A new year - a new country! Gmar v'chatima tova everyone -
Happy Rosh Hashana. Zvi and I wish everyone a healthy and amazing year ahead.
The end of our year has been truly a time of growth and amazement,
professionally and personally for both of us. The month of August found us
based in Dhangadhi, Nepal at the Geta
Eye Hospital. Dhangadhi is in Far Western Nepal
- an area that historically has been neglected by the Nepali government
and was the scene of some of the worst fighting and atrocities of Nepal's
recent civil war. Until just 10 years ago, this whole region would be virtually
cut off from the rest of the country during the monsoon season with roads being
washed out and bridges non-existent. A little over half a century ago, this
region was jungle - dense, humid, malarial jungle. Few people lived in this
plains region. With DDT and other technologies, malaria was virtually
eradicated and the jungle was cut. People began moving down from the hills and
snatching up as much land as possible. As Dr. Arjun told me - "Those who
stayed in the hills were the rich folks 50 years ago, who now look to those
"poor" folks in the plains for help." Indeed, while we saw very
few other foreigners around Dhangadhi, on a brief visit to the nearby hills we
saw cars and jeeps for Save the Children, UNICEF, CARE International, UNFP (UN
Food Program) and more. Food security and inaccessibility to health services
are major concerns in the hills region around Dhangadhi, and Geta Eye Hospital
conducts ongoing community-based eye camps and screenings when possible. The
hills around Dhangadhi are a different world altogether. We took a brief trip
there to find it cold, wet, misty, mysterious - so unlike the hot and humid
rice patties surrounding Geta.
Geta Eye Hospital, as it stands today, is something of a
jungle mirage. The new gleaming 3 story modern facility serves nearly 100,000
patients each year, with roughly 80% of its patients coming across the nearby
Indian border. An eye examination costs Npr. 30/ (USD$0.28) and cataract
surgery between $9.00-$25.00 depending on the complexity of the surgery and any
subsidies a patient might receive. Patients can choose to stay in the shared
ward or pay extra for a shared or private "cabin" for their stay after
surgery. Patients tend to come with their whole family, especially the Indian
patients. Families can opt for a private or shared room, however most are
content to camp outside. Most bring cooking supplies and either purchase wood
or bring a gas cooking canister. At night, - as August wore on, the rains
slowed, Ramadan ended and patient
numbers began to increase - the hospital complex resembles a summer camp, minus
the tents and counselors. Families sit quietly, children mill about staring at
the pale foreigners. Those who already had surgery wear the "White badge
of Honor" - the bandage protecting their new eye. During the busy season,
there will be between 300-500 surgical cases a day. Fights sometimes break out
in the evening, providing those camping out some entertainment beyond waving
their homemade fans and perhaps dreaming of home. In the morning there'll be a
mad flurry of activity as different doctors dash through rounds, nurses
following close behind to make notes, put in drops, and send those with
suspected infection or complications to the ward for further examination.
Monkeys scurry about, recognizing the small pink bags that people receive from
the canteen. Early mornings are primetime for monkey theft as people are
quickly trying to eat, pack, and get in the registration line early. The
monkeys make a mad dash and carry their booty to a rooftop sanctuary, dodging
any thrown rocks or the canteen boys slingshot missiles. Tame spotted deer mill
about happily munching on what they find and the ever present collection of
dogs complete the picture.
Over the past 6 or so years, Geta has hosted a revolving
door of foreign doctors learning Small Incision Cataract Surgery (SICS). This
was the main purpose for our stay at Geta and Zvi was not disappointed. Despite
the rains and busy planting and festival season, he was able to perform over
130 cataract surgeries and close to 50 other procedures during his 5 week stay.
The full time ophthalmologists - Dr. Deepak, Dr. Suresh, Dr. Arjun - all have
thousands of cataracts to their credit and provided Zvi both guidance,
mentorship, and many many games of chess in the quiet evenings. Zvi's
subspecialty training in Uveitis continues to serve him well, and he has been
consulting on cases in the outpatient department as well. Geta's nurses
likewise provided Zvi and the other visiting trainees (Dr. Joyce from NYC and
Dr. Vijay - a recently graduated Nepali ophthalmology resident) not just the
support needed during the surgeries, they provided guidance, mentorship and could
long spot complications and/or necessities before it was even vocalized by the
doctors. The nurses, ophthalmologic assistants and other staff create a
well-oiled machine that is helping what was once considered a Nepali backwater
into a center of international ophthalmologic care…which makes Geta's history
and its director, Dr. Bidiya Pant's story all the more amazing.
The history of eye care in Nepal is an incredible story. Nearly
30 years ago, it barely registered as a need. Even 10 years ago, the system was
fairly limited to urban Nepal and not nearly so efficient or affordable as it
is today. While many outside organizations, including our sponsor the Himalaya
Cataract Project, are huge game changers in Nepal, the local initiative,
vision, and determination of men and women like Dr. Reetha Gurung, Dr. Sanduk
Ruit, and Dr. Bidiya Pant are what truly has made eye care in Nepal what it is
today. If you're curious about eye care in Nepal, a new book about Dr. Ruit and
HCP came out this past June - Second
Suns - I haven't read it personally yet (despite lugging 10 hardcopies with
us to Nepal for Dr. Ruit), but the reviews are good!
Geta Eye Hospital is a smaller story - one that is much more
personal, tangible perhaps because we have been there - perhaps because I have
met other incredible, honest, humble people in my travels who simply saw a
need, and decided they'll do something about it, no matter what. Thirty years
ago, Geta Eye Hospital did not exist - it was a basic primary health care post
in the jungle. Eye care in Nepal itself barely existed; the first
ophthalmologic epidemiological study was first completed in 1984. A Swedish
ophthalmologist and his wife began to organize Geta shortly after that study
came out.
Bidiya Pant was an ophthalmologic assistant from nearby,
among the first to graduate with this new intermediate level certification. He
joined the staff there as an ophthalmologic assistant. He worked there for 7
years - there was one ophthalmologist on staff, with occasional visiting
doctors who'd come for a few months at most. Geta was drenchingly hot in the
summer and humid, with not much relief in the winter. Electricity was spotty.
Doctors simply didn't stay long. Yet the patients flocked there - they came
from across the border, they came from the neighboring villages, they came down
from the hills. Bidiya worked 6, 7 days a week, eventually performing surgery -
a highly controversial move despite the lack of staff. The SICS technique had
not yet penetrated Nepal, not for another decade, nor had interocular lenses
widely arrived. The surgery Bidiya was doing was intense, and required significant
recovery time and a lifetime of "granny glasses". While the center
grew, Bidiya had a vision - this was his home region and he understood the
potential. He realized as an ophthalmologic assistant though, his voice simply
wasn't going to be heard so he decided to pursue an MD.
Medical school in Nepal at that time was highly restricted
to 30 students a year. It was 1992, the Iron Curtain had just fell and Russia
was seeking foreign funds and students,"You just sent in your paper work
and paid the tuition, they expedited your visa and I was a medical
student."
The Swedish doctor - while recognizing Bidiya's drive and
appreciative of his work ethic- did not approve of his plan. Bidiya left for
Russia anyway, leaving his parents, wife and 3 children, and paying his own way
initially. When he left, the Swedish doctor had to hire two people to replace
Bidiya. The first year in Russia, Bidiya learned to read and write Russian. A
decade later, he returned to Nepal a full MD. During those 10 years, the
Swedish doctor saw what the importance of what Bidiya was doing and arranged
for scholarships. Bidiya visited his family in Nepal during his 10 years
abroad. Dr. Bidiya Pant returned and completed his qualifications to practice
ophthalmology in Nepal. He returned to Geta as the senior Ophthalmologist in
2004.
"At that time I was the only full time
ophthalmologists, others would come and once they learned what they wanted,
they'd leave. I'd perform surgery late on Fridays, than head to the hills
arriving at 1 or 2 am on Saturday. We'd do a screening and surgical camp all
day, than I'd come home late Saturday night and begin work again on
Sunday."
During this time period, the SICS technique became
mainstreamed through the efforts of Dr. Ruit. Intraocular lenses were being
manufactured and produced in Nepal, the entire landscape of ophthalmologic care
was rapidly transforming. Dr. Bidiya learned from other pioneers - Dr. Ruit,
from Tilganga Institute of Ophthalmology. Partnerships were formed, and visions
and dreams were becoming reality. Through a partnership with the Fred Hollows
Foundation and the Seva Foundation, new structures were built at Geta. A modern
clinical facility (no longer was the emergency department in an old mud and
stick shack), operating theatres were
designed to specifics. Generators were acquired to cope with the frequent power
outages, comfortable living quarters were built to attract doctors to stay.
Support and nursing staff were sent to Tilganga and India for training as were
management to learn how to create a well-oiled and efficient machine. Brick by
brick Dr. Bidiya and his team built up the hospital. Another full time
ophthalmologist joined in 2007 - Dr. Deepak Khadka, who remains as Geta's
senior ophthalmologists and head of the training department. Other
ophthalmologists joined and remain - today there are 7 full time
ophthalmologists, who are often joined by visiting Nepali residents and
international trainees. Progress continues both in terms of infrastructure -
more patient wards and guest rooms are being built, a fountain and garden is
being inlaid, additional staff quarters are nearly complete. A staff pool is
functional to combat the heat (and no one is above air conditioning!) A workout
room and library are also planned. Dr. Bidiya also is focusing on furthering
the quality and availability of care, and staff are receiving sub-specialty
training as well. Geta Eye Hospital intends to run their own residency program
in the near future, and already is establishing their own satellite clinics in
nearby border towns and in the hills. Daily dreams are made reality - the dream
of sight, the dream of seeing home once more, the dream of offering a
"second sun" to his community…
Meeting people like Dr. Bidiya (a quiet, soft spoken man
you'd have to lean in close to when he spoke in English) is a highlight of this
type of work. One of the main missions of Himalaya Cataract Project is to
create more opportunities for local visionaries to have the tools they need to
create change - hence the big emphasis on education. Local leadership allows
for lasting solutions, and while there is a great deal of international
collaboration and partnership in this story, there is also a Nepali man - a
Nepali man who was once a boy and a young man and perhaps did not expect to
become a doctor, a leader of his country, a pioneer. His vision and
determination are inspirational since we perhaps can all find our own story
within his, the chance meeting, the opportunity acknowledged to create and do
and change. Looking back and writing about Geta's story perhaps makes it all
seem so inevitable - Nepal's eye care is a
success story but it took time and doubt, and some plodding along and belief
and hope day after day to reach this point. It is perhaps too easy to point to
other places (or even ourselves) and question why they are not Nepal, why
haven't they achieved success, and where are the Dr. Bidiyas? In telling Geta's
and Dr. Bidiya's story, particularly at the start of this new year and as we
venture off to other countries, we can look back on this story and think, and
smile and remember, and borrow a bit from these incredible visionaries, and
say, "Why not here too?"
We are off to India next week and than to Ghana the end of
September. We are filled with so much love and gratitude to everyone for their
support and messages from home. A huge Mazel Tov to our brother Shmuel on his
engagement to Yocheved Radnor - we can't wait to celebrate in November! Another
huge Mazel Tov to cousins Marissa and John on their marriage! We're so sorry to
have missed the wedding but are looking forward to many more celebrations
together.
Gmar v'Chatima Tova - A happy and healthy new year! Come
visit us if you can!
Much love,
Jamie and Zvi
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