Page 2 Welcome 3 Welcome to Okhaldhunga for a Safe Delivery! Golden Jubilee Celebrations Who Are Today s Outcasts? Produced by

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2 Page 2 Welcome 3 Welcome to Okhaldhunga for a Safe Delivery! 4 Golden Jubilee Celebrations 5 Who Are Today s Outcasts? 6 Child Friendly Hospital 8 In Other News A Dream is About to be Made a Reality 12 The Year in Numbers 14 To Give 15 Produced by the Communications Team, UMN Editorial Team: Tuk Bahadur Harijan, Kristin Bøhler and Erik Bøhler Design: Phil Rawlings Photos: Mats Ivar Takle, Leif Gunnar Vik, Dorothea Vestøl, Magne Vestøl, Kristin Bøhler, Erik Bøhler and Erlend Berge ( UMN

3 Page 3 Dear It is so exciting to thank you all, the people of the Almighty God around the world, for your prayers, precious gifts and support as the physical means by which we impact on the lives of people, and for being part of our team during the past year. Two years ago, I took over as Hospital Director of Okhaldhunga Community Hospital. The last two years have passed very fast. On one hand, these two years have helped me become even more familiar with the hospital s curative as well as preventive activities. I now understand much better the perspective and behaviour of the staff, community, other stakeholders, political figures and government line agencies towards our hospital. On the other hand, they have been two years of struggling within myself, within the entire team. Continuous endeavour was needed to sort out additional land for the hospital extension; to bring the Master Plan for the extension of the hospital to completion; to face and solve the problem of shortage of doctors; and all the other problems. Facing and dealing with them have really strengthened me to stand even bolder. These two years have seen very good achievement, stories of happy endings when very sick people with all the odds against them survived as the result of the combined effort of medical care and prayer. There have also been the inevitable sad stories of severely sick people who either came too late in very poor condition, or with problems that were beyond our capability and resources here in Okhaldhunga. During these years of progress, we started the Master Plan, planning for the hospital s extension on newly bought and registered land. Recently some local people donated land worth more than NRP 500,000 (USD 5,880) to the hospital for the helipad and place for the generator house. As the result of progress on Master Plan, the construction of the access road and the TB patients residential building are in the final stage. The Out Patients Department building is half finished, and the Main Treatment Block is just below the plinth level. After the completion of these buildings, we will have infrastructure ready, but we will still have to find equipment and furniture, for which we need further support. We were only able to provide holistic care to all our patients and progress towards our Master Plan with all your help and prayer support. Thank you on behalf of the entire team of the hospital, of all the patients and their families, for being a part of all of this. Tuk Bahadur Harijan Hospital Director

4 Page 4 A successful emergency Our Maternal Waiting Home was used by 270 pregnant ladies last year. One of them was a young girl, pregnant for the first time. She stayed there from two weeks before term, and one day she complained of abdominal discomfort. On examination, she had a rapid pulse, and persistently very high fetal heart rate. This means the baby s life is in danger. So she was taken immediately to the operation theatre, and the child was out in fifteen minutes! It turned out that, as feared, she had had an abruption of placenta that is, the placenta had loosened from its place on the uterine wall. This can result in a lifethreatening hemorrhage for the mother, and no oxygen to the baby. It is an extremely serious situation for both of them, even in modern, Western hospitals. But this time it all went well, because we got the baby out in time. Without the Waiting Home, the girl would have had seven hours walk to the hospital! In a small place like this, where everyone knows each other, and their own job, things can sometimes go faster than in bigger settings. First time ever: TRIPLETS in Okhaldhunga Hospital! She was pregnant, but had a whole month left to term. She came here from Sollu, the neighbouring district, because the local Health Post found her belly was very large and she had very high blood pressure. An ultrasound showed there were three babies in there! She had severe pre-eclampsia, an emergency situation. So an hour or two after reaching the hospital, the surprised husband and wife were the parents of two boys and a girl. Anyone want to come here to give birth? The winning team! (left) Nirmala (in blue), who found the rapid fetal heart rate, surrounded by Dr Yagya and Dr Martin, who did the operation; Sister Bishnu, who gave the anesthesia; Dr Erik who resuscitated the baby; Kristin from the Maternal Waiting Home; and a small, happy family.

5 Page 5 50 years of service to people and glory to God! 2012 was a special year for our hospital. We turned fifty years old! March 14th was the date for the grand celebration. Guests of Honour The Norwegian Ambassador to Nepal, Mr Alf Arne Ramslien, laid the Foundation Stone for a hospital built on the same values which have been here from the start. Representatives from the local church read from the Bible before it was placed inside the Foundation Stone. UMN s Year Planner for 2012 was also placed there after Mark Galpin, UMN s Executive Director, read out UMN s Values. A local journalist added the day s issue of the local newspaper, and the box was made a part of the cement foundation for the new hospital building. Other special guests were Gauharka Rai, the village headman who provided the houses for the first dispensary nearby, and Ella Dick, daughter of pioneer founding doctor James Dick. Ella read a congratulatory letter from her father. After the ceremony, all the hospital s staff went through the whole bazaar to raise money, shouting, dancing and singing. Local shopkeepers were challenged to contribute to the construction of their own, new hospital. The text on the t-shirts is the hospital s slogan:

6 Page 6 Six strong men came with him some days later. A son who had been born just after his father was chained was one of the guards, as was an elder son who had been eight years old at the time, and still remembered his own fear and his mother s sufferings from his father s violent spells. There have always been outcasts people who are not welcomed, who are pushed to the edges of human society. In Jesus time, it was people with leprosy. They were regarded as religiously unclean, cursed by God, and posing a threat to anybody who came near. Jesus refused to accept this. He talked with them, included them, and even touched their bodies. For him, it was unthinkable that anybody could be excluded from the fellowship of human company. We say that he was, and is, The Great Doctor and we, as small doctors, can learn a lot from him. So, who are the outcasts of our time? Here is a story about a man who may represent such a group. When people from Okhaldhunga Community Hospital s Public Health Unit came to his village they found him in a shed, with his feet locked between two huge logs. There he had been sitting for 21 years. For all those years, the two logs had kept him from moving. Why? It started when, as a young man, he developed serious mental problems. He became violent, so violent that he was a threat to his family s lives, and his own. After a while, the family could stand it no longer, and the villagers chained him up like this. Since then he has been sitting there. Between the violent spells he was calm, and could do some simple tasks of work where he sat. Our community health workers found him when they did a systematic survey of the new area where they planned to start working. They got to know the family, and after a while convinced them to bring him to hospital to try medical treatment. He was put on large doses of antipsychotic drugs. Two weeks after starting the medication, he took his first tour out of the room where he had been alone with his guards - his first steps as a free man after so many years. We went for a walk around the hospital and greeted people we met. His legs were trembling and weak, but he was happy. He was discharged to his home a week later. Two months later, he was due to come for follow-up. I was hoping he would show up, and wondered how he would be. This time he came with his wife. She said: My husband has lost 21 years of his life. But now he is alive again, and he is just like the rest of us! He himself was just as happy as he looks in the photo, and his legs were now so strong that he had walked all the way to the hospital himself! The local radio station made a program about this case, interviewing the patient himself, his son, and hospital staff. A result was that shortly afterwards another acting-out mental patient was admitted. And there are many more out there. People with mental health problems, especially those with socially unacceptable symptoms, can be said to be the outcasts of today. As medical people, we have been given the necessary means to treat them, and thus bring them back to society. Psychiatric medication, psychotherapy, Christian fellowship and prayers help, and they are all available to us. The Great Doctor was concerned about the people with leprosy in his day. So we will be concerned with the outcasts of ours. Erik Bøhler Medical Coordinator

7 Page 7 Both husband and wife have given their permission for the publication of this story and photos. In their opinion, This ought to be known to all the world!

8 Page 8 For the last five years the hospital has been working hard to be a child-friendly hospital. We have used a number of tools to achieve this. 1st Tool: Free treatment for all children below 12 kg Families pay for the medicine, but nothing else. In five years, we have more than doubled the number of children on this programme, from 986 to Previously, very few girl children were brought to hospital, and less than 33% of all pediatric patients were girls. Last year, this figure increased to 44%. This is very encouraging! 2nd Tool: Good care for mother and child during and after delivery Expectant mothers can stay for free in our Maternal Waiting Home for two weeks before their delivery. After delivery, every mother has 24 hours in hospital to get the breastfeeding started before going home. Many mothers, however, need more time than that, and no one should go home before breastfeeding is working. The little ones get their own knitted incubator! (See cover photo.) 3rd Tool: Care for children with special needs After treatment in hospital, children with disabilities and malnourished children get a chance to stay in the Nutrition and Rehabilitation Centre, before going home. Like little Maya who was very anemic. She was weak, and did not play at all. She received a blood transfusion in hospital, and other treatment. Now, she is recovering fully in the Nutrition and Rehabilitation Centre, with nutritious food and play training. She loved sitting in the swing and singing in her own way.

9 Page 9 Ganesh before and after his operations From when Nabina was very small, she had pneumonia on and off, and her parents spent a lot of money on medicine. They also made many visits to dami jankris, the local healers. They had to pay them with hens and even a goat, but the child became weaker and weaker. No appetite, no strength to play or to walk uphill. 4th Tool: Child Rehabilitation and Child Heart fund Ganesh (top right) is one of many children in Okhaldhunga who have a new chance in life, even if they were born with disabilities in a poor home. A very unhappy mother came to Okhaldhunga hospital five years ago. Her child had a cleft lip and palate, and even his hands and feet were malformed. After delivery, the father was scared and ran away. Ganesh s mother was not alone; she got help here in the hospital to feed the baby, and assistance was provided for plastic surgery treatment in Kathmandu. This poor little baby has grown up to be a happy little boy thanks to this good care, and the father returned to the family after the operation! For the last five years, we have sent around fifty children each year through Sundar Dhoka Sathi Sewa, a faith based organisation in Kathmandu. They receive our patients, guide them to the right hospital, feed them, pay for their treatment and care for them in different ways. Their service has been possible due to funding from Samaritan s Purse in Canada. This year eight children from poor homes have received surgical treatment for cleft lip and palate. When they brought her to hospital, we found a cardiac malformation. The cost of repairing the damaged heart would have been more than the father could earn in a lifetime. We sent them to Sundar Dhoka Sathi Sewa, who guided them to Ganga Lal Heart Hospital. Samaritan s Purse paid for the investigation; Ganga Lal provides the operation for free to poor children. Today, Nabina is a joyful little girl who can play with other children, and no longer gets pneumonia! Last year we sent ten children (under 15 years) with cardiac malformations for treatment to Ganga Lal Hospital. That gave new life to the whole family! We had another poor boy who was 19 years old. He had been to Ganga Lal, but did not have enough money. Sadly, he died a short time afterwards in our hospital. Clubfeet Children born with club feet also get free treetment through this program. Children who would never have been able to walk, are treated soon after birth and are fully healed. From Okhaldhunga s Children and Social Service Department in Okhaldhunga Hospital, we give thanks to Sundar Dhoka Sathi Sewa and Samaritan s Purse. Kristin Bøhler Nutrition/Social Work Advisor

10 Page 10 The Wonder Story of Life A woman went into labour an hour s drive from the hospital. But on the way, and with still half an hour to get to the hospital, the child s legs and body were born with the head still stuck inside her! When they reached the hospital the doctors rushed in and with obstetrical manipulation the head was delivered and resuscitation started against all odds... Drama Behind the Scenes There was drama behind the scenes of the jubilee celebrations when an emergency cesarean section had to be performed, and a man with liife threatening bleeding was admitted. With so many guests, we were able to get the right type of blood for transfusions for both of them, which would otherwise have been difficult to get (one was Rh negative!). Thanks to all the guests, both these patients survived....and the boy lived! After the tough start, he had to stay in an incubator for the first couple of days. Here Mr Khamal from our laboratory is checking his blood glucose. Mother and son were discharged after a few days, both well. Now we hope and pray that the little fellow doesn t develop any further complications. B Positive He is 19 years old and has just given a pint of his own blood to his wife, because she bled during the cesarean section. His wife is alive, and so are his newborn son and daughter. Without the hospital he wouldn t have had any of them left. He shares his joy with us, and he reminds us about why we are here: administration, staff issues, moneymatters and new buildings, they are all important, but that is because they are preconditions for helping more mothers and children to survive.

11 Page 11 Four Heads are Better Than One We have had a good team of doctors this year. Here Dr Laxman and Dr Yagaya examine x-rays of a patient s ankle together with Drs Bøhler junior and senior. Four heads are better than one, and they can inspire each other. Mental Health Mental health work is a considerable part of the job here in Okhaldhunga, as anywhere else in the world. We see the whole range of mental problems, from anxiety to incapacitating depression and psychoses. Among the inpatients there are almost always some with such problems. But this is a field which is too often given low priority. It may feel more important to remove an inflamed appendix, than to treat a depression, but it isn t. Mental problems are emerging as one of the most important groups of diseases globally, and for many of them effective treatment is available. Five years ago Okhaldhunga Hospital decided to give special emphasis to this area. We didn t have the necessary skills and resources ourselves, so we developed a long-term plan together with CMC, a Nepali NGO which supports mental health work in the periphery. Specialists from CMC visit us in Okhaldhunga twice yearly, and our staff visit them in Kathmandu for training. Here Dr Prabin (psychiatrist) and Ms Baby (psychiatric nurse) visit to provide lectures and practical supervision during patient consultations, which are most useful. There are about 35 practicing psychiatrists in Nepal for a population of 26 million.

12 Page 12 Construction of the new hospital in Okhaldhunga started in December Three buildings are under construction; one single-storey building for Tuberculosis (TB) patients, one two storey building for outpatients (OPD) and a three-storey building that will be the main hospital building, containing all the different wards, operating theatre, delivery room etc. The TB building is about to be finished, the OPD building will soon have its first floor concreted, and foundations for two-thirds of the columns for the main treatment building are completed. We are about two months behind schedule. Many retaining walls, the access road and the water tank are built. Additional land and a nearby house have been purchased. Currently, the hospital consists of lots of small buildings located on different levels on a relatively steep hillside, and was built for 32 beds. Staff and patients often have a difficult time when there are more patients than the hospital is designed for. During the rainy season especially, staff and patients struggle as they have to move between the buildings to access wards, operating theatres, dressing rooms, x-ray, labs etc. There are often up to patients, plus their relatives and friends. The training hall is often full of patients, though it was built for meetings and training purposes. Sometimes we have even had to put up a tent. The new hospital will have 50 beds, and a master plan will be made, outlining possibilities for further extension if needed. The local community has been co-operative, and neighbours have even given a piece of land for a helipad! They are all eager to see the earthquakeresistant hospital becoming a reality. With a team of Project Engineer, three overseers and a foreman, Magne Vestøl from Norway is the Project Manager. Tundi Construction is the main contractor. There are several sub-contractors, and local people have the opportunity for a good income from the project. Construction work has been very entertaining for patients and friends coming with them to hospital. An excavator in action is not common here in Okhaldhunga, where there are no roads. Crushing stones using fire and water is also interesting. One of the main challenges has been lack of space for placing the new buildings, getting access to different sites, and storing construction material. Though we have bought some land, we still pray for more. The other main challenge is to get good quality materials delivered at the right time in a remote, often in-accessible place like Okhaldhunga. Getting the right manpower at the right time is also a challenge. When the concrete mixer needs repairing, it takes several days to get the right person to come from Kathmandu. The main work is planned to be completed in December this year. The main donor for the Extension Project is Normisjon, a Norwegian organisation. The Swiss Embassy has given a considerable amount for energy purposes and laundry services. Nepalis who have emigrated from Okhaldhunga have also supported the project, along with other individual donors. We are very grateful for this. We still need your help to renovate the old buildings and to furnish and equip the rooms in the new hospital. Please see To Give on page 15 for details on how you can contribute. Dorothea Vestøl Social Worker

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14 Page 14 It has been a busy year in the hospital as you can see from the figures below: This Last Year Year Outpatients seen 23,787 21,771 Emergency cases treated 1, Babies delivered Patients admitted 3,461 2,905 Surgeries performed 1,478 1,207 Bed occupancy rate 100% * 100% * * Okhaldhunga Community Hospital has only 32 beds but accommodates up to 50 patients. Friends of Okhaldhunga is also available in pdf format from the UMN website. If you would rather not receive a paper copy of our magazine or you have changed your address please us at: och@ntc.net.np Last year (15th July 2011 to 14th July 2012) this happened in Okhaldhunga Hospital: Ü 27,000 patients came to the hospital. Ü 2,509 of them needed help from the Medical Assistance Fund (MAF) to pay their hospital bill. Ü About NRP 3,600,000 (almost USD 45,000) were used by MAF. Ü In addition, 2,145 children weighing less than 12kg were given free treatment. Of these, 44% were girls. Ü 620 women were given free delivery services. Ü 272 women stayed in our Maternal Waiting Home until labour started. Ü 43 malnourished children were admitted in our Nutritional Rehabilitation Centre. Ü The number of major surgical procedures increased by 50% from last year. These figures have saved many lives. Many of you who read this have contributed to making it happen. The population of Okhaldhunga District sends you its sincere thanks!

15 Page 15 When donating to Okhaldhunga Community Hospital, please send us a letter or och@ntc.net.np (and copy to fin@umn.org.np) giving the following details: 1. Your name 2. Your address 3. The amount 4. The date of the transaction 5. The account number it was paid into (if by money transfer) 6. What area the gift has been given for (e.g. hospital extension fund, general use, training, etc.). Please also state clearly that the funds are for Okhaldhunga Community Hospital. All undesignated gifts will be used as needed. The above details make the tracking and allocation of donations much easier. Thank you. There are three main ways you can give financially: Internet Banking & Money Transfer Set up a payment or monthly standing order to transfer funds. UK & European Currencies Pay to: United Mission to Nepal Sort Code: Account Number: (Sterling account) (Euro account) NEPALI CURRENCY Transfer or wire to: Standard Chartered Bank Nepal Ltd. PO Box 3990, Nayabaneswar, Kathmandu, Nepal Account Name: Okhaldhunga Community Hospital Account Number: Swift Code: SCBLNPKA US Currency Standard Chartered Bank Nepal Ltd. PO Box 3990, Nayabaneswar, Kathmandu, Nepal Account Name: United Mission to Nepal Swift Code: SCBLNPKA USD Account No: NRP Account No: Please remember to note: For Okhaldhunga Community Hospital or For Okhaldhunga Hospital Extension Fund Donate Online Give via credit or debit card from anywhere in the world. For UK donors, this site offers tax-efficient giving. Mail Donations The other alternative is to send a cheque made payable to Okhaldhunga Community Hospital and post to: Okhaldhunga Community Hospital c/o United Mission to Nepal P.O. Box 126, Kathmandu, Nepal Again, please advise us that you have posted the cheque so we can ensure it arrives safely and contact you again if it is not received. Another safer option would be to send the cheque with someone visiting Nepal from your own country. If you contact us we can let you know details of anyone who may be traveling to Okhaldhunga in the near future. All donations made will receive a letter of acknowledgement and thanks. Other Options For help or advice about giving please contact och@ntc.net.np or look at our website:

16 Okhaldhunga Community Hospital United Mission to Nepal PO Box 126, Kathmandu, Nepal Phone: Fax: