National Home for the Rehabilitaion of children with malnutrition (NRH)

Time to go back to work. I was to spend about a week and a  half working with the NRH in Lazimpat Kathmandu.

http://www.nyof.org/programs/nutritionalRehab/pudding.html

Learning about malnutrition was not something that was covered in my four years at college so it was an interesting opportunity for me to spend some time developing my professional skills. 

Infant mortality in Nepal is one of the highest in the world (64% per 1000 live births). According to a UNICEF report, half of all Nepalese children under the age of five who do survive are malnourished.

 

The Rehabilitation house is a really great setting. It's a large house with several out buildings, a garden with a children's slide and a kitchen garden for vegetables. There is also a large roof terrace that the carers use for sitting in the sun and doing oil massage with the children. Oil massage is particularly beneficial when the children have some oedema (swelling) related to their malnutrition and exposing their skin to sunlight for a short period helps with the production of vitamin D. It's also a relaxing experience and helps create a parent-child bond the lack of which may have been a contributing factor in the development of malnutrition. 

We also had the opportunity to participate in and help fund an outreach clinic to a remote hillside region a few hours away from Kathmandu. The organisation carries out these clinics occasionally (funds permitting) and they are an extremely important part of the work they do. These children have extremely limited access to healthcare and education levels in these remote areas is often low. It also helps develop a picture of malnutrition situation in Nepal as a whole. 

We had some training the day before then packed up the bus and headed for Karvre 2.5hrs away. We were to travel along roads you would hesitate to take a 4x4 down but somehow we made it. 

When we arrived the need for the outreach work became clear. 328 children, some with older siblings had arrived with their carers to be weighed measured and assessed for their nutritional status.

 

There was also a hand washing station to show the children how to wash their hands properly and to try and educate people about good hygiene practices, a lack of which leads to diarrhoea, a leading cause of acute malnutrition. There was also a nutrition stand and an ongoing talk about how to prepare, use and combine foods in the most nutritionally beneficial way. 

I was very surprised to learn that it is estimated that only about 12% of cases of malnutrition are directly attributed to poverty. The vast majority of cases are due to cultural practice and a lack of education. This is maybe why it is a situation that finally seems to have turned a corner and is atlast considered to be improving.        

Each child that was registered also received a bag of "super flour" which is a blend of toasted pulses and legumes which has a HBV combination of protein and can be quickly and easily reconstituted to make a nutritious porridge.

Thanks to organisations such as NRH carers are being given the education to be able to provide appropriate nutrition for their families and maybe malnutrition will eventually be overcome.  

In the jungle..................

The half way point has come and it's time for a break. I decided that I would go to the jungle for four days "hoilday". I can say without doubt it was the best trip I have ever taken. I didn't imagine that I would see so much wildlife in such a relatively small area.

Arriving at the right place was no small feat. The fact that you are in Chitwan is not hard to work out. Where on earth to get off the bus as a non Nepali speaker is another matter altogether..............
The travel agent said "last stop Chetrisali", ok except you go through a town with no comprehendable bus stops, hotels you recognise have sent jeeps to these "stops", people get off, the bus gets rapidly emptier, then the bus turns out of town down an increasingly remote looking track and a sense of dread begins to develop in the pit of your stomach. Have I missed the stop? What am I going to do? There are no taxis............visions of having to be humiliated on the village ox cart while being dragged back in the right direction start to creep in to your mind.

Then fortunately the bus pulls in to a field, what seems to be miles from anywhere and in no way does it resemble a main bus terminal, anyway that's what it turns out to be and thankfully there is my jeep!

There is no noise like no noise......................
A bumpy ten minutes later and we arrive at the hotel, the overwhelming sensation is how quite it is. After the blaring chaos that is Kathmandu it's like walking out of a concert with your ears ringing.

In my room I found the amazing luxuries of a flushing toilet and a hot shower! Oh how I have missed you! I will never take you for granted again! An outside hole in the floor with a bucket of all be it warm water in the middle of January is not exactly for the faint hearted!

Then there's a knock at the door, time for the Tharu village tour............
We set off  on foot to what almost looks like a fake village. The Tharu are the native people of the area who managed to develop some resistance to malaria. They make their houses from a type of yellow mud and tall grasses (.......and maybe bamboo, obviously wasn't paying attention!)
Anyway it was a bit odd to be shown round somebody's back yard, although they are clearly used to groups of tourists looking at their building materials.

Then we went for a short walk to the river. As we got close silently (yes really they don't make as much noise as you think) my first elephant came walking towards me. They are amazing animals, really difficult to explain but not like anything else that I have seen.
She stood silently while her passengers disembarked then turned and headed back the way she had come.

.............in hind sight this elephant has tusks which if I was paying attention means "she" was actually a boy!

Then there was a rumor of rhino further ahead so we set off a bit quicker, when we got there though all we could see was the top of them in the distance, walking away through the tall grass.

That night we all had dinner in the restaurant, I say all, me a Norwegian/English couple and a Chinese girl.

Then it was time for bed to dream about what tomorrow would bring.

1AM........................

Unfortunately "tomorrow" came a bit too soon. I was rudely woken by a large rustling noise, I turned on the light to find that the jungle was no longer just outside!
The bag I had left my lunch remains in was making a huge noise and I couldn't see what was in it! I did what any independent self empowered woman would do ...................threw a towel on the bag (because that stops snakes escaping!?) and FLED!!!!!
Although was outside any better? Rhino frequent the garden near the river, if this was in my room what was outside of it??!!! I couldn't see if it was a rat, a snake or whatever. There was not a soul to be seen, I didn't want to cross the garden as visions of tigers and rhinos were now paralysing me, in the end I had to knock on the room next door and wake the poor guy up from dinner, apologise profusely then do what every man dreads and ask him to be manly in the face of some unknown terror!
To his credit I don't think he was much less afraid of the rustling bag than me but he did go in my room and poke it! The middle of the jungle and no bloody sticks to be found. We wanted to throw it out of the room but neither of us dared to pick it up. Anyway he did manage to discover that the terror of the jungle was in fact only a small mouse! Not the anaconda I was envisaging. It ran out behind the bed and much beating everything with a flipflop and shining a torch everywhere determined it had hopefully fled too!

An uneasy nights sleep later it was time to go canoeing. The canoes are made from an entire tree trunk dug out in one piece. It was early morning and the mist was just lifting so it was really beautiful. We saw crocodiles, peacocks, kingfishers, deer and other people riding elephants.

....................I also found a large "mouse stick" in case my little friend came back!
We saw the elephant breeding center and the twin elephants Ram and Laxman, only the second time twin elephants had been born in Nepal. (presumably in the center rather than ever!)
Then we nervously went for a walk in to the jungle.We saw some deer but still no rhino.
That afternoon I took a jeep safari and we also spent 5hrs looking for rhino...............which evaded us.
We did see the gharial breeding center in the middle of the park. Gharials are a sort of crocodile that mostly eat fish and have a much narrower snout.
That night we went to the Tharu culture show which was amazing, the stick dances were supposed to frighten off animals amongst other things!
Then I returned to my room, with large stick (similar to what the guides defend tourists with when bears/rhinos/tigers attack!) All food and rustling type material was outside along with the bin. The stick was next to my bed, off went the light.

5AM...................
The little bugger was back! trying to scratch a hole in my rucksack to get at a sealed up packet of cookies! I turned on the light and he fled back behind the bed, I beat everything with the large stick, (not entirely sure what I would have done with a splattered or concussed mouses) but there was no mouse to be seen!
The next day I gave up the fight and changed rooms.

St Valentines day.................
I didn't have anything but an elephant ride at 3pm I asked to take an extra canoe trip............"ohhhh it'll cost you extra!" that's OK.............forgot to ask how much!
Anyway we took another canoe trip and saw just as much as the day before, then Ram, the guide not the elephant, said lets go hiking and look for rhino.................errrrr how's a girl to refuse that kind of offer?
So looking like Jane of the jungle in my new gaiters we set off...........
Ten mins in to the jungle and feeling no less nervous than last time, (no doubt helped by the dia warnings in lonely planet about the dangers of hiking in to the jungle on foot and the likely hood of tiger attacks complete with account and how you might be ok so long as you're in a large group............Right so me, the guide and a stick...............OMG I am going to die here!) the monkeys start making alot of noise shrieking continuously. Ram grins "Alarm call, maybe we be lucky, maybe we see tiger!".........and sets off not in the opposite direction like any sane person, but towards where the monkeys are hollering. OMG I the nerves were a sixth sense and I am actually going to die here!!!! (........at least it might make front page of the Knaresborough post, "Local girl eaten by tiger") 
Anyway we were unlucky (depending on your point of view) and we didn't see a tiger, nor after 2hours hiking through the undergrowth did we see any rhino. We did creep up on a sleeping crocodile and because we were quite got quite close to a large group of deer but that was about it.

 

Then to the elephant riding when finally at the last minute and the last possible opportunity we saw mother an baby rhino grazing in the field. 

 Then it was time to go back to the hotel. The jungle is a very romantic place, the sun sets in the mist on the river and after a long day crashing about in the jungle or being bashed about in a jeep it's nice to have a beer and relax.
This was the view while I shared a beer with Ram and watched the sun set. Unfortunately being a nepali wife is not for me and the jeep drivers job is taken! Still a pretty good way to spend Valentines day though.

Volunteering.....

Ok so here comes the serious bit, the reason I am actually here.
I am volunteering at the Punarbal Plus school for children with and/or affected by HIV/AIDS. The school supports children who would otherwise not receive an education because of fear and stigma preventing them from attending mainstream school.
http://www.punarbalplus.org/
http://www.facebook.com/?ref=home#!/group.php?gid=114096779316
Many of the children whether they are infected or not come from economically deprived backgrounds due to loosing one or both parents to HIV/AIDS. Even when the parents are alive they are often shunned by their families and communities which drastically restricts their ability to earn a living. Lack of income leads to a poor diet, a poor diet means that opportunistic infections have a greater chance to take hold leading to periods of prolonged illness and even death.
These families can barely put food on the table, much less buy school uniforms and pay school fees.
The school supports these families with free education and at least one hot meal a day.
They also advocate for a more inclusive practice amongst mainstream schools, opposition coming mainly from the parents of non infected children.
The stories of discrimination I have heard so far beggar belief, bodies of victims being only partially cremated then tipped in to the river for fear that the virus will be released in the smoke.
Community members threatening to set fire to a victims family home if they didn't move, refusing to share eating and drinking utensils, or even the same table. Being told "You don't need to eat because you will die soon"

Many people believe that Nepal is on the brink of if not experiencing a HIV epidemic and that it is where Africa was 10 or even 20yrs ago in terms of dealing with it.
Although within the general population the infection rate is relatively low, certain groups are seeing disproportionately high numbers of infection, intravenous drug users, sex workers, economic migrants to india who then come back and infect their wives and street children. Child carpet workers are also thought to be one of the main sources of child prostitutes due to the extremely low wages and poor conditions, there is also a common but mistaken belief that sex with a younger partner means there is less risk of HIV.

Ten years of civil war, ineffectual government and slow economic development have lead to a chronic shortage of jobs and although 25% of Nepal's budget is made up of foreign aid, it rarely reaches the poorest remote regions. This has in turn lead to mass economic migration firstly towards the Kathmandu valley and then often to the bright lights of India's booming economy further south.
Away from home for months even years at a time many men succumb to the temptations of the big cities, and knowingly or not return to their wives HIV+.

HIV is very much a taboo subject even between man and wife and as is very often the case women are dis-empowered by it. There have even been cases where husbands lie to their wives about their status thus preventing them from seeking treatment for themselves and future children. The risk of a HIV+ woman with the correct medical treatment giving birth to a HIV+ child in the west are less than 1%, here there are no available statistics............
There was even a case of a man who knew his status and was receiving treatment. yet when his wife questioned why he was taking medication he told her it was for indigestion.

Women's lives are hard here, when they are not cooking, washing up and doing their families laundry in cold water in a bucket at the bottom of the garden they are mostly responsible for the house and childcare. In such a traditional, conservative, patriarchal society it takes a particularly strong and often rebellious woman to speak out.

All in all I am glad I was born where I was with the opportunities and freedom that I have.

Thanks to all of you that donated towards my excess baggage by the way, as Etihad kindly donated the fee I used your money to replace the younger children's school room carpet.............42euro well spent, today I also ordered new curtains at an extortionate 4.50euro!

Left my memory stick at the house, so will post the photos here next time...........or you can look on the facebook group page

http://www.facebook.com/?ref=home#!/home.php?sk=group_171378486223965&ap=1

The school is also raising funds for new bunkbeds if anyone or company wants to sponsor one or contribute towards one.
Items the school needs are.........
bunkbeds for two students 107euro 3 needed
mattresses 40euro 6 needed
bed and pillow cover 8euro 6 needed Please email me if you are interested I will be doing some media promotion when I come back so you would (if you chose) get some free press.

Thanks Guys you have all been more than generous already
xx

Two hours, three spring rolls and one cockroach.................

Just incase you're wondering the food here is actually ok, I haven't (yet) died from one of the long list of diseases the practice nurse warned me about, nor (touch wood) succombed to the dreaded Delhi belly. Travel and moreover eating are not for the fainthearted here. Having said that, the Director regularly sprinkles some black spice over my food to ward off high blood pressure, never mind that the amount of milk, eggs and fried potatoes she gives me has tripled my cholesterol count in a week!.......and yes the milk is boiled and no I haven't asked from which animal it comes!
A short walk past any of the meat "shops" would pursued even the most ardent meat eater that vegetarianism is possibly the way forward, if only to avoid Delhi belly! Sainsbury's it is not!

Then we come to Dahl Batt................
Possibly the bane of my life here, the last thing my mother said to me as I'm loading Diocalm into my basket in ASDA was to point at the senna and say "I doubt you'll be needing those hahahaha"
Yeah you try eating a mount Everest size portion of boiled rice and lentil three times a day and see what that does to your insides!

Not sure which is worse Delhi belly or Kathmandu constipation!

Still atleast I am not starving....................

If the cholesterol doesn't give me a heart attack then the diabetes inducing amount of sugar I am being forced to take in will.

So if I make it out alive I will no longer be a *cough* svelte size 12, I will be an obese toothless diabetic with a cholesterol problem

So anyway in a bid to escape being force fed Dahl Batt we decided to go to a restaurant.............

1) never trust an Australian to choose an eating establishment, have you seen bush tucker trials?
2) never eat somewhere it takes two of you to brave the toilet facilities
3) never eat somewhere you cant see what you're eating
4) never eat somewhere that takes 2hours to make 6 plates of food
5) never eat in empty restaurants
6) never eat somewhere you have to drink from the bottle because the glasses are so dubious
7) never eat somewhere that considers the entertainment to be a tap dancing cockroach on your table
8) be grateful the "entertainment" was provided AFTER the meal had been consumed
9) console yourself that your spring rolls were very hot and in Asia it's common to eat insects anyway!

Atleast one of the other volunteers is a trainee Dr...............

Chaos in Kathmandu:

Hey Guys sorry its taken so long……………electricity, internet and my time off don’t often coincide here! When they do more often than not either the internet or the electricity cuts out before I can press send!

This time however I have managed to borrow a laptop and am writing on battery so I can upload it later when the power and internet come back on.

I arrived safely in Kathmandu just over a week ago.

Richard took me to Manchester and all 39.5Kg of luggage and I checked in fine. The plane to Abu Dhabi was COOL by the way! A far cry from the last time I flew long haul. Your own individual TV with phone, and games console, blanket, pillow, vanity case with sleeping items in it; which might have been useful if they hadn’t woken me up every hour to feed me and give me free beer………….

Hung around in Abu Dhabi for 3hours watched the sun come up and used their free complimentary internet/computer station – Leeds Bradford take note! Then on to Kathmandu.

I am volunteering with an organization called volunteer aid Nepal. They arranged for me to be picked up at the airport, thank goodness!!! It was like arriving in the middle of a riot, police with big sticks, the sort you don’t argue with were keeping the majority of the hoards back. Those that weren’t behind the barrier were trying to take your bags from you for the bargain price of 20euro!

Luckily a bit of fore thought meant I had emailed my photo ahead so the bus driver recognised me before I even saw him. Having arrived at the same time as an air India flight from Delhi I can tell you the word “Chaos” doesn’t even come close……….. 

When we got to the bus and I had managed to get on without paying 20euros there was a another girl called Emily from Germany sat in the back corner, the driver shut the door not too sure whether that was to keep us from getting away or the baggage guys from getting in, anyway we had to wait for another guy from Belgium to make it through the gauntlet then we were off.

Driving through the early evening streets into Kathmandu is like driving 500yrs back in time. Apart from the plastic refuse everywhere and the odd Bollywood sign not much in the way of infrastructure has changed. We arrived at our hotel which thank goodness was 1) not next to one of the all night music bars of Thamel and 2) not some cockroach infested mud hut. Needing a small army of Sherpas to get all of my luggage up the stairs finally I got to my room. Then reality strikes, why do none of the light switches work? Why is there no hot water tap on the “shower”? Why are is there no obvious signs of heating when its about minus 10 in here?....Oh that’s right I came to the other side of the world and apparently in to an entirely different century!

At least the room was clean and there was enough room for all my bags, and thank goodness there was an actual western style, fully functioning loo!

Then there was a knock at the door, Emily had come to compare rooms and ask if I wanted to brave the “restaurant” “Are you sharing with someone else?” She asked, before she had even seen the twin beds, errrrrr “No……….Oh yes I always travel with this much luggage!”

The “restaurant” served tea and a range of meals, we chickened out and ordered tea while trying to remember if the nurse had said tea was ok or whether that too needed filtering and chlorine tablets………..Another girl had ordered food so we decided to see if she would get poisoned first. A cup of tea and a festering but possibly safer option of a Boots airport sandwich from the day before and it seemed like it was time for bed.

Luckily I had got a sleeping bag for Christmas so at about 7pm I (foolishly) went to sleep. At about 2.30am a combination of jetlag and a pack of wild dogs in the street below meant I was wide awake! Oh no what have I done? I thought…………

Fortunately tomorrow is another day………

The sun was shining and surprisingly warm, I discovered the hotel had a roof terrace and actually their apple pancakes didn’t poison you!

We went to the office to discuss what I was going to be doing and I met two Australians, we arranged that I would go to work in a school supporting children infected with and/or affected by HIV/AIDS for four weeks and then possibly go to the Kanti children’s hospital, yes I could arrange to meet some street kids and yes I could go and ride elephants in Chitwan. Thankfully I seem to have found an organization that can fit volunteers to their chosen projects rather than making the volunteers conform to theirs…..

The next day I was to move to the Directors house where I would be staying, but for now the Australians suggested we do what they do best (which is certainly not play cricket! ha ha ha) and drink some beer! Then go for dinner and drink more beer!

We found a nice restaurant serving Nepalese food and after various questions about whether the salad garnish would kill me (it was washed in iodine water so apparently not) I managed spring rolls and my first experience of momos…….washed down with more beer! Momos are like a sort of DimSum with a spicy filling.

All was well, I had sorted my placement, moved half a ton of stuff around the world and not died from some sort of salad induced dysentery.

Thank you Etihad!!!!

A BIG THANK YOU!!

Finally got confirmation at the 11th hour that Etihad have kindly agreed to add a complimentary 10kg bag of excess luggage to my all allowance, meaning I can now take a total of 40kg so all your kind donations can be transported at no extra charge!

Dear Sarah,

We here by confirm you the acceptance of 10kg excess baggage and we have already put an authority message on your PNR. You don’t need to pay anything extra. 

We wish you a very best with your great job.

 Thanks,

Think that's a testament to "if at first you don't succeed............"

Right speaking of which, with just over 28hrs before I have to leave best sort the packing situation............

Sarah xx

WOW!!!

A HUGE thank you to all of you kind people and local business people who have helped me and donated things for me to take to Nepal.
I was able to purchase 12 kids polo shirts and some boys underpants at a huge discount from Marks and Spencers in Harrogate with donated cash. Lots of you have sent me toothbrushes in the post, blagged them from your dentist or left them anonymously in the box at work. 85 in total!!!! There's ten boxes of children's multi vitamins which will probably go to the clinic for children with malnutrition. Various second hand books and games. Pens, pencils and glitter.

Unfortunately I have had to put a stop on donations due to luggage restrictions and a certain unyielding middle eastern airline who are not willing to make any concessions to help me deliver them.
Anybody with any contacts to help me get stuff there cheaper or donations towards excess baggage charges will be very gratefully received!!!!

Thanks to Ella Gascoigne at StartupPR for the advice on twitter and general support gathering.
http://twitter.com/#!/StartupPRella

Thanks also to Bear Grylls for the message of support and pretty sure Davina is a secret fan too.........

There will be more fundraising opportunities when I come back as needs will obviously become more apparent once I have been...........

There is more than likely going to be a fundraiser at Kelly Teggin's hairdressing the money from which will go to the most appropriate cause identified during my time away.

Thanks again I am sure everything will be very much appreciated
Sarah x

Ready, Set..........almost Go!

Hey Guys,

Well hasn't the last three and a half months since I have been back in the UK gone quickly!?
Two months of that was spent in and out of the Drs surgery getting needles stuck in me but better safe than sorry. (That was TEN big scary needles by the way!)

My Italian friend Margherita owns a bookshop (Melting Pot -Via Vetabbia) in Milan, she sent me a customs and culture guide for Christmas, I was eagerly reading through it on Christmas day when I came to this section...........
"Rivers are polluted with refuse- floating, swimming, sunk and in the case of cadavers bouncing along bloated" .............right then, that would be the reason for the ten injections!

I've finally managed to (more or less) sorted out what I will be doing, or rather what I'd like to be doing. Fingers crossed that I get to do all the things planned. For those of you that don't know I really want to spend most of my time in an orphanage type project and try to fit some side projects in around that.

In Nepal almost 50% of children under five suffer some form of malnutrition so I am really hoping to see some of the valuable work done in a rehabilitation clinic that is trying to address this. According to the UN it's one area that seems to be showing signs of improvement.
The second thing I am really keen to get involved with is one of the projects for street kids. Nepal has some 5-6000 street children and that number is growing by 500 a year. Most have run away from home to avoid domestic violence, heading for the bright lights of one of the big cities. What they find is usually a life of danger, intimidation and exploitation, leading the vast majority into alcohol abuse and the street kids food substitute of choice; a glue sniffing habit.
Finally, if that's not enough to keep me out of mischief, many people believe that Nepal is where Africa was ten years ago in terms of the HIV/AIDS epidemic. Although levels of infection in the general population are relatively low, certain groups, child labourers amongst them, are on the edge of an epidemic explosion. Children, girls in particular are often affected indirectly by being taken out of education to care for a sick parent.
Widows and orphans (who are often seen as "parent eaters") are discriminated against enough without the added stigma that HIV can bring. HIV+ children are not allowed to be schooled in mainstream education, a lucky few manage to find places in the small number of schools that have been specially set up, often staffed by HIV+ adults. I'm hoping that I will be able to spend atleast some of my time teaching in one such school.

So that's the plan when I'm there, I also want to collect some supplies to take with me.
I have written lots of begging emails and letters but as usual it was for the most part you generous people that have filled my suitcase rather than the big boys.
I have yet to put it all in one pile, .......................at present there are various smaller piles around my house.

A huge thanks to all of you that sent me toothbrushes, vitamins and "liberated" promotional pens from work. I have used some donated cash to purchase (at a big discount)12 kids polo shirts from Marks and Spencers while working there over Christmas and various second hand books and games from charity shops.
HOPEFULLY Etihad will decide to be benevolent and let me have an excess baggage allowance, Yes thats you ETIHAD!!!! ..........remember publicity can be both good and bad!!!

Final few bits to sort out this week, nit combs and scabies lotion...........I notice you were all too chicken to pick those from the list!!

Thanks also go to Morten Svenningsen a Danish photo journalist for letting me use one of his amazing photos, hopefully I will soon be able to take some of my own
.....................thanks Michelle for the use of the camera!
In the mean time take a look at the professional ones: http://www.lightstalkers.org/images/show/612621

I am currently using facebook
http://www.facebook.com/home.php?sk=group_171378486223965
but will be moving to here once I leave.

Itchy feet means its clearly time I was hitting the road again so it's a good job that next Tuesday is D-Day!!!!

Please please please get in touch if you can help, have contacts, hints or tips........

Thanks Alot Guys
Sarah x