Over February and March of 2022, I had the opportunity to join Mountain Heart Nepal and its hospital Siddhasthali Rural Community Hospital (SRCH), in their work to create better access to quality healthcare for some of the most remote communities in the country.
My journey with Mountain Heart Nepal began at the end of 2021 when I contacted the organisation through its website. Then, I got in touch with Dr Aban Gautam – the founder of the organisation. He had taken the time to speak with me over video call and explain Mountain Heart’s story, its purpose, and volunteers’ role in helping the NGO achieve its goals. It was a conversation which left me excited and motivated to join them – not only because of the opportunity to learn more about the challenges of practising medicine in such remote areas with only very basic supplies but even more so because it impressed on me how this organisation would be making tangible improvements to people’s quality of life.
My time in the town of Hetauda (where Siddhasthali Rural Community Hospital is located) and the mountain village of Mundu (situated in the Langtang region where the SRCH satellite clinic is proposed to be constructed) was eye-opening and allowed me to understand better the true necessity of the work being done by this small group of people. Whilst there, I was involved in various healthcare-related activities, which included performing routine checkups, delivering lessons to underprivileged children, and giving input on a public health education initiative. All this was rewarding enough, and having this experience in a place known worldwide for its rich traditional culture and breathtaking landscapes made it all unforgettable.
Before heading into the mountains, I had the chance to spend some time learning about the country’s public health care system, as well as its customs and everyday life. Mountain Heart is currently in the middle of building a fully-fledged hospital in Hetauda known as Siddhasthali Rural Community Hospital, which, once up and running, will be available to the public on a ‘pay by donation basis’. It was here that Dr Gautam’s team welcomed me. Anil Gautam was the architect responsible for the building project. The immense hospitality he showed me was something I would come to know as a common characteristic of the Nepali people. In addition, Dr Aban’s mother, Goma, went out of her way to make sure I was always comfortable and, no doubt, well-fed with local food full of flavour. The short time I spent living with Goma impressed me with her vital role in creating the foundations upon which a family can grow and her support at home and in life, allowing her children to achieve their goals. Even during our time on the building site, I could see – she is a force to be reckoned with!
When I arrived in Hetauda, I was shown the hospital building site and the plans for its layout, which Dr Gautam and Anil had worked on together. Their combined experience in medicine and architecture came together to create a blueprint that used the space as efficiently as possible from both perspectives. I even had the chance to get involved at the site and get my hands a little dirty helping out there when I was not doing other work.
The plan for me was also to help out at a local clinic during my time in Hetauda, as the main hospital of Mountain Heart Nepal was still under construction. Whilst there, I learnt a lot about the public services available to people in Nepal, including the treatment of tuberculosis and the COVID vaccination programme. In addition, I was able to brush up on my obstetrics skills by assisting with antenatal checkups and even visiting a birthing centre in the area. I also had the opportunity to visit a local school and talk with the children about health and hygiene. This was one of my highlights as both the children and staff were very receptive and extremely grateful to have someone giving them a bit of their time.
My time in Hetauda was packed with different experiences, making it feel like I had been there for much longer than one short week. I was taught about local customs and beliefs by Anil, shared meals at the clinic and on the streets with colleagues, and was even invited into people’s homes when they recognised me outside. Every one of the people I was introduced to went out of their way to make me feel welcome and to show me a little bit about Nepali culture and ways of life, and I left Hetauda feeling fulfilled and immensely grateful.
The rest of my time with Mountain Heart was spent in the village of Mundu, located in the Langtang mountains at about 3500m elevation. Here you indeed are in the heart of the Himalayas. Mundu is a two-day trek from the nearest place accessible by car – Syabrubesi. From here, we ascended almost 1000m, passing through the small, peaceful communities of Langtang, where everyday life is still very much based on traditional Tibetan customs. As we moved higher, the landscape gradually changed from the lush, dense, green forest where monkeys swung through the trees to large open spaces where crisp fresh snow crunched beneath our feet and yaks grazed silently outside the teahouses. The journey was challenging but rewarding. My breath was taken away each time I looked up to see the scale and beauty of the mountains towering above us, if the increasing altitude was not enough to do that already.
Having arrived in Mundu over 30 hours after leaving Syabrubesi, I was stunned to find out how difficult it would be for medical help to get to someone in these villages within a reasonable time frame, especially in an emergency. On the second day, we walked through what was left of the small village entirely destroyed during the 2015 earthquake.
Hundreds of people died there that day, isolated and without any support from the country’s emergency services, which were being drawn to more central areas affected by the disaster. Everyone you speak to in Langtang lost someone that day, a brother, a mother, a friend, or a child. It is not easy to describe the feeling that comes over you as you walk over the rubble of what used to be a place where just a few years ago, people lived and worked, where children played and grew up. It is hushed there. A sea of grey stones at your feet and some of the tallest snow-covered mountains in the world towering above you. Nothing was left of the village except the one little house that survived that day, standing under the overhanging cliff that saved it from destruction.
The locals have lived in this region for many generations and have adapted to the tough lifestyle of being in the mountains. It is impressive to watch them transverse these trails carrying loads double their body weight. Due to the harsh environment, very little grows in the area, and families rely on the income generated by tourists. The trail up to Mundu and beyond is dotted with teahouses which provide accommodation and meals to those trekking in the area, and this is how many people make their living. A wandering foreigner can find a warm meal, a clean bed, and many friendly faces inside the humble stone buildings.
Once in the village of Mundu, I was shown the small clinic, essentially a 5x3m room with no medical equipment. It was the place where everyone in the Langtang region received healthcare. I was staying in a teahouse close to the clinic, and the morning after we arrived, I was introduced to a paramedic, Gajendra. As the sole healthcare worker in the entire region, he would be responsible for all issues that may arise. However, any new illness or injuries would need to be moved out of Langtang.
There are only two ways out of the mountains – a two-day trek down narrow, steep paths or a helicopter evacuation, the costs of which will have to be covered by the patient and their family and which are, needless to say, quite hefty. Only a few days before I arrived, a local elder had passed away due to a haemorrhagic stroke, which could not be dealt with in time. Unfortunately, as things stand, the people of Langtang have to sacrifice their fundamental human right to healthcare to continue living as they have for generations.
I experienced the vast majority of the people in Langtang had long-standing conditions. For example, many Tibetans living in Langtang suffer from hypercholesterolaemia, high blood pressure, and to a lesser extent, diabetes. This seems to be primarily due to a lack of access to fresh foods contributing to a poor diet and a lack of education.
Gajendra and I discussed ways to create more awareness within the local population based on this information. We created posters for the clinic and held talks for some people who visited. Unfortunately, it is tough for them to change their diet as this would require spending more money on buying and transporting food from better-connected areas. In addition, the community is trying to use some of the land in the area to build a greenhouse; however, again, this would require significant funding.
There is an intense desire amongst the people of Langtang to improve their quality of life so that they can take care of themselves and their families the same way people do in the cities, but for them to do so, they require some help. Dr Gautam and his team have taken on the responsibility of creating the opportunity for others to come in and offer their skills and knowledge to slowly help them reach their goals through establishing a satellite clinic. They had also received land from the community to build the same. As well as for those that do not have the luxury of donating their time, fundraisers are held to obtain some monetary support. Even a little goes a long way, and any kind of help is welcome, whether in manpower, medical know-how, or just a small donation. It will require a lot of people to come together for Mountain Heart’s humanitarian goal to be achieved, but it is attainable. And I can guarantee that those who chose to be a part of this project receive just as much as they give back. Ultimately, it is not at all a donation of services but an exchange of experiences.
About the Author
Dawn Grech is a licensed medical doctor with interest in emergency medicine. She completed her Doctor of Medicine and Surgery in 2021 from the University of Malta and is training to become Emergency Physician in the UK.