Fotojournalist Erlend Berge » www.erlendberge.no

Okhaldhunga Hospital

I 2008 bodde jeg seks uker på sykehuset i Okhaldhunga i Øst-Nepal. Det resulterte i den dokumentariske boka “Life – in Okhaldhunga Community Hospital”. Boka ble trykket i 2.000 eksemplarer i Kathmandu. Venner i USA, Nederland, England og Australia solgte boka til inntekt for pasientstøttefondet på sykehuset. Til nå har boka samlet inn over 100.000 kroner. Her er et utdrag:


Life in Okhaldhunga Community Hospital

text and photos by Erlend Berge


A short visit to Okhaldhunga Community Hospital in 2004 made a great impression on me. I was immediately struck by the poverty and disease. However, behind this lie amazing stories of real people and communities rising to the challenges that life presents.

Again in 2008, over a period of six weeks, I experienced the life of a thriving hospital. Within its walls, a unique community of patients, caring families and staff exists. It is a hub where new friendships are made and mutual support given to previously unknown friends.

Lives are saved.

Outside the hospital walls, people live their daily lives. Men and women plant and harvest their rice, working on the steep terraces while preschoolers play nearby. Older children have morning chores, attend school and relish playtime climbing tall trees. Life is hard in this hilly region where farming provides the livelihood for most people. This is the backdrop for the significance of Okhaldhunga Community Hospital.

I hope the stories and pictures in this book will bring a far away world closer to you.

The most common health problems in Okhaldhunga are infections. Tuberculosis remains a disease of poverty in rural Nepal.
This is mainly due to malnutrition and poor living conditions. The hospital treats about eighty TB patients annually. Nine out of ten are cured following adequate treatment. Patients from “TB Row” are, from top to bottom: Tika Bahadur Rai, Nurbu Sherpa, Lakpa Sherpa, Jiba Sherpa, Rajendra Bishwa Karma, Nausari Rai, Karna Bahadur Tamang and Dawa Sherpa.

In a valley in eastern Nepal, just south of Mount Everest, lies a cluster of stone buildings. Okhaldhunga Community Hospital may not look like a hospital from a distance, but this little institution with 45 beds is making an enormous difference for 180,000 people throughout the district.

Here you get close to the core of life; its joy and grief, birth and death.

Not every story has a happy ending. Tuberculosis and typhoid fever are rife and have deadly outcomes in Nepal. These diseases could easily be cured with medicine.

In the 1960s Dr. James Dick was a surgeon in the Scottish army. There he met a Nepalese Gurkha soldier who asked him, “Are you really going to treat young Scottish soldiers for the rest of your life? Why don’t you come to a village like the one where I grew up? We don’t have any doctors.”

Dr. Dick rose to the challenge. He went on foot over huge parts of eastern Nepal to find the most needy area. One day he came to Okhaldhunga, but the people did not want doctors or medicine; they had been living for centuries without them.

Gaoharka Rai was just back from service in the British army and knew the importance of health and hygiene. He worked with Dr. Dick to get the hospital started. In cooperation with the United Mission to Nepal, the hospital was established in Okhaldhunga in 1962.

The hospital has had doctors from Japan, Australia, USA, UK, Norway, Germany and the Netherlands. Today, 95 percent of the staff are from Okhaldhunga.

Typhoid fever is a common illness in Okhaldhunga. It is usually simple to diagnose and treat. All it takes is a few days of antibiotics. Those who live far from the hospital and cannot afford to pay for being carried often arrive after several days of illness. This may result in perforation of the bowel with subsequent peritonitis, which requires long and intense treatment. Hence, mortality is high.

Sabita Poudel arrives at the hospital after having been carried on a strecher for ten hours. A team of twelve men from her village carried her. For a pregnant woman or a severly sick person, it can be a very troubled journey to the hospital.


The mountains and valleys make transportation within the Okhaldhunga district hazardous. Patients are often carried for several days to the hospital.


Most inpatients manage to pay their hospital bills, but for those who are really struggling, the hospital’s Medical Assistance Fund is in place. Applicants for social support from the hospital are means-tested according to the amount of land owned and what it yields. There are no safety nets provided by the government, therefore sickness can be a huge economic burden for families. The thought of an operation, long hospital stay, and the large bill to follow, is a frightening prospect for most Nepalis. Loans must be avoided, due to the unscrupulous money lending practices in rural areas.

Tir Kumari is at the nutrition center with her baby daughter, who needs an operation on her club feet. Her baby is also malnourished and must gain weight before this procedure can be done.

Tir Kumari Bastaula lives with her husband, her parents-in-law and her newborn child. She did not know that the man she married was in debt. One day the debt collectors came and demanded both their house and land. The family was unable to pay the debt of $1000.

“We live in constant fear of the debt collectors coming and demanding money. It is wonderful to be in hospital and far away from our problems,” says Tir Kumari.

Because they could not pay, the family members are now the slaves of the debt collectors and have to be available for work every day. Their pay is their breakfast and lunch; dinner they have to provide themselves. Their work consists of grinding flour, cutting grass, carrying wood and working in the fields. When the debt collectors do not insist on them working, they are able to get a day job. The women usually get paid one dollar per day, and the men, two dollars.

Khadar was the caregiver for his father Bir Bahadur. This involved cooking, washing up and doing laundry, a big responsibility for a teenager.

Sixty-year-old Bir Bahadur was carried on a stretcher for a day before reaching the hospital. He had a twisted bowel, and his body functions had come to a standstill. His condition was critical and without surgery he would die. Nevertheless, Bir did not want an operation. He had no regular income and had only a small piece of land to feed his family. His life savings amounted to twenty dollars. How could he possibly pay the hospital bill?

The Medical Assistance Fund covered all hospital expenses for Bir, including three operations and a two-month stay in the hospital. The final bill came to $800.

Bir is burdened with a large loan; if he had died on the operating table his family would have lost both home and land. Now, he hopes the money lenders will allow his thirteen-year-old son, Khadar, to take on his loan.

While Lilamaya is waiting for Prabin to recover, other patients benefit from her kindness.

Lilamaya Ale Magar went to the hospital because her two-year-old son Prabin was ill. He was admitted with a renal illness. Mother and child had to live at the hospital for two months. Though she knew nobody at first, she quickly made friends. Within a few days, she was busy preparing meals for ten other patients. Praban’s mother is not a unique example. Such friendships are being made all the time, regardless of caste. This would be unusual in life outside the hospital.

The caste system was part of Nepalese law until 1950. Sixty years later many high caste people are still demanding to be treated as superiors. They believe low caste people are here to serve them in this life.

The caste system is a living reality for many people in Okhaldhunga, where lives are determined by the family into which a person is born. The system dictates with whom a person can drink tea, eat food, visit and marry.

Staff belong to different castes and yet work together. Some patients react to being cared for by lower caste nurses, but staff refuse to endorse the caste system. There are also many high caste patients who don’t want to share the same kitchen as the lower caste folk. They need to accept that in the hospital there is equality for all.

Some years ago a study showed that twice as many boys as girls were admitted to the hospital. Why the disparity? A major reason is that the poor need to prioritize which children they bring to the hospital. Girls are a bad investment since they move out when they marry. This led the hospital to implement a new rule: children under twelve kilos are given free treatment. Now the inpatient gender balance has improved.

This child would have had less chance of survival without a Caesarian. Four minutes after birth the pink color of life returned.


In Okhaldhunga district, there are more than 3,000 babies born per year, yet only 250 women give birth in the hospital. A scant one out of five births is assisted by qualified health personnel in Nepal. The UN ranks the country as one of the worst in regard to child-birth related deaths.

Poverty is the chief reason why so many choose to give birth at home. Today, a birth at the hospital costs $30. Charity from the hospital’s Medical Assistance Fund is used to reduce the price.

There are many ways the hospital addresses the problem of high maternal mortality. “Waiting rooms” are provided for pregnant women, caesarian sections are available, and an incubator is in place for premature babies. Training to assist in child birth is given to women in villages across the district. These strategies save many lives in Okhaldhunga.

Last time Pun Maya was pregnant, the delivery started at home and she was carried on a stretcher for two days to the hospital. When she arrived, the baby was already dead. This time she came one month before term and gave birth to a healthy child.

Two months before full term, Amrita Rai began contractions and was carried on a stretcher for eight hours to the hospital. Here she gave birth to twins. At birth, Sisir was only 1.5 kg; his brother Basanta was 1.9 kg. When discharged, both babies were well over two kilos and were nursing successfully.


This man has just lost his wife in childbirth. With a young child already at home, he has his hands full. He has decided to adopt out his newborn son to a family in a nearby village.

Children climb and fall from all kinds of places in this steep country. It may happen while hunting berries for themselves or cutting leaves for their animals. Not all fractures can be manipulated and put in plaster. Some need an operation.  This is essential for children who will grow up to make a living as farmers in the hills of Nepal. It is hard enough to handle the plough with two healthy arms.


Many life-saving operations, such as the removal of an abdominal tumor, are performed under primitive working conditions. An ongoing challenge for the hospital is the need for a long-term surgeon.

 


Also read the story of Nirmala and her four children