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.