Technician Training

Last winter, for the first time ever, we had foreign dentists meet our technicians, supervise them treating patients in the field, and assess their treatment outcomes. This has been an enormous opportunity for us as an organization and for our technicians who are working hard to provide the only dental care in their villages. This week, we had Dr. Keri back for a second training based on findings from last winter.

Our refresher training included two days of classroom work and a one-day treatment camp at a school. Keri covered topics related to infection control, pain diagnosis, pediatric behavior management, informed consent, treatment planning, and charting. Based on the results of our study of treatment outcomes in fillings placed by our technicians, we introduced a new instrument used to prepare a tooth for a restoration.  On day two, we had a few patients come in for practicals, including Aidan and Pascal.

 

 

 

 

 

 

 

 

 

 

 

 

On day three, we treated about 100 children and adults with supervision from Keri and from Dr. Kafle from our referral hospital, Kantipur Dental Hospital. This gave the technicians and assistants a whole day to apply the concepts from the classroom training to many different types of patients.  I was worried we might not have enough patients during summer vacation…but that was definitely not a problem.

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Over this last year, I’ve realized how far JOHC has moved in to new territory in the oral health care world in Nepal, and really, in to the health care world generally. I’ve come to appreciate that our technicians are true specialists in low-resource dentistry, with training and institutional support that has allowed them to venture in to realms of sophistication not typically expected of providers serving the rural poor. I’ve always been committed to making sure their scope of practice remains safe and appropriate, and at the same time, I recognize that there’s been far less time and money invested in identifying how safe and how good a service can be when the customers are millions of people who cannot rely on reaching a conventional health care setting. Such questions are asked only from the perspective of established institutions and well-funded people in power; that this leads to widespread, unnecessary suffering for the vulnerable is very obvious.

The other side of the same coin is that it inadequate services can be easily excused because they fit a conventional mold.  While Keri was here, we took time to visit the dental section of the public hospital.  We met some great doctors, many of whom are only one or two steps removed from hospitals or people we work with.  But they are working in an underfunded environment with rusted instruments; we observed numerous breaches of infection control in our short 20 minute visit.  The sanitation and safety measures used in our rural clinics are significantly stronger than those we saw in the dental ward of the hospital, even though we are working in a much simpler setting.  Why?

Something else that’s magical about this newfound opportunity for more training and collaboration is getting to know our field staff better, and as a group.  Our clinic assistants – all women (also, on all of our teams, either the technician or team leader must be female) – are these incredible women who tend to listen quietly and then, with very little fanfare, make everything run smoothly.  Without them our infection control protocol would be hash.  They are always the first people to show up at a training or field program.  Biju is raising four children and managed to complete the rice planting in her fields the day before she made the six hour trip to Pokhara from Sindure with her nine year old in tow.  Renuka and Pabitra are always smiling, never miss a thing, and both have put in long stretches of work without pay while we straighten out agreements with their local governments. Sita is upbeat, diligent and ready to toggle between different roles without being asked.  They are just SO AWESOME.

It was a good week.

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Nooks and a Little Sauce

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Over the course of 13 years in Nepal, I’ve spent almost all my time in villages. My whole understanding of Nepal, and all my friends, routines, the food I eat, the places I sleep, even the way I speak the language and therefore the way I think, have been organized around my adopted family and rural life, or its popular sister, the cramped and thankless circumstance of recent urban migration.

But this summer, I’m full-time supervising a city-based office with four people and a field staff of 16; getting a latte each morning; diving in to health care policy and human rights frameworks. I schedule coffee meetings and visit offices. All told, it’s only in the last 1-2 years that I’ve started getting to know some of the other long-term foreigners and NGO founders living in Pokhara, who all pretty much know each other, because they all live in the city, which for me has always been just a place to visit for work. And when I’m here, my non-work life is completely centered around my (recent urban migrant) Nepali family.

There’s a vague sense of discovery about this new routine. For example, I’ve been sleeping in a room in the office, and – this is going to sound weird, but – slowly realizing I can put things there to make the bed and little space around it mine. Like: a new blanket. Or: a hook on the wall. This is an especially weird feeling. In all the time I’ve lived in Nepal, the only space that’s been mine-ish is the small house in Kaski, with its two beds and one dresser that I share with the rest of the family. A single bed and little shelf of clothes for me alone, that I can modify to my liking, is a bizarre amount of freedom that I’m only even noticing bit by bit. (Mind you, we’re talking about a bed in the finance and admin room of our office.)

Obviously, I have no trouble with this in the rest of my life. But in Nepal, well, it’s just not the way I’ve learned exist here.

IMG_9195The other night, I had Pascal and Aidan for a sleepover at the office, with its main attraction, the Internet. We watched movies and ate treats. We’ve also been out for boating and out for dinner, because it’s fun, and we live in the city. And yet these are activities that have never remotely crossed my mind in the past, because they are more similar to how I live in the U.S. It actually never occurred to me I could do them here because the communities I spend my time with mostly don’t.

Today I went to a salon and got my hair done. A salon.

When I was a kid, I was literally the pickiest eater the world has ever seen. I know you think your kid is pickier, but trust me on this one. I was okay with a short list of simple foods, and I would gladly sit and watch everyone else eat rather than be forced to alter this known quantity. Once, I went to my best friend Katie Schultz’s house, and they made me pasta with butter while the rest of the family enjoyed a normal meal. It wasn’t till I put the pasta in my mouth and a terrifying and unfamiliar taste exploded on my tongue, that I found out that butter doesn’t taste like margarine, which is what we had in my house. The feeling of shame and fear sitting at the dinner table, hoping nobody would notice if I didn’t eat, is still with me almost 30 years later.

It wasn’t until eighth grade, on a school trip to Smith Island where I was stuck in an adolescent group eating situation, that I tried tomato sauce for the first time. For a few years – ok, until college – I’d put a little blob of tomato sauce on the side of my plate, and kind of dip my fork in it. Eventually I worked my way up to normal pasta, but to this very day, when I make my own meals, every component sits side by side so I can mix as I go. I’m no longer alarmed by new foods like I was as a child, but I don’t adventure much. I eat the same reliable items almost every day.

What, you ask, does this have to do with Nepal?

I’m not sure, but all I can say is it kind of feels the same. I’ve spent a long time in this environment adjusting to the absence of almost everything I was accustomed to before I came. I found my nook and I’m comfortable there. Rural life in particular, while not materially complex, runs miles deep, and each iteration, each day, each season and year, enriches and returns itself to the last one with a sense of familiarity and certainty: the next one will come too, even if we are not here to see it. I haven’t made a life of travel. I plopped down in one place and snuggled in. Altering its fundamentals even in small ways creates a whole orchestra of funny tastes on my tongue.

Also, FYI, we eat the exact same thing for every meal in this country. PHEW.

Mean time, I do like this blanket though. How do you like my office nook?

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Getting Schooled in Vendor Outreach

 

The only question I get asked more often than if we need dentists (answer: YES! as mentors and teachers for Nepali technicians) is if we need donations of toothbrushes or paste. While that’s a conservative yes, because we provide a limited number of those supplies to schools, most of the time, the answer is, not really, unless they are donations of something purchasable in Nepal. Because, if you think about it for a second, it’s pretty obvious that going to some village and handing out a bunch of disposable hygiene products once might make for good photos, but it doesn’t do much for anyone who needs to use these items every day forever.

Instead, one of the four core activities in JOHC is called Vendor Outreach, where we work with village shopkeepers to make sure that dental hygiene products are locally available and affordable, the same way sugar, salt, incense, and laundry soap are.

In the past, vendor outreach has mainly consisted of having local JOHC teams – i.e. residents – visit the shops in their villages, look at products, talk to vendors about fluoridated toothpaste, and sometimes put up posters or stickers that help people identify toothpaste with fluoride. But this summer we’re working on stepping it up. The main reason is that schools need supplies to run their school brushing programs. For that, we provide brushes and paste on a declining schedule, but by the end of two years, either students or the schools have to finance $1 per student per year to run their brushing programs permanently. Even though this is extremely inexpensive, our experience has been that when supplies run out, often schools just don’t replace them. If we want schools to buy brushes and paste, they need to be extremely easy to get.

Therefore, in June, we started Vendor Outreach 2.0 by looking for the best-priced wholesale distributors in Pokhara, with the idea of setting up a direct link between village shopkeepers and the best possible deal on dental care products. But when we approached our first shopkeeper with this idea he told us he already buys his supplies from a wholesale truck that comes through his village on a regular schedule.

P1000170 copyOk, we said, could we get the truck to go to the best-priced wholesale places? We showed the vendor the prices. The vendor showed them to his truck guy. The truck guy offered a better rate.

So that was over.

Onward, then, to Salyan, one of our harder-to-access regions, where Gaurab was organizing a vendor outreach program for the following week. He had a list of about 25 shopkeepers and their phone numbers. It occurred to us that we should invite school teachers also, since the point was for the teachers who run the brushing programs to connect with the vendors who supply the products they need. This stroke of insight made us feel brilliant. Actually, that was a really good idea.

Before the Gaurab’s trip out to Salyan for Vendor Outreach 2.0, I suggested that he print out little slips of paper with the location and contact info of the best wholesalers we’d found in Pokhara. That way we’d make sure all Salyan’s shopkeepers had this info in a nice tidy fashion. For the best deal.

“So how’d it go?” I asked Gaurab back in the office on Tuesday.

“Great,” he says. “We had over 20 vendors and a lot of the teachers running their school brushing programs came too. We made visits to a number of shops, and I brought the poster with the fluoridated toothpaste packages.”

Vendor Outreach in Salyan

“Awesome, did you give out the contact info for the wholesalers?”

“Yes but…”

“What?”

“I mean, they said they already get brushes and paste at that rate from their wholesale trucks.”

“Are you serious?”

“They said they can totally visit the wholesalers we found if they happen to come to Pokhara,” he consoled me.

“So basically, we’ve spent the whole summer on this, and what you’re saying is…village shopkeepers already get brushes and paste at wholesale prices from trucks that deliver right to them.”

“Yes.”

“All these schools already have vendors down the street with access to these products at the cheapest prices we can find.”

“Yes.”

“…So Vendor Outreach is basically just…getting the teachers up the street together with vendors, and convincing them to purchase supplies down the street.”

“Yes.”

“Like all we have to do is get everyone together and talk about it.  Maybe assign a specific shop to each school.”

“Pretty much,” Dilmaya chimes in.

“Guys,” I said.

“I mean, they can use the wholesalers we found if they come to Pokhara,” Gaurab reminded me comfortingly.

“Why is everyone going around handing out free dental supplies?” I demanded to nobody.

Back to the drawing board.

We find this over and over. Our complicated ideas for fixing things are 99% irrelevant, with a critical 1% of something that is missing: information, a tool, a little encouragement, some social integration, a familiarizing element or formality. Vendor outreach will continue to involve oral health education for shopkeepers, because most people are not aware of the importance of fluoridated toothpaste in preventative care. But then it’s mostly a matter of building relationships between vendors and purchasers–especially between schools and specific local shops to source the supplies for their very affordable brushing programs.

In other words, we need tea parties more than we need supply chains, more than we need products, more than we need anything that’s not already there.

In conclusion, we’ll enthusiastically be taking donations of items such as art supplies for oral health games in schools, certificates of achievement for Oral Health Coordinators, funds we can spend on having local tailors sew brush holders, holding workshops, lobbying local leaders, creating teaching materials; and actually, if anyone wants to offer rides to our field officers out to Sindure and Rupakot and Salyan so they don’t have to spend so many hours walking or stuck on buses, that’d be great.  Also, snacks.  Help us out – there are many things we need to do our part well, and lots of opportunities to support communities in Nepal.

As far as brushes and paste though, I think local shopkeepers figured this out quite some time ago.  Duh.

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Vendor Outreach in Sardikhola with technician Megnath Adhikari

Vendor Outreach in Sardikhola with technician Megnath Adhikari

A Bamboo Village

I am so excited about this post. I started hoping I’d get to write that title a few weeks ago, and now here it is.

We went back to Archalbot today to see how things had progressed since our tin delivery about a week ago. In contrast to our first shelter outreach effort, where we left not knowing how many heads we’d actually covered, in Archalbot we found a village of new bamboo houses. Some of them are still in progress, for a few reasons. One is that the houses in Archalbot didn’t fall completely; most people still have homes that are dangerous, but not technically unlivable, which slows down the shelter construction. The second is that it’s planting season, so people kind of got something up as quick as they could, and plan to do their plastering and finishing in about a month.

Still…this was a pretty great sight to see. Let’s start with the earthbag house. It’s been covered in a bamboo frame and turned in to a pretty sweet little cottage with electricity and everything hooked up, and a neighboring home built right next to it, much like the attached houses they are temporarily replacing.

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Next up, remember Kushal? Here is a photo from the tour he gave me of his original house, and here he is in his new bamboo home.

 

 

 

 

 

 

 

The site we glamped at in Kripa’s yard, which was previously the buffalo shed, is now a bamboo outdoor hotel (which unfortunately, I seem not to have taken photo of!) And this lady, Kripa’s neighbor, was seriously so happy about her bamboo cabin that she absolutely insisted we come back again after the planting season, when it’s all plastered and everything, to stay the night.

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I could post another load of these photos. They were just great, one after another.

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For the sake of transparency, I should admit that there was one woman who hadn’t built a thing; her tin was sitting on the buffalo shed waiting to be used. In the end, we didn’t pre-check all the frames or original houses in Archalbot, because we’d spent so much time there and the homes were so concentrated that we relied on the community to police itself (and in fact, it was a neighbor who brought us over there). This house is one of those that is ambigiously unsafe; cracks in the walls, but generally a more appealing place to live than a temporary house, so it’s kind of up to the owner whether or when they’re going to bit the bullet, move out, and rebuild.

We had an awkward interaction where I politely explained that she didn’t really need a roof – which I could see from looking in her house – so we’d be giving it to another family in the morning. I said we’d welcome do our best to provide anything else she could think of for something she actually needed. That was at 7:30pm. When we came to pick up the tin the next morning at 9:30am, we found the following:

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Well, that worked. For something.

So we have the successful, the more successful than we actually we wanted…and Uttam. Of all the houses in Archalbot, Uttam’s family’s are my favorite. Unfortunately they’re on borrowed land and in the last week and a half, the landowner said they can’t stay, so in theory they’re going to have to relocate this whole operation to their own land, where their ruined house is still taking up a lot of space. As a result they didn’t bother building the front wall. But I still give this house an A- overall, and an A+ for improvement from starting point.

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However the trophy goes to Uttam’s older brother, whose home is quite smaller. Remember when I this family didn’t want to go cut bamboo because they said nobody would help them? When Uttam’s older brother and his wife left for the woods with their tape measure, and when he showed me where he’d planned the guest area? This guy and his wife looked so proud of their house and so grateful that something in this world hadn’t proved to be a sham.

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When I took this photo of Uttam’s brother outside his house with his grandson, he called me over and pointed to the camera, and I knew he was going to say what people always say: “Please send me a copy of this picture.”

But he wanted something else.

“Show this photo to the world, ok?” he said. ”You know, something for people out there to remember me by.”

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The Long Road to Tin

 

IMG_0105Everyone predicted a tin shortage in Nepal, and now it’s here. Just last week, I got two bundles of tin for Uttam’s family in the morning and delivered it to them in the afternoon. Now we are ready to bring 53 bundles of tin to our two villages, Archalbot and Bharte, and we’ve been trying to get tin for five days. I have all kinds of random new phone numbers stored in my phone – in addition to all the people we’ve met in the communities where we working, I now have contacts for Tin Shop Dhumre, Tin Shop Lamjung, Tin Shop Udipur…

Last tuesday night at about 6pm, I finally found a hardware store, on reference from one of the guys we’ve gotten to know in Archalbot, that had the 50 bundles of 12ft. tin we needed.  They had a tractor and everything. We’ve been putting people off in our villages for about five days, so we confirmed our plans on the phone and got ready to go the next morning.

Dilmaya and I set out in a cab from Pokhara at 6am. On the way, we decided to provide $300 in cash relief to Bal Kumari to help her repay her loans, because I shared a post about her on facebook and people offered to support her. So we had to find an ATM that would work in Dhumre. Two of them wouldn’t take my card, and finally Dilmaya was able to withdraw $300 and I shoved it in my bag and we were off again.

We arrived at the tin shop in Udipur, just north of Bote Orar before you get to Besishahar, and things started to get crazy. First, our cab driver demanded more than the fare he’d agreed to. Then, the tractor driver seemed like he was never going to show up. But things got really funky when the shop owner suddenly informed us that the tin would be $10 cheaper per bundle than she’d promised me on the phone the night before. In rupee terms, that’s an extra 53,000 rupees – enough to cover ten entire houses according to her original price.

I normally keep my southasian cool pretty well, but I was enraged. This is exactly what the government said wouldn’t happen when others said it would happen. And our hands were totally tied: we had fifty families who had built homes and, after we’d told them to sit tight each day for a week, were waiting for us to show up with roofs because we’d totally promised this time it was for sure. Today.

There’s also the blinding fury of watching people casually do something awful, such as profit off of the plight of earthquake victims and manipulate social workers encumbered by a tin shortage.  Certain things will really light your fire, if you know what I mean.

Stuck between an major rock and a hard place, called our pal Pradeep, the head official of shelter relief for Lamjung district, to explain our plight. Among other things, he told us to check the weight of the tin. Turns out that even 26 guage tin comes in all different weights and thicknesses. When we went and looked, the tin was only 42kg…lightweight. It folded like tinfoil.  They were selling it at the price of medium weight tin which is 25% stronger.

Reluctantly, Dilmaya and I realized we had to give up our plans for the day and drive up to Besishahar, Lamjung headquarters. We’d spoken repeatedly with tin vendors there on the phone, but it was impossible to get any straight answers. We were going to have to sit down in person at a tin vendor and wait it out, even if it meant calling all of our contacts in their villages, again, and telling them, again, to trust us.  We were still coming.  Really.

Before we left Udipur, we walked up the street and took down the name and number of another tin vendor named Sagar. He seemed like an honest guy. In any case, we sure had learned all the right questions to ask, and we needed all hands on deck.  The way the tin situation is working is that vendors in this region, which is in central nepal along the edge of the earthquake’s epicenter in Gorkha, drive about 10 hours south to Chitwan to pick up tin near the border in India.  Then they drive it back up here.  Often, they can’t say for sure what kind of tin they’ll be returning with until they get there and see what’s in stock.  That’s what Sagar was up to later that day.   If you’re lucky, you can order ahead of time and there will be a delivery of exactly the thing you need, which is what we were trying to do.

IMG_0106So that’s how we found ourselves in this shop, Raja Enterprises, in Besishahar, where we sat for about three hours, watching the owner Rajesh make calls about tin. And at 5pm, when we’d finally secured and ordered the tin, and it wasn’t going to come for a week, we were ready to get in a bus back to pokhara, successful on one hand and defeated on the other.

Then my phone buzzed. It was Sagar from Udipur – the guy we met in the morning. He was driving to Chitwan to pick up tin and could get us the 50 bundles we needed by the day after tomorrow.

Reboot. Reschedule. We reordered the tin from Sagar. Plus some other items of a different size from Rajesh in the shop where we’d spent three hours. By now we knew our list of households, the size of their tin, the number of people in their homes and the areas of these villages they live in so well that we were referring to them by their first names. FIFTY OF THEM.

Dilmaya got a call from a friend and said wearily, “I’m ready to open a tin business.”

So this all meant that we were going to stay the night in Besishahar, and hang around tomorrow, because there was no point in going all the way back to Pokhara only to turn around again tomorrow night.

It was late evening and we were absolutely wiped out. On the way home, we passed a steel-working shop, and suddenly I had an inspiration.  After all, we had a day to kill in Besishahar, and this place looked like a Willy Wonka Dreamland of junk turned wonder.

I went in and described my imaginary safe-box. “Is this something you could make?” I asked.

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A Willy Wonka Dreamland of Junk Turned Wonder

A Willy Wonka Dreamland of Junk Turned Wonder

Gaky’s Light Family

 

This may come as a surprise…but in addition to our adventures in bamboo shelters, Eva Nepal still has it’s regular programs going. This week our Gaky’s Light Fellows graduated from 12th grade and from their fellowship.

Two years ago, we received 415 applications for the 12 fellowships that we awarded to Nirajan, Anju, Pabitra, Puja, Sandip, Ramesh, Orientation (4)Bhagwan, Krishma, Shristhi, Sabina, Narayan, and Asmita. Each of them has an incredible life story, and within the next few weeks, I hope we will be posting a tumblr that profiles each of them as well as the eighteen GL fellows before them.

The class of 2015 had a special bond, because it was when they arrived that we established the GL community house.  This batch as lived there together and become a true family, and bonded with a handful of wonderful foreign teaching residents who lived with them – Noam and John, Mary, MJ. While most of our past fellows came from Pokhara, this class comes from all over the country. Anju is the first young woman to leave her very conservative community in Janakpur to study higher education in a city sixteen hours away. Nirajan’s home is in remote Dolpa, and he’d been living on his own in Pokhara since he was twelve, performing at the top of his class. Each of our kids’ stories is unique and beautiful. You couldn’t dream them up.

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These young adults have changed tremendously since they first came together in 2013. At the beginning, basic life skills like arranging a cooking schedule and working out group living issues IMG_7108were new and difficult. Their behavior was segregated heavily by gender. I’ve watched their dress and their mannerisms become urban, confident, progressive. In their weekly Saturday workshops they’ve learned how to use a computer, spell check, do interviews, plan events, speak in front of a group. We’ve taught sections on body language and online image crafting. A number of our fellows have published articles in youth journalism international, including reporting on the morning of the earthquake and on the aftermath shortly thereafter. Last summer, they all did one-month professional internships in sectors ranging from software engineering to child welfare to public health and journalism. Four of them did their internships in Kathmandu.

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But I think the thing that had the most significant and lasting impact was the one where we did the least work: the community house. Each birthday was a whole-house affair. The girls wear each other’s clothes. All of the boys staying in Pokhara are moving in together, except for one who got a job in a nearby youth hostel. The peer community they’ve gained from this transformational two years together is obviously going to be a part of their lives forever.

With this graduating class, we’re bringing Gaky’s Light to an end, IMG_0021at least for now, so that we can focus on dental care, which is our more scalable program. But boy am I going to miss these kids. I am so proud of them. I am going to miss our sleepovers and henna parties. I’m going to miss eating breakfast in Connecticut over chat with them while they eat dinner in Pokhara. At least I know they will be keeping my social media pages full of news (work that online image crafting, kiddoes) and keeping in touch with each other.

GL alumni speaker Kiran Banstola

Their graduation featured lots of speakers: male, female, alumni, parent, me, and our featured speaker, Ramesh Khadka from Right 4 Children, who told his unbelievable life story of growing up on the streets of Kathmandu for ten years and then becoming a very successful social worker with street children.

Instead of going for a day-long celebratory outing like last year, we decided to spend the afternoon at a refugee camp in Pokhara that is housing earthquake victims from the ravaged epicenter in western Gorkha. Our fellows bought and served afternoon snacks.  The Gurung areas of Gorkha have a unique culture, language, and dress. Many of the older people don’t speak Nepali. There were some stunning faces in the crowd. I let the kids and counselors use my camera – I didn’t take all these photos.

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But I did take this one below, one of my all time favs. The woman in the white shirt kept laughing every time I tried to shout 1-2-3 in their Gurung dialect. Watching her through the viewfinder made me start laughing too. That of course made her laugh harder, which made me laugh harder, and soon this entire group of people couldn’t stop laughing. I love this picture.

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And this one…

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You Win Some, You Delay Some Wins

 

Well the earth bag house was coming along pretty well, but this week the rain started, which means planting season has begun. Colin has been working incredibly hard for hours a day in the heat, along with Moriah, an American volunteer who found out about the project on the facebook page that’s being used to coordinate earth bag building projects in Nepal. But completing an earth bag house in a week requires 8-10 people working all day, and we’ve had trouble getting consistent manpower from Archalbot.

I also have to confess that my part in the collaboration with the earth bag project went differently than I expected. After our experience in Parbat, I thought our main housing challenge was motivating people to gather bamboo (or other natural materials from the environment or their damaged homes) and build good quality shelters for us to provide tin roofing for. I expected, at the start of this week, that the earth bag project would be leverage for other local building projects, starting with Uttam’s bamboo house – in other words, that people’s interest in seeing the earth bag home completed would motivate them to fulfill our requirement that they also build a bamboo home for another especially needy family. I also expected that not everyone in Archalbot needed or wanted to move out of their cracked homes and live in bamboo houses. We thought we’d end up with be two high-quality sample homes in Archalbot – one earth bag, one bamboo – and residents would choose to one or the other them if they desired.

Instead, what happened is that once Uttam’s bamboo house started getting built, everyone became extremely motivated to go cut bamboo and make similar homes. It was much more successful than I ever imagined. And the earth bag house, while a brilliant long-term building solution, is extremely labor and resource intensive compared to familiar local building methods such as bamboo. With time and money scarce, everyone quickly became pre-occupied with the solution that met their needs and existing skills most efficiently. By mid-week, the strategy had reversed: we were pushing people to finish the earth bag home as a requirement for further tin distribution for bamboo houses.

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Uttam’s family’s two bamboo houses under construction

I realize maybe this is starting to sound a little weird – us putting these conditions in place for aid distribution, leveraging one community project against another. But that’s often the best way to collaborate as well as introduce new concepts or infrastructure in a place where people are used to doing things a certain way, and where the hierarchy of priorities is a well-entrenched survival system. We use this principle all the time when we do dental care. We have to put conditions in place that wedge new priorities in to this hierarchy: providing treatment only at the clinic and requiring people to go there to access it; charging nominal fees; making sure local shopkeepers sell toothpaste, but not giving the toothpaste out for free, so that people have to buy it themselves from the same place they buy sugar and soap. The reason for this isn’t for our benefit, it’s that the goal of our dental project is not to distribute toothpaste or provide one-off treatments, but to elevate the overall level of long term, sustainable oral health care in the places we work.  That only happens when people reorder their own priorities and behaviors, no matter what country or situation they live in.

Similarly, the purpose of the earth bag house is to train people in an earthquake-safe, affordable building method. But at first, it’s just a weird performance using rice sacks and dirt, so you can’t blame IMG_9549people for wondering if it’s really worth their time. It’s important to leverage the attractive elements of the project: the creation of a new structure, the intrigue of a new idea brought by foreigners, the incentive that we’ll provide materials to trainees for building one of these houses themselves. If we can capture participation based on these points, we can hopefully keep people’s attention long enough to teach the skills we want to transfer.  Like our dental clinics, the point is to see people absorb this safe-building technique over the long term because they realize it has value.

So leveraging earth bags and bamboo against each other was a great idea, but the thing I didn’t anticipate was that the time of year and the urgent need for shelter would make the one of the two so much more attractive. So for anyone out there doing earth bag building, my suggestion is, wait until about late September, just before the harvest time. Better yet, the best time of year would be December or January, the only season when there’s any semblance of a real break from field work. While earth bagging is a fast, democratic construction method compared to a block or large mud and stone house, it does require a lot of city-based resources and labor compared to other readily available options. There are almost no families that have 8-10 people in their household who can work intensively for 8 hours a day for a week, and definitely not during rice planting season. That means that families will have to hire labor, and that means other people need to have time.

IMG_9720In the end, Colin and Robin decided to have Archalbot build a bamboo shelter around the half-finished earth bag home, with the goal of returning to finish it up in the fall. So here is a photo of our nepal’s first earth-bag-bamboo-tarp home. Tarp soon to be replaced by bamboo.

In the evening, the community had another meeting about why the earth bag house hadn’t been completed. There was quite a bit of contrition – people hadn’t fulfilled their promises to help out. But there was still confusion over the concept that the earth bag house was a training opportunity, not a private building project. No matter how many times we explained this – and I speak pretty fluent Nepali, and Dilmaya is Nepali – the tendancy has been for people to think of the earth bag project as “Mahendra’s house.”

In any case, there was this slightly downer of a meeting, and everyone vowed that when Robin returns in the fall they will all be totally ready to devote time to completing the training. Then we went home to eat dinner, and I got a phone call from little Kushal.

A speaker system had been set up in the yard, and we had a rocking dance party. And why not, man. You win some, you delay some wins. When I left in the morning, there was cut bamboo lying around all over the place, ready for construction.

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Small Bundles in Big Spaces

 

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View across the valley, from Bharte

After my visit to Bharte, I went up to Besisahar to spend the night. Many of the international NGOs working in Lamjung operate out of a hotel called the Himalaya Gateway, and I wanted to sit in on a training by the Danish Red Cross on shelter distribution. Plus, I had to retrieve our first delivery of tin: two bundles for Uttam’s family.

I arrived bedraggled and hungry at the hotel at 8:15 pm after many hours of hiking up and down in Bharte in my flip flops (points for irony on the hotel name, Himalaya Gateway). I sat down and talked for a while with Laurienne, the head of CARE’s relief effort in Lamjung. I’d met her at one of the shelter cluster meetings and found her to be a really nice person, so I’ve kept in touch. It’s pretty funny that I’m running around in my flip flops in Bharte and taking a bus to Besisahar to a pick up our first two bundles of tin, while Laurienne is coordinating the transport of 1200 bundles of tin on 28 tractors – TWENTY EIGHT TRACTORS – we had a good laugh over just the image of 28 tractors climbing up the narrow jeep “roads” of Lamjung district. A bit of a nervous laugh, too. The delivery of all this tin is probably going to take a toll on Nepal’s fragile environment. The Red Cross has committed to almost four times that many homes in Lamjung alone – one of the less affected districts.

Speaking of damage, I got myself a pint of ice cream (“Ma’am, how many scoops would you like?…The whole container?…????…Certainly.”). I turned on the air conditioning in my hotel room which noisily and enthusiastically set to delivering air at the same temperature as the rest of the room. I took a shower and fell asleep on the fluffy bed.

The next morning I went to the Red Cross shelter training. It was super interesting, but probably not something I will be able to use much. The topic was how to conduct efficient mass distribution of tin sheets, building kits, and envelopes of cash. For your kind information, and so I can make some use of my training, I offer you the following tips on distributing thousands of corrugated tin sheets to remote Nepal: distribution area has one entry and one exit; recipients move through in a single straight line only, no criss-crossing; vests must be worn at all times and a flag clearly visible to signal that this is a humanitarian space; a question and complaint-receiver stays outside the delivery area.

Also, it is suggested that your team (and, one assumes, your tractors) arrive at your distribution area the night before.  Because there might be some problems with travel.  Maybe.

Mean time, I was coordinating our first delivery of a grand total of two bundles of tin for Archalbot. In the morning, I ran in to the Chief District Officer of Lamjung at the hotel, and of course, we are old friends. I said I was delivering two bundles of tin today in Archalbot and asked if he had any transport suggestions.

The Chief District Officer looked at me funny and said, “Two?” Awkward pause. “That…doesn’t seem like a enough.”

Right right, I said.  True enough.  But see it’s part of this thing that’s going step by step. I promised there’d be more.  There will totally be more.  Also, I’m two bundles ahead of the Red Cross, and I’m going to enjoy every bundle of my lead for each hour that it lasts.

It was about 2:00 by the time I hopped in to a truck with our two bundles of tin. The hardware store owner had a delivery vehicle that was headed south anyway, and agreed to take our tin sheets (and me) for free. And thank goodness this truck was large enough to house a killer whale, because only thing inside it was our two little bundles of tin, which you literally couldn’t even see in the gaping darkness.

We hit the road and I called Kripa to say I was on my way with Uttam’s roof.

IMG_9669When we arrived in Bote Orar to unload the tin by the side of the road, about eight people from Archalbot had come down to roll the sheets and carry them up to the village (note to self: get a tractor when it’s time to deliver tin to the other 15 families). I hoisted an end of one tin roll over my shoulder, uttam’s sister in law took the other, and we were off.

I could hardly believe it when I arrived at Uttam’s house.  I’d only been away for 24 hours, but what used to be the tarp shelter in one field was now two bamboo frames under construction, with lots of people about.

The family called me for snacks. They had gone to buy a few kilograms of meat – a pricey indulgence – to feed to all the people.

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Later, I was talking with Uttam’s brother. Even after all the days we’d been in Archalbot, working on the earth bag house, sleeping in Kripa’s home, stopping by to visit people in their yards and encouraging them to go cut bamboo, eating and bathing and washing our clothes with everyone else – after all this, Uttam’s family wasn’t completely convinced that we’d really show up with their tin.

It wasn’t until I’d called from the truck a few hours earlier, to say I was on my way from Besisahar with the tin, that the mood turned celebratory. That’s when someone was sent out to buy the meat.

Oh, and also, added Uttam’s brother, they’d made this excellent and spacious bamboo frame, and as I could plainly see, one bundle of tin wasn’t going to be enough to cover it.  They would need another, he informed me.

Very clever, Uttam’s brother.

Uttam and his brother building their bamboo house

Uttam and his brother building their bamboo house

If there’s one moment that will stay with me the most, it’s when I asked Uttam’s oldest brother, who is building the IMG_9677smaller upper house, to explain what each area of the inside would be when it was done.  He and his wife had clearly thought about this.  He pointed to the place where the kitchen fire would be, and the sleeping area (there weren’t exactly a lot of rooms, but that’s not the point).  I motioned to a spot at the edge of the house that was a few feet wide.  From the frame it was clear that the roof would slope down over it.

“What is this for?” I asked.

“That’s a place to stay if someone comes to visit,” he said.

Uttam’s family’s two houses are still going up, but before I left the next morning, I was happy to take this picture of his wife and two month old baby.  Another small bundle in a big space…nice improvement.

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Stones in the Sky

 

It sure is hot, I’ll tell you that much. No matter how much water we’re drinking, it just seems to turn directly in to sweat. I’m thirsty all the time.

It took me about two hours to walk from Archalbot to the next village over, Bharte. But it was two hours in the direction away from accessible travel. Bharte is next to Archalbot on the map, but once you get a little way in, it’s pretty far from anything. Instead of the clustered communities I’m used to in Nepal’s hills, Barte’s houses are often a few hundred meters apart.

Let’s just say it’s a lot of walking.

It took me about an hour and a half to get to Barte from Archalbot this morning. I met up with a guy named IMG_9645Pashupathi, president of Nepal’s Red Cross Chapter in Bharte. The first place we stopped was at a collection of households sharing a tarp in the yard.

We sat down and discussed the plan: we’ll provide one roof per family if they build walls. Each time we have this first conversation, it has a different feeling. Some people seem over-eager to get what they can whether they need it or not; some proud and cautious. We’ve even been some places where homeowners didn’t seem to see the point of what we were proposing—as if the entire situation seemed too overwhelming or pointless to try to break into. In Sirewari there was a friendly, open vibe, and people caught on right away. I took down the number of the person who seemed like my best contact, a young mother named Santa.

Next we went around back and visited the home a woman who unlocked the door of her boarded up house. I peered inside, where the orange tarp over a hole in the roof cast a firey glow onto the wooden staircase and various items and broken wood stowed in what used to be her living space. The scene looked ominously like those iconic photos of ground zero, leaving me momentarily mesmerized.

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From there Pashupathi took me on a very long climb. It took us about an hour winding up quiet hillside paths to reach a soaring ridgetop in Lakhure. It looked like you could roll off either side of the hill and land all the way back in the valley. Summer clouds have obscured the piercing Annapurna peaks that would break the horizon in winter, but and endless fall of terraced fields across the valley are in full green bloom, spilling down from the sky in a dizzying cascade.

IMG_9784I went to four houses along this ridge in Lakhure, all of which were leveled in the earthquake, all of which belong to Dalit (“low caste”) families. This was my first visit to a place where houses where actually completely demolished. And what to you know – all four families had rebuilt themselves shelters, which they’d covered with traditional grass and reused tin. Most were using their tarps on top of these completed shelters to keep water off the fragile roofs.

We spent some time talking with Bal Kumari, a widow – read, highly marginalized in rural Nepal – whose two daughters are married and whose two sons are still in school. She hired people to rebuild her fully leveled house in about 10 days. They literally took the stones of the rubble and put them back in to a house. Which, admittedly, used to be two levels, and is now it is one. But it’s a sturdy, warm, normal house. With old tin and a tarp on top (we will be bringing her new tin shortly). She still doesn’t know how she’ll repay the $300 debt this put her in to.

IMG_9664Other members of this community had cut and woven bamboo, or spent hours collecting and bundling grass for their roofs. I know the pundits talk about the resilience of the Nepali people so much it is becoming a cliché. But it is very moving to see this courage and persistence concretely, as stones and walls and laboriously crafted grass roofing.  The only aid they’ve received here is some rice, oil, salt, and tarps.

We’ll be bringing tin up to Lakure next week, and in the mean time, I hope we can find a way to employ a few of the people from these houses as day-laborers to help rebuild elsewhere in their community. They’ve certainly proven they know more than I do about it.

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Bal Kumari Bhujel inside her house, which was leveled in the earthquake. She hired help on credit and rebuilt it herself.