Tag Archives: Calibration Study

Janakpur, Nepal

2012-02 Game Set and…. Devdas? The Study concludes

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Well, that’s it! Today, officially, we have finished the calibration study. Pending review from Jonathan we will have completed this section of the study. It’s been an absolutely massive effort – working flat-out for the last month with no days off including the last 14 days where we have been continually searching out children to measure. Today we completed the matching, reaching our 109th child. We lost two data points – one child who was unable to complete the study and one who was the wrong age… but we overshot enough to be able to super-select the best quality data from the remainder and chase after our elusive equation.

Saliva Samples: Deuterium Calibration test
What we came for – tiny bottles of saliva. A lot of effort for something so small! It will be worth it in the end…

It has been an incredibly interesting journey trying to get this data together but it is also has taken a great toll on both Delan and me… and staff also – key players have put in more than their fair share of hours to return these children. Following the first two days in which we got 40% of the sample we struggled along in dribs and drabs for the remainder of the 12 days, with children coming most days in ones and twos and occasionally larger batches. We visited a sheaf of local schools, called in favours from staff’s families and visited city “villages” setting up scales and batch processing local children who all seemed thoroughly interested to find out their weight number… We have measured literally hundreds of children to get the ones we needed.

On the Bike with Chaube
I have spent a good portion of the last two weeks riding on the back on bikes to and from various schools and Tole (villages) Here’s a shot I snapped traveling through the main thoroughfare during “golden hour”.

All’s not quite finished however – we do need to get the saliva samples home – whist still frozen. If you know anything about living in Nepal – you’ll know about the power problems. At the moment the office generator is on 24 hours a day to power our freezer. But as usual things are not as easy as they seem on the surface. The general electricity supply in the office is haphazard to say the least. I’ve felt on more than one occasion that I’m risking my life by messing around with extension cables and whilst trying to rig up power to my portable editing suite. In the store room a faulty fuse connection has meant that the switches panel sparks dangerously at you beneath the plastic. These sparks have successfully burned through the tape that I placed over the freezer switch (a “don’t touch this switch” kind of arrangement)… besides being deeply concerning that it is possible for electricity to burn through a plastic switch in this fashion… this has ultimately led to us having to constantly checking the confounded machine day and night as it now keeps turning itself off and on. Luckily today an electrician visited the building to repair this problem. Funnily enough I recognised him as one of the construction workers who I have spied working on the roofs of one of the buildings opposite these last weeks as I sat out on the veranda working. Once the samples are safely away from Janakpur we have an arguably higher chance of success for regular electricity in Kathmandu. As soon as they reached London they’ll be sent away for analysis – In the mean time I will be keeping a beady eye on things as best I can.

So… having planned almost a year and a half ago now to go abroad to do something like this it brings a great sense of satisfaction that this actually happened in a relatively ordered fashion and ultimately and that we have successfully managed to complete study with really excellent data. The staff here at MIRA have given so much – in particular Chaube and Ragab who have been tirelessly working alongside Delan and me. It’s not an empty statement to say that without these people we would not have been able to do the study. Not speaking either the national or the local language essentially precludes one from doing anything more than simple sign language and thus makes impossible the explaination of our intents. Thinking from their perspective I dont think I would have trusted some large stranger who didnt speak my language asking me to produce saliva and drink some “special” water drink… So whilst the calibration film has helped a lot in explaining the process of the actual testing but fundamentally it is the MIRA staff who on the ground have fix things with the participants, the families and the schools and villages we have invaded to try and get the children that were needed for the study. Finally it’s worth noting that the children here in Janakpur have been absolutely incredible. They are superbly well-behaved and have been incredibly good doing the saliva sample testing. You might say “saliva samples?… that’s no biggie…” But really it is far harder than you would think to produce these samples correctly. I thank the children and their families for being so generous with their time and for being such a pleasure to work with!

Indeed an essential part of my job throughout these last few weeks has been to supervise the children in the waiting period. As a means of control over a range of different children (and often their many different family members) I’ve used fizzy drinks, biscuits to placate and have been able to rig up my computer with a second screen so that they can watch a film whilst they wait (and I can get on with other work as well!). This is the most consistently simple way of controlling children with whom you cannot communicate directly in terms of language. The one tripping stone has been that I only have one film which really was suitable to be watched by these children. But just as Europeans enviably speak many languages, people living on the subcontinent do the same… Indeed there are such a plethora of different languages that it’s hard to keep track – So whilst Maitili is the local language most Janakpurians speak both Nepali and Hindi.

This being the case I’ve been playing the only Hindi film that I have: Devdas (2002 version). Based on a story by Sarat Chandra Chattopadhyay (1876-1938) the film is a famous tale based in Bengal in the early 1900… An epic tale of woe and of lost and longing love – that re-echoes the mythology of Krishna, Radha, and Meera of the Hindu tradition. Devdas and Paro who despite being childhood sweethearts are rent asunder as adults when Devdas returns as an adult from his 13 year training in Law in London by their respective families arguing over family honour, caste and status inspite of the clear love that stands between the two. The songs from the film are sublime – if you’re at all interested in listening to some great relatively contemporary Bollywood music that doesn’t trip into Western influence then I thoroughly recommend you stick it on on Devdas (link to Spotify)… Or at the very least watch this YouTube clip of the famous “Dola Re Dola” or my personal favorite “Silsila Ye Chahat Ka” the opening gambit of poor old Paro.

Barhabiga at Dusk
With the end in sight – I look forward to really exploring Janakpur in the coming week…

My focus in the coming days before I return to Kathmandu (…now there’s a scary thought!) will be to film extensively in the district…having been so focuses on the calibration study I’ve had little energy to go out and shoot…little energy to get under the skin of the place as I usually try to when I’m travelling… I’m up to date with the photos I’ve take so far and am managing a smattering of medicine by the by. But… with the dates confirmed for finals exams it’s quite a prospect to be looking down the barrel of finishing medicine once and for all. A real thick slice of self-discipline needs to be laid on in this next stage so that I can hit the ground running and finish all of these projects before going back home. Wish me luck!

Janakpur, Nepal

2012-02 Janakpur Week 1 in Photos

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Here’s a selection of images from my first week in Janakpur:

Classic Grammar in Janakpur
Classic Grammar in Janakpur – next to Rooftop Restaurant “The only Choice for Smart People”
Mesmerising Chanting at Jhanaki Temple
The main street running under Ramanand Chowk has a distinctly post-appocalyptic feel…
Rehearsing the script
Calibration Film – Sonali and Sushil rehearsing the script
Suzanne Commisioning Sheets
Suzanne has upgraded her hotel room with many home comforts including specially commissioned sheets!
Curious Hotels: Janakpur
Curious Hotels dot the road on the from the airport – this is one of the strangest!
Out for a stroll on Barhabiga: Janakpur
The vast open ground of Barhabiga is a great sight on way to work in the morning
Janakpur: The Centre of town’s always crowded with cyclists and motorbikes flying past
MIRA Spirometry
The Main follow up study has many components including Spirometry which is often a challenge to explain!
Janakpur Goat Fashion
The goats are often draped with coverings – to keep in the heat? Fashion? – you be the judge
Janakpur Traffic Jam
Probably my favorite photo of the week.
Didi - Janakpur
An elderly lady asked me to take her photo whilst I was waiting for Suzanne to buy her custom sheets.
Beard Twizzle at Jhanaki Temple
An enviable moustache!
Dal Bhat Bimla's Janakpur
Eating Dal Bhat (THE traditional Nepali Meal eaten by everyone before work each day) at Bimla’s house is a highlight of the morning at the office – a curious meal for Delan and Suzanne who are used to eating breakfast but perfect for people me who forgoes and is always hungry by 10 o’clock! (It’s a running joke that I always get seconds!).
Bimla waiting for us at her house.
Bimla waiting for us at her house
Janakpur, Nepal

2012-02 Slow progress and Fixit for Nepal?

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So this is my third week here in Janakpur. We are creeping slowly and steadily up with the study but reaching the point at which it becomes increasingly difficult. In this study to aim to get representative values for the entire range of body weights of Janakpur’s children – so… rather than proportional representation we are recruiting children equally throughout the range. The upshot of this is that the extremes of weight, the very small and very large children, are much more difficult to recruit as they are, according to the normal distribution, much fewer in number. We are currently chasing schools and children who need to become recalled from the main study but we’re not having as much luck as with our initial forays last week where we were concerted effort able to recruit 140 children over several dedicated days (of which about 90 so far have turned up). At the close of play today we need to recruit about another 30 children – 30% of our sample… Frustrating considering the speed at which we launched out the gates (we did the first 40% in ONE day!)…but that is the nature of the beast with this kind of study.

Jonathan left yesterday back to Kathmandu and is spending his last night in the lovely Rana Palace, the Shankar hotel… relaxing somewhat before heading back – a flying visit that was very helpful for us on the study although he’s set the bench high on what we have to achieve (vis a vis above). Hopefully Delan has had some useful input on his Ph.D. – from what I could see from their conversations Jonathan unearthed another barrow full of references to chase -something I remember fondly (now – though at the time it was perhaps more of a cause for a headache!) during my BSc year with him. On the flip side he gave Good reports of both the study and of Janakpur – although I’m sure he’d prefer it if there were a few more mountains around the place!

Elsewhere in Janakpur things are shaping up on Barhabiga – there is now a roster of poles driven into the ground on the northern side which I anticipate will evolve into awnings and perhaps food tents or accommodation for the upcoming festival. I’ll be interested to see what the waste output will be from this festival – specifically the plastics and other nonbiodegradable substances. The area is already strewn with rubbish so I’ll be very surprised if it is not more so in the wake of this event.

I don’t know if it is related to the festival itself but they have also been removing the trees which stand on the outskirts of the field. Actually, the other day as I was walking past the team of men as well as a group at the base of the tree soaring who were taking down the tree was quite a spectacular sight I captured it on film to a took a few photos as well. It seems a shame somehow as Janakpur is really a very wet city…it would seem to make a lot of sense in my mind to have trees planted not only to absorb water but also to stave off the aggressive heat in the summer.

Further strikes are affecting the region with many transport services haulted for up to two weeks. For those families we are trying to recruit who live in outlying regions this makes it next to impossible to get here. I dread to think what a rickshaw from the border with India would cost and how long it would take! I guess that Striking could be jokingly viewed as something of a national sport for the Nepali people but really it is indicative of the disarray that things are in. I’ve been creating “fix-it” list mentally for the Nepali government. Which runs along the lines of :

Electricity – the number one point of progress for Nepal as far as I can see – seems crazy that country with the highest mountains in the world can’t generate enough electricity from hydroelectric power. I have heard from an energy consultant in Kathmandu that 52 projects are ready to be built which would increase capacity of the country from 10 arbitrary units per person to over 100 arbitrary units. It’s hard to articulate how many problems this would offer solutions to. I cannot see any convincing arguments against this many. In my limited time visiting the country access to fuel of all sorts has been a major topic of discussion and has featured as the main point in several strikes. I don’t suspect this will change any time soon. In Kathmandu, cars literally queue for days to get petrol. A continuous power supply would enable manufacturing to increase, schools and hospitals to be open and to be run with improved services and on a national scale make available electric cooking devices which could potentially save women looking after their families many hours a day, which could very well be more usefully spent looking after the children, gaining an education themselves or even God forbid pursuing some leisure activities. I just don’t understand why the country with such a possibility has such problems with power. Throughout the governmental echelons how can any issue supplant this for its import and potential great capacity to improve whole of Nepal?

Sewerage, sanitation and waste systems infrastructure – investment in sanitation infrastructure would improve quality of life universally. This would probably have to be supplemented with a national re-education program in disposal of rubbish. Although by no means unique to Nepal… (vis a vis India) concepts of when and how to dispose of rubbish for individuals seem ludicrously absent from all echelons of society. Here in Janakpur rubbish is literally jettisoned into the street or swept to a safe comfortable distance…say 2 m away from your front door. Periodically someone takes initiative to sweep this street flotsam into a pile where after day or so…After a day or so of being picked over by dogs, cattle and pigs someone sets it on fire as a means of disposal. On my walk to work there are several allotments which are so thick with rubbish as to take on the appearance of a complete wasteland. Coupled with the open sewers on the side of each road the primordial stench that emanates from certain places on my journey is at times overpowering. I’m thankful that I’m not here for the boiling summer.

Transport infrastructure?

Education for women – this is absolutely fundamental…

National Health Service?

etc. etc… Tonnes to improve here… tonnes… the challenge is doing it all in a way which suits Nepal – and is led from within…

Janakpur finds itself in the 3rd poorest region of nepal – with a multidimensional poverty index equivalent to something like the lowest of the 8 ranked countries in the world.

In other news Suzanne has had a hellish couple of days, having fallen ill and suffering setbacks with her project. My phone had slipped into “Offline” so I did not get her texts of appeal over the last few days. She reported night sweats and hallucinations of people standing around her bed. Not a great shape to be in for certain.

With regards to her work Suzanne’s project focuses on indoor air pollution. This involves going to people’s houses and coordinating with families so that she can set up her equipment within close proximity of the main cooking stove. The huge variety of fuel types are used here, from wood to kerosene etc. of particular interest however is the use of dried cow dung which is burnt after being prepared straw and dried out in the open son. I saw a great number of installations of this done fuel on my trips to the villages last week including watching as we sped on past women preparing it by hand. It’s a curious thing the main proponent through preparation for the family, the woman, also spends a great deal of her time manually handling animal waste before going on to prepare food. As Suzanne says this place is something of an ideal litmus test for the hygiene hypothesis. Suzanne’s work is not being without mishap – as she works closely with families the various idiosyncrasies of environment she is working in that particular day can substantially affect the result she gets. For example today she reported back that after having set up the equipment she turned to see family goat launching himself across the room at one of her monitors, knocking i it flying. As she scrambled to pick up the pieces together then proceeded to chew on the extension cable power in her equipment, luckily disconnected from the mains at this stage otherwise I highly suspect that’s Delan and I would have had mutton curry tonight, and completely disabling experiment.

Goat by the door Janakpur, Nepal

Other issues she has had include families carefully covering up her equipment so that it doesn’t get dusty – despite the fact that she has specifically put her equipment there to measure the dust in the environment! With blonde hair, blue eyes and fair skin she is an immense curiosity for the local children and has to work whilst being crowded by between 20 and 40 people daily. Sounds incredibly fun and interesting but I can imagine incredibly stressful with regards to try to get decent quality data!

Bit of rambling post this evening but something which reflects growing insight that I’m gaining to the functioning of this interesting country. It perplexes me that people who are so endearingly genuine could be on a national level in such apparent disarray. It certainly makes me feel glad that I enjoyed the basic privileges of a Western life without complaint generally.

I’m falling steadily towards unconsciousness as I write so I’ll conclude here and follow-on with some fresh stories tomorrow.

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 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