Monthly Archives: January 2012

Janakpur, Nepal

2012-01 Calibration study at 55%: Two days of organised Chaos with Janakpur’s children

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Well here we are again. I’m writing to you now after having just had a celebratory beer with Suzanne (although ironically she was drinking coffee, heading in one direction was I was heading in the other). I just submitted my job preferences for the next two years. I don’t hold much ambition that my preferences will get me very far but at least I got down on paper what was probably important. The suggestion from the school that I rank all 270 of the programmes was a fair if not depressing reminder of how arbitrarily I feel the whole process represents individuals. Anyway we will see what comes of this coming weeks and months. I’m glad to be rid of it as it has been heavy on my mind this week!

The last two days have been incredibly busy. We have had 85 children visit our study centre of which large proportion had been included in the calibration study which I am here to perform. The gods must have smiled at us because both days had fantastic weather – with perfect blue skies and warm sunshine – the various worries about my professor arriving, the strikes and the festivals preventing people coming were all fears to be allayed as the first drips and then drab and torrents of people arrived on Sunday. We clocked through at maximum capacity… bear in mind that we’re not simply talking about single children… We are also talking about all their family members who accompanied them on this, I’m assuming, special occasion of visiting the research centre. It was quite a sight to see hearing from the veranda 50 families gathered on our front lawn.

We used a wrist band tag system to avoid mixing children up. 50 kids can be easily confused from one another in the chaos!
The families of the children waited very patiently all day outside in the warm sun whilst we kept the children inside for the 4 hour waiting period.

I’ve been thinking for some time about doing a serious film down here. The ideas are formulating and we are collating various plans together which will hopefully enable us to get the shooting down before I leave in three or four weeks time. We have great potential to do something quite substantial here. During the last two days I managed to organise with the local staff and Delan filming of parents and children involved in the study – with progressively better success. We held pseudo-focus groups which I filmed on the front lawn in lull in the protocol when the children were under strict confinement with Suzanne inside who was kept busy all day controlling chaperones, traffic flow and doling out biscuits and fizzy drinks with military precision. Drinks, biscuits as placation tools aside one thing for sure is that you would never get 50 English 7-9 year old children into a confined space with such impeccable behaviour. The children were incredibly well-behaved and even in terms of the protocol performed far better in their task of giving saliva samples and did even my highly educated adult study sample from my bachelors year. So far we havent rejected a single data point… There’s no substitute for doing things carefully I guess. It brings a sincerely deep sense of satisfaction that all our hard planning has come to fruition and everything is running almost without a hitch.

The challenge now lies in populating the plot for our data range with children at the extremes of our size distributions. The main trick is that we are trying to do study which will train the larger population state using a technique of high accuracy than what we are currently using for that wider group. In order to do this we need equal representation throughout the whole range of our data even though this may not really be reflected in the actual numbers withing the population we are studying. In simple terms this means that we are targeting our most underweight and most overweight (relatively speaking) children from the study when they may actually only represent a small fraction of the overall amount included in the wider group. This being said we also have the lucky flexibility of being able to roll out the tests in children who are not involved in our study but are of the same age range from the local populaton. Hopefully we will be to conclude a whole rest of the calibration study in the coming days/weeks. In any event only have three or four weeks left here so they can’t be very much room for delay.

It is been a great pleasure to have Prof. Jonathan Wells here. I was remarking to Suzanne this evening that it makes me reminisce about my year in research and my dreams of one day becoming a full-fledged researcher. These dreams have come really muddied by school and all the various other ambitions I fill out my brains with – somehow talking with him again reminds of the the amibitons i developed a couple of years ago… Certain I’d like to do a Ph.D. it would really give me a chance to study some these are areas which I am very interested in but simply do not have the time to give much thought to currently. Trying to juggle medicine with design study and maintaining/establishing my business contemporaneously with working pretty full days doesn’t leave much room to manoeuvre in terms of slacking. I look forward to starting a Ph.D. if only for the reason that is specifically designed to enable you to pursue your interests and look after questions were striking after.

One of the main reasons that it’s a real pleasure to be back in the company of Jonathan, aside from the fact that he’s one of the most chilled out people and seems to exude “continuous positive regard ” (although he is a deep cynic when it comes to established societal structures (not necessarily mutually exclusive granted!)), he is also a incredibly stimulating person to discuss things with. Although for most an expert in nutrition and body composition reasearch, Jonathan’s a prolific writer and voracious reader with deep knowledge over many areas – so any discussion will always bring up the issue of your own inadequacy of knowledge in almost any area of discussion. He has transited through remarkable number of disciplines (starting out as an anthropologist) and his knowledge is so broad base that you can throw him into any discussion and he will always have an interesting and valuable contribution to make. It’s been a particular pleasure reminiscing and sharing anecdotes of the last two years. I have a deep and profound respect for this man who has taught me so much, not least of which is scepticism for conventional wisdom and recognition of the need to voice opinions on matters which are taken for granted that really should be debated. We share a similar backgrounds despite being of different generations. I sincerely hope that if I am not able to maintain my research interests….we will at least maintain our friendship.

So the coming days and weeks are filled with further work but should leave some room to manoeuvre on the many other projects I have boiling in the background – not least of which is medicine and the looming threat of finals). I have the pleasure of two more days company with Jonathan and a new training programme in photography and film which i am to be running for staff at the office before and after work….
Let me know what you think of the stories and the photos. There’s plenty more curiosities to be unveiled here in Janakpur!

Adios,

Seb

Janakpur, Nepal

2012-01 Saraswati: The Goddess Of Letters, Strings (And More) & New arrivals?

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Following a week of strikes we have shipped upon a festival period with a holidays on Saturday, Sunday and Monday (today). I’m not sure about the celebration on Sunday but today’s celebration reveres Martrys who died during the establishment of democracy in Nepal in the recent past…. But really the main focus of this weekend is to celebrate the Goddess of education which happened on Saturday… Huge investment has been made by the citizens of Janakpur in creating multiple small shrines across the city many of which had been blaring out ridiculously large amounts of Bollywood music at maximum decibel level throughout the day and night. Only now are people beginning to recover from this holiday hangover.

I’ve got a few recordings which I will upload in time which really articulate the hideous nature of some of this noise. Coupled with the almost nightly inter-street-dog savagery – listening from my window it literally sounds as if they are tearing each other apart – this is made for a series of disturbing nights for me these past few days. The merciless regimen of hourly outbreaks has really disturbed me and I’d imagine everyone else in the city. Nonetheless I have been getting more sleep than London so I cannot complain (although it may be argued that I am working harder? – Not sure – either way despite the chaos it is 1/5 is stressful as being back in the Big Smoke). I dont have to put up with Sawmill snoring or supermax TV volume back in the UK however.

Delan and I were discussing cultural aspects of noise pollution. As far as we can determine there doesn’t seem to be the same level of concern for others when it comes to music. Suzanne chipped in as a warden in student halls she always had trouble with loud music complaints from students from the subcontinent. Culturally It is entirely acceptable to play loud music in the company of other people who have not expressed any desire to share in your experience. Herkening back – A classic example of this was in from Pachmari, India where my friend Adam Byrne and I had taken a hike to escape the chaos of the town which for two days of the year (the two days we were staying) becomes a Festival (which mean Landrover) Hub and the local population doubles in size. We reached the top of Pachmari hill and began gazing on the incredible panorama before us… and suddenly out of nowhere a young boy turned up with his phone and started playing loud music to his phone – completely spoiling the atmosphere and the magic of the view we were experiencing.

Noisy Boy - Pachmari
You can’t escape the noise – even if you try in Indai
Pachmari HIll Viewpoint
When the boy left Adam and I were able to enjoy the Epic view we’d climbed for!

START RANT Festival side I don’t see the value in such indiscriminate use of volume upper on your oversized Sound system when really the only person you are seemingly entertaining is yourself stop when it’s also 4 AM and I’m having to visit the bathroom once every 5 min because I’ve got gastroenteritis from violent and malicious local bacteria or viruses which I have only come into possession of a result of poor hygiene of everyone (effectively including myself as well as frequently there is no running water when it comes time to do it have a wash of les mains END RANT. I think it’s just a bit much sometimes to be constantly assaulted by noise. On the flip side Jonathan’s very much enthused by the music… I guess having a short duration’s fine to sample but living here…

Mob of children in Janakpur
Walking into the bedecked schools I was mobbed each time. Thankfully my companion Sophiya kept the best of them at bay.

Anyway back the the matter in hand: On the day itself (Saturday) everyone rolled out their finest garb – as it was celebration of education children were everywhere abound on the streets, dressed to the nines. Each school had something of an open day, revolving around its shrine of the Goddess Saraswati. It turns out that nearly office there are something like 10 to 15 local schools so I went with Sophiya – a new recruit here, posted from Kathmandu who explained the local customs and helped stave off the insane mobbings that would occur anytime we entered a school. Together we transited all these different schools. Was quite interesting to see how some of them are put together for example the Einstein Public School, an impressively fronted establishment which really on the backside is just one single classroom and a large space in which to accommodate children outside within a retaining wall. Apparently the classes rotate from early in the morning sessions to mid morning to late morning sessions, meaning that the school is run in two batches. We paid our respects to the Goddess and each of the schools and were offered by attendees a small gift of sweet things to take away. I got daubed with red on my forehead which mustered bemused Jonathan when he met me off of his flight from Kathmandu.

Saraswati: Goddess of Education

The positivity of the day extended into the night with many people partying onwards. Sunday was deadly quiet in comparison – with no music overnight and a sense of “bank holiday” in the morning as we were rolling out to prepare for the study day.

Suzanne recently discovered that the shrine which I have been observing being steadily built on “Barhabigha”, the vast open public ground which serves many functions including religious prayer site, back gardens of the hospital, cricket ground, volleyball pitch and local bus parking stand, is due to culminate in attendance of approximately 1,000,000 people in the city on 7 February….this seems rather insane and I must admit that I’m somewhat acceptable about this number… But even a 10% representation of this group means a hell of a lot of new arrivals in the city. I better clean off my memory cards and make sure that I spent some time down on the ground that this is indeed the case … the thing is that I would I genuinely not be surprised if it did happen . I guess I will be reporting soon on this!

1 million expected for Festival in Janakpur
There are supposed to be around 1.000.000 people coming to Janakpur to celebrate a large festival on Barhabigha
Janakpur, Nepal

2012-01 Missing photos

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I promised photos yesterday but didn’t deliver because of an arbitrary problem with the internet. further serious issues with the internet – not sure what’s going on – but here are a few of the shots from this week in any case….

A white face is such a rarity here in Janakpur – I’m constantly followed by gangs of local kids
Mists in Janakpur
Fog closing down the near sight visions – people creep suspiciously through the mists
Long distance Rickshaw - Mahotari
Rickshaw cyclists travel for miles out to the sticks – one of the only forms of transport alongside oxcart and infrequent public buses
Buffalo Janakpur
One of the most prized possesions of the Janakpur family. They’re not cheap – weighing in at around £500 – which in Local terms is an absolute fortune.
A local farmer in the villages of Mahotari – the adjacent district to Janakpur (Dhanusha district)
Janakpur, Nepal

2012-01 Riots and Festivals: a week off for Janakpur (but not me!)

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Back again after a week’s absence.

It’s been an incredibly busy week somehow… great intentions to write but decided to catch up on some sleep which has been rather lacking since I got here to Nepal.

I therefore propose that this be a brief post. Consisting mostly of photos – hopefully a picture will speak 1000 words?

We prepared the ground to run the calibration study on Sunday and Monday but there are many factors which may prevent us from doing this. As Rita, a friend who is currently working in Kanti Children’s hospital with two other UCL colleagues, mentioned in her recent post that “there be strikes” in Kathmandu. Janakpur is no exception, indeed we’ve had several days of strikes this week including a student strike. people strike all the time in Nepal – there are many issues of contention and the government is still not very stable. Between the price of gas, the price of electricity and various groups lobbying various causes ( I won’t pretend to articulate any knowledge of the intricacies of this)…. It’s a wonder how any work is done at all – indeed on a national level what is this doing to the economy I wonder? Furthermore the next three days are also festivals so effectively the whole city has shut down for the week. Delan, Suzanne and I have been pondering over dinner how people keep going financially… Everything shuts including small corner shops. It seems that there is pressure on those businesses which remain open – even riding down the street on a motorbike is apparently taboo. We’ve also had two days of incredibly heavy fog they would have been called a “Pea Soupers” in the olden days. Photographic opportunities aside this poses a major problem in that flights cannot land in this weather. My professor, Jonathan Wells, is expected tomorrow and I sincerely hope that the fog which we had today doesn’t visit us tomorrow otherwise he may be joining us on Sunday, Monday – or not at all as he flies back to the UK soon after! There are a myriad of other possible problems but Delan and I have resigned ourselves to certain truths about the situation and we shall make the best of it. The MIRA whole team is behind us for the two days including Suzanne who’s kindly agreed to help us manage the children during a four hour waiting period – playing militant dinner lady by controlling their consumption of fizzy drinks and ONLY fizzy drinks in the layover period (toxic stuff called “Miranda“). We’ve invited around 140 children down to the centre and have no idea how many of these will actually come on time or even on the right day! (Oh… and several family members may well come down as well – it’s going to be hectic to say the least).

Most of this week has been my working on the film which provides information needed to gain consent from the parents (and to standardise information delivery as we’ll be dealing with a large throughput of people). We shot the film on Saturday with through the staff’s children. I had Sonali, Sushil several others helping out on the day as well as Delan who was our “sound man”. Sonali and Sushil have been a great help, Sonali in particular has taken a great interests in the process of production of the film. In many ways is the first film which I have so thoroughly planned and shot. It has taken several days both write the script, to shoot and even more to edit. I’m really pleased with the finished product – even more so considering that the voice-over is in the local language “Maitali” – this has been somewhat hellish to sync correctly as I have next to no idea what is being said but somehow we managed it.

I’ve also been out into the villages this week, riding on the back of Rupesh’s motorbike through the dusty hazardous roads that fallout from Janakpur main. Rupesh is one of the staff at MIRA who’s trying to convert me to Paan – a betel leaf snack shoved up inside your lip and chewed out slowly over and hour (with obligatory “hocking” of the red waste onto the floor). Travelling outwards the contrast between the city and the rural regions is incredible, even considering the basic (by our standards) standard of facilities in the city main. It is a beautiful country however – at the moment yellow oilseed rape (far as I can tell) is growing in the fields and the flat hazy distances with spires of cooking fires and village temples in the distance are incredible to behold. The roads are god awful. I always felt a pang of pity for rickshaw drivers carrying their passengers out to these sticks the distances that they cover simply passed and one things for sure they will be to charge a tourist rate! Stopping in the villages I attracted a great deal of attention – naturally it’s not every day white faced man hulking a huge camera comes sailing along. I was cautious of my camera but I got a few lovely shots of the locals. I spent a great deal of time shooting from the hip on the back of a motorbike – such a great deal of varied life passed us by as we sped along. People are really very poor here but everyone seems happy – at least as far as I can see. I wonder if you transported one of these villagers to London and asked them to observe the people there – would they say the same of Londoners happiness? I would guess not.

On the subject of photos we engaged an incredibly interesting focus group on ethical photography of children in research settings, organised by Delan. Somehow managed to engineer a five valent Skype call between Nepal (3 of us), London (3 members) and Edinburgh (1 member) – I was impressed by our having manage that – but more so by the discussion of the various issues surrounding the topic in question –  Consent for photography and stability usage of these photos by the group. Experience was very interesting to hear the different perspectives and also to try and equate them to my normal “travel standards” and how I found myself operating in capacity as photographer at the Children’s Hospital in Kathmandu… The idea anyway once Delan and his colleagues have fought through all the qualitative data is to collate a set of ideal standards are taking photos in this research setting. The challenge granted that something which would be quite helpful both in raising the profile of the issues/challenges and hopefully providing some kind of guidance. I’m of the opinion that from here on in the expectation will be for more visual content in research be it photography, video or other media and as such these kinds of issues do need hashing out relatively soon.

Tracking back a bit I also had a great pleasure to visit Janakpur’s famous “Jhanaki Mandir” temple with Sonali after we had conducted the major filming on Saturday. I was able to film within the temple grounds as well as small clip of a group chancing a mesmeric song which was re-echoing round the walls. The indolent cows amused me, the sights and smells sent lights flashing around my brain and I received with bemusement the attentions of all the locals who were visiting the temple. I think my being with Sonali and actively engaging her (I was in the process of teaching her further film techniques) somewhat staved off their intrusions although a few of the bolder ones still pushed forward to introduce themselves and ask “which country?”.

Finally – I’ve been ranking my jobs for next year this week  – a form of slow torture. My quandary is because of the curious allocation system with which doctors are assigned their jobs (FPAS) I am in the bottom quartile for my foundation school – so have to rank all 270 jobs on offer for next year. It’s a total headache as there are so many different factors which come into play in deciding whether or not the job is good or not. In the end I came up with a sort of algorithm – a points system – and I’m simply going to submit without really much further thought into the matter having wasted already five hours this week. This may not seem like a lot but bear in mind that my choices may very well have nothing to say on the matter of which job I get – given my position in the rankings. Plus it really is like stabbing yourself repeatedly in the eye at times trying to differentiate between these jobs.

Anyway having said I’d keep it short – I’ve obviously been proven liar… Oh well.

I have a few more specific posts and like to write in the coming days – so tune in for curious stories about “the Hotel menu: A-Z”, “my hat” “tea in the morning” and “Power in Nepal  – living by the generator”…  etc etc. Janakpur remains a complete curiosity – although there is very little to do here apart from work there is much to observe upon and to mull in one’s mind – politics, health and life and death – the cradle of human experience. A very curious place.

Adios for now – my next post may well be after the study’s finished!

S

Janakpur, Nepal

2012-01 Power cuts and the perfect place to study

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It’s Friday night and I’m sitting once again in my hotel room.

The brothelFirst of all I have some good news. I went shopping yesterday and bought a 35 W bulb. This may not seem like much for those of you who used to burning your 60 Ws back in London but in here it makes a huge difference. My room is now clinically bright – and the pleasant news – is not as dirty as I’d feared it would be when suffering this illumination. I did buy a bottle of “Colin” cleaning solution (this seems to be the only one you can buy in Janakpur) a mysterious blue substance which professes to give a winning shine to any surface. I half suspect that the chronic dust from the streets here in Janakpur precludes any real use in committing to thorough cleaning. For the minute however I am satisfied that I have a certain degree of autonomy over this space for the next five weeks and as such will try keep it as the French say “propre”. Take home message: Starting to feel at home.

The Palace of Light
After installing a 35W bulb

Things are progressing nicely along at work. It’s been quite a busy week getting to grips with planning the project ahead but we have made real progress and seem to have established a plan of action for getting the study done. If, and this is a big if, things go to plan directly we could even have the project finished within two days. Experience, both my own, and that of Delans, Suzanne’s and pretty much anyone else have spoken to tells me however that things are less likely than more to go to plan – but even if we manage to get 50% of the project done through this scheme then we are well on our way to early completion.

The basic plan is to invite a large number of children who are present in the wider follow-up study to the centre to conduct the test on one of two coordinated days in which we will have most of the staff members from the office at our disposal. In addition my old supervisor Prof Jonathan Wells, one of the world experts in paediatric body composition (handy to have on the study no?!), is flying in to visit the site and to help us on these two days. With such a narrow window of time for him to be arriving it is just our luck that the days in which he is around our three national holidays one of which “God of students” day, means that none of our participants are likely to be outcome to the centre. Factoring in possible delays due to problems with taking off from Kathmandu (domestic flights are very frequently delayed or cancelled because of difficult takeoff and landing conditions), there exists even the possibility that he won’t make it down to the site having come all the way to Nepal. I sincerely hope this doesn’t happen as I’m very much looking forward to having him join us here and to experience this incredibly interesting part of the world.

Life here in Janakpur is remarkably regular. I am in for work at 10am, leave at 5/6pm, join Delan and Suzanne for dinner in the hotel (apparently the best restaurant in town) at precisely 7:30pm (although I am always late of course!) and then retire back to work from 9:30pm till 2am before getting some shut eye.

I once dreamt a few years back but being allowed to be left alone to study and work. It may seem strange but this is one of the closest environments to which I’ve been able to achieve this. In London my life is fettered by numerous tasks, administrative or otherwise which are a constant distraction and impediment to progression. A Spider network of social connections, I find myself as I flip between tasks being something of a social butterfly, and a manic family makes life awfully complicated at times. The upshot is that my desired output in photography, film, design, websites, research and of course my ability to study for my medical degree is reduced as compared to some potential imagined maximum. Don’t get me wrong, I still am able to get to grips with most things but often be juggling so many balls and being so snowed under that I can barely see for looking as to the way ahead. Somehow Janakpur for seems simpler. There is a defined job for me to do here – all of my worldly needs and comforts are addressed by living in a hotel – Things are cheap so I don’t have to worry about money – people are friendly and I am left in peace to get on with my work. The only mild discomfort is the frequent “load-shedding” (central electricity power cuts) as I type we’ve just flipped over into “load-shedding” so I have flipped on my recargeable LED side light. For a guy who travels with 2 multisocket adaptors – I have had to become something of an expert at managing the power consumption of my laptop juggling battery recharging versus the schedule of power cuts.

Film Training team
Filming training team: Delan, Chaube, Sonali and Sushil

If the current rate of progression continues I should come back to Kathmandu in five weeks time with lots of lines scored through on my to-do list which believe you me is many miles long. We will see as we go on this topic but suffice to say that this week I’ve been able to finish one film, click the study rolling and organise a complicated photography shoot (as well as training) and have tackled two websites to the content building stage (the structure, the wireframe is in place, we are on a testing server and we are ready to start throwing content onto the pages. This is actually one of the simpler things in website building it seems – design something I’ve taken up the last six months in earnest and has been studying really could extensively but have only now reached the stage where I feel confident in building robust websites. Adding to my work list in the coming weeks will be my own website which is currently a flash creation which is no use to anyone with an iPhone, and iPad or anyone on anything slower than superfast broadband (takes me about 10 min to load my homepage here from Nepal).

Lots to do, lots to do.

So – tomorrow is a video shoot. We’re shooting the “explanatory” film for the calibration project. I had the pleasure of training three of the MIRA staff members, Sonali, Sushil (also tomorrows star actor) and Chaube today in the rudiments of filmmaking and photography. We went over the principles of aperture and shutter speed, focusing and basic sound recording (Delan’s going to be my dedicated sound man tomorrow). It was great to see their interests and desire to get involved. I’m incredibly keen on the idea of providing training in developing skills the names of staff here at the centre so that they can increase their portfolio of skills and hopefully in future (with the right equipement) using this to promote the work that is done down here. I’ve also had several radical ideas about website development of local institutions here. Specifically I think the local hospital could use good website. I was wondering if they might use it to advertise their services and also to link with other institutions, both within Nepal and internationally, perhaps to gain donations to help investment in hospital medical technology and general service provision. If this idea materialises, and if I have time in my spare 5 min, I will write something on it (and hopefully show the finished product when it’s done!).

For now of a few more changes to make to Kanti Children’s Hospitals new website. And then planning to curl up with the intriguing Stephen D Levitt “Freakonomics“. More on easy reading with the iPad in future I’m sure but for now adios.

Janakpur, Nepal

2012-01 Nepal: Three days in rural Janakpur

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Well, here it is – my very first blog post.. after all these many years….Really, this time of travelling I had intended to set up a blog before I went away…but in the maelstrom of activity since, well since as far back as I can remember somehow this idea got shelved temporarily. Anyway here we are.

Back in a Brothel?

As I write I sit watching the blinking red electricity bar above my red lit room lamp at 1 AM in my grimy little hotel room in the centre of Janakpur. Next door there lies a man who’s snores I have never heard anything like. Yesterday, I was concentrating on something when I remarked to myself “I wonder what they are drilling at 11 PM at night?” – Today I realise that that great cacophony, mercifully becoming more intermittent as the gentleman slips towards progressive sleep apnoea, eminates from the rotund occupant of my neighbouring room. The whole place has an air of a brothel, at least from my perspective sitting in the corner of this shabby room and it’s curious red light, with my belching companion next door – I am sure my old companions Laura and Catherine would revile this a trip down memory lane here (Glouchester place 164a 2009 – The Brothel). However the rest of the hotel is fair, if a little quirky, so I shan’t complain too much. After all I am only paying £4.60 a night for two beds hot water and electricity which in the grand scheme of things is pretty okay by me. I have certainly stayed in far more expensive abodes with far more inferior specifications… (I do miss my lovely room in the hotel Courtyard though)…. (Hotel Courtyard). I’m sure I’ll write more in the future about the bourgeois foreigner lifestyle of living in a hotel for three months but for now I’ll crack on.

Working hard

So, I’ll be up and about six hours to get ready, answer a few e-mails and head across town to the office. I’m here in Janakpur working on my SSC ( student selected component for those of you who are not up with the medical school lingo) a research SSC performing a calibration study children on who are in the process of a second follow up trial  being followed up having themselves been being born to mothers who were enrolled in a trial looking at the effects of supplementary micronutrients in 2003 and 2004. (Lancet). The organisation is I’m working alongside and under the auspices of is called MIRA (LINK) or Mother and Infant Research Association. They are a non-governmental organisation, working towards the general betterment of health for women and children in Nepal. I’ll talk more on this subject later I guess but for now saves me just the need to say that things seem to be awfully complicated at work but we are making progression and with a little luck and hell of a lot of  organistation we should get the work done in the next few weeks.

My job

My role here really is to assist my supervisor Delan Devakumar, a paediatrician by training but now Ph.D. student and soon-to-be public health trainee who currently undertaking his monster of a Ph.D. here in Janakpur (follow-up study of over 1000 children who are scattered across many different districts in this incredibly rural part of the world). Some years my senior, he’s taken my help, for what it’s worth, in conducting this calibration study. To cut a long story short essentially this “calibration” directs the wider study (the 1000 children follow up) by creating a specific equation for one particular machine which we are using here in Janakpur to follow up the children. The technical for the equipment in question is a bioelectrical impedance analysis (BIA) machine, brand “Tanita”, Japan. Some of you may be familiar with these machines from your local gym… it would be the machine which you step on in the corner (possibly charging you £1 for the privilege) which gives you all sorts of remarkable statistics about the percentage body fat and bone mass etc etc. It’s incredibly cheap and efficient once you’ve bought the kit to keep rolling off data from these machines (providing you buy the right one mind as the cheap ones really are a waste of time) – they barely have any running costs and are really not that hard to use… although we have run into quite a comically ridiculous situation with the first group of children we run through the study (more on this later – it has something to do with the arm position of the children holding the paddles on the machine ….Insanely frustrating situation we find ourselves (or rather Delan finds himself) in!).

The science (sort of)

So…  You might wonder how such fabulous information is gained just by standing on a machine which sends an imperceptible amount of electricity through your body and prints out detailed results within seconds. Essentially it’s a derivative process, the machine takes the resistance pattern in your arms, body and legs and combines them through a series of complex equations to produce all of this supposed percentages in weight. This being said, depending on the machine, the actual accuracy of this really can be anywhere from questionable to downright wrong. This is not to say that the machine we using is completely useless it’s just that it has to be taken for what it’s worth which is very much derived process. The calibration I am performing involves using a far superior technique “total body water analysis by deuterium dilation principle ” aka “the heavy water test” (well, maybe it’s not known by that but anyway that’s what it is). Using this technique, we measure 100 children of varying body mass indexes and also do the “body composition analyser” test with this group. Working with the results we get from the one very accurate test we are able to “train” and equation for the wider study population. Quite a clever way of getting around the problems with the BIA machine.

Polluted air

Once this study is done, I’m also set to help my fellow medical student although also in reality senior colleague Suzanne. Suzanne has got an impressive history in academia, having already completed a Ph.D. in epidemiology and has since found one of the most interesting target routes to completing medical training that I’ve come across to date – it’s not quite clear to me but it seems to involve veterinary medicine, several different schools and have a lot of hard work! She’s an incredibly efficient worker and in many ways a polar opposite to me – she will be up in 3 1/2 hours precisely to go for her morning run! She exits Nepal earlier than I do, so I’ve agreed to carry on her primary data collection after she leaves to help here add to the mountain of data she’s already collecting on indoor air pollution.

Janakpur Cow Driven carts

The main Point

But, I feel I digress from my main point and probably for those of you reading the main interest. Life here in Janakpur is good so far. I am set up and enjoying the work so far. The noxious smog which tends to build up in a Nepalese cities isn’t so present in Janakpur. Instead there’s the lively smell of filth, stagnant water and mulched organic decay kicked up from the roadside piles that line the street or indeed are simply generally placed for you to navigate as you bring your way through the crowds, rickshaws, cows, dogs, pigs and screeching motorbikes. It certainly adds interest to journey to work and I can’t help but smile at the local citizens who stare absolutely dumbfounded at my white face, wondering perhaps, “what on earth are you doing here… I mean really – what on earth?”. I try to stroll confidently along, all the while drinking in the sights and smells and occasionally, capturing them on my oversized camera which seems to bring equal amusement as my peculiar features. My leaden arm extension does not just bring amusement to the local denizens but also to my colleagues.

To be continued…

So…hopefully in the coming days and weeks I’ll be able to continue this blog, and perhaps also begin to start recanting my initial foray Kathmandu which was quite an adventure in itself (although really a testament of long and heavy work rather than any of the usual travel stories – certainly a different style of travelling). I’ll be sure to post regular photos and to try and entertain you with quips and anecdotes from this quizzical country.

Best wishes to you all and welcome to my blog!

Seb

Kathmandu, Nepal

2012-01 New Year’s Eve in Kathmandu: Quick friends and the Qatar crew

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Nepali Wedding - NYE
At the entrance to the wedding

New years eve is always a bit of a conundrum for me in that I’m never quite sure where to place myself. My friendship group in London town tends to celebrate the occasion together with the birthday of our friend Lauren who was born on the last day of the year. This year I knew that things would be tricky socially having just arrived in the country but I expected at least to fall on my feet with regards to some party or other. Having been heavily involved since my arrival with editing the county souvenir, when the day came I spent the early part of the evening attending first a “homecoming wedding” with Dr. Ajit and his family of a family friend who’s daughter had just returned to Nepal having got married abroad some months ago. It was a good perspective on Nepali weddings – large events – lots of food and many extended relations and friends in attendence. After this Dr. Ajit and I went back to the editing grind and in the event we ended up editing articles right up until the witching hour. Dr Ajit dropped me back my hotel at 11:45 and I rushed out, bought and quickly polished off a beer on my way to the to the nearest bar in the centre of Thamel. With literally 5 minutes to go I rolled into “Paddy’s Irish bar” paying the exorbitant Rs.400 entry fee (about £3) and laid down a further thousand rupees for a double Scotch whiskey.

New Friends at Paddy's Irish Bar
New Friends at Paddy’s Irish Bar

With 1 min ago I turned to the nearest people at the bar an Indian lady from Mumbai and her colleague and introduced myself before the lights suddenly went out and we started to wish each other a happy New Year. Actually it was just load shedding kicking in prematurely and there was some fiddling before the generator kicked up and 30 seconds later the band then called down the New Year proper. Somewhat confused and laughing we then did the whole well wishing process again with the traditional embrace of the New Year. Everyone was quite merry so I needed to play catch up pretty swiftly. I introduced myself and got acquainted with the gaggle of people who are gathered near the bar. A couple from Delhi, my new friends from Mumbai and team of Nepalese physiotherapists with their expatriate volunteer colleague from Scotland. We exchanged pleasantries and commentaries about our times in Nepal. Most people are coming to the end of their journeys it seemed, celebrating the New Year before heading home to start work in the new week. I tracked over to the other side of the bar and encountered an English accent on the air. Sitting down I joined a group of English speakers all of whom were apparently teachers working together in Bhutan (as far as I can hazily remember). It was one of those kinds of nights that is truly international. Not knowing anyone really particularly well we forged something of a improtu gang ready to take the night on head first…. however just as fun was getting started the party was closed down. In fact all over Thamel all the bars shut at 1am and in a moment literally thousands of people were on the streets. I remember thinking at the time that if one place had a late licence that they could literally print money by the sheaf. But in the end, not for want of trying, our gang could not find a place to carry the party on. For about 20 min we searched hither and thither and “queueing” for bars which were apparently still going on underground. Having been in this situation quite a few times in the past, without a formal plan of action, I sensed doom on the progress of the night.

Aye Aye Captain!
The riddling captain and my new friend from Mumbai.

However all of a sudden the minibus appeared out of nowhere and a British guy jumped out and started directing people inside. My first thought was that it was some kind of press-gang arrangement where we would be taken to one of those “exclusive bars” and be charged a lot of money. My danger sense was wrong however and actually it turned out to be genuine so I jumped in and introduced myself to two lovely ladies who I found myself sitting next to. Our team which by this stage included the Mumbai couple, the Delhi couple and a few other stragglers also piled into the car. I quickly found out that as circumstances would have it we had joined an entire Boeing 747 crew from Qatar Airways. The British chap who jumped out was the captain of course – and the two lovely ladies were naturally air stewardesses. After five minutes of general hilarity we settled into further discussions about who had come from where and what the plan general was. We were already on the road and rolling… I had no idea where we were going but we trundled off in the minibus somewhere as far as my sense of direction told me to the south west of the Thamel area. People kept saying “Park Plaza” which I took for a hotel destination. After a time and a chance for more extended introductions we eventually entered a large walled compound of, evidently one of the most expensive hotels in the city. Arriving en masse as we did our party then divided into two. The first group stayed with me and we managed to reopened the bar whilst the second group went off to ply the casino. I can’t say anything particularly important happened in the ensuing hours but we enjoyed each other’s company in the fashion that tends to happen when you’re with people you’ll likely never see again – fresh and disinhibited (or maybe that was just the alcohol?). We shared some stories and I was quizzed about my “small camera” (5d with 35mm f1.4) I was particularly impressed with the riddles of the two pilots – I guess they’ve a long time to train their delivery whilst cruising at 35,000 feet.

Seb in the Park Plaza
Explaining something which seemed important at the time (but probably wasn’t)

Eventually after a few photos and some fond farewells we decided to pack it in and I stole out of the hotel in the early hours of the morning to grab a taxi back to my place. In the process very carefully depositing my green hat, scarf and gloves so that I would have to come back to reclaim them on another occasion. Tired and surprised that despite starting the night out friendless I had achieved such a bounty of experiences I fell into a contented and somewhat inebriated sleep – ready to carry on with the editing in the morning.