GP Sarah Watson and her husband Ant volunteered in Nepal with PHASE in March 2015.

Our journey to Wai, in the Bajura district of western Nepal, was slightly longer than we expected. Kathmandu airport was closed due to an accident and so we were flown to Kuala Lumpar where we stayed for the next five days before getting the plane to Kolti, in Bajura. From there it was a three-hour walk to Wai. Were it not for the Kolti airstrip, this would be a seriously remote part of Nepal. The fact that there are daily (if conditions allow) flights from Nepalganj gives less of a sense of remoteness than the upper Gorkha valley, which we had visited on our previous trip with PHASE. From the moment we set foot in the village of Wai we were made welcome

. The village elders and their families, with flowers, garlands and red paint on their foreheads, greeted us. Then we all sat round on a big tarpaulin and introduced ourselves (the locals as well as visitors). Sunita had come with us from the PHASE office in Kathmandu to travel round several health posts, and she acted as translator. The welcome continued throughout our stay in Wai. If Anthony, who was working on an irrigation project, happened to be leaving on his own from our “home”, our neighbours – the lovely Mr and Mrs Ginn – would see he was well supplied with food and tea!Wai is a beautiful village, reminding one almost of a Mediterranean mountainside.

 The accommodation for PHASE workers lies at the edge of the mountainside, and as the hillside has a concave shape, there are wonderful views from here across the rest of the hillside village. The early mornings in March are cold, but when the sun hits the village at 8.30 am, steam rises with a vengeance from all the rooftops – one could almost imagine the village was on fire. People come out to warm themselves in the sun, the chattering starts, and the village comes to life. PHASE became involved in the area around Wai only seven months before our visit; previously Government Health Workers (GHWs) had been the only form of access to health care. So the PHASE Auxiliary Nurse Midwvies (ANMs) had a big challenge ahead of them.

 They are doing a great job and standards have improved a great deal over this period. However, they still face daily challenges, and have been unable to make progress with the PHASE philosophy of allowing all patients to have consultations in private.The days would start, as in all village households, with household chores followed by a meal of dhal bhat taken in the kitchen (on the floor, naturally). The working day begins around 10 am, and goes on, usually without a break of any sort, till around 5 pm. Arriving home, there would be tea and a ‘snack’, such as noodles.

Hopefully there would then be time for me to have a teaching session with the girls, before they had to prepare the next meal of dhal bhat, eaten at about 8 pm. This worked best on two occasions when the ‘chaps’ cooked the food, giving us time for teaching! Dharma was best at this. He is the PHASE Social Mobility Worker and is involved with everything from money saving meetings for village women, to agricultural and hygiene projects. My days were usually spent at the health post, commenting where possible on Chitra’s and Suprina’s, and sometimes the GHWs’, consultations.

The patients we saw were usually not so different from British General Practice; small children with coughs and colds, adults with coughs, skin conditions, joint and back pains, and significantly more gastritis than we would normally see. Quite a few “extras” turned up when word got round that an English doctor was there! We saw a profoundly deaf six-year old boy, very bright but without speech. His parents were motivated to help, but had taken him to a hospital and been told that nothing could be done till he was 10 – quite incorrect! With help from the PHASE Medical Coordinator, Dr. Gerda Pohl, we were able to advise reputable (and probably much cheaper) hospitals. On other days we did home visits to other small villages, up to two hours walk away.

 I loved these days! It’s wonderful to be able to trek these remote mountain paths with stunning views.When we arrived at the villages we would be made very welcome. Chitra or Suprina would settle themselves with a small group outside, and wait for the group to become bigger, which did not take long at all! They would then talk to them, usually about childbirth, potential complications, preparations beforehand and care afterwards, with the help of a laminated picture sheet. Perinatal and maternal mortality has always been high in this part of Nepal.

A major focus of PHASE is to tackle this. The aim is that every birth should have an ANM in attendance. They will always go to a home delivery, however far they may have to walk – provided somebody tells them. Anthony, meanwhile, would go off at 7 am with Dharma, Yam and other local men, armed with a long length of hosepipe, two walking poles and a GPS. They used these to measure water flow and fall along the stretch of river. One day, as they were about to pass the school along the riverbank, the army stopped them. 

The school leaving certificate exams were taking place, and nobody was allowed past, in case they might be smuggling in the answers. Finally a teacher was found to accompany them! PHASE is having a gentle, but very positive impact, in this area. They are very much respected by the community, who turn to them for advice on various issues, and are clearly delighted with the support they receive. After a final night at Wai, we were sent off in celebratory style by a gathering of neighbours. Another wonderful experience – thank you PHASE!

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