Hope Center

Nepal, December 19 2002.

Namgyal Dolma was Tibetan, 37 years old and married to Nyima, 40 years. Parents of two small girls, Tenzin Tsewang, 9 years, and Dekyi Yangzom, 6 years, they decided to have a third child hoping for a boy.

Met in June, they were in full form. Re-examined in September in their small shop of Pokhara, we always noted the roundnesses of the mother-to-be, smiling, attentive and very attaching. We did not evoke the subject, by decency and respect of their private life. Another person will learn to us later than they already lost a child in the fourth month of pregnancy.
Their shop of Pokhara is accessible with its turquoise stone collars, its rings assembled on money. And all one each one which returns visit thinks that this family lives at ease. While passing in the back shop, one discovers the back of the decoration. Only one and simple room in which all the family lives. A part of 3 meters out of 3 only with two beds in L and a stove to cook toukpa (soup Tibetan) or some momos (kind of raviolis Tibetans). No table, no chair. The toilets are with outside and water also. The promiscuity and the simplicity of the places let suppose very modest living conditions. Nyima was useful in the Indian army and does not perceive any pension. Dolma holds the shop but taking into account the political situation in Nepal, tourism is in crisis and nobody any more or almost attends the shop. The two parents ask so that we sponsor their two gamines. It is to speak again of all that that I go to their shop on December 11, 2002.
The iron curtain is lowered and it is informed me that, patient, Namgyal are hospitalized in Gandaki Hospital. I think one moment that it will be confined prematurely and I put in my bag some large babies. But a friend says to me that the condition was really serious and I give up the effects with the hotel.

In Gandaki Hospital, we discover Namgyal under perfusion and respiratory assistance. It is unrecognizable, more nothing to see with the serene and soft face previous months. She does not hold upright, is with half conscious or unconscious in an austere room. One says whereas that to me made two weeks that it is there and that its state degenerated after a taking away of liquid on the level of lungs.
In short, its state does not inspire anything good and we wonder well why it there is left. Intensive care would seem better appropriate to its state. A nurse, inadvertently perhaps, leaves the medical file on a corner of the bed. Opposite the mention -cardiac pulsations at the foetus - one reads the word -ABSENT in large capital letters.

We understand that there is already nothing any more good to hope for side baby and the doctor will confirm the death inside the belly of the mother. The continuation it is a terrible sequence.
Transported to the intensive care, it will receive a strong medicine likely to fall through. What was made? The body of the baby was thrown to the river by the Tibetans. While returning, they joked, affirming that this day the fish would have eaten well!
Then, it was a hemorrhage and the search for fresh blood groups A+. We will have recourse to the local radios to reach that point. Lastly, the kidneys will cease functioning and the doctor will even entrust whereas his chances of survival are tiny, that it does not have there more hope. We all will sleep at the hospital awaiting the final outcome.

During the night, I due to return to me to the toilets. I discovered then what the correction prevents me here from describing. “Of the toilets overflowing of excrements” is the most courteous expression to summarize the thing. In other toilets in fact towels mouthfuls of blood will draw my attention.

This night there not again case admitted in CIU (intensive care). The day before, in the night, a girl had been transported in room of childbirth. Come from Lamjung, with a few 75 kilometers of Pokhara, his/her brother and of the friends had decided to lead it to Pokhara, as soon as the first contractions had upset it. They carried it during eight hours, rolled in a cover. Then they were three hours of bus since Thumsikhot and finally the taxi to join the hospital. A nurse's aide of the village had advised to her to wait the last minute to go in Pokhara, to be confined, because nurse's aide said: “Your health is good and that of the child also”-. His/her sister will entrust to us that it had advised to her to come in Pokhara at least a month before the date planned for the childbirth but the opinion of the nurse's aide had carried it. The result it is a fast childbirth but of a dead child born bus too many time wasted to go to the hospital. And a girl who finishes with the intensive care in the coma. It, it was left there.

Namgyal, in the early morning, goes better seemingly. A doctor will say to us that its state clearly improved since the day before and the hope returns. One advised us with new to bring fresh blood. One sends to us towards pharmacy with long lists of very expensive drugs to provide in urgency. And one organizes oneself.

The following day I join the hospital around 10 a.m. A friend says to me that Namgyal is definitely better, that its eyes are opened and that it hears our words. Appearances are misleading: the kidneys do not function anymore and it did not urinate since more than two days and half. « It is condemned if it remains here” us a doctor entrusts, “ with a septicaemia, kidneys and a liver out of state to function, its only chance is to join Katmandu in the ambulance and to obtain an impossible dialysis with Pokhara, for lack of adequate material ». The consulted LAMA will say that according to him “it is useless to bring Namgyal to Katmandou” and Nyima is hesitant. A choice between religion and science.

Finally it will listen to our matter: « it is your responsibility and it is the mother of your young girls; a chance exists, tiny, to save it but it is a risk to be taken; you decide”.

Then, we left for Katmandu at 1 p.m., in the ambulance, without nurse because the hospital could not affect one of them. Us were explained the rudiments to regulate oxygen, water and other perfusions. A course of a few 6 hours on a road not always in good condition.
Moanings of Namgyal to each pothole; anxious glances. Arrived in Teaching Hospital in Katmandu, Namgyal is allowed immediately with the urgencies. The continuation goes very quickly and it is the horror.

Initially a body which abounds in blood. Staff evacuates some in quantity by the mouth. With my opinion it made an internal bleeding, but the heart holds good, the electro one - encephalogram is normal.

And one asks us to press a balloon of air at regular rate/rhythm to help it to breathe. One as well as possible carries out what one says to us to do. Time passes. The nurses, hopelessly seeking an intact vein after two weeks spent to the hospital, take blood. And then staff disappears and we are there to pump while a jet of blood runs nose of Namgyal. And then tears run along its face, of the red tears, the last tears of Namgyal, tears of blood.

Ten minutes later all will be finished; her heart will have ceased beating and the young Tibetan who relayed us to press this balloon of air remains there, jellyfish, the balloon between the hands knowing only to make.

Around us a girl shouts her desire for committing suicide Apparently, she absorbed badly drugs. We, we fought, with Namgyal, to save Namgyal. An useless combat since that it left us. But only after the facts one can thus state such obviousness, with less can be to be LAMA.

Transported at the mortuary, the body of Namgyal cannot be put in cold place. One discovers the absence of normally functioning refrigerator. They manufacture heat.

We deposit a white shroud on the body without life and let us give up it in this room. There does not remain to do anything more than to go home and to announce the death to the sisters of Namgyal, sleeping at the house. The words then will be useless.

Lifted to a height of 4 hours of the morning we join the hospital for puja (Religious Ceremony) said by large Rimpoché (LAMA Tibetan) of Swayambunath. It evacuates the spirits of the body and we leave then towards Teku for the cremation. It will be led perfectly and nothing, plus nothing, remains body under the glance hagard and in tears of Nyima which did not cease praying, a malla in hands. Namgyal left, her smile disappeared, will she return to us?

This history can inconvenience some of them, others knew that in other countries, of some will wonder why I tell it.

The lesson which one can draw from this fine tragedy is in any case very important.

·  First it is important to say that before managing the drugs to Namgyal, one always asked us to produce the invoice with the mention “ paid”.
And these drugs had a very high cost if one brings it closer to the social standing in Nepal. The admission with the intensive care was not possible that after payment of the invoice.

And the first teaching: in Nepal if you have the means, you survive the hospital. If you are poor and in bad health, you have very few chances of you to leave there.

Namgyal, herself, was too sick at the time or we arrived, to survive there in spite of the lavished care and drugs and the financial participation several to pay the invoices; others, for much less serious than they, leave there also their life.

· Another report : the absence of really effective stations of care in the villages and of nurse's aides worthy of this name, sometimes, causes useless deaths. The girl of Lamjung lost her child and if her interdependent family had not had money to pay the care, she would have also died following badly advised councils.

· Another teaching : the communication with the staffs was sometimes very good, in other places it sinned from the lack of clearness and an obvious lack of confidentiality. Everyone hears all on everyone.
Side organization, they are often the close relations of the patient who must manage fault of personnel.
· Other made proven : it is sometimes difficult to choose between science and religion. The LAMA had it considering the fatal death of Namgyal, yes I think it. Was it necessary for as much refusing the last chance which remained to save a life? We think of having done what it was necessary to make. Only one regret in this history: not to have arrived at Pokhara earlier.

· Another report always : the Nepalese hospitals under are equipped. Cankered beds, covers of another age. Unhealthy conditions and a lack of material. The intensive care is them equipped well a priori. Maintenance leaves something to be desired. The refrigerators with the mortuary with Katmandu produce heat and not cold.

· No infrastructure of reception to accommodate the families and one sleeps on benches or with same the ground in the corridor in front of the entry of the intensive care.

· Finally one will draw like another teaching limits of our action here but also its base even.

We did all that it was possible to make, humanly and financially. But the elements were baited against Namgyal which, I specify it, had also tuberculosis.

Our immediate action consisted in finding godfathers for the two girls of Nyima. From the disappearance of their mother, the two children are always sponsored by us and follow a normal schooling in a school of good quality in Katmandu.
Our action is also to provide to certain hospitals in which we have confidence of the medical material (tables of care, beds, stethoscopes, etc) and of the effects distributed free to patients (glasses, crutches, wheel chairs, etc).
Our action also consists in sponsoring the studies of young Nepalese wishing to acquire medical knowledge for then making some profit the communities. A better formation would avoid annoying events like those which have occurred for the girl of Lamjung.
Our action also consists in encouraging education so that better informed children do not leave themselves any more misused by inadequate councils as regards health or interested and corrupted politicians.
Our action is to encourage education for one day to see the human development in Nepal posting an ascending curve, to allow the local populations, of any origins, to have a better health and a spirit criticizes more developed for better analyzing and including/understanding the situations.
Our action is to encourage all that can make evolve the society towards better conditions of existence and the best way to reach the target is to encourage is education. “Support for education is the base of our action in Nepal”.
*Alain LAVILLE is coordinator of HUBLO Nepal, ONG recorded in Nepal.
Contacts:
HUBLO Nepal (ONG)
Address: PO boxes 3019 Katmandu Nepal -
Telephone 00-977-1-4353387 gold 9806567267
E-mail: hublonepal @hotmail.com or alain_laville@hotmail.com
www.hublo.org.np