The hot season is well underway here now. The grass is getting dry and brown, but the flowers are lovely. Especially the rhododendron flowers, which are the national flowers of Nepal. For several weeks of the year, you meet people carrying these bright blossoms. Unfortunately, as the season goes on, in order to get the better flowers, one often has to climb high into the trees.
One young boy fell from a rhododendron tree while trying to pluck some blossoms. He fell from quite a height, and landed on rocky ground. It took several hours for the family to bring this young man (15 years old) into Tansen Hospital, where he was seen in our emergency room by one of our orthopedic surgeons.
You can see from these X-Rays that his injuries were extensive. He had major fractures of his femur and his tibia on same side which created what was called ‘a floating knee’ because it would only be attached by ligaments after that kind of injury. Also, due to the severity of the trauma, he had a major blood vessel injury to the main artery running behind the knee right at the point where the main branch separates into 3 branches going down to the lower leg.
When the boy was admitted, he was taken to surgery where, in addition to stabilizing the bones with external fixation, the surgeon attempted to repair the artery. However, it was at a critical location and had been some hours since the injury. Regrettably, by morning his leg had no blood flow to the lower half, and he was taken back to surgery for an above knee amputation. A metal rod was placed into his femur to reconnect it at the same time.
What started as a fun outing ended in tragedy for this young boy. An amputee in Nepal faces a very difficult life – here in Tansen pretty much everywhere requires walking up or down rocky paths. He has done well after the surgery and is healing, but it will be a long road to recovery for him.
Thanks for your prayers for this young boy and his family. We are thankful that we have skilled orthopedic surgeons available here to help so many with traumatic injuries like this. And we are thankful for friends like you who support the work of United Mission Hospital, Tansen.
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Last week, we had a farewell gathering for 4 resident medical officers who have been with us for a while. These doctors came to us after their internship, and worked in various departments to gain experience before applying to enter a formal post graduate program. And, as is the case with most of our junior doctors, they get no outside recognition for their experience here, because we are not a part of a recognized training program.
R did his medical school at CMC Vellore, a prestigious medical school in Southern India. Nepal was considered a mission partner by CMC, and had facilitated the training of both medical students and residents sponsored by the United Mission to Nepal (UMN) over several years. It was an excellent program to give children of UMN staff, especially those without the financial means to send them to a private medical school in Nepal, China, or elsewhere, into a career in medicine. In fact, 3 of our senior orthopedic surgeons are products of this program. Unfortunately, with the changes in rules in India to favor domestic candidates, CMC has not been able to continue this program. R and several others have returned to Nepal after their internship in CMC, with no way to get back to CMC for their residency. R is from a less wealthy family. His father worked in our hospital as a leprosy clinic assistant. This fed his family and kept a roof over their heads, but did not earn enough for medical school tuition or entrance fees to private residency programs. R’s father had diabetes, and suffered a stroke soon after retirement, just as R was returning to Nepal. Even though he was trying to study for his postgraduate entrance, R was working full time to support his family, and caring for his father at home, including going home to give the insulin shots during his tea breaks. Even though it was heartbreaking when his father died, it did allow him to apply for programs overseas, and finally this year he was able to get into an overseas program without paying a lot, where he can work to support himself and send money to his family, while he is trained in general surgery. He is a hard-working young man, who knows everything I do, and could be trusted with any patient’s care. I am sad to see him leaving us, but I know it is a good move for his career. He is not a believer, but I think he genuinely cares about serving underprivileged people in Nepal, and with family still in this area, I am hopeful that he may be coming back after his training to work here again.
S studied medicine in China. When he returned, he took a couple different jobs at different private hospitals, where he said the money was okay, but no one was teaching him anything. He found our hospital vacancy announcement on line and applied. In his 18 months with us, he has matured from an indecisive passive student into a sensible resident. He is now able to manage most patients presenting to our hospital, and get them started on the correct treatment.
M and Y were both students at the medical college 30 minutes down the hill. It is a private college that emphasizes profit over education or patient care, and many of the graduates lack even basic skills an intern needs to have. But M and Y both worked hard in school and their internship, as well as in the 2 years they were with us. M is from a minority religious background, and Y has a seizure disorder, which gives him a tremor and got him fired from his previous job, but they both thrived at our hospital, proving their character to overcome any disadvantages they had.
S, M, and Y are well prepared for passing the residency entrance exam, and are hoping to get seats in their chosen specialties. They will all be excellent doctors.
I enjoy teaching, so it was good to celebrate the progress that these 4 had made. But I was especially struck again by their comments that their time here in Tansen has significantly shaped them, and all 4 said they will carry their experiences with them for the rest of their career. Even though many of the doctors I have helped train over the years are now working in Western countries, it is good to see each subsequent batch of residents come out, with some of them staying to serve in Nepal, even in our hospital or in another remote location. Many do not show any signs of coming to faith in Jesus. But I trust that the Tansen experience they so value and will remember the rest of their lives will include an impression of the Christians among whom they worked, and how our faith made a difference in our lives. May the seeds that fell while they were here find good soil, where it will spring up in God’s timing.
(Please remember not to post on social media. Thank you!)
Once there was a husband and wife who lived on the edge of a small town in Nepal. Their marriage had been arranged by their parents as was usual at the time, and is still practiced today. In those days, many children died of illnesses by the age of 5, so it was common to have lots of children to ensure that some reached adulthood.
Especially important in the Hindu faith is to have a son who lives in order to perform the funeral rites for the father and mother so that they will be able to get to a higher level in their next life.
This family was fortunate in the eyes of many. They had 5 sons and 2 daughters who all grew up and married. The 2 daughters became members of their husband’s families, but for the sons, the land that the family owned was divided into 6 parts. One part for each son, and one part remaining for the parents and the home that they lived in.
One son died, and his wife and children sold their piece of land and moved to a city several hours away. Another son moved with his family to Kathmandu. He and his wife had been very poor, but their luck changed in the big city and the family soon became wealthy and lived in a big home. The youngest son moved to India and married a lady there and stayed on in that country. Two sons remained near the parents. One built a home, and the other lived in his parent’s home (the original family home) and helped care for his parents in their final years.
This son, who lived with his parents, married and had a couple of children, but they remained together in his parent’s home. When the elderly parents died, the son who had been caring for them continued living in their parent’s home, and even added a small room to accommodate his family better.
Tragically, this care-giving son died leaving his wife and children. Two of his brothers came back to look over the properties and to determine how to divide the portion that had belonged to the parents. Unfortunately, the home that was being lived in by the widow of the son who had most recently died was in the way of dividing the land in a way that pleased the other brothers.
So – to solve the problem, half the house of the widow was knocked down to make 2 brothers happy. These two brothers were not poor – in fact, they probably have more than they will ever spend. But they still fought to get this small bit of land that had belonged to their parents.
Perhaps this is why God has written that the religion that He accepts as pure and faultless is to look after orphans and widows in their distress. (James 1:27) How unhappy He must be when families fight and are divided over issues like small bits of land, or money – or even decisions about whether or not to get a vaccine.
Being physically quite distanced from our family, we try to remember that loving each other and supporting each other is so important. Having a family is a blessing. And caring for those who either don’t have family, or whose family is estranged, is part of what makes us the body of Christ.
Please remember not to post this on social media. Thanks!
Thank you for your prayers, comments and emails! We were happy that the visas/work permits were issued about 3 1/2 weeks after we had to stop work – and since then it has gotten quite busy! We appreciate those of you who have been checking in with us. We think of you and are thankful – even when we don’t write.
Nani was a 10 year old girl living with her family in an East Palpa village. Her mom took care of pretty much everything – not only did she do house work and the farm work, but she would also try to get daily wage (labor) jobs for which she would earn about 250 rupees per day (a bit over $2). Nani’s father went to India about a year ago to work as a cook, but has not sent any money to help the family. She has no siblings, but 2 uncles live there in the home – one of them can neither hear nor speak. He does help by taking care of their goats and cutting grass for the animals.
So, when Nani complained to her mom of a stomachache and headache, her mother didn’t worry too much. But 3 days later she had a fever, swelling and pains all over. Her mom then took her to a local medical hall for a check-up, but her aunt thought she needed better treatment and brought her to our hospital.
Nani was admitted from our Emergency room into the pediatrics ward. She was critically ill, and in a lot of pain. She didn’t want to eat and the nurses provided an air mattress for her to try to make her more comfortable for sleeping. She had so many tests and procedures – 7 ultrasounds, 3 operations, 2 minor operations, 6 pints of blood transfusions and 26 days on oxygen. She was suffering from multiple abscesses, scrub typhus, and was bleeding in her intestines. Her right hip was dislocated, and she had osteomyelitis in her right femur. This child was hurting in so many ways!
Our surgeons worked many hours with Nani, and she spent time in traction. The physiotherapists helped her exercise and regain strength and range of motion as she healed. The social services/pastoral care team made sure she was provided with nutritious food, and later provided toy therapy and then help with school work. They also spent hours giving spiritual and emotional support, teaching about health and good eating habits, and just listening and encouraging as needed.
Nani slowly began to improve. She learned to get around on crutches, and was gaining strength from eating a healthy diet. She started playing with others, and improving in her reading and writing skills. She spent 86 days – almost 3 months! – in the ward of Tansen hospital. And she got better!
Nani’s mother could not have afforded to pay for this much care on her own. She did borrow some money from her neighbors, but the majority of her care was paid by the gifts of friends from around the world who give to the Medical Assistance Fund for Tansen hospital. When Nani left the hospital, she swung happily on her crutches down the road towards home. We were looking forward to seeing her for follow up in the coming months.
Unfortunately, the lockdown (Covid) started again, so the follow up was done by phone. The report was good – Nani is able to get around using just a stick (cane) and is continuing to improve. Her family and friends were very thankful for her return to health because of the care provided from the Mission hospital in Tansen.
Nani wants to get back to school, but due to lockdown, classes are only done online. She is one of the many village children who are missing out on school as there is little to no internet access in the hills, and even if there is, most families don’t have the money to purchase a smart phone in order to connect to online classes.
Thanks for praying for our hospital – and also, thanks for prayers for the children of Nepal!
The wind is blowing, the rain is falling, and the clouds are drifting by (and sometimes through!) the house… Is monsoon starting? We are not sure, but we have measured at least 14 inches of rain in the past 3 days. We suspect this is related to Cyclone Yaas which was hovering over the Bay of Bengal. We do love seeing the green hillsides which is an amazing contrast from the dusty brown of just 4 weeks ago.
Covid 19 – still around in ’21…. Nepal is still in lockdown, and it was made even more strict in Kathmandu for this coming week. Right now, the next end date is June 7. Here in Tansen, the lockdown has been tight from the beginning of May. We can get food items from shops between 7 and 9 am – but items are available on a hit and miss basis. Once again the problem of people not being able to work in order to purchase food may be a greater risk than the virus.
Yesterday we were very happy to see that for the first time in a month our covid ward had less than 20 people! We are thankful that our oxygen plant and generator have kept working through this time. (Thank you for your prayers!) There have been 23 deaths here in May from covid – the youngest was only 11, and the oldest was 80. People are still waiting for vaccines to become available – less than 2% of the population has had both shots.
In the midst of this terrible pandemic, the government of Nepal has fallen apart. Parliament was again dissolved – with elections planned for November.
To make things worse for us, the work permits for the missionaries here expired on May 22 – and have not yet been renewed. The government officials (the ones remaining in offices) don’t seem to be in a hurry to move the paperwork through. It is beyond frustrating for the medical doctors… Les has been trying to keep useful by running courses for the junior doctors – ACLS and ALSO training. But not being able to see patients is quite difficult.
We continue to pray and hope that God will show mercy to this country. We are thankful for glimpses of his handiwork – including the beautiful blooms of the Queen of the Night flower which we enjoyed recently. We are thankful for our own health, and for the opportunity to learn more and more how to trust in God when the future is so shrouded in mystery. Just like the clouds which now completely obscure the view of the hills and valleys around us.
Post script: It is Saturday evening now – and the Himalayas are all out and we can see blue sky again. We are looking forward to our morning walk/run tomorrow.
Please remember not to post on social media! Thank you
This time seems harder. It was over a year ago (March 24, 2020) that we went into lockdown for the first time. It started when there were maybe 5 cases of Covid 19 confirmed in Nepal. The lockdown was initially for 2 weeks – but it kept being extended…again and again and again. Things finally began to open up after about 6 months – and there was a spike in cases in October, but not really anything major here in Tansen.
Then – April 2021. We were starting to plan for the future again. Starting to work on visas for new people – some of whom had been waiting more than a year to come to Nepal. Starting to hope that people could get their lives back on track. Rumors started about India – and the news kept getting worse.
Tansen went into Lockdown again on May 1. The hospital once again moved patients out of the medical ward to convert it back into the isolation ward. Previously, even during the highest numbers in Oct and Nov, we had only 5 – 10 patients daily in our isolation area. Over the course of the year, we had only 3 – 4 deaths from covid here.
All of that has changed in the past 2 weeks. Our isolation ward now has 20 – 26 patients each day.
We can only provide oxygen for 20 patients unless we are able to get another compressor for our oxygen plant. Unfortunately, we would have to bring the compressor in from another country, so it would take 2 – 3 months to get here. We are extremely grateful to have the oxygen plant here to help at least 20 people at a time.
We have lost 4 patients already in the past 2 weeks. At least 26 staff have tested positive and most are isolating at home with only mild symptoms. Only one was hospitalized, but he has other medical conditions. We are also thankful that almost all of our staff had been vaccinated, which we believe is keeping them from more serious illness.
The out-patient department is once again pretty much empty. Our in-patient census is down as well – no one wants to come or stay here as so many are now testing positive.
The airport has closed down again – so flights in and out of Nepal have been cancelled. There are groups of climbers on trekking routes who are now coming down with the virus. Most hospital beds in the country are taken.
The situation in Nepal is not as bad as in India, where we hear that people are literally dying in the streets due to lack of hospital beds and oxygen. We personally know a man from Delhi who had to hire a vehicle to go to the Punjab to get into a hospital and onto oxygen. His pregnant wife and 3 year old daughter became sick after he left, and also are covid positive. Thankfully, someone helped get oxygen for the wife, and she is home trying to take care of herself and the little one. The wife’s mom lives here in Tansen and is a good friend – she is beside herself wanting to go to help, but is unable to travel to Delhi due to the lockdown…
As before, we see the wealthy and influential people being taken care of – while the poor and marginalized suffer once again. Our hearts are broken for the many who are so needy all around us. Almost 8% of the Nepali people have had at least one vaccination – but that has stopped now during the lockdown.
We are thankful to hear that things are better in the U.S. Please remember Nepal, India, and other struggling countries in your prayers.
(Please remember not to share this on social media. Thank you!)
Just outside the hospital gate are many varieties of houses, restaurants and hotels. Most have been rebuilt and modernized with cement (rather than the traditional mud, brick and tin.) However, there are still a few places that have been put together with whatever could be put up cheaply.
Each morning we walk by a certain house where a widow and her son live. They have been there for over 10 years – even though it is not their land, but is owned by the government. We would call them squatters. When we first came, the husband also lived there, but he became ill and died several years ago.
We came to know that this widow, with whom we often chatted, was actually the second wife of her late husband. His first wife and children lived in a near-by village. This is still more common than we would like in Nepal.
So – after the husband died, the first wife decided to move in next to the second wife, and to build a hut and “squat” there, too!
The second wife has become a believer and we see her coming to church regularly. She is not able to work, and her son has been ill, so the church, and others have been helping her with food. There is no water where they live, so they have to carry it from the local springs and taps. (It is a 5 – 10 minute uphill walk to carry water to their home.)
We know that they don’t have much money, so we were really surprised the other morning as we were climbing the steps beside their homes. Les said – “Look at that! A satellite dish!” Wow. No water. No toilet. But – we have TV! We never cease to be amazed at what people consider to be important, and the choices they make!
This dish is on the first wife’s roof – and we don’t know them really at all, so we don’t want to make assumptions that may not be true. But it just struck us as something we have noticed over the years here in Nepal – the juxtaposition of the old and new.
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Just a few days after our last post in December, we were on our way to the U.S.! We did a 2 week quarantine and got to spend Christmas with our grandchildren. It was wonderful. Then – we got Covid just at New Years time! We are so thankful we had only mild cases, and were able to see family again after another 2 weeks of isolating. It was a strange trip this time, but overall restful and good.
The work permits came through at the end of December for the expats in Tansen. When we returned on Feb 4, we were able to get our first dose of the vaccine! We started back to work on Feb 7 and it hasn’t slowed down since! The numbers of covid patients in Nepal has gone down hugely, and here in Tansen, our isolation ward is now empty, and will once again become the regular Medical Ward. We are thankful for this – the hospital is very full and busy these days… it is virtually impossible to maintain any distancing between people. Most are still wearing masks. Training programs are starting again, as well. Thank you for your prayers for Nepal – and we do pray that there won’t be a second wave! Vaccines are starting to become more available.
Les was finishing up today when he went back to check on a young man (15 or 16 years old) who had come in during the night as he had swallowed pills to try to kill himself. He started to wake up when Les was there and wanted to be allowed to leave so he could go get more pills and try to kill himself again. Unfortunately, our psychiatrist is away for the week, but Les and another pastoral care worker spent a lot of time talking with this young person and praying for him. Les was able to start him on some medication, but he certainly will need prayers. Les is once again back in his element and loving it!
I was happy to see that the 2021 Friends of Tansen magazine had finally arrived. Unfortunately, we are still unable to mail anything internationally, but we do have the digital version! I hope you will enjoy the stories from this past year – a bit different as everything else has been lately.
We love the comments you post – thank you so much for sharing in God’s work in Nepal and for encouraging us along the way. Here is a recent photo from a wedding we attended. Tansen in on the hill behind us.
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I (Les) have not been allowed to work this past week. My work permit and registration at the Nepal Medical Council both expired on Sunday, November 22, and have not been renewed. In fact, the same thing happened to all the foreign missionaries in Tansen. At least for me, as a US citizen, I have a 3 year visa in my passport. Those on our team who are not Americans had to go on a tourist visa to stay in Nepal legally. But none of us are working until we get the work permits. Since we arrived here 30 years ago, this is the first time we have had to stop working. This is the result of several unfortunate things converging at the same time:
1. When the last 5 year agreement was expiring in January, a new agreement still needed to be written, so we were all given 6 month extensions. But the government decided that the UMN hospitals should no longer be managed by a foreign mission, but by a trust set up in Nepal. This is probably the result of increasing nationalism and Hindu lobbyists gaining more influence. This was announced in May, and we were given another 6-month extension to allow time for the legal work of forming the trust. UMN now has the trust established, but there was not enough time for the hospital agreement to be made before time ran out on November 22.
2. Nepal’s new federal system, written into the constitution that is being implemented now, means that the provinces have more self-governance rather than everything being managed from Kathmandu, the capital. Unfortunately, it is still not clear which powers are being given to the province. It seems that everything now requires approval from both the province and the federal government, doubling the bureaucratic red tape and administrative hurdles. The hospital is getting registered as a new community hospital in the province. But the provincial office staff are learning how to do this themselves, apparently without much guidance on what this process should involve. For example, they requested that the personal information and professional qualifications of all 400 staff be photocopied and submitted. Now that all details have been submitted, they are waiting for a committee with a radiologist, pathologist, physician, and managers to meet so they can review our application. The work in Kathmandu to get our visas cannot go forward until the hospital is registered in the province, and UMN and the government have a working agreement signed.
3. Dashain and Tihar, the 2 main holidays of the Nepali calendar, fell late this year, so most government work was shut down or running with minimum staff from mid-October for a month. And usually when the person with power to authorize something is on holidays, their duty is not delegated to anyone else, but left until that person returns. So right when the crunch was on to figure out an extension or some other deal, nothing was happening until right up to the last few days before time ran out.
4. Lock down and work from home during the Covid-19 pandemic affected all work by both the government office staff as well as the UMN staff working in Kathmandu. Even the hard working ones were struggling to get things done that had been previously managed efficiently.
So while we are forbidden to work, we are taking a break, and have come to Pokhara for 3 days to celebrate my birthday. (We returned safely to Tansen last night) We are also praying about how long we should wait in Nepal for our work permits, before we take a longer break, returning to the USA to see family and friends. On the one hand, we don’t want to leave if God wants us to stay, and if the work permit will be approved soon. But on the other hand, it is even harder to be away from family when our reason for being here, working in the hospital and ministering to patients and visitors, has been taken away for an indeterminate amount of time.
The hospital has been struggling along with only the Nepali national staff working, at least the ones who have not been quarantined for testing positive for Covid-19. Thankfully no staff are critically ill. Hospital work is now running at under 50% of our normal capacity. It is hard to see patients waiting for tickets to be seen, or giving up and going home without care, when we are right here and willing to help. It is also sad to think of the new junior doctors, who still need a lot of supervision and support from the senior doctors, losing half of their mentors. We are certainly thankful that we have at least a few good senior Nepali doctors working hard to keep things running.
So pray, pray, pray! God knows what He is doing, even when we don’t. We are trying hard to see where God is going with all of this, and to join in with Him rather than to fight against Him. Thank you to everyone who supports us in prayer, especially in these coming days.
(Please remember not to share this on social media. Thank you!)
Little Khari was just six months old. She lived in a mud/brick house in the village with her older sister, her mom and her grandma. Her father was away in India, trying to earn a cash income to support his family. Until the lockdown (Covid) he was working a good job at a hotel, but that ended in March. He decided to remain in India in hopes of finding some other work, as he knew there was nothing he would be able to do in Nepal. Other than a small senior citizen stipend that the grandmother receives, this family had no money coming in on which to live.
The family did have a little land, and they could grow enough to feed themselves for about 4 months of the year. However – there was only the mom and grandma to work the land and plant the crops. They also had to care for the one oxen they owned.
One day, Mom and grandma had to both be out working in the fields. Khari was left with her older sister – who was just a 2 year old toddler. At some point, Khari rolled into the fire used for cooking and began to scream and cry. Her mother was too far to hear, but a neighbor heard the cries and went to investigate. She pulled Khari out of the fire and took her outside and called the mother.
Khari was still conscious when her mother got to her, but her legs were badly burned. Due to the lockdown, getting any transport was difficult. They managed to get her to a nearby hospital, who referred them to another, bigger hospital in Butwal. That hospital also said they couldn’t help Khari and suggested they go another hour up the hill to the Mission hospital in Tansen.
When they arrived in our Emergency room, the doctors immediately admitted little Khari. She had 12% burns on both legs below the knees, and 2% were deep burns. She received various treatments here – and the mother was provided with a high protein, nutritious diet so that she could breast feed Khari and help her to heal.
This family had to borrow money to get to the hospital – and if it weren’t for the gifts sent by people like you to help give free care for poor patients, little Khari wouldn’t have been able to obtain medical care. Her mother wouldn’t have been able to get good meals in order to gain strength to be able to feed and care for her baby.
Lockdown and Covid have affected us all – but these people who had so little to start with are struggling so much. We are so thankful that – because of you – the hospital can be here….still open and serving the most needy among us.
Khari did fully recover and was able to return to the village with her mom. Thanks for your prayers – and for your support!