Dental Care Anyway

IMG_4898I’ve been in Pokhara for about five days now. All the usual activities – Saturday workshop with our Gaky’s Light Fellows and Asmita’s 18th birthday party at the community house, where I continued practicing my henna tattooing skills on all the girls…

Last week Kaski Oral Health completed this year’s teacher trainings in each of the three villages that launched over the winter. This is where one teacher from each school, who is called an Oral Health Coordinator, learns to conduct a daily brushing program and also do oral health education throughout the school year. We had to postpone our OHC trainings because the earthquake hit right when they were originally scheduled, and when we did hold them, we had to think about how to keep oral health care relevant in the context that teachers are now facing.

IMG_0525There are approximately 129 damaged homes in our working areas, some of which are unlivable, and just outside of a village where we work in Parbat, a nearby area has experienced even more extensive damage and our dental technician has asked us to help. So we’ve made one trip out there, and we’re considering how to approach another. About 13 schools need some or total rebuilding in our 10 villages. All these realities must be acknowledged as we continue trying to advance the work we’ve been doing in oral healthcare over the last eight years.

One widespread issue is that shelter aid has been largely limited to people whose houses were totally destroyed. For thousands and thousands of people whose homes are standing but too dangerous to live in, significantly less help has been available – by not receiving tent distribution, for example, and that’s where organizations like ours filled in. Going forward, the government is compensating only $250 per damaged house, compared to the $1000 that will go to families whose houses are flattened. Then again, everybody will need to rebuild from scratch, and even a simple village home costs closer to $3000.

All of this is why I want to start pulling back from using our limited relief funds for tents and start focusing on transitional housing that will last people for the length of time needed to rebuild.

On a tangential topic, we’ve outgrown our one-room office, and leased a new space that is currently totally empty, which is both exciting and intimidating. So in between scouring the internet and Facebook for examples of tunnel shelters and super-adobe shelters and shelters that reuse tarps, I am also turning over possible arrangements of the sunny new rooms of our office, which have yet to be set up as our home.

I took a detour from dreams of shelters and offices yesterday to spend the morning with our field officer, Dilmaya, at Deurali Primary School in Kaskikot. This school is just five minutes from my house, and it is where Didi and Bishnu attended grades 1-5. I have known the teachers there for twelve years. For about 4-5 years, Deurali school ran a daily brushing program we’d helped them start, but it eventually petered out. Their Oral Health Coordinator, a really sweet young woman named Chandra, had asked me last winter to help them restart it.

So Dilmaya came up to Kaskikot with her backpack full of brushes and paste, had lunch with me and Aamaa at home, and then we went to Deurali school and sat down with all the teachers in the office. Govinda also joined us – he is one of the founders of KOHCP and was the team leader in Kaskikot for the six years the program ran there.

IMG_0577I was amazed when the headmaster pulled a notebook out of the cabinet. He had kept a log, which started in 2011, of each purchase or donation of brushes and paste, each poetry project or dance performance the school had held to advocate for oral health care. We discussed the school’s plans for future sustainability as our contribution declines next year, a plan we require. The teachers presented each of us with kata scarves, a traditional way to welcome and honor guests.

You all may or may not remember that when we tried to hand-over Kaskikot’s KOHCP programs and clinic in 2012, the project collapsed due to personal interests among government officials (a soap opera that, for better or worse, was covered in a 2013 Washington Post story). So it’s a bitter pill I live with that in order to keep this program growing and developing elsewhere, I had to be willing to watch it fail in my home village. And since then, we have since expanded to 7 clinics in 10 other villages that cover an area of about 50,000 people.

Nevertheless, sitting in this tiny school in my back yard, which has no more than 35 young students, and seeing the enthusiasm and sincerity of the teachers to restart their brushing program, was just awesome. We were all so happy with each other that it was basically one big appreciation fest.

Now that we have field officers, we offered to have Dilmaya come back and run a workshop for the teachers on oral health education, where she can teach the art, math and game activities we do with OHCs now to help them promote oral health care in addition to doing the brushing program.  Their teacher took the new brushes and paste and ran the day’s brushing program.

So that was a nice little pick-me up. Now, back to Pokhara to look at earthbag building.

Looking for Shelter

 

I woke up tired today. Partly because I stayed up so late writing, and partly because we’re all sleeping on the floor of the living room by the front door.

But I had an interesting morning. I made my way to an outdoor lot full of incomprehensible discarded piles of things, where Dr. Kiran’s group, SXJ-95, was meeting about their transitional housing unit, a clean white bubble sitting in the middle of the mess. It was really fascinating to hear how they’d developed this design by researching other units, most notably the post-earthquake shelters used in Pakistan. I’m going to save the details, because I hope to produce a quick audio slideshow about it.

IMG_8773While I was there watching, two government officials came to inspect the prototype, and discuss minor modifications so that it could be used to replace a destroyed Health Post in rural Lalitpur. By the time we left, the builders were getting back to work on the second unit, with a plan to drive the pieces to Lalitpur and set up a shelter within two days.

This has really got me thinking about transitional housing as a possible use for our relief fund. I plan to either donate it to a group doing really valuable work in rural areas, or finding a project that we can do well. It has been such a chore to procure and deliver tents – which are getting more and more expensive – and it’s frustrating to know that, while obviously better for people than no tent, this is such a short-term improvement. Plus, each time a transitional shelter is placed in the field, it’s an opportunity to get feedback and improve the design, so if we can collaborate with a group like Kiran’s, perhaps we could contribute to the larger good in terms of research and design.

SXJ 95’s unit costs about $500, but they put a lot of thought in to user feel and aesthetics. On one hand, this means we could potentially offer rural families upgraded transitional housing; on the other, we couldn’t afford very many. I plan to keep in touch with Kiran about their test in Lalitpur and maybe see if this design could be used for another health post or school classroom. Here’s a recent article by Gordon Brown, former Prime Minister of the UK, on the importance of reinstating schooling for basic child safety and welfare (sorry for the sensationalist title).

I left the crazy stuff lot with its shelter bubble, and my next stop was the Ministry of Health and Population. The World Health Organization holds bi-weekly meetings in collaboration with the Nepali government, where all of the major players in town for recovery – large iNGOs, foreign medical teams, etc. – come to share information. These meetings are divided in to clusters, such as Health, Communications, Shelter, Security etc. I went to the Health Cluster meeting.

This is the opposite end of the spectrum from the WHR’s and SXJ-95’s of the relief effort. Kiran dropped me off, and I hopped out of his car into a parking lot full of oversized, logo’ed SUVs. I made my way to a packed meeting hall – probably close to 100 people of various nationalities. I sat in the back of the room and scanned the emblazoned vests in front of me: World Vision, Save the Children, AmeriCares, International Medical Corps. Japan, Switzerland, Canada…and then in the back, some straggling foreigners like me, probably there to get the lay of the land.

IMG_8789The meeting was led by the WHO rep to Nepal, Dr. Lin Aung, with government representatives in attendance. I had missed the first 20 minutes or so, but listened to some updated figures, and then attendees were invited to share what they’d been doing. That part seemed a little odd. They would announce the name of an area – “Sindhupalchowk?” and then various groups would stand up and say what they had been doing in Sindhupalchowk since the last meeting. It was more information-sharing than strategizing – but maybe these groups have other methods that they are using for truly coordinating their efforts.

After the meeting, I went to go talk to Dr. Aung. Ironically, I was trying to meet him all winter because I thought he’d be a good person to know for Kaski Oral Health, and I was never able to get in touch since I’m rarely in Kathmandu. But when I introduced myself, he turned out to be a very friendly and genuine guy. He gave me five minutes of undivided attention, even though another half dozen people were waiting to talk with him.

I asked what he thought a small organization like mine in Pokhara could do to pitch in to the relief effort. Like others, he said we should be thinking medium and long-term, which is where multilateral agencies aren’t nearly as agile or embedded. He said that with our community ties, we should focus on counseling and psycho-emotional support.

I said, “We don’t know anything about post-disaster counseling.”

He said that the psycho-social cluster is developing protocols for this kind of thing and gave me an email address where I could access this info.

All of which tells me that, for better or worse, coordination is almost completely at the discretion of aid providers. I think – and you could argue that this makes sense under the circumstances –things are really set up such that, in order to find the best way to participate, organizations large and small have to make a point of reaching out.

I’m not sure why I’m a little hung up on this. But I suppose we’d like to think in a humanitarian crisis of this nature, somebody has the answers and can tell us all what to do – and maybe somebody should know. But the basic fact remains that everybody is winging it to some degree, and I can’t argue this is exactly anyone’s fault. It seems like it’s really one of the cruelties of the whole situation.  The real blame lies in the injustices of the past that led to poverty and bad planning and lack of security, not in the present where nature took over. In any case, it seems like coordinated strategic planning is largely a matter of self-discipline.

Before I left for Pokhara, I went to visit a friend who is the CEO of Teach for Nepal. Most of their teaching fellows were there for a day of counseling with social workers from Israel, experienced at working with disaster trauma. I learned that one of TFN’s young teachers perished in Sindhupalchowk. The day of the earthquake, my friend and her husband were unable to call a helicopter to Sindhupalchowk, so they drove 5 hours to get there and dig through rubble themselves.  It was out there that they realized they’d actually lost her.  Now they are left with continued aftershocks and their other 89 fellows to send back out to their schools.

Everyone is spinning.

By the time I got on the plane to Pokhara I admit I felt pretty down. I had also spoken with my friend’s husband who has worked on a shelter that costs just $100 and might be a good option – we could potentially provide an entire community of about 100 -200 families with safer housing while they rebuild. But everyone is so hurt, psychologically and otherwise. The scale of rebuilding that’s needed is really hard for me to wrap my head around. I really just wanted all of it to go away.

At the airport in Pokhara, Prem was waiting for me. And as we crossed the road, Aidan was on the other side sticking his head out the taxi window, shiny as a stamp, his cheeky toothless grin lighting up the whole city. Pascal insisted on sitting in my lap for the seven-minute car ride. I gave them some super-sized squirt guns and unloaded the rest of a bag of Reese’s Pieces.

We went out into the late afternoon Pokhara sun, and walked to a plot of land up on a hill, where leveling strings are stretched across deep foundation holes in the ground. Prem and Didi are building their first house.

*      *      *

IMG_4905

For anyone wishing to support Dr. Kiran’s group, SXJ-95, you can do so here: http://bit.ly/1ReQ8gj.

Teach for Nepal is providing relief in their working areas, and will have a special focus on rebuilding schools. You can support them at http://nepalrelief.teachfornepal.org.