Remembering Life is short

Monsoon seems to have arrived early this year.  Yesterday, a tragedy occurred near us which is a reminder that in spite of the life giving properties of the needed rain, there are also consequences….  A group of business men and women – all from our town of Tansen – boarded a bus to travel out to a village an hour or so away in order to look at a project which their Savings and Loan was involved with.  Along the narrow road – located along the side of the mountain (as are most of the roads around here) – they met a jeep and pulled over to the edge of the road to let the jeep pass by.  Due to both the recent rains, and to the less than stellar road building practices here, the edge of the road collapsed, and the bus fell down the side of the mountain 150 meters (450 feet).

Palpa bus crash 2018

Because it was raining, and because rescue was hard on the side of the mountain, it took some time to get people up the hill and loaded into jeeps to take them to hospitals.  Because we were one of the closest, we had at least 10 (living) patients arrive in our Emergency Room needing care.  One was eventually transferred to another nearby hospital, and two others were sent by helicopter to Kathmandu.  The latest death toll is 14 – with 9 or 10 survivors.  One of our young resident doctors lost both her father and her uncle.  Another former doctor lost his uncle.  A worker at the guest house was relieved to learn that her son (the bus helper) was only injured, and another doctor’s grandmother was also injured.  Les and I walked into the bazaar last night and saw multiple shops closed, with many people sitting or standing in groups talking about the disaster.  This is a huge blow to the community of Tansen where these men and women were leaders in the business community here.

This morning, as we were having breakfast (again in rain and clouds) we heard another helicopter landing on the parade ground in town.  This brought back our memories of 6 years ago – when Les had his brain bleed and we traveled by helicopter into Kathmandu.

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We were reminded again of how short life is – and how our times are held in God’s hands.  We pray today for so many families who lost their loved ones here – and we also give thanks for 6 more years of Les’s life!

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Be careful what you teach!

Les is never excited to go to work on days when he is scheduled for office duties (admin) – but when it comes to teaching classes, he is always ready to go!  He came home recently with a great story of how he might need to be careful about the subjects he decides to tackle in his sessions!  I’ll let him tell it:

We have “tutorials” as doctors every Wednesday, where each department presents a lecture on a topic for all the doctors.  As I am the most senior person doing obstetrics now, I have the privilege of organizing topics for our department, and supervising when other, more junior, doctors are presenting.

 A few weeks ago, I was teaching a class about obstetric malpresentations.  The most common example is a breech presentation (baby is delivered feet or butt first).  I had just finished talking about how we sometimes have to use forceps to deliver the baby’s head after the rest of the body has been delivered, when there was a message from the doctor covering the emergency room that a woman had just arrived in a jeep with the breech baby delivered half way.  Several of us immediately left the classroom, and found the woman still in the jeep outside the ER.

  The resident had managed to deliver the whole body, but not the head.  We could not feel a pulse for sure, but we got the woman on a trolley and pushed her quickly up to the maternity ward, where I was able to then demonstrate the forceps application I had just finished lecturing on!  The baby was initially flat, with no pulse or respiration, but responded quickly to resuscitation by the pediatric team of doctors.

One of our therapists was not very positive about a good outcome – not knowing how long the baby had been lacking oxygen.  However, mother and baby were sent home after just a few days, doing well and happy about the care they had received.

We all had a good laugh after we were finished, saying that I need to be careful about what I teach: Sometimes classroom lessons turn into real life cases!

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Catch up and Travel

It’s May! Where have the months gone? February and March flew by here in Tansen with lots of time spent at the hospital for Les – seeing patients, teaching residents, and leading trainings for village health post workers. Debbie gave multiple hospital tours, welcomed people and fare-welled many, too.

We enjoyed a wonderful Easter morning celebration – meeting together at 6 am at the town hall along with fellow believers from all of the 7 churches in Tansen. We sang, worshiped, and heard encouraging words from various pastors. Then, the churches all walked around the bazaar area showing their joy and faith in Christ’s resurrection.

April has been a month of gatherings for us. We started in Pokhara for a 3 day retreat with all the expat volunteers currently working in Nepal with United Mission to Nepal. Our team was in charge of worship music again – and Les played guitar, I played clarinet, and we both sang as part of the group. We had an encouraging time together sharing about the work UMN is doing in Nepal, along with hopes and dreams for the future of this country.

We just returned from another gathering of missionaries – this time all the United Methodist missionaries serving in the Asia/Pacific region. It was wonderful to reconnect with people we had met in Thailand almost 4 years ago, and to meet new friends, as well. We were blessed that Thomas Kemper – head of the Global Ministries of the UMC – came again to be with us in Cambodia.  It was encouraging to be together and to learn of God’s Kingdom work all throughout Asia. The UMC sends missionaries “From everywhere to everywhere” and it was an honor for us to be among people from many different countries.

We got to enjoy some of the sites in the area – most notably Angkor Wat. It was very hot while we were there, but we really enjoyed visiting these ancient sites in the jungle.

 

We are safely back in Tansen – but we wanted to share some of our travel adventures as we have never had a trip with so many glitches in flights before.

We flew to Kathmandu on a Thursday, and on Friday morning we woke to 2 pieces of bad news. One – a plane had gone off the only runway at KTM airport, and even though no one was hurt, the airport was closed for several hours which was causing lots of delays. Two – our original ticket had somehow been cancelled and we were last minute booked on another set of flights.

So – we joined the massive crowd at KTM airport and waited many hours to catch our flight on Malaysia Airlines. It left KTM 3 hours late, and we missed our connection in Kuala Lumpur. A kind agent booked us on a flight to Bangkok, and then another one to Siem Reap. We arrived just in time for opening worship – and we ate our supper during the remarks!

Our time at the conference was fine – and on Thursday morning, we flew from Siem Reap to Phnom Pen to get our Malaysia flight back. They wouldn’t allow us to get a boarding pass at the counter because they said we got cancelled when we missed the connection the previous week! Our kind travel agent worked so hard, but couldn’t get us on the flight, so he booked us on Melindo Air to KL. We had to wait in line an hour to get through immigration to retrieve our suitcase, then re-entered the airport for the next leg of the flight. However – they told us since we hadn’t flown the leg from Phnom Pen to KL, we would have to pay a penalty. At that point, we were working really hard to remain polite. We didn’t pay a penalty, and did manage to get on the flight to KTM and made it the rest of the way without trouble.

We enjoyed visiting different Asian airports and traveling various airlines! It didn’t make for the most relaxing trip we have ever had – but we were thankful for safe arrivals.

Now we are down to two months in Tansen before we take off again for the U.S. and home assignment. Looking forward to seeing many of you at that time!

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Reluctant Servant

Happy New Year!  We are currently in Michigan – enjoying a few days with children and grandchildren – it’s wonderful!  We fly back to Kathmandu on Monday, and once we get settled back there, we’ll write more about our travel adventures.  In the meantime, here is a short story we wanted to share.  Please know we are only fellow servants – we are so thankful for each of you and for the work you are doing in the places God has planted you!

In early December, I (Debbie) escaped to Pokhara for 2 days.  I hadn’t been away from Tansen for over 2 months – and it is impossible to “escape” from work unless one actually physically leaves Tansen – and I needed a small break.

I got up the second morning – thinking to get a cup of coffee, and go sit at the lake and work on my bible study.  I found a nice little seat near the lake, settled myself with my drink and books, and started to read.

Maybe 10 minutes later, I heard a voice saying, “Namaste”.  This is the greeting in Nepal  – but I had earbuds in listening to my bible study, so I ignored it.  It happened again – and a third time.  I turned, and there was an old man with his wife – obviously not aware that someone sitting with earbuds in with a book and a coffee wanted to be left alone!

So – I said hello.  He started to share his story – he and his wife needed money.  They didn’t have a house, and had come down the hill to beg for money to eat that day.

Well – I had an internal struggle.  Here I was, sitting trying to do a bible study – something God wants me to do, right?  But – here was a couple asking for help….  What would Jesus do???

So – I put my stuff into my bag, and said if the man and his wife were hungry, I could get them some food and tea.  I’m not sure I was very gracious about it.  We walked down the path, and I found out that this couple actually had 2 living children – one with a previous wife and one in a boarding school. (They had one son who had died.)  They owned land, but didn’t want to sell it in case their children wanted it later (when they are grown).  They have other family, but said they didn’t get help from them.

I don’t always understand people as well as Les does, but I wanted to try to find out about their situation. We got to a tea shop, and I got them some bread, tea and some snacks.  They then asked for money for daalbhaat (a rice meal.)  Usually we don’t give money, but I gave them a little cash to use for purchasing some food – and I gave it to the wife asking her to make sure that is what it was used for!  I also told them the reason I was trying to help was because of Jesus and His love for me.  I encouraged them to go to church both to get help and to learn more about Jesus.  I left them there – feeling like I hadn’t really done anything to make a difference in their lives.  The problems these people are facing are much more than a cup of tea, or even a plate of daalbhaat, could solve.

I didn’t write this because I want you to think I was being a “good Christian”.  I don’t always do the right thing – and even when I do, I don’t always do it with a good attitude.  (I still haven’t gotten back to that bible study….)   We all face small decisions in our days that we wonder about – did it make a difference?  I pray for this couple – and so many more like them who don’t have what they need and have no easy way to get help.  And I pray that God will use even a reluctant servant like me.

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Health Camp

Note: This blog was written by Les – usually Debbie is the one posting.  Les went on this health camp last week and we thought it would be interesting to share.

Please remember not to link or share this blog on social media.  If you want to send the link to a friend via email or message that is fine.  Thanks!

Pyuthan District is just 2 districts west of Palpa where we are located.  It seems so close on the map – only about 40 miles as the crow flies.  However, on the roads in a bus, it took us 10 hours to arrive!

Wednesday morning at 6 AM, 13 of us set off from the hospital to serve at a free medical camp in Pyuthan district.  Our group included 2 GPs, a pediatrician, a general surgeon, an orthopedic surgeon, 2 resident doctors, 2 physicians’ assistants, a dentist, a dental assistant, a pharmacist, and a pharmacy technician.  We were 2 missionaries and 11 Nepali Christians. The group was sent by the Tansen Hospital Christian Fellowship, invited by the local church in Pyuthan, to minister to the community.

The trip, especially the final bit, was quite slow and dusty.  The location is very close to where UMN had a hydroelectric project in the early 1990s on the Jhimruk River. The church had arranged for our team to have the health camp at the local government health post.  The Health Post had moved into a new building 4 months ago, and the old building, just adjacent, was standing empty, so we could have our own space without getting in the way of the staff.  After we arrived, we found out that the local health post in charge had just done the refresher training (MLP) for 3 months in Tansen, and had a very positive regard for how we had helped her.  So she went out of her way to help us.  The local church had arranged for tables and chairs, but we needed more than that to do everything we were capable of.  This person gave us access to the procedure room in the new building for surgical procedures, which allowed our surgeons to actually treat some people with tumors, abscesses, and other surgical problems.  She also arranged that patients needing laboratory tests could go to the health post lab for blood counts or urine tests.

Our accommodation was arranged in the local hotels.  I shared a room with our pharmacist.  We had twin beds in the room, with cotton “mattresses” about 1 inch thick.  It was probably very good orthopedic sleeping posture, but I had to keep rolling in the night when my hips or shoulders started hurting!  We shared a bathroom with 2 other people in the hall.  No toilet paper or towels were provided, so I was glad I had packed some.  The floor was bare cement.  The local church had set up a mess hall in a believer’s home, about a 10 minute walk from the clinic and hotels.  Volunteers from the church prepared meals and cleaned up.  The food was village Nepali style; rice, lentils, and curried vegetables.  A local squash called lauka is in season, so we ate that almost every meal.  I was thankful for the food, even though it started to all taste about the same.  Needless to say, I was very grateful for the variety when they gave us goat meat the second night.

We had purchased about $3000 worth of medicines at a pharmacy in Butwal on our way there.  (Money had been donated by a group from overseas for the funding of the entire camp including medicines.) We spent Wednesday evening setting up the rooms, and on Thursday we started with an opening ceremony, including a hymn, a prayer, the required speech by the local politician, and also a word from the pastor of the local church.  Then we went right to work seeing patients, who had been informed about the camp ahead of time, and were eager to be seen by a doctor.  The church volunteers worked at crowd control, registering people as they arrived, and directing them, a few at a time, to the doctors’ examination room and pharmacy dispensing area.

Many of the patients had minor chronic complaints like knee pain and back stiffness, for which we just advised exercises and some pain relieving drugs.  Some were more interesting.  One of the ladies with back pain mentioned that she had an old cut injury on her knee.  When we looked at it, she had an old fracture of her patella (knee cap) that had never united.  She could not actively extend her knee. So she was walking with her knee flicked into a locked position, and this was what caused her back to be working unevenly and cause the pain.  Our orthopedic surgeon was able to advise her about coming to Tansen for surgery to wire her patella back together, and then to do therapy so she would have a normal pain-free gait.  Another man wanted advice about his diabetes and hypertension, and casually mentioned that his leg was weak “since a fall during childhood.”  That leg had normal sensation, but showed the obvious muscle wasting typical of a polio survivor!  He had no idea that he had lived through polio, and was happily putting up with his “childhood injury”.  He was obviously living a bit too well, and we were able to advise him about diet and weight control, as well as ways to compensate for the weak leg when he walked.  One man had a big fatty tumor removed from his back.  A young lady had an unsightly congenital growth removed from her chin and lower lip.

At the end of patient visits on Thursday, the pastor invited us to visit his birth home, which was just an “easy wade” across the river, to meet his family, who were now all believers.  The 2 female volunteers decided not to go, so about 12 men followed the pastor down to the river.  He walked upstream till he found the shallowest part, but it didn’t look so shallow to me.  He said we can remove our shoes, socks, AND TROUSERS, for the wade across; no problem!  So there we were, following his example, in our underwear, wading through the water mid-thigh deep, to the other side.  If he can do it, by golly so can we!  We re-robed, and had a nice visit with his family.  We also visited the first church in Pyuthan district, established just 13 years ago.  Now there are almost 20 churches in the area.  I was again humbled, seeing how actively the Nepali believers are showing God’s love to their neighbors, and inviting them to come to church.

By the end of Friday, 866 patients had been seen.  Not only was the crowd well controlled by the volunteers, but everyone who came was able to be seen.  All treatment was given for free.  There was only one dissatisfied patient I am aware of; she grumbled about that fact that we couldn’t do thyroid testing at the camp.  We are happy that for the most part people are very grateful here still for whatever care that we can give. There were also tracts and gospel literature available, and volunteers to chat with people as they waited, or to answer their questions about health or about the Christian faith.  We trust that the seeds planted will take root, as the church continues to grow all across Nepal.  The camp was officially closed on Friday afternoon with speeches of thanks, certificates of appreciation, and prayer.  $750 worth of remaining medicine was donated to the local health post.

Distant mountains

Ladies cutting rice

On Saturday, we left the camp early to start the trip home.  We stopped for some sightseeing, as well as to visit one of the volunteer team members parents’ house, arriving back in Tansen about 7 PM.  I was inspired again on this trip by seeing how everyone on the team tried to serve without counting the cost.  It’s great to see our Nepali sisters and brothers taking up the mantle of caring for the still many poor and needy across this country.

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Flooding in Nepal

We returned back to Tansen last week from a wonderful visit to the U.S. where we enjoyed seeing our family and many friends.  These visits are always too short, and we are sorry if we didn’t get to see you – we will look forward to it next time!  We were so blessed to have all our children together – for the first time in 2 years!
While we were away, Nepal was hit by some of the heaviest monsoon rains in recent history.  Here is Tansen we haven’t experienced much difficulty – just the fact that the roads are now worse than ever.  However, in the Tarai area (the low lands) it has been devastating.  I would like to share a recent email from the UMN director, Joel Hafvenstein, about the work that UMN is doing and would like to do to help.  This note was written last Friday.  Since then we’ve had more rain!
Dear friends,
The full scale of the flood and landslide damage in Nepal is becoming clearer by the day – and it’s a much worse picture than we knew when last I wrote.  According to the initial rapid assessments of the Nepal Red Cross, across Nepal at least 461,000 households have been displaced and over 65,000 homes destroyed. Sunsari and Morang, where UMN serves, are two of the hardest-hit districts.
The floods have affected more of the Tarai plains than any disaster in living memory. The people of the plains have long felt that they do not receive as much help from INGOs or government as other Nepali citizens do; this perception of neglect has been a major factor in the conflicts of recent years. Our response to this major disaster can either confirm that narrative or show that we do indeed respond to great need anywhere in Nepal.
I am proud that UMN has been one of the first agencies in Nepal to mount a significant emergency response in the Tarai. Many others, concerned by the lack of international media coverage, have waited until they could confirm funding before beginning to spend on relief. But because of the proven generosity of our supporters around the world, we had the confidence to set into motion a major rapid relief effort even before all the money was confirmed – knowing that the earlier our aid reaches the survivors, the more good it will do.
Between today and Sunday, we will distribute two weeks’ food supply and a range of non-food necessities to over six thousand displaced households in Sunsari, Morang, Nawalparasi, and Rupandehi districts. The total cost of the materials we are giving to flood survivors (not counting the cost of transport and distribution) is around US$300,000.
Amazingly, the commitments we have received to date cover most of this cost.  So many thanks to everyone who has given, and especially to our German partners at Diakonie Katastrophenhilfe. I am confident that we will raise the remaining $50,000 to pay for our initial rapid response. Anyone who feels moved to help can contribute here.
We also have some opportunities to apply for funding for the next stage of relief.  After our initial distributions, we will be meeting again with the poorest people in the most heavily affected villages, to assess their most pressing needs going forward and see what we can do to help.
Please pray for God’s protection over the distributions this weekend, that they would not be disrupted by quarrels or further bad weather. Pray for the health of UMN staff and partners; influenza had already been afflicting Nepal before the flood, and several have fallen ill while working hard on the response. And above all, keep praying for those who have lost family members, homes, crops, livestock, and household goods to the disaster.
Sincerely,
Joel Hafvenstein
Executive Director
United Mission to Nepal
Note from Debbie:  Please don’t post this blog onto social media.  It can be shared via email with friends.  Thanks!

 

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Statistics and thoughts on changes in Tansen

Les wrote this about 2 weeks ago – but then we got busy with work and helping Hannah get ready to move away from Nepal. (More on that later). Hope it is interesting still!

This is the busy season at Tansen hospital. Monsoon is not yet fully established, so there is no rice to plant. The roads are still mostly passable, before some of them get washed out with the rains again. The people from along the Indian border, who are used to warm weather, are no longer afraid to come up where the temps are now usually in the mid 80s. This is not bad for sitting at home in the breeze with a cold drink, but it makes the clinics very hot, with short tempered visitors all anxious to get seen quickly and get out of the building. Ceiling fans help a little, but we are all sweaty and grumpy in the heat of the day. (The only air conditioning is in the operating rooms.)

After a string of very busy hot days last week, I (Les) was told that we had set an all-time record for our outpatient department, seeing 510 clinic patients in one day. This inspired me to go look at the annual statistics on how work volume at the hospital has changed in the past decades. Some of this is showing the changes in the country of Nepal and the environment the hospital is working in. Some of the change is due to improved services that we are now able to provide.
  Dates of stats          1990-91                              2015-16
Total Admissions:          5663                                      12728
Bed Capacity:                   102                                         169
Overall mortality rate:   5.65%                                   2.43%
Total deliveries:               536                                        2295
Caesarean Sections:       12.5%                                   14.2%
Outpatient visits:           100,218                               98,338
Full time Nepali staff:     255                                      396
Expatriate Staff:               16                                            12

There has been some population increase in our area, but most of the increase in patient load is from the building of roads and increased access to vehicles to carry patients from the villages to Tansen. There is also more awareness that doctors can help with illness. I hear a lot less now days about visits to the witch doctor, or illness being causes by spirit possessions.

Another change these days is that a patient quite often presents with a condition which needs a consultation with a specialist. When the family has the means to pay for the trip into a medical college, we refer them from Tansen to Kathmandu or another city. However, there are also more services we can provide in Tansen: a High dependency Unit with ventilator support, many more lab tests (especially biochemistry), endoscopy, echo-cardiograms, and CPAP for babies. Most orthopedic cases are managed operatively rather than by prolonged admission and traction. Broken legs usually go home in less than a week. Laparoscopic surgery has been started on most types of cases, which also has a shorter recovery time.

I am not sure why the mortality rate has gone down. Maybe we are able to save more people, or maybe we are admitting some “less sick” people. And many of us believe that the continued prayers from around the world affect the work here as well.

Deliveries in this district are now happening in a hospital 90% of the time. This has caused an explosion of our maternity case load. (Just last night while on call I attended a breech delivery, a forceps delivery, and a complicated obstetrical tear that needed repair. All of the women and babies are doing well this morning.) Cesarean sections have not increased very much. Both of these are good statistics for pregnant women in this district, who now expect to survive the delivery and have a healthy baby. (I still have a very vivid recollection of a woman in labor during our first few years in Tansen. She cried through the first hour she was with us about how she was going to die. I thought she was just afraid of labor pains, until she finally looked at us and said, “Are you saying that I’m not going to die?!?”)

The most important statistic though, in my opinion, is the last one. We continue to move towards a facility fully run by Nepali staff. We are able to recruit more local people who have the basic qualifications we need (doctor, nurse, accountant, etc.), even if they do need some additional training after we get them. And we have a large group of interns and residents working to learn at our hospital, some of them Christian. I see a future where the missionaries come in fewer numbers to not just “be the doctors” at Tansen hospital – but to train and encourage the Nepali doctors and staff in their work. In the meantime, we continue to covet your prayers and gifts for the work at Tansen hospital.

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