Terrain
This picture was actually taken from the window of the room Sudikshya and I stayed at in the hostel. The terrain in this picture illustrates the type of terrain we traveled on during our journey to Gorkha District.
It was a long ride down a very bumpy, winding road through the hills of Nepal towards Gorkha, which meant no additional sleep unless I was prepared to sleep through what would look like seizure activity as my ears continued to pop. These "hills" as the other two kept calling them, are really what I would liken to the size of the Rocky Mountains back in the States. Sudikshya and Dr. Pandit both laughed when I explained to them that when you come from a very flat place, any major increase in elevation tends to leave a person marveling at the view. Sudikshya's response was to ask if Indiana was similar to Illinois because she noticed lots of corn and flat land there--of course that was a big "Yes."
Sudikshya lived in Ottawa, Canada for several years during undergrad and visited the States a few times. She was familiar with the idea of seeing land that was so flat you could see a horizon where the land and sky meet. To her, being originally from Nepal, she thought it was neat to see someplace to flat. Ha! You hear that Midwesterners? Someone actually has land envy. I practically wanted to invite her to come visit me in Indiana during the Fall--this gal needs to take a hayride on some of this flat land!
A Little History
Nepal used to be a "Kingdom" up until the civil war here, which eventually led to the removal of that monarchy and the formation of the "Republic of Nepal", which only happened about ten years ago. According to Dr. Pandit, the road we took also goes to a common tourist town called Pokhara and is also the major highway used for imports and exports from India. Such a highway did not exist prior to the birth of the Republic and has been a very large component of developing Nepal's economy. While it is still an evolving nation, the cell phone towers, development of roads, and the adoption of a Parliamentary judicial system have really helped to improve quality of life for the Nepalese.
This is one of the walls of the castle in Gorkha District. This wall was at least 150 feet in the air and located near the castle's keep.
There were many historical sights to stop and see along the way to the Gorkha District Hospital, which was going to be our first stop in our feasibility assessment. The other major stop we made while we waited on the availabillity of the physicians at the District Hospital was an old castle. This paricular structure did sustain some damage from the earthquakes, but only at what I would describe as the castle's keep. Otherwise, all 800 steps and the surrounding walls remained with good integrity. That's right--all 800 and I walked up them all. You only live once, right? Or at least that's the Chriistian theory. For scientific purposes we were just testing that theory to see what would happen if one of us croaked during the skyscraping trek up the 800 steps to what seemed like the clouds. (Sorry, maybe that was some bad humor.) Namaste!
Sudikshya was kind enough to take this photo of me as we decended from the top of the castle. It had some beautiful views!
Gorkha District Hospital
This picture was taken just outside one of the District Hospital's main building. As you can see, it has several buildings and the patient influx is near-constant from my observations.
Once we arrived at the District Hospital, we were ushered into an office area where the Medical Director would meet with us. I sat and listened to Dr. Pandit introduced us alll and explained the reason for our visit in Nepalese. As this conversation evolved, the number of people in the room began to grown from 6 to roughly 10 or 11 and we were being served hot tea. I did not speak Nepalese, but I began to get the impression that the increase in meeting attendance was a good sign.
Once this meeting was over and we were making our way towards the lab facilities, Sudikshya explained that the staff was very receptive to the idea of assisting in collecting public health data and processing lab specimens. The Lead Lab Technologist and the Medical Director invited us to tour their lab, which wouold give us an idea of what additional equipment this facility would need. This was a very large victory very early on in our journey because the hospital staff were willing to do whatever they could to hellp with the implementation of publlc health surveillance. This is the equivalency of a major hospital partnering with another university hospital to collect and process data that will eventually lead to improving the overall heallth in the Gorkha District. Hooray!
District Health Office
The next stop was the District Health Office in Gorkha, which would be the U.S. equivalence of a county-level department of health. The aim of this meeting was to speak with the Gorkha District health officials and gain their perspective of how feasible a publlic health surveillance system would be in this region of the country. Keep in mind, there are lots of components to consider:
-Geography: Gorkha District contains some of the most mountainous areas in the world.
-Transportation: The terrain only allows for motorcylces or 4-wheel drive ATVs in many areas, so transporting samples will be a challenge.
-Communication: There is an app that will help with the reporting of epidemiological data and is perhaps one of the lesser challenges because despite elevation, the cell coverage is pretty decent.
(Note: I still have yet to figure out how there is such good cellular coverage in the mountains of Nepal, but in flat, rural Indiana near where my dad lives is a notorious dead zone. That figures.)
-Specimen processing turnaround: The first two components I listed above are really the limiting factors on decreasing the turnaround time for results. The idea is to shorten turnaround time on processing the cultures so that treatment is less delayed.
-Establishing a unified reporting system: This somewhat ties back into communication, however as with anyting for study purposes, there are going to be forms that need filled out. And before they are filled out, they need to be developed (Yawn!).
As luck would have it, the visit to the District Health Office did not greet us with as much enthusiasm. The good news is, the officialls we spoke with and expressed their reservations on the feasibility of specimen collection and processing. The bad news is they were asking what "incentive" there was to motivate such actions. Great. That was the type of response I was mentally anticipating and mulling over during most of the trip from Kathmandu. I was reallly unsure of what exact "carrot" to dangle on this one especiallly because of the cultural differences. The most obvious motivator in a poor economy would be money, but is that it? I'm still brainstorming and came up with another few ideas that may be helpful in providing some incentive.
Unity
However, the one thing on our side is that Nepal is still in a post-disaster/recovery state. Many of the locals encountered on our trip so far have all been quick to offer their stories of the "Bhūkampa", which is Nepali for "earthquake", and is an indicator [to me] of how largely this impacted the people. It has been well-documented in the field of disaster management that anytime there is a large-scale incident, a sense of unity becomes commonly felt among the population affected. In some cases that could be the people in a small village, in others, an entire nation. (Examples: USA 9/11/2001, Haitian Earthquake 2010, Japan Tsunami 2011, Boston Marathon Bombing 2013, London Subway Bombing 2005, etc.)
This sense of unity oftentimes promotes a sense of duty among individuals to become more involved in recovery and to help where they are able. It is because of this post-disaster state that I hypothesize other officials in the outlying Heath Posts in the Village District Committees (VDCs) will not require a large incentive, and will help implement a public health surveillance system knowing that it will promote a healthier Nepali population.
Just a side note:
Unfortunately, many times post-dsaster scenarios give birth to implementing concepts that would never have gained stakeholder buy-in before the disaster. It's because of post-incident findings and lessons learned that many stakeholders begin to "see the vision" behind necesssary adjustments and are less reisstant as a result. I'm channeling my inner Steve Irwin here: This conundrum is commonly found in a more "traditional" setting where people are not accustomed to--ahem--change. In many cases, this can leave more proactive emergency managers feeling as though they are banging their head against a wall and tap dancing in an empty auditorium. Who knew that such a small, one-syllable word could cause such headaches?!
Sleeping Accommodations
After we made a few other stops we traveled back to the City of Gorkha and made a discovery after a little more recon: The place was not leveled.
This is another picture taken from the window of my room at the hostel in Gorkha. As you can see, many of the buildings are still standing and appear to be in good condition as they are still being used. I am told by several locals that civil engineers came by each building to do an inspection shortly after the second earthquake.
In fact, most of the buildings there were still standing tall and appeared to remain in decent integrity. (Of course this was just a basic windshield assessment, but it counts if the buildings are still being used!)
We made our way to a hostel that Dr. Arjyal set up for us and proceeded to drop our belongings off and head to dinner. This trip just dramatically improved: No tent necessary AND we get a hot meal.
Nighttime view of the City of Gorkha from the hostel I stayed at during my tour in Gorkha District.
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