2012-02 Suzanne leaves: Presentations, Spring time and back to work.

Well, here I am back in Kathmandu. As it often do while starting a blog post I will discuss coffee briefly. At the moment I’m sitting in the dark and sipping cold Nescafe which I’ve mixed with tap water. This tastes just like it sounds, absolutely disgusting, and of course for those of you who have read my previous posts this is due to two factors: having smashed my cafeteria on the flight back from Janakpur to Kathmandu and the fact that in Kathmandu I am back in the clutches of load shedding.

Anyway, it is self-inflicted so I won’t impose upon use my grumblings about coffee any more. Needless to say as soon as power kicks in either with the generator or load shedding is mercifully lifted I will have a nice hot cup of coffee. Until such time then I shall write on. Being in a pensive mood I’ve decided to listen to Joanna Newsom. For me she holds a certain nostalgic remembrance of having lived with Kenzo and Tamsin in my second and third years of university. These really were some of the happiest times. I think we made a good team, a testament to which is the fact that we still are great friends. Curious that I should choose to live and architects, but I guess it underlies the fundamental rebellion I have with doing anything by the book. Medicine tends to railroad one’s sense of destiny and so I have always tried to resist every turn my ultimate fate. Arguably the biggest decisions are still to come particularly this nascent desire I have to try and use all these artistic skills I have accrued over the years together with my medicine. Who knows what will come of it – and being somewhat cautious here I will not elaborate in public some of the schemes which I’m cooking up. Chickens and eggs after all.

So Kathmandu on my return really is a fantastically pleasant place. There is something of an air of European spring to the city at the moment with some of the most gorgeous weather that I have ever experienced. Being from a cold clime on the return from the somewhat sweaty Janakpur the ambience is really is quite pleasant. To the nearsight the ring of hills and In the distance the glorious mountains with their sparkling high-top white peaks, really elevate the mood to a higher plane. Despite my grand intentions to study 24 hours a day I think it would be amiss of my human spirit not to take advantage of this place here and now can see little bit of it, even if that only means climbing the nearest hill.

Back to Kathmandu
Back in the big smoke – with a touch of spring warmth the place feels more like the south of France. Great to be back

This new-found fondness Kathmandu lies in some contrast to Janakpur which very much grew on me. I certainly don’t think my initial impressions of there were as favourable as my return here – but as all things relating to both comfort, the recounting of former experiences experiences together with a fond return to people you know AND the perception that things generally are more pleasant — obviously these will improve your estimation. Simply put it’s great to be back and I really am looking forward to these final weeks in Nepal both in terms of my ability again to study but also the fantastic weather and I’m sure the many interesting, meetings I’m sure to have.
In terms of my immediate return, three events have taken place. The first was my presentation delivered to the Professor DS Manandhar of MIRA on my work in Janakpur. Despite very little preparation time, including within which managing to meet Penny, Christie and Bernie for breakfast at the fantastic Or2K restaurant before their afternoon departure, I pulled together a short but hopefully enjoyable presentation on my work down in Dhanusha. I decided not to focus so much on the scientific component whilst giving the presentation … overall the calibration study really is something of a one-liner in Delan’s thesis. You might wonder therefore that such efforts almost a month of continuous work should be had to get this. But that of course is the nature of research – that often the most difficult things reap very little reward. Hitting analyse on a data set may take mental conception but really is quite simple in contrast to history behind all those numbers which is often a story of pain, difficulty and general travail and really caveat. Yet the history of the numbers, if you will, is not the significant component of the research. It is instead the output, the meaning of those numbers. Of course I cannot entirely sell the calibration study up-river – it does have some intrinsic value in documenting worldwide variance between different populations in terms of the subtleties of their relative tissue hydration. Slowly but surely those who really are interested, amongst which I include Prof. Wells this holds the key to many more grand questions which I won’t profess to know a huge amount about but do have the potential to inform more grand designs.

Thus to complement the relative sparsity of scientific wisdom I imparted I gave an overview of the training that I had conducted and the documentary which I had also begun in Dhanusha – it is by no means finished but having 12 days of solid shooting completed we really have something quite exciting on the cards – by slipping together a few seconds of silent imagery which seem to be generally appreciated. Anyone who knows Janakpur, or who’s been there memories of the railway (the only one in Nepal) and of the animals and of the general busy chaos will recall strong and possibly… fond memories.

Indoor Air Pollution
All that smoke: who knows what the future holds?

As a direct counterpoint Suzanne’s was far more scientific and involved in the really quite complex work she had completed in Janakpur. I have much admiration for her having really completely evolved her scientific capabilities from a UK based epidemiologist to a full on field researcher – the running joke that she was literally “in the field” lost neither its candour nor its impact with the incredible histories like a goat eating the cables to her equipment and head-butting various monitors across the room before being banished to the roof – or even stumbling out of the kitchen where she could barely breathe because of the thick smoke. I think she would agree with me that out of the three of us, Delan, myself and Suzanne – that she really had the greatest change in her perspectives on what she was studying certainly (I won’t suppose other more general perceptions although she did allude to them) and thus arguably really got the most out of being in Janakpur. I see in her a rejuvenated curiosity and strong desire to continue working in this field, indoor air pollution, which she reports has a relative dearth of special interests in it despite its widespread impact across the globe….And in this respect I think in future when I go to one of her lectures as (undoubtedly) one of the world leading experts I’m sure she will fondly recall these times with almost opaquely rose tinted spectacles (she’ll leave off of remembering the bad times, the sickness and the distress when things didnt work or there was “so much confusion”). Granted she will have a bright future in which ever field she chooses to pursue and will make great contributions to such…. But I should hope that the sense of perspective she has gained from her journey here really will inform her work – so that it has the greatest capacity to make meaningful benefit for the people here. I cant recall if I have previously reflected on this but with regards to indoor air pollution really quite simple changes can have profound effects on the problem it poses. I see her work here as the start of a very exciting chance to change the lives of many women not only in Dhanusha but also more widely in Nepal and other places around the world.
With these potentials alluded to – particularly in her qualitative work – it was great to see such enthusiasm from those assembled at the presentation and I hope to see many more exciting studies exploring facets of indoor air pollution and its impact on health growth. On a another level, cooking practices are quite a profound reflection on cultural role of women. I should hope that through the ultimate identification of the issues that the lot of these women can be improved as happy by-product of directing change in methods and means alone. As Suzanne put it “it is empowerment is not just education which we’re after”.

The famous Pink Bike
The famous Pink Bike: no longer to be prowling the streets of Janakpur in search of smokey kitchens.

With the presentations completed I proceeded to interview Prof Manandhar. He really is quite interesting gentleman and we had a good two hour interview in which I was somewhat thwarted by struggling technical issues (not having had enough time really to unpack and organise my things I was scrimping on battery power and generally feeling that a bit stressed that I wasn’t capturing the right things during the interview). Nevertheless, we both felt that the initial foray whilst useful might be very much benefited by a second attempt with the Prof having a chance to reflect on some questions I had asked him and for me at least a chance to get all my gear in order! There were some comments about the general disruptive jubilation that seem to be emulating from the office which makes me smile somewhat. It is always a good thing to be able to be a laughing terms with someone very quickly. In the process of doing this documentary I have received many privileges of access and such a session with Prof is no exception.

That very night (Friday) Delan’s parents arrived in from the United Kingdom. We join together for a lovely dinner, ironically having been there just that very morning with the girls, at the Middle Eastern themed Or2K. Parents together with the usual three suspects – we were also joined by Naomi and James, British researchers also working with MIRA. Very enjoyable evening which saw me sinking into a quiet and peaceful sleep after the fact.

Back to work at the hospital
Back to work in Kanti Children’s Hospital

The morning hailed Suzanne’s departure. We shared together with Delan and his parents a final breakfast before wishing her well on her way. I’ve reports that she made it safely back to base and is missing Dal Bhat already. Delan and his parents have also made moves to travel around the country, something which I regrettably realistically going to have to pass on doing (certainly by my usual frenetic travelling standards). And I shall meet with him again on his return to Kathmandu before he ultimately heads home to United Kingdom – leaving me finally alone to continue what really is now my elective placement at Kanti Children’s Hospital.

I’d say that’s enough for this article now. I have several more which I wish to recant from my Janakpur experiences as well as ultimately going backwards in time to recall my first forays in Kathmandu and who knows even previous to this – celebrating some of the more interesting photos I’ve taken of the years might be a good start on that road. One of these days I’ll write a musing article about the purpose of it all… But now let’s leave it at a simple dual effect of sharing my experiences with you all whilst performing something of a catharsis and what all of this crazy business means.

“See you space cowboy”.

2012-02 Janakpur: Week 5 in photos part 2

Part 2 of week 5 photos – Gallery Style. Enjoy!

2012-02 Janakpur: Week 5 in Photos part 1

With 12 days continuous shooting behind me I’m trying to put the pieces back together now that I’m in Kathmandu. Tomorrow I start back again on my clinical placements – the second part of my elective in fact (I’ve inverted my SSC and elective placements for any medics who might be prepared to take arms against me on this point).  Today on my first day off in ages besides sharing a lovely dinner with Delan and his Parents,  I’ve had a small chance to get to grips with, to try and stay on top of, the photos from Janakpur. Here is the first of two posts from Week 5 – being out with the camera throughout the day meant that I had so many opportunities to capture the various facets of the incredibly photogenic Janakpur.

Please enjoy – and as always if you’re interested in anything here comment or send me a message and I will be sure to reply….

A brief meeting in Or2K

Terrible photo of me meeting Christie, Ed, Bernie, Penny and Barrat (Sherpa and guide) in Or2K. Glad we managed to meet albeit briefly.

And to my many medical friends who are now finishing their electives (including Bernie, Christie and Penny who I met just Friday gone) I wish you safe travels back to Terra Firma and strength of mind against the looming threat of exams.

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2012-02 Well, That’s all folks

Today I leave. Listening to Mitchell’s Blue to celebrate the passing as I pack up my bags. I’m going to miss so much of Janakpur, The Rama where I’ve lived, MIRA where i’ve worked, the city in which we’ve all endured – and most importantly – some of the most generous people you’ll meet on this earth – right here in the Terrai.

More on this when i’ve got time to mull it all over in Kathmandu (in between frantically writing a presentation that i’m giving tomorrow lunch time!)

Thanks to you all for reading of my experiences here in this small corner of the world. I will be writing several more articles when I’ve got some thinking space back in the big smoke. I’ll be back at the end of March from Nepal proper – so until then . Lots of interesting adventures still to be had (not to mention oodles of work as well).

Wishing you the best,


The Sun Sets on Janakpur
My time in Janakpur comes to a close…

2012-02 Sita Ram: Barhabigha

Pictures can only describe one aspect of the atmosphere of a place. The festival on Barhabigha really reflects something of the inner nature of life here in Janakpur – how everything revolves around the cultural cycle  – much more than it does or even potentially ever did in the west. The next festival is always around the bend and religiosity or at least spirituality and mysticism is a fundamental part of existence for most people here. The chanting on Barhabigha was continuous, day and night with the constant refrain of Sita Ram in its plethora of intonations. With the office so directly opposed near the site I must admit that the constant intrusion was more than a little vexing at times. Some of the musical interpretations were to my ears rather abhorrent and the distraction whilst trying to work was at times unbearable. There we many times however that I was struck by the deep beauty of the incantations and on this occasion, cycling past I was caught by a primal tingle in my spine – the kind that purest forms of music seems to strike in me – certain lilts in pieces that seem to cause almost a welt on the consciousness – disarming and profound at the same time. This was one of those moments and – after I had collected myself I took my camera and captured some rather shakey footage of the mist ridden scene that morning. Now the festival is over and the hiatus of music is held until tomorrow when the next celebration begins….

Turn the volume up and try to imagine being here with this noise permeating across the entire city – hopefully it will give some paltry rendition of what it has been like to live here these past days.

2012-02 Janakpur: Week 4 in Photos

A selection of Photos from my 4th Week in Janakpur. This week mainly involved chasing around schools and nearby “tole” (Villages) in search of children and thus a great deal of time spent on the back of Motorbikes. Also passed a really lovely evening with Chaube – eating at hotel local to his home. Afterwards we enjoyed some Paan together. A memorable night certianly – some of the photos are therefore credited to him (I especially love the one of me and the owner in the restaurant). Great to have some photos of me for a change!

PS – if you feel like commenting, please do! I really enjoy hearing feedback. Thanks to all those of you who have sent messages – Really encourages me to post more… Also  – do people prefer the “gallery style” as in Week 3 photos, or this “slideshow” style? What is easier to view them all on?

Please enjoy!

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2012-02 Goodbye Delan, Filming and Happiness in Janakpur.

Well here I am enjoying my second cup of coffee this morning. Last night I changed my order from 730am to 830am, deigning to take something of a lie in this morning. The first cup arrived at 8:26 and the second cup at 8:47! Slumbering after the first arrival I have enjoyed two lukewarm sweet cups this morning, drinking both after a 30 min cooling stage. Now feeling no different than I did before (this coffee is palatable but has no effect on my physiology) I have decided to write something about this rather hectic week.

Dr. Delan
Delan’s left us for a better place: Kathmandu.

The biggest news of course is that the big boss has gone home. Delan left on Thursday to Kathmandu to renew his visa and to give himself enough space and time to write this important Ph.D. upgrade. Here in Janakpur sure that the constant struggles with the study would have precluded him from actually finishing this in time – and having worked so hard I think it would be atrocious if we were not able to jump through this “hoop”. Suzanne, having done a Ph.D. already, was instructing us as to the various subtleties of this procedure – apparently people rarely fail and the minimum requirements are relatively light (a few thousand words and a brief presentation) – but having said that there is a degree of internal competition amongst the Ph.D. students, rifling to produce something magnificent. I suppose when one is presenting in front of an audience it would disturb the psyche if the presentation you deliver is paltry in comparison to all the others. I feel that as Delan is spending such a great deal of time abroad actually collecting primary data – one might argue that his time has been more directly spent in his work. I don’t have any real worries for him therefore. For my part – If I do eventually get round to doing a Ph.D. I would like to do my own primary data collection. Again not something that I was really that aware of before, apparently a large number of Ph.D.’s are written on pre-existing data… This makes sense of course – there are literal treasure troves of data out there in almost every imaginable field – however for my own sense of self I should like to think that if it came to it I would have a specific question which I would like to potentially address with my own original data. Who knows what time will offer?

Things feel different without his buffering presence here. But there’s no time to mourn his loss as both Suzanne and I are frenetically running around trying to finish our respective projects, mine the filming and has a clinical placement and her fieldwork. Currently we are pitching to return to Kathmandu on Tuesday. It has been a great pleasure working with a man for these last five weeks – in some ways we are quite akin – both really very much interested in the practical application of work that is done here but in others quite different. I have enjoyed immensely this company, his sense of humour and I hope he goes on to do great things following his Ph.D. One thing is for certain that his ability to stay calm and collected when things are fraying to pieces is remarkable. An interesting study would be to monitor the blood pressure of Suzanne, me and Delan in a given challenging situation here. I am relatively certain that his would stay the lowest.

To celebrate his departure we held two leaving parties. The first was a more relaxed social gathering at Rooftop restaurant (” the only place for smart people”). It was incredibly enjoyable to see staff after hours. I was pitched with Suzanne, Bishnu and Gagan at one end of the table whilst Delan enjoyed the company of Chaube and the rest of the gang at the other. It wasn’t a long evening, perhaps sensibly Bishnu called time early on, but the merriment was good enough to be remembered long hence. Rupesh my buddy from the trips to the villages and I sat next to each other and bantered away. Proudly, they bestowed upon me the nickname of Hashmuk (Pronounced “hashmook”) which means “smiling face” (because I am always grinning, they said). I think, to have a nickname implies having made a certain impression and I’m glad that this mine! Not that I should wish to disclose it here but there was much hilarity over the eventual naming of Delan (certainly amongst the staff) in the days that followed. Overall I think this reflects a real sense of camaraderie which we have developed with the team. After the meal the bikes drove 10m across the road to the nearest Paan shop, where Suzanne tried here first and last Paan. Deeply happy and a little tipsy we three cycled back to base in the dark.

Paan After Dark
After the meal we gathered around the nearest Paan stall and ordered our fill. Not an enjoyable experience for Suzanne!

The second celebration, a more formal affair, was on the Wednesday before Delan left where all staff present at the office gathered and there was a small imparting of gifts. MIRA and Delan gave both Suzanne and I lovely paintings and mugs from the women’s develop the centre tagged with the words “MIRA Dhanusha”. The style of painting is really quite something – simple but elegant and with incredibly subtle pastel colours which have a real organic feeling. Suzanne is in particular details in the scene the focus of her work – women and their indoor cooking environments. If and when I eventually gain a permanent place to live I should like to frame this – a celebrated memory from this beautiful time here. Each of us made a small speech – although I spoke too quickly and I am sure most of what I said was drivel. The sentiments we three shared together underlie the fact that we really have had incredible time here and really do value the working relationship we have built towards our respective goals with the staff. Delan obviously has a different perspective on things both coming back in the near future and having been here before – but I think he feels that this time in particular working together with Suzanne and me has been somewhat different. I should hope that the MIRA team feel like they have got something out of our being here beyond added confusion and extra work in their day to day activities. Hopefully memories from our brief visit will be valuable throwbacks for further celebrations ahead. Even when we don’t understand each other fully everyday brings more laughter than I normally have in a week working in London – that at least is universal…For my part I’m thinking hard of an appropriate gift to leave on my departure on Tuesday.

MIRA Dhanusha team 2012
Everyone gathered for Delan’s leaving ceremony

The other major happening this week has been the filming. I have been given leave to film something of a documentary of the larger follow-up project here. So far I’ve been shooting since Sunday last and have amassed six days of film. It has been a struggle as usual to organise things but I have actually managed to get a lot of the main things I wanted to film completed during the course of this week: Two days filming with two local families, a number of interviews with MIRA staff and filming around and about the city of Janakpur – totalling over 200GB of footage. It has certainly been a whirlwind keeping on top of the schedule and keeping my two cameras running. I have several more things on my list for the coming days and not the insubstantial task of translating between three languages (Mathili, Nepali and English) for the various persons of the film we are going to produce. Currently we plan to produce four versions – three of which will at least get updated again when the final results of this project are available. Ultimately it is hoped that we can use this to articulate the work we’re doing here both to the local community, nationally in Nepal and also the international community in the wider sense. I won’t belabour the point here but it has been an incredible privilege to be allowed to do this and I really hope that it will have some beneficial impact.

Villagers gathered round the Camera
People are always very excited to see their photos! I really wish I had some kind of portable printer. Next time I’ll take a polariod camera as well.

My parting thought here is something along the lines of what Suzanne and I were talking about together a dinner last night. Here in Janakpur I had expected to arrive and to be absorbed by the problems that supposedly exist in this part of the world. Indeed from an outsider’s perspective, reading statistics about the major determinants of “quality of life” and living standards one would say that this would be a terrible place to be. Indeed, even arriving for a short time one I think would be struck by the real poverty here and the way in which things just don’t seem to work as they do in the West (electricity, sewerage, gas and the many other facets and “difficulties” of living here). Suzanne says that had she have stayed just a few days here impression would have remained as such. But having been here now five weeks my lasting impression is not of the poverty or of the lack of proper facilities but how happy people seem to be here. There is almost constant air of festivity and people you meet a relaxed, non-confrontational and overall seem quite content with their lives.

It has made me reflect on certain issues regarding the imposition of ideologies about how things should be… specifically the idea to come in and change things for the better. Now, don’t get me wrong I still strongly believe that certain things were fundamentally improve people’s life and overall happiness. Specifically, those that relate to health – as poor health and fears surrounding illness can be singularly powerful in destroying happiness. Those factors potentially relating to economic material gains really I question their value. Having been in a really quite simple rural home yesterday I was struck by the desperately elegant nature of the place. Almost Japanese in its reverence for a certain rustic simplicity – it really was a beautiful place to be – but by our developed assessments a mud floor and mud walls would not score many points on a living standards questionnaire. Sweeping generalisations aside – it has made me consider the meaning of existence of a population level – coming back to my old axiom that if nothing is certain in this world (neither of why we are here nor of whether anything lies beyond) it is better to be happy in this life and to breed happiness in those around you. So I should congratulate the people of Janakpur who seem to have achieved an overall sense of contentment, which I certainly cannot recognise as being so widespread in my hometown, in spite of the fact that they live in one of the supposed poorest regions of the world. Standards of living may be different but altogether does that really matter if each day there is enough laughter to get you through? I would say this of course but I think the axiom holds true. After all what’s it all about?