Hajur? I didn’t understand what the man said. He repeated himself and I had to stop a nursing student to translate for me. He asked how his wife is feeling, ma’am...He’s using the low form ma’am. She meant that when he referred to his wife, he had used the form of address for animals. Above the low form isthe address for children and usually husbands to wives, then an honorific form for colleagues and wives to husbands, then there is a highest form of address for royalty and priests. Err, your wife is fine, congratulations, here is your daughter (Iused the utra-polite word for wife). I handed him a baby bundled in his wife’s dirty patuka (cloth belt) and shawl—they hadn’t brought a baby blanket. His 2 year old first daughter bounced on his lap next to the new baby. The father looked grateful, every member of his family was doing well.
This is at the government regional hospital. For the 119 beds, there are 3 obstetrician-gynecologists and 12 nurses. There are another 20 nurses who volunteer. In one day, with the help of 30 students, the staff and volunteers will do 25 deliveries,180 prenatal visits, 2 to 10 abortions, and attend to other major and minor obstetric or gynecologic outpatients. One’s first impression is chaos but there is an order that is not readily apparent. I didn’t realize that the government healthcare is largely propped up by volunteers. Once nurses, auxiliary nurse midwives, heath assistants, and community medical assistants have completed their training, they volunteer. Sometimes as long as two years, they hope to find a job in the private sector or go abroad. Half of all Nepali nurses and doctors leave the country. So with international calls to increase the number of healthcare workers, it is actually, for Nepal at least, an issue of lack of paid healthcare positions...there are plenty of midwives and nurses at least, simply without jobs.
The hospital income (user fees) covers maintenance and staff salaries—government hospital salaries are less then half of what the private sector offers. Any government money would (theoretically) cover new equipment and an addition to the physical building. When a Nepali comes in for care, they buy their supplies—and essentially cover the cost 70-90% of their care. And with a miserable lack of political will, there is no continued investment in healthcare and no long term plan to do so. It’s a little depressing...
Some of you may have heard in the news that the Maoists have ended their 4 month ceasefire. To announce this, they let off a few bombs around the country—with no fatalities. It is always hard to get an accurate picture of things, as journalists are, according to Journalists Without Boarders, the most heavily censored in the world—but the taxi drivers reliably offer a wealth of local coverage, and things have been relatively quiet here in Pokara. The most danger we’ve been in was being charged on a trail by the usually passive buffalo. When I was passing her house, she put her head down and ran at me. I thought, oh dear, this is going to hurt...she pulled up short, with her horns pointing at my stomach. I steadied my wobbly legs and yelled at her to go away. The very old man of the house shouted something at her, and she ambled towards him. -–Oh Father! I called out,what did I do wrong? (more like, what wrong I do?)...Oh Little Sister, that one’s crazy but she gives good milk! We started down the trail, looking back often. Kai and Aaryn’s friend informed me that when I’m speaking to a buffalo, I can use the low form of address—not the honorific form (I had basically said in a quivering voice—Oh Madame buffalo, please go away—-maybe the old man thought I was crazy...)
