwarika's and a couple of trips to Bodhnath and Bhaktapur before return flights on Friday.  No doubt some shopping will feature also!
An excellent trip all round - we have nearly finished our final report and our presentations for Kathmandu, so just some goodbyes to say now.  Started last night after a lovely dinner with Jonathan, Elizabeth and Dila.
Hope to update you next week on how things go in KTM.
Tristan xx
By the way, if you're considering it or inspired by anything you've read on this blog please note doctors are not the only people who can volunteer with Global Medic Force.

Pulled this way and that.....

So our time here draws to a close.  Not too much extra to report.  We are both feeling ready to come home now, although not homesick as such I think we feel our usefulness is coming to an end and it's better for local staff (as intended) to get on with doing what they do and try to improve some things as per recommendations.  We feel a bit pulled in many directions.  Local staff are trying to squeeze in last minute things that could've been done earlier but weren't, usually with "Nepali time" as the reason....  we are being asked to write reports for GMF and also to present for FHI next week - initially twice on 2 days, now three times on days which keep changing, neglecting the fact we have asked for time off to sort a few things out in Kathmandu, and also failing to appreciate that we could return home earlier if the days do change...  we shall see.  Patience definitely required at these final hurdles.  Life is generally good though - a few dinners arranged to say goodbye to new friends in the next few days.  Will be strange to leave yet we have confidence in much of the local structure and the ability of local staff to take things forward.
One thing I am looking forward to is a good, RVT style dance!! 
Hope to post a couple more times before the return home.  I really can't thank everyone enough for the support during he fundraising and our time here.  Has been truly incredible.
Thanks indeed.
Tristan xx

Valentine's Day

Well I can't decide if I am gutted or glad that I forgot my camera...  Cue the Valentine's Day event at the Palace of Om in Dhangadi....  started as a sedate affair with singing on stage...  the lack of girls and excess of boys was noted.  A few girls were present, although with their mothers as chaperones.  I was sitting next to a young (and handsome) primary school teacher and we got chatting.  Apparently the Far West remains very traditional and girls are not permitted many freedoms...  he also asked if I like to dance...  and then the DJ (after a few technical hitches) started playing.  Which resulted in a good hour of sweaty, all male, erm... raving really!  Very amusing indeed and I am sure I feature in many video clips and mobile phone pictures.  Much back slapping and many handshakes later I left on a massive high.  A very good (and surprising) evening indeed.  All male dancefloors I am accustomed to, but heterosexual ones are not so common!  the girls remained in the front row of seats watching the proceedings - not sure if this is the best way to pick a husband?  But perhaps it helps choose which ones to avoid?!!


PS Apparently this is the only day of the year that they are allowed to have a DJ and dancing! Even more of an honour....

Quiet office days....

Helen and me are spending some good time catching up with office work.  Today is the Mahashivarati festival when - we have been told by our waiter - everyone smokes hashish before spending tomorrow praying!


Some contrasting views of Dhangadi for you, and a couple of shots (with consent) from the clinic.


Here also are friends Jonathan and Elizabeth, here working in educaion with VSO and settling into their new place.  We wish them all the best for their time here.


Hope you all have a great weekend and as before, very best of luck to Paul Joseph tonight - am awaiting news eagerly! xxx

Doti

We are surprised but it is lovely to be back in Dhangadi and even Hotel Saathi!  Not that Doti wasn't great, although there wasn't a great deal to do after work, but we did use he time to catch up on report writing.


The drive was incredible - views across to the Himalaya which, unfortunately, were obscured by rain on the way back.


Stayed in a guest house with the most incredible views.  The clinic sees around 700 patients and has the least access to things like medications and investigations of anywhere we have been.  The staff also don't get much supervision - locally at least - although are excellent and work 7 days a week 24 hours a day.  Patients may walk 2-5 days to clinic so if they pitch up in the middle of the night it's hard to say "come back tomorrow".


Women with problems in labour face a tough time as there are no obstetricians and no facility for Caesarean sections...  if it's a really tough call then the choice is usually to save the woman over the baby as she can "always get pregnant again".....


Town itself quite beautiful  a long main street down the spine of a hill - and you will see some (hopefully) good pictures.  


It was our first "goodbye" to a site we have mentored and they were incredibly sweet and grateful.  Very humbling indeed.  As usual news of our presence had spread like wildfire and people came from far to be seen by the foreign doctors....


The journey back today was hair raising.  We awoke to pouring rain and a powercut.  Packed by torchlight but we were unsure if the driver would be happy to attempt the rather tricky road....  he did so masterfully though - negotiating landslides and falling rocks!  Thanks heavens for 4 wheel drives...  Helen (sensible) slept most of the way leaving me doing the looking out - gripping on tightly and plugged into my iPhone in hope of some sensory deprivation and a bit of inner calm!  (wasn't too bad really, but being dramatic is so much more fun.  Did have it's moments though).


So now we're back and catching up.  A period of assimilation ahead as we plan all of our reports and feedbacks, as well as doing some more mentoring and attending debrief sessions.


Was very sorry to miss Anthem at the RVT last Friday.  Every best wish to PJ for this coming Friday, and much love and congratulations to Lydia and Tim on the (final and arduous but well worth it?) arrival of Miss Rosa Isobella MaGuire.  I look forward to the pictures!


Hope everyone else is well and thanks for the messages whist I have been away.


Tristan xx

Doti - the Photos

Ok, first, the photos:

Blue Diamond (actually from Dhangadi) - also see Blue Diamond Society
The road to, and arrival in Doti
Doti Day One (1)
Doti Day One (2)
Doti Day Two
Doti Day Three
Doti Day Four
Doti - The Return

No internet access until Wednesday 10th Feb 2010 (at least)

Attended a Community Home Based Care Team meeting at Seti today.


This is a quickie as loads to sort - Doti (hill country) has been brought forward and will be away from early on Thursday 4th Feb until at least Weds 11th Feb banda (strikes) permitting so probably no updates until then....


Look forward to posting after my return.


Txx

Week 3

Suddenly here we are in week 3.  Amazingly have discovered that my friend Catherine who works for VSO has been to Mahendranagar!!  Incredible...  not really on the tourist trail.  The VSO volunteers here are working in education.


Spent the day in clinic mentoring yesterday.  The real photo opportunities here are the ones that remain in your head - too voyeuristic to photograph.  The 7 year old girl yesterday who had walked 5 days to take the bus to clinic and has TB and HIV coinfection - asleep on the ground outside with a respiratory rate of 60/minute; the young boy in the middle of a rubbish tip by the side of the road looking for pens (the refuse workers have been on strike for ages); the middle aged woman being wrapped up for her open air cremation and her grieving husband circling the pyre three times as is the custom.....


Today we have been just outside Dhangadi to another STI clinic and the Community Home Based Care teams for monitoring and a very interesting Q&A session.


Next week we go to Doti and will be away from the internet for the week although we are coming back a day early because of the Maha Shivarati festival on Friday.  After that we are likely to be in the office more often as we get our presentations and final reports compiled.


Please check out the 2009 report for my friend Mike's charity in Kenya here.


Have a great week Txx

The most amazing suspension bridge

We had some time off after teaching on Friday at Mahakali.  We met Manoj's wonderful parents at their family home and stayed at Hotel Opera.  Manoj is our FHI link here in Dhangadi.  I apologise this blog contains 5 photo album links but on Saturday we went to the wonderful Dodhara-Chandani suspension bridge - 1.5km long - amazing in the morning mist - and linking two villages on the Indian border to mainland Nepal.  Followed by a team buiding picnic on the river bed (10kms down from a politically divisive big dam so quite nerve racking, and no, I didn't have to play football!).  Then back to Dhangadi - planning some work but server was down and load shedding occurred so no power.  Sunny though which is nice.  Time for a couple of beers and another shave (first time anyone else has shaved my head in early 14 years) then dinner and catch up with two VSO volunteers back from training in KTM.  Woken at 4am by lots of throat clearing and bathroom noise from the room next door, but saw a lovely dawn.  Now catching up before clinic.  


Congrats again to Merv and Erdem - the pictures are great.


And thanks to everyone for continued messages.  We are doing ok here and feeling settled in.


Hugs Tristan xx

Off for the next couple of days

Just time to show you my rickshaw to work and also to say congratulations to Paul Joseph on deservedly getting through to the national final of Queer as Talent - hear him here.  More on our return from out near the Indian border.....

A little frustration on the path....

Hmm so we discover that the doctor at Doti - our third site - will also be in Kathmandu for training when we visit.  Very frustrating for me!  This means that I get some time with the doc at Seti - then she goes off...  I have missed the doc at Mahakali - altho hope to catch her in our final week, and will miss the Doti doc entirely.  Their core training is essential but couldn't have com at a worse time for our mentoring efforts.  So looks like Helen gets a secretary and PA coming with her for the ride ;-))


Am sure we can still deliver some good multidisciplinary interventions and education, but it's a tad annoying.


Life otherwise good though!  Getting some good time and really finding out a lot about how things work here so we are going to be able to deliver a thorough and important final report.  I already think we have conclusions that will be of real help, and a few blue skies ideas about research projects which may be possible.


You can see some photo of the ward at Seti here.


Hope you are all having good weeks.


Tristan xx

New rooms, new days

We have now both moved rooms and life is a whole lot rosier.  Mahakali is a long old drive and quite a well functioning clinic so I think we are planning a bit of time reallocation.  Today we went shopping after clinic and I got myself a topi.  Very good although my head is a tad too big (!) for it so may have to get a good one tailor made.  Lots of patients turned up tday as they had heard a "famous foreign HIV doctor" was in town - umm - hardly!  And our remit is to mentor not to provide clinical care, so I think they were disappointed!


Tomorrow we are back at Seti then doing presentations in Mahakali on Friday before staying the night there.


Life revolves around food, internet, teaching, sleep and filing reports as - I think - previously mentioned!


Wishing Peter Chadwick a very happy birthday for today and very best to all of you for your kind and continuing support.


Txx


ps - if you've time, I loved this episode of House I watched last night - "just being a doctor doesn't make you a healer" - quite!

Mahakali

Today we went to visit Mahakali - a revelation after Seti.  Fewer patients but a big difference in the hospital, feel and town.  Helen and I may be changing our schedule a bit to ensure we get maximum time with the right staff at the Seti and Mahakali sites (a very terrifiying experience was being shown the operatng room at Seti Zonal Hospital yesterday - I won't go into detail but Helen and me have agreed to pay for a helicopter transfer out if either of us need an operation in the next few weeks!).  As ever we were given a very warm Nepali welcome at Mahakali by staff and volunteers alike.


Very pleased to congratulate Marta and Duncan on the safe arrival of Mathilda Goose, who is a beauty and, given her parents, unlikely to be a slouch in the IQ stakes either!


I have moved into a dryer room (117 for anyone who fancies calling - we are 5h45 ahead) at the hotel (the damp was becoming seriously oppressive) and life is generally good.  Helen is moving into the "honeymoon suite" later so should be good too!  Sun has shone all day today ("you English when you have nothing to say look to the sky"!) and the absence of freezing morning mist was very nice indeed.  The drive to Mahakali was beautiful - verdant greenery, hills and rivers, yet too fast to allow good photos.


We are very busy with three sites to mentor as well as plenty of reports to file and questionnaires too.  Also have two presentations to prepare for the final week in Kathmandu so it's pretty non stop but al good xxx

Busy day

Not time for much - a few grey pics.  Busy day today - presenting a global overview of HIV to the whole hospital at lunchtime .  Internet access may be less in next few weeks but hope to keep you posted. Many thanks to Dr Mark Nelson and the St Stephen's AIDS Trust.  Have a good Monday xx


ps heard Merv and Erdem had a rocking Tavern last night and a well deserved mention from the Dame Edna Experience.  Ever best wish and congratulations for your civil partnership boys.  Love Txx


Later in the day and just time to add more pics from our Teaching at the Seti Zonal Hospital.

Life in Dhangadi

It's our day off here in Dhangadi but we are in the office catching up with emails, skyping (wonderful) and filing reports.  You can see pictures of the hospital, clinic and places we have visited here.  After a day of work yesterday we had an afternoon touring some of the voluntary agencies working in HIV here in the Far West of Nepal, including the Nava Kiran Plus care home, the Association of People Living with HIV/AIDS in Nepal and the orphanage, full of children who are HIV infected and have been rejected by their villages and schools.  We were treated like royalty, although felt a little guilty at being such a distraction and, to be honest, prefer getting busy in the clinics to receiving the VIP treatment.  Nonetheless it is giving us a clearer picture of who people are and what they do as there are many agencies involved in delivering HIV services.


I was reminded of one of the true delights of being in Asia and had a very professional shave in cut-throat styli (safety razor, of course) at a barbers here for RS30 (about 27p).  20 minutes, multiple creams and some rather 70's aftershave later Helen will vouch for the fact I didn't stop raving about it for about an hour.  Only had my chin "done" though.... haven't yet let them near my head (well, it was getting dark...).  If only such things were readily available at home (a bit like foot massages in Hong Kong).


Police and riot shields were out in force and the Maoists had been planning a general strike, but fortunately this risk seems to have receded for the time being.


Nepal seems to want to become a gay tourist destination although I am not sure Dhangadi will be on the map!  Sunil Pant previously worked for FHI but is now the only openly gay member of the parliament here and is supporting this cause.  From Facebook, if I have the right Sunil Pant, it looks as though we have a friend in common who is a Vauxhall Taverner!  How the world gets ever smaller.....


We have also met a lovely man, Dila, here doing voluntary work from Uganda, and two teachers who are working with VSO, and who are looked after by someone managed by a friend of mine.  Even here the connections are quite mind blowing.


Finally, a tune for you, courtesy of J&S - many thanks.


Have a wonderful weekend and remember - Sunday here is a work day! xx

Starting work in Dhangadi

So here we are in Dhangadi, following our trip with Buddha Air.  More photos here.  Stunning views and a very stunning landing through thick cloud.  An effusive welcome from Manoj, quick settle in to the hotel and then to the hospital.  The hotel is not quite as we expected, but am sure well cope!  The clinic is tidy and the staff - including a relatively new doctor - are happy to see us.  Litter in Dhangadi is a problem - surely a growth industry waiting to happen - waste management and recycling in Asia?!!  Quick ward round and back t the hotel to settle in.  Internet access not so readily available here altho we can use the FHI office.  Updates may be sporadic but will try and keep you in the loop  Thanks for all the supportive messages and best wishes - really means a lot.  Even having any internet here and mobiles too makes such a difference compared to my India travelling in 1994 xxx

FHI Day 2

Many thanks to Mike Kear for the press release.  I think I can also put my photos in with a link - try clicking here for FHI Day 2.


We had a wonderful day - more induction at FHI and also visited the wonderful team at the local teaching hospital - Nepal's first to be established.


This evening we visited Pashuputinath and were honoured to be given permission to watch an open air cremation.  A truly life-memorable experience, and very normalising compared to the British Victorian habits of birth, death and mental illness being hidden behind closed doors....


I have discovered my partner here, Helen McIlveen, sits on the Expert Advisory Group on AIDS and she continues to impress me both personally and professionally.  I hope that our meeting is a link that we can use benefit patient services in GUM, HIV and Family Planning in the future, but also that we have a great time together in the next 5 weeks.  Certainly our skill set and life experiences seem to complement each others.


Tomorrow we should be off to Dhangadi on Buddha Air, fingers crossed, although these flight have a habit of being delayed or cancelled apparently.


Not missing home too badly and looking forward to finally arriving in and settling in the area of most need.  Hope to report more from there.  Tristan xx


PS - anyone fancy a holiday in Pokhara sometime?  Annapurna trek followed by some parahawking? More here! 

FHI Day 1

Very intense but welcome induction day following collection this morning.  Lectures and chats - everyone most friendly and welcoming.  Kathmandu is feeling very homely but the next challenge will definitely be the move to Dhangadi come Wednesday.  Really does sound as though ASHA and FHI are doing amazing work here - the Community Based Home Care programme is especially inspiring.  More lectures tomorrow and a trip to the local teaching hospital.


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Photos - hoping this works

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Nepal to date

A good day - explore Patan then to the Monkey Temple and Durbar Square, where I was blessed by the child goddess Kumari.  Then on to dinner and shopping in Thamel with Helen, my fabulous partner here from Newcastle.  A short post as the weekend is over and work starts tomorrow with an 0845 pick up.  Think we are both ready to get stuck in now, although normally nervous at what to expect.  Have been trying to get pics uploaded for you but not much joy - Facebook seems to be picking up more readily so check there if you've access.  I will keep trying here when I've more time.  Sweet dreams Txx

Arrival!

So arrived safely in Kathmandu after a very good flight with Jet.  Bit chilly up here - 20oC by day but drops at night...  shoppers paradise though if you're into ethnic Indian ware or discount Salomon/North Face etc hiking goods/fleeces/waterproofs etc.

Charity schedule sounds pretty full on.  Will be spending tomorrow sight seeing then Monday/Tuesday induction at Family Health International and the local University hospital.  Off to Dhangadi on Wednesday  have been told to prepare for busy days but quiet evenings...  DVD shopping will thus also feature highly tomorrow!


Heading for some well earned shut eye.


Hugs Txx

D Day

Right... we're off... almost....  Thanks for the many, many good wishes... rarely has a boy felt so supported. 


Guess I'd better get packing!

FunDaMental 30/01/09 (2)

FunDaMental 30/01/09 (1)

The idea and the funding

Having worked in HIV for some time I have been aware of a charity that facilitates short mentoring trips to various sites - Global Medic Force (previously ICEHA).  Their programmes appealed to me in many ways as they aim to educate and empower local staff to provide excellent HIV care.  Having been the beneficiary of so much good energy and support from the community of friends I have at the Royal Vauxhall Tavern, and having seen how well fundraising efforts have gone there for UK based charities, particularly on World AIDS Day, I decided 2 years ago to see if I could raise some funds for a trip with GMF, to try and take some of this goodwill to those affected by HIV outside of the UK, complementing our UK based charitable giving.  This coincided with a mail out from GMF saying that for £9000 you could "sponsor" a clinic or programme.

For the first 12 months I fundraised online, via an email list which Vauxhall Taverners can join.  We raised a little over £5K which was a stunning start - thanks to all who donated.  Towards the end of this year we held a charity night - FUNdaMental - at the RVT on 30th January 2009.  With the very kind support of the GMF UK staff, especially Sarah Aggett and Rachel Mair, as well as Mike Kear, Diana Taylor, Jason Dickie, Paul Oxley, Zoe Lyons, Gill Manly, Jonathan Hellyer (as Trannie Lennox), Debbieanne O'Donovan, Thomas Ernst, Paul Cooper, David Venon, Justin Blair, Marjo Cooper, Karl Stevens, Robert Taylor, Howard Turner, Eddie K, Phil Marriott and Rob C, as well as all of the people who came and supported, or bid on or donated items for the auction, or worked at the Tavern on the night - too many to mention individually - we raised another £7K, thus smashing our target.

Now the time has come for me to go and make best use of some of these funds - and the tremendous energy by which I have been supported - and hopefully achieve some good HIV skills transfer out in rural Nepal.

Many thanks to everyone concerned in getting me there.

Outline of schedule

So - the dry, impersonal stuff to start!  I am scheduled to arrive in Kathmandu on 16th January and will be staying at the Hotel Tibet.  I will be in Kathmandu for a few days for inductions with the local charity Family Health International.


On 20th January I am due to fly to Dhangadi and will be based there for 5 weeks to rotate to various clinics and hospitals.  For the majority of this time I will be staying at the Hotel Saathi.


The sites I will be visiting are:


• Seti Zonal Hospital ART site Dhangadi
• Kailali Doti District Hospital ART site
• Mahakali Zonal Hospital ART site


The patients are mostly on first line antiretrovirals at all 3 sites, with only one patient on second line drugs at Seti.

Seti Zonal Hospital (regional referral hospital): this is the third largest ART site in Nepal serving most of the far west district as a referral hospital for all medical services.  There are approximately 900 diagnosed HIV infected patients at Seti.  Doti District Hospital has approximately 300 HIV infected patients; Mahakali Zonal Hospital has about 220.


I am due back to Kathmandu for a debrief in the final week and then fly back, all being well, on February 26th.

1 week to go

I have received my schedule and plans for Nepal and am off on Jan 15th.  This is a test post for my new blog as I think blogging may be easier than multiple emails.  Please follow me during my travels!