Raw and Fragile Life in Rukum

©Vince Ng

Imagine fields of yellow mustard flowers as far as the eye can see, painted over a landscape of fast-moving rivers in the foothills of the Himalayas. Villages, comprised of brown houses that were painstakingly built by the hands of their owners, are perched upon mountain slopes that test the physical stamina of the inhabitants every single day. The tallest building in Rukum, a four story concrete warehouse, stands proudly in the bazaar’s dusty road lined by numerous general stores and chai tea stands. Caravans of mules with empty loads make their way back to their owner’s stable by memory, never caring about the honking rice delivery trucks waiting for them to clear the road. Children run and chase the ‘Suzuki Pulsar’ motorcycles that pass by, a manifestation from another realm. This scene is like a step back in time for me.

Every morning when the sun’s light touches the land, women with saals covering their heads and upper body emerge from their brick homes carrying large bronze water jugs and journey to the river below to fetch water. They sit and mingle while brushing their teeth by the water as the sun starts to warm up their bodies. The talk is usually about village gossip or that there are a few strange foreigners living at the hospital (namely me). Passing by, I let out a “Namaste Didi. Tapaain sanchai huncha” (“Hello sisters, how are you doing?”), to which their replies are giggles as they turn their eyes away.

I go for my morning rounds everyday to visit one of the five villages within walking distance. On occasion, I see some of the patients whom we treated the day before in their casts, lounging in their front yards. Sometimes villagers invite me into their homes for lemon grass tea. Others just want to show me their home and even chase me down to drag me back to their place. Their hospitality is so warm considering the very few possessions they have. It’s a dream for some to even own a few heads of oxen or cows because then they can sell the milk to the bazaar to make steady income (one ox costs about $300 CDN).

Mornings at the mission hospital begin with devotion and a daily meeting. Everyday, a different speaker talks about one Bible verse, followed by two or three hymns sung in Nepali. At 9am sharp, the day begins in the IPD ward as we follow up with patients bed to bed. The IPD has five main sections: Children, Female, Male, Intensive Care Unit, and Isolation. There are about 50 beds, hundreds of flies and no privacy. Two toilets are shared by the entire building of patients. There are about ten light bulbs for this building. The hospital runs on a gas generator, which costs about $10,000 a year for fuel and logistics. Considering a paramedic’s monthly salary is about $60-70 per month, the cost of running the generator is astronomical and economically unsustainable.

By the end of the rounds, there is usually a lineup at the OPD and ER in the front of the hospital. Patients with hospital forms in their hands all crowd in front of the door. The guards have been accustomed to making people form lines to wait their turns. The two Nepali doctors and one volunteer foreign doctor see about 100-150 patients per day. Dr. Simon, having immense experience as a professor of surgery in his university in California, usually takes charge of the ER. He helps to direct the young Nepali paramedics in their tasks.

Life is Rukum is raw and fragile, despite being blessed with such natural beauty. Being in such a remote region, serious and abnormal cases occur quite frequently. From my personal observations, the type of OPD cases in Rukum followed two main trends: freak accidents or illnesses resulting from living conditions. People in Rukum are still living in conditions that do not sufficiently protect them from the uncertainties of their surroundings. Homes are made without ventilation in the kitchens; there is no insulation from the cold or insects; water outlets are shared communally by an entire village; there are no toilets or a sewage system; garbage is burned in large open pits; roads are easily damaged by the monsoon, and malnutrition is rampant when crops become damaged or farmers go into debt; landslides sometimes cover entire houses.

Some freak accidents that I witnessed during my short time at the hospital included: a girl getting struck by lightning, a newborn baby with a physical deformity in which he had two heads, gore injury from bulls, snake bites, and injuries resulting from falling off a cliff. Other more preventable cases included pneumonia, diarrhea, leprosy, infection of injuries, COPD, TB, cysts and abscesses in newborns.

After my first two months in Rukum, I had already been exposed to more life and death than most people have seen in their lifetimes. As my work was coming to an end, my next stop would be Tansen Hospital (Palpa District) and Anandaban Leprosy Hospital (Kathmandu Valley). To reach these destinations, I would need to first travel by plane to the Indian-Nepali border city of Napalgunj in order to connect to a highway, and then take a one day bus trip towards Central Nepal. It was hard saying goodbye to my friends in Rukum whom I worked and lived with everyday and to the villages that had become so engrained in my heart.

However, I was very excited to go to Tansen, a city whose story and people drew me from Japan to Nepal, and to visit a great Japanese doctor whose ashes are buried under a humble tree within the hospital.

This is the second of a four part series about my time at the mission hospital in Nepal. To view pictures, click here. To read the first blog in the series, click here.