As you know, members of the AFPN association went to Nepal in November
2010 for a three weeks’ stay. Well naturally, these members have paid for the travel out of their own pocket (because Françoise refused to pay for all of us out of her own pocket !!).

The purpose of the travel was
· to meet our partners,
· to check the proper funding of the scholarships,
· to take the measure of the economic situation of Nepal in order to adjust the
  amount of the scholarships if necessary,
· to evaluate the medical care offered in the hinterland of Gorkha in general and  
   particularly in the village of Lapu,
· and to bring to Paudwar the financial help raised by the "Collège Jean XXIII".
The aim was also to buy enough supplies for our stand so that it is
attractive during the different events we organize..

So we had scheduled a 9-day trek around Gorkha, leading us to Barpak, Laprak, Lapu and Arughat and then a 3- day hike around Pokhara, to go to Paudwar. We wanted to meet Badri Maskey, our correspondent in Gorkha: he has taken care of the scholarships for 14 years. He is also initiating a service of regional tele-medicine. Badri had also asked us to finance a private clinic in Arughat. Deepak Upadhyay our correspondent in Jiri had told us he would be away but we had planned to go to the school of Jiri even though he wasn’t there.

So very early on Sunday, November 21st, we were all in Frankfurt Airport. Some had come by car, others by train, from Baden-Baden or Strasbourg. Some had taken the German railways, the price of which was included in the plane ticket, bought in Achern. The complete team (Anne, Chantale, Danièle, Fabienne, Françoise, Marie, Simone and
Bernard, Jérôme, Luc) was ready to register the luggage when an alert caused the temporary evacuation of the hall . After a quarter of an hour, the suspect bag (not one of ours!) had been taken care of by the security forces, so registration could go on.

Everything goes off smoothly during the travel, with a stopover in Bahrain : there we appreciate the cosmopolitan atmosphere of the airport which allows turbaned men from the Emirates and veiled Arab women to be next to very shortly dressed European women with complete peace of mind.
We land in Kathmandu on Monday, November 22nd at the end of the morning.
At the airport, we take our visas; we get our luggage back and go through customs. There is nobody to greet us: the taxi chartered by Chandra Gurung is caught in unbearable traffic jams that get Kathmandu congested! We are patient and soon Shere and Kumar are coming with the traditional flower garlands and take us to the Shakti hotel, located in the tourist district of Thamel.

Chandra, Ganesh’s brother, had handled the logistics: he was in charge of getting the licences and permits for the trek, of booking the means of transport and the hotels, of recruiting the team of guides, cooks and porters and of organizing our trips in the countryside of Gorkha. He meets us in the Shakti's garden and has us fill the various papers for the Embassy of France to prove that each of us is correctly insured.In these difficult mountains, if an accident occurs, an helicopter will be necessary to pick us up! And it costs more than 5000 $; without money, the helicopter doesn't come! We think of our Nepalese brothers and sisters who don’t have these advantages.
I (Françoise is speaking) am impressed by the professionalism of the smiling Chandra :
he is straightforward and smooth at the same time, reassuring and pleasant.

In the afternoon, everybody does what he/she wants : some of us explore the city ; Fabienne goes to visit a family relation who lives in an orphanage in Patan. As far as I am concerned, I get ready to perform the various tasks assigned by some of my "Népalsaciens" friends.
In the evening, Chandra takes us all in a Nepali restaurant for dinner and we enjoy a good daal baat, drink rakshi and appreciate traditional dances of different ethnic groups.

Tuesday, November 23rd:

Early in the morning, the special bus chartered for our team takes us to Gorkha. The road is in good condition and we arrive at the destination at noon.

Gorkha is a large village situated on a mountainside at an altitude of 1500m, and it is dominated by a ridge on which a Hindu temple is perched. We go down to "Gorkha Inn", a beautiful hotel with a quiet beautiful garden, located in the center of Gorkha. The daal-baat offered by Badri is ready.

Then Badri joins us. He gives us the welcoming scarves and takes us into Gorkha.

The tour begins with his own pharmacy, in the rear-room of which he has put in a computer with webcam, to communicate with medical centers in Pokhara and Kathmandu. Telemedicine is on the move and is scheduled for December 10th !

Then we start walking to the historic city centre, where the royal palace, now transformed into a museum, is located. It is unfortunately closed but we can stroll through the gardens. We are looking at a vacant pedestal : the statue of Prithvi Narayan Shah, the unifier of Nepal and founder of the Shah dynasty that ruled until 2006, has been dismantled.

We cross the shopping street and meet Santosh’s parents. He studies medicine at the campus of Dhahran and his parents run a small shop. In addition, to improve the income of the family, Santosh's mother prepares and sells rakshi (which is a local strong liquor).

We then go to the local hospital to visit it. The premises for hospitalizations include two rooms with 8 beds each. The technical platform consists of a laboratory and a radiology. The operating theatre allows the carrying out of small operations.

Then we go to the training school "CMA " (Community Medical Assistant), which trains the nurses/midwives of the clinics. Badri is no longer their manager but he still is an Advisor. The school has again moved to another place, but the teaching facilities have not evolved...

For the record, the school trains "Community Medical Assistants" in 15 months. CMAs are responsible for "Sub Health Post", the secondary clinics. The main clinics are run by Health Assistants who are trained in 3 years. There are many schools of CMA in Nepal. Their program is national. The studies include a theoretical part and a practical part,on a base of 6-week-sandwich courses. The new books are printed in Nepali language only.

Finally, we go back to the hotel where we made an appointment with the seven scholars who have just joined the school for a 15-month training (September 2010-December 2011).

Six are waiting for us. The students, a little bit nervous, introduce themselves each in turn, in English. We remind them the philosophy of our association, and stress the fact that they have to settle later in a remote area of Nepal. We ask them a few questions
about their projects, make some comments. Marie tells them that whatever their job may be, be it in a little clinic or for a glorious project, their aim will be to do a serious job there and do their best. Francoise, still concerned about the place of the clinic examination, knows that it is reduced to its bare minimum in the Nepalese practice. For this reason she tries to evoke, in Nepali, the spirit of her teachers at the Faculty of Strasbourg, those who have practiced and taught the best medicine in the world ... strenuous exercise and probably without great effects !

Badri gives us the scholars’ résumés and cover letters as well as the scholars’receipts showing that they received the money we had sent them through him. We drink tea and say good bye, so they can go back before nightfall (no electricity in the streets !).

We notice that there is still something to be done to help health facilities in Gorkha. We are sad to see that the handicraft cooperative doesn’t exist any more.

In the evening we enjoy the good food cooked by the chef Teke Bahadur. Ganesh, our friend and guide, joins us at 9pm. He has kept on trekking for 2 months.

Our Nepalese team is now complete. It consists of a guide, 5 assistant guides (Shere Gurung, Kumar Gurung, Prem, Suke, Dike Rai), a chef (Teke), 5 assistant cooks and 15 carriers. We carry everything: food for the duration of the trek and every equipment needed for the bedding(tents and mattresses).

Wednesday, November 24th:

We are awakened with a glass of hot tea by the assistant guides. It will be so throughout the journey.

After a hearty breakfast prepared by Teke and his assistants, we leave. Badri, who is responsible of promoting tourism in the back country, had planned to join us. But he is ill and prefers to give up.

We first take the path to the temple which is 100 or 200 meters above Gorkha.

After a short visit, we go down to Naeshwar then to the Darudi khola ("khola" is the Nepalese translation of "river") where, after a never ending descent, we reach the team of cooks who prepared us a nice lunch.

In the afternoon, we take the path which, from the valley floor, goes up the river and follows it until the evening. We cross a long Darudi khola suspension bridge and continue on a track under construction. It is very dusty but fortunately few vehicles are driving by. We bivouac at the edge of the water and take the opportunity to swim.

Our camp consists of 5 tents hosting the 10 tourists we are, a tent for the guide assistants in charge of looking after the camp at night (trek groups draining possibly some thieves enticed by the contents of the tourists’ rucksacks), a tent "kitchen", a tent "room-to-eat", which is used at night as a dormitory for the assistant guides and
cooks, a tent "toilets "erected around the hole dug for the occasion.

The carriers are housed in huts maintained by the owners of the campgrounds.

Thursday, November 25th:

After a glass of hot tea, the assistant guides put 2 bowls of hot water before each tent. With a little planning and training, we manage to wash ourselves, stealthily under the tent without splashing.

We take again the track that we momentarily leave to cross Finanstar Village, located down at the bottom of the valley.

While we cross the village, we walk in front of a small pharmacy.

Françoise has lost her toothbrush, we stop : a young woman appears. Ganesh asks if she consults and where she studied. She answers that 12-13 years earlier she was a pupil at the nurse school of Gorkha, where she was granted training thanks to French people’s funding! Her name is Tara.

She moved to Finanstar here 7 years ago with her husband who is a health-assistant. She provides on-site consultations ; her husband gives medical treatments in the surrounding villages, including childbirths; they also have a store and a pharmacy. The
nearest dispensary is located on the mountainside, directly above the village, a 45 minutes’ walk away.

The drugs are transported by truck on the track, which has been built 2 years before.

A small group of onlookers has formed around us, some of them are complaining so we examine them, with Tara’s permission.

Then we continue our journey and at the end of the village, find the runway. Incidentally, we note with some sadness that the problem of the waste management is far from being resolved : plastic bags, aluminum packaging, batteries are strewn on the path, especially near villages.

We continue our walk in the valley, upriver.

Along the way, in the afternoon, we cross a small town, Baluwa, which has a small private care facility; but the nurse is not there and we continue our journey.

Farther, the path is blocked by the festivities of a wedding. We go round the house where the festival takes place whereas Ganesh, who attempts to cross right through the wedding, is nearly robbed by drunk guests !

We follow the river until the evening, to the confluence of the Rangrung khola, near which we camp; we bathe and do a bit of laundry in its cool waters.

Friday, November 26th:

We begin the walk to Barpak in the cool of morning.
After crossing the Randrung khola, the path directly rises and then climbs almost without any respite. The weather is overcast and the 1200m of ascent before reaching Barpak, located at an altitude of 1950m, are quietly swallowed.

We are heartly greeted there: Badri is the Chairman of the committee to promote tourism in the district of Gorkha and he had phoned to tell them we would be arriving.

This also is a new fact : the extensive use of the mobile phone : the aerials have allowed to bypass the step of telephone wiring, technically impossible to install in these very mountainous landscapes.
We’ve also found that a very important job had been done for accommodating the tourists in terms of comfort: instead of the infamous slippery and stinky cesspits, we have had some beautiful seatless toilets, with a basin made of ceramic and a u-bend. A bucket of fresh water was at hand and the toilets were always clean and odorless.

Francoise has a bittersweet thought: she realizes that preventive health face a polite indifference, whereas the promotion of tourism gets otherwise more efficient results...
Barpak is a large village of 8000 inhabitants, for a basin population of 14000. The place is opulent, not only because the Manaslu path went through this village before the construction of the road of Arughat, but also because it has provided the English Crown with many Gurkha mercenaries who, like all migrants workers, have sent their pay back
to their country. Moreover, once they have gone back home, their time of service completed, the former Gurkhas have been and still are important actors of development of their village by virtue of their occidental experience and because of the fact that the Crown finances projects of development brought by them.

The houses are built of stones and prayer flags flutter in the wind, hanging up on poles.

While our camp is being settled in the school yard, we go to the clinic where we are greeted with tikka and flowers garlands.

The Health Assistant graduated 15 years ago : he has worked in Gorkha Hospital for
8 years and then was appointed in Barpak, where he has been working until now.

The sub health-post is a house with 3 rooms and it operates with a team of 4 people.
The main diseases are :
. respiratory, favored by the cold and and the smoke of house-fireplaces
. traumatological
. and obstetric (however deliveries mostly occur at home, with the help of
  the mother-in-law).

The vaccinations are performed by a mobile team who comes every month because the clinic doesn’t have a fridge to store vaccines.

There is no possibility to perform blood or urine tests. The pharmacy has only 22 drugs supplied by the Government (amoxicillin, metronidazole, trimethoprim-sulfamethoxazole, worming, eye drops). We shall find these same medicine in all government health centers.

This health-post attracts a population living as far as two days'walk. The nearest reference center is Gorkha. The health assistant expects a lot of support from the tele-medicine; he expresses needs in oxygen supply equipment (extractor) and radiography.

In the afternoon in town, we also meet a former student of the School of Gorkha who has created a private health center. He would like to be trained in dentistry: caries are very frequent, particularly due to the high consumption of sweet products and the aging of the population.

In the evening we are invited by the "Club for the Development of the Village" who has cooked a-daal baat for us.

This club is called "Three Stars", referring to the three castes of the village :
. the Ghale caste, which is the aristocracy of the Gurung and is made by the families
  of the "4 clans",
. the Gurung caste is the second one : it is made of the 16 clans of the
  "Inferior" Gurung,
. the Bikas or "untouchables".
"There are 3 castes but 1 community".
This club was created in 1997 (nb: the caste system was abolished by King Mahendra, 50 years ago and it was abolished a second time by the Maoists ; but it may persist because the surname ipso facto indicates the caste or the ethnic group: a Shrestha , for example, is a Newar; a Sharma is a Brahmin; and even if he left the caste system and converted to Catholicism, for example, when I say "Mr. Sharma," I know which caste he belongs to.) The chairman of the club is Mr. Jit Bahadur Ghale. The club has payed for the construction of a suspension bridge 80m long, for roadworks in the village, for a micro power station for a nearby village and even for a school in a remote village at 3 hours walk. It has promoted the building of toilets and plans to supply
houses with running water.

The village also has a women's association, the "Seven Sisters ", organized to accommodate tourists; but they were not here this day.

After the daal-baat, according to a Gurung custom, women come to us with a basin of water to wash our hands, our mouth and our nose!

Saturday, November 27th :

We leave Barpak and resume going up the mountain.

The trail climbs boldly, so our carriers rent mule services. 700m higher we leave the forest of young trees then of rhododendrons and cross stubble. The trail follows the ridge and makes its way up to the Gupsi Danda pass, which is at 2670m. The weather is beautiful and the landscape is gorgeous: in the west, the Buddha Himal, majestic with its 6672m ; in the east, the jagged line of the Ganesh Himal, reaching 7422m at its highest point.

We leave our flower garlands on the votive monument that marks the pass and begin the descent, as steep as the climb was.

This leads us, after an always tasty and consistent lunch, to the village of Laprak, located at an altitude of 2100m, mostly inhabited by Gurungs.

Two French associations are supporting Laprak: "the Friends of Laprak" and "the Children of Laprak”. These associations support the school. "The Friends of Laprak" give sponsorships for children. Both associations are actors in the renovation or construction of new buildings. "The Children of Laprak" help with the clinic.

Again, we camp in the courtyard of the school.

After settling in, we go and visit the clinic. Built with the help of the association "Children of Laprak", this building is larger than the government health clinics. Besides an office and an examination room, it consists of a room devoted to teaching, which can accommodate 15 to 20 people and a room in which the nurse is accomodated.
He comes from another region and has been working at Laprak for 18 months.

He sees 15-20 patients per day.
The pharmacy, here again, as in all government clinics, has 22 drugs, excluding tuberculostatic treatment (there are about 5 patients per year in tuberculostatic treatment).
The surgical instruments are washed and sterilized by boiling ; the syringes and needles are collected in a special box and buried. The clinic is equipped with a TV that allows watching health education programs.

The reference center is Arughat.

After dinner, villagers arrive in large numbers, by torchlight, and bring us a pitcher of Rakshi. They sing, dance and then invite us to join in. Our porters quickly do the same. At the end of the celebration, a small basket goes from hand to hand to collect the free contribution of each one. The sum is immediately counted and delivered to the village committee to everybody’s great applause. Its future use is immediately explained : this money will be used for the road maintenance and for other projects concerning the village development.

Sunday, November 28th:

After breakfast, which is always generous and different each day, we set off again.
The path goes down through the village and then along the mountainside. We leave the old path of the classic trek around the Manaslu (which goes down to the Machha khola which it crosses before going up to Singla), to go to Gumda.

We pass many people going in the other direction, loaded up with woven bamboo mats, wrapped around long poles. Indeed, farmers go to remote fields with their cattle, goats and cows ; they build shelters under which they stay for a few days: the mats are the roofs; while the cattle graze, they plow the fields, which are narrow terraces, then, the work once carried out, they move towards other plots.

Our way leads us to a river, the Malong khola, where we stop for lunch : the location is idyllic, sunny and protected by some trees, cooled by the stream which flows into waterfalls.

Once again we have enjoyed the delicious and varied food cooked by of our dear Teke, and we start off again, cross a small shaded forest , then a succession of terraced fields before reaching Gumda.

We take possession of the campground, and then we go to the Health center.

This one built with the help of a Dutch association. It is a house that has a ground floor where there are the office, the examination room and the room where wounds are dressed. On the first floor, there is a wide room in which training sessions can be organized. There is also a room in which patients can be kept under medical supervision and can be put on a drip.

The office is abundantly decorated with posters for health education. One of them shows a pregnant man. We are scratching our heads : what can it mean ?
The caption reads "If it were YOU (guys) who carried the babies, after HOW MANY pregnancies would you stop ?"

Dil Prasad Gurung who has worked here as a nurse for 22 years is from the village itself.

The opening hours are from 10am to 2pm nonstop, but he is also in charge of the emergencies. He sees 12-25 patients per day. As for the other clinics, the pharmacy is limited to 22 medicines; he completes them with his "private” pharmacy, which enables him to improve his income.

He makes an inventory every 3 months.
He estimates that 10% of patients would need heavier care available at Arughat, even Gorkha or Kathmandu but few of them have the money to go there to be treated.
He is assisted in his task by a young woman who comes from time to time and who is paid by the villagers.
He would like to be assisted in his work by a nurse, who should be employed by a foreign association and he would even propose a candidate.

After visiting the clinic, we walk in the village. Its atmosphere is festive because of the holding of a fair which is good for trading and meeting friends.

Moreover a ceremony is taking place, organized for the first anniversary of the death of a respected shaman. It is officiated by two llamas, born in the region but formed in Kathmandu and by two jankhris.
One of the llamas is wearing particular clothes : a red and black dress, adorned with white and yellow ribbons ; on the head, he is wearing the tiara with the 5 facets; in his hands he has a drum that he is hitting with a curved stick, while dancing to the sound of cymbals. The ceremony lasts all night long and the next day but we have only time to take part in the first hour of it.

As hot it was during the day, as cold it is at night and our tents are covered with a thin crust of ice.

Monday, November 29th:

We leave Gumda, walking on the mountainside, in the direction of Lapu.

The path rises and goes near some chörtens ; Ganesh explains to us that this is a Gurung cemetery. The bodies are buried and the graves are topped with a chörten sometimes ornated with a pole on which prayer flags are hung.

There are also chörtens which are on the paths. These are for the ashes of people who died in a foreign country.

The path winds through a forest, then, after a peak, goes steeply down to the
Dharche khola, where we stop for bath, laundry and lunch. We leave after lunch and reach Lapu early in the afternoon.

Lapu counts 9 hamlets, the farthest of which is at 1:30 hours’walk, for a total of 4000 people.
As for most villages, young men who have the opportunity migrate to India, to the UAE or to the Middle East, particularly to Israel and send their wages to support their families. The living conditions can be very hard and deaths by dehydration, heat stroke, exhaustion and accidents are not exceptional. In the villages, the elderly people, women and children are the only ones left...

At Lapu we are greeted at school with great ceremony. Students give a little show and the director invites us to visit the buildings.

The school welcomes 240 students studying until they are in Class 8.
The teaching team consists of 8 teachers including 5 paid by the government and 3 by the local committee for the development ; the subjects which are taught are mainly English, Nepalese, mathematics, geography, health with first aid, family planning and contagious diseases. The school would really need help and we promise to send the information to the associations Friends of Laprak and the Children of Laprak ...

The VDC (Village Development Committee) has a chairman and 9 advisers, the president is elected by the villagers over 18 years old.

The village has decided to build a small clinic. We go on site. It is a building with two rooms (3 square meters each), but only the walls have been built: there is not enough money to continue the work (no roof).

Yet, the nurse is already in Lapu : he is a young man, born in the village and who studied at Gorkha two years ago. u
Until now he has consulted in his own home in difficult conditions ; he sees 2-3 patients every day, 40 during an epidemic ; he gets no salary: he has only a few drugs that he buys and sells to have money.

Late in the afternoon we go back to the village. Françoise is surprised by plowshares partially buried at the corners of some houses. "This is to protect them from demons" one of our chaperons explains.

We go to Ganesh's family home where his 84 years old mother lives ; his older brother, the father of Asha who is the young girl who is studying medicine in Dhaka (capital of Bengladesh), lives next door. We measure the intelligence and the tenacity this young woman (Asha) shows to have managed to study in so hard conditions. There are no more than 22 people in the village who passed the SLC (degree one takes when one is 16 years old).

After the meal, the village invites us to a festive evening, traditional dancing performed by two boys dressed as girls. Money is collected and is allocated to the village committee.

Tuesday, November 30th:

The next day we leave. First in balcony (balcony is terrace with abrupt edges), the road plunges down to the bottom of the valley where the Budhi Gandaki flows. We go down 1200m altitude difference and it is pretty hard on our knees. We think of all the sick people who are evacuated to Arughat hospital because it is that path they need to take, evacuated on a stretcher with carriers.

We stop for lunch. A woman arrives with a child burnt at the thigh 10 days ago (deep 2nd degree). A poultice of medicinal herbs has been laid and the appearance of the wound is clean, we resist the temptation to wash everything and make a super dressing with products of our kit : it could not be renewed. Obviously the burn is healing well and we reassure the mother (hoping that the little boy has been vaccinated against tetanus).

We continue our journey through a forest of deciduous trees, arrive at the river bank and walk downstream. We stop to camp late in the afternoon.

Wednesday, December the 1st:

We follow the wide trail that runs along the Budhi Gandaki. We cross a large village, Arkhet, and then arrive late in the morning in the city of Arughat.

We are surprised to be noisily greeted by the Local Cultural Gurung Band,

5 musicians in local costume, black topi , black vest and pants, playing drums and harmonium, holding flags and banners; they smear our front with red powder and pass flower garlands around our necks then lead us through the whole village.

Badri Maskey had asked AFPN for help to build a private clinic, so we are interested to know what care is already offered and in the afternoon we visit the Primary Health Center.

This governmental structure is oddly located at the top of a fairly steep hill : we say
to ourselves that if somebody is able to climb up, he must not be too ill !!!

The buildings are spacious and were expanded two years ago ; there is a consultation and examination room, another room with 3 beds for hospitalization, a laboratory for blood and urine tests. There is an X-ray machine that cannot be used due to lack of electricity (electricity is only available at night but patients can’t be there
then…).

The team includes a MBBS doctor, a health inspector, 4 nurses and 2 laboratory technicians.
The staff salaries are payed by the government, the community complements to encourage men and women to stay. Opening hours are from 8 to 15h plus somebody on call for emergencies.
There are 40 to 50 patients per day. 7 patients are monitored for tuberculosis, 2 for leprosy.
The doctor moves in the surrounding communities. The dental extractions are done on site.
The pharmacy includes 35 different drugs, provided by the Government, however insufficient in quantity.
The laboratory makes blood and urine tests ; HIV diagnosis is made by a quick test on the premises but treatment must be followed at Pokhara. Vaccination campaigns are made by a team of Kathmandu once a month.
The instruments are sterilized by autoclave, the wastes are burnt. There is electricity, but only at night so the fridge works at night only ; pockets of water are frozen during the night ; during the day they are used to keep things such as vaccines and drugs cool.
We ask them for their need and they say that they would like an
electric generator.

Going down from the Primary Health Center, we see that there are already three private clinics in the city.

That evening and for the last time we taste the meal cooked by our dear Teke. For the occasion, he had laid on a first-rate meal and prepared a big "happy return" cake.

Thursday, December 2nd :

At dawn we start walking to Gorkha, i.e. westbound. The bus takes a difficult track, which leaves the misty valley and climbs up the hill ; it runs under the ridges, with beautiful views.

We get stuck but finally, due to the muscles of a dozen brave volunteers who are
pushing hard, the bus can continue. We need 4hours to do the 40km which separate us from Gorkha.
We say good bye to the troop of cooks and carriers : they stay in the
bus to Kathmandu, to the east.

In Gorkha, we have lunch at "Lapu lodge" with, to vary, a good daal- baat.
Then we go to greet Badri. He is no more ill and puts the finishing touches to the installation of his consulting room of tele-medicine.

We take a bus to Pokhara, that we reach at the end of the afternoon. We stay at the "Candle Inn" : the grand hotel architecture has a certain cachet, which is why Ganesh has chosen it for us.

We do not know it yet, but because of this change of hotel, we "miss" Gyan Bahadur, former headmaster of Paudwar, who would have wanted to accompany us ; but he looked for us at Lake View Resort, where Françoise thought we would be. As she had not yet understood that the Nepalese people know perfectly how to use a mobile phone, she had completely forgotten to tell Gyan about the change of accommodation.

Friday, December 3rd :

We go away early in the morning with the bus rented by Ganesh. We are 18 people with bag and baggage, which is too much for a "micro-bus".

The road up to Baglung is tarred. In Beni, we leave our vehicle and after "another" good daal-baat, this time in a small store, we get into another vehicle.

4 years ago, this transfer was necessary because there were no bridge which allowed buses and other trucks to cross the river. But now big beautiful and sturdy bridges cross the Kali Gandaki. The change of vehicle is due to the change of District : buses of Parbat circulate only in the Parbat district and those of Myagdi only in Myagdi district.

We go away but after 300m the driver stops, appalled : he was gone without his assistant. But the aid is an important figure, almost as much as the driver. He is necessary for the success of all the maneuvers to be made by bus (crossing another vehicle on a narrow road, reversing) ... a bus without any assistance is a blind bus. Fortunately, the driver’s assistant quickly (quickly??) joins us and we can go on again safely.

We get off the bus at Tiplyang and go on by foot : the trail has now disappeared beneath the dusty trail. The track goes through the gorge along the ravine and we are relieved to be on our own legs rather than in a metal box on wheels.

Once at Gar Khola, le Nilgiri suddenly reveals itself in all its majestic snowy peaks. But if the peaks are always lined in white, its glacier in the lower part of the rocky slopes, seems to have totally disappeared. We reach Tatopani late in the afternoon and we stop at the "Trekkers' Lodge". Basuda is still in position, assisted by her elder son.

The village has not really changed, the road bypasses it downwards and runs between the houses and the hot springs. These were well fit out : there are two large hot pools continuously fed by sources. A "massage parlor", built nearby, is really very appreciated by weary hikers.

Saturday, December 4 :

After a bath in the sources followed by a good breakfast in the lodge, we start again walking, cross the old suspension bridge and begin climbing up to Paudwar that we reach around noon.

By a sheer fluke, at the same time, the village hosts a group of 21 American students from the New Mexico University: they are led by Dave, an emergency physician, and accompanied by Mahabir Pun.

Dave worked in Nepal in the years 1993-1994 ; he has gone back every year for a 4-6 weeks’ stay within the framework of a program funded by the Faculty of Medicine.
As far as we have understood the story, the program offers students in their 3rd and 4th years of study an internship of Emergency Medicine : this includes a theoretical instruction in Kathmandu on the reality of the health system in the country and then a discovery on the spot when they go hiking in the backcountry. At Paudwar the students have spent the afternoon visiting two small structures of care in the village and attending medical consultations performed by Dave.

Mahabir Pun has an extraordinary career and has a large fame in Nepal.
He was born in the village of Nyangui ; the village is mostly populated by Magar people and is located on the south-west of Pun Hill. At Nyangui, Françoise ensured the training of a "village health agent" in 1989 ; she also examined many children in the framework of primary health care by the association "Medical and Health Assistance". So Mahabir grew up in Nyangui among goats and sheep. His father was a Gurkha, and on his return to Nepal (after his career in the army) took the whole family in the Terai (Nepal’south region), where Mahabir was given the opportunity go to school: he became a teacher ; in 1989 he got a scholarship to study in the USA where he stayed until 1996, when he passed his degree in the science of education. Let us point out an outstanding fact, as Ganesh observes it : he has come back to Nepal and EVEN more: in his native village. There he has evaluated the needs and has created a school ("Himanchal High School"), focused on teaching computing and on creating projects able to generate income. He has returned to the U.S. to complete his training. To develop both the educational system and the economic potential of his village, he has learned to collect and repair computers and has created a wireless computer network for the remote villages.

He aims to do distance teaching through computing but also, to develop the economy of the country, through speaking to isolated farmers as well as professionals of tourism. Finally he is also moving towards telemedicine !

In 2007 he was awarded a Philippine prize, Magsaysay Award, almost equivalent to the Nobel Prize in Asia. For information (thank you Wikipedia) Ramon Magsaysay was a Philippine president known for his courage and honesty, devoted to his people and to democracy. The award was established in 1957 by the Rockefeller Foundation and the
Philippine Government.

The local committee, who organized a welcoming celebration, regularly postponed it every hour throughout the afternoon and unfortunately completely forgot to associate us with this visit of the care structures. So we are humbly waiting until nightfall until the U.S. group is willing to attend the dances presented by school children.

During the evening, we officially give to the Director of the school, Madam Tham Maya, the money collected by Mr. Pierrel at the time of the "John XXIII College's rice bowl".
Then the beautiful dances start and we are invited to join them, until late at night.

Sunday, December 5 :

Before setting off, we go back to school. The Committee gives us a letter to thank Mr Pierrel in which they explain how the money would be used.

We remind them that the object of the AFPN is the paramedical training : in 2001-2002 we funded a scholarship for two young women of the village (who have gone away to another health center after some years) but we are ready to consider any new request corresponding to our philosophy.

Then we go to Gorepani.

At Chitre, we see a brand new clinic, the "Shree Shanti Hall Medical and Dental Clinic" : it was built in 2006 by a Belgian association named "Himalayan NPO Projects" which finances also its running (himalayanprojects.org). Its staff includes two nurses ("CMA") who live on the premises and have a small plot of land to better their income.

At Gorepany, we go to the lodge. The most courageous climb to the Pun Hill summit for the spectacle of the sunset on the Himalayas. With a bit of luck, the Americans have taken the same way.

In the evening, Marie and Françoise go to the Lodge where they are accommodated and discuss with Mahabir Pun and Dave.

Mahabir speaks
about tele-medicine: he works for its development in collaboration with the "Model Hospital" of Kathmandu and invites us to meet him there a few days later !

Monday, December 6 :

The day is used to go down from Gorepani to Birethanti through the thick forest of rhododendrons then the terraced fields; they cover the mountainside down to the valley where the Bhurungdi khola flows; it is a tributary of the Modi khola that it joins at
Birethanti.

At Nayapul, a vehicle booked by Ganesh takes us back to Pokhara where we stay again at the Candle Inn. We say goodbye to the carriers.
In the evening we take a last meal with our guides, in a good lakeside restaurant where we invite them.

We have greatly appreciated their professionalism : in the dangerous crossing, they have discreetly been watchful so that everything went well; and when we left the camp in the morning, more than once they have recovered one or two forgotten objects: they were true guardian angels, and were always in good spirits.

Tuesday, December 7 :

Françoise, who has finally understood the importance of the mobile phone in Nepal, has again got in touch with Gyan Bahadur, so they meet in the morning. Some members go to the mountaineering museum, which traces the history of the Himalayan great achievements, while other still go to the lakefront stores.

Gyan gives us news from the two young women whose training was funded by AFPN : after taking care of a small structure in Paudwar during some years, they have left the village. He feels sorry for us.

Shanti stayed 4 years in Paudwar then went on an additional 6 months’ training and now works at the hospital of Pokhara. She supports mobile surgical teams and is apparently appreciated for her skills. Gyan assures us : "She does a good job".

Til Kumari stayed two years in Paudwar. She currently works for an NGO linked to the AIDS problem (I (Françoise is speaking) guess it is essentially preventive, but perhaps it is also care and support).

Indeed these young women have not remained in their villages ; however, they are still working in care, and probably for the people in remote areas.

As far as she is concerned, Françoise believes that the help of AFPN was not in vain. We reiterate our proposal to Gyan to support a health project in Paudwar.

It’s time to head back to Kathmandu in the afternoon by plane, which allows us to appreciate the marvelous sight of the mountains seen from the sky.

We fly along and at a good distance from them from the west to the east, the nose glued to the window, striving to recognize them. We fly over Gorkha, easily identifiable by its temples and over the overcrowded valley.

Wednesday, December 8 :

We initially planned to get to Jiri school where 7 young women who began their studies in February 2010, are entitled a fellowship. But first at that time of year, the students are taking their exams so we are not sure to meet them ; and secondly the travel, by bus, means one day to go and one to come back : too much time spent without being sure to meet them.
So we give up and use that free time to visit Bhaktapur and the Valley.

Bhaktapur is one of three royal cities, which was restored in the 80’s. The center of the town is very charming. The houses are made with red bricks, have 2 or 3 floors. The window frames are made of carved woodwork and many Hindu temples adorn the squares.

Then the afternoon is devoted to a walk in the surrounding hills.

Thursday, December 9 :

Everybody is going according to his preference: some visit renowned places of Kathmandu, others do their shopping...

We spend part of the morning shopping to buy the supply for our stands when we take part in different events in France: bags, packets of tea ...
In the afternoon, Ganesh takes us with him to his house : his cousin Shere teaches us how to prepare momos (kinds of dumpling filled with meat or vegetable).

We are very attentive students : we have already promised to cook thousand of momos for the next Culinary World Tour in Strasbourg which is organized by the collective inter-association Humanis, of which AFPN is a member !

Friday, December 10 :

This morning we are received at the Embassy of France by Mr Jean Romnicianu, First secretary and responsible for the relations with French humanitarian groups.

Mr Romnicianu has an invaluable experience of Nepal where he stayed many times, already 25 years ago as the director of the Center of French culture.
His feelings about the country is that even if politically there is a degree of uncertainty, (the new constitution has not yet been adopted), people reinvest, build, in short they show some confidence in the future.

He listens to us speak about our stay and he confirms the AFPN special position among the French associations : most of them have as objectives education and childhood. He encourages us to go on giving grants for training but he warns us against financing structures that could not function later because of lack of resources. He notices that even in the most disadvantaged areas, residents have developed a strategy for care.
For that reason, creating an unsustainable structure would risk to kill what already exists.

In the afternoon, Françoise goes to the Model Hospital, where Mr. Mahabir Pun had given her an appointment to meet Dr. Saroj Dhital, the program manager of telemedicine.

The Model Hospital was built by a
Nepali NGO, founded in 1991, called "Public Health Concern Trust" PHCT-Nepal (phectnepal.org), affiliated to the Social Welfare Council, whose goal is to improve the health of the Nepalese. His philosophy is to take into account the whole person and not just the disease, to combine technology with human values, to make the care system accessible to everyone, including the poorest.

In 1993, the Model Hospital included 18 beds ; it has become a center care of the third level, with 125 beds in 2003. Its services include curative care and technical services : biological, radiological, endoscopic and electrophysiological ; these services are oriented towards the prevention and treatment of first help for surrounding communities.

It is on these grounds that the Model Hospital has developed tele-medicine and computer science for remoted areas (training through internet).

Telemedicine is a potential aid to diagnosis and decision for patients in remote areas without them having to move to Kathmandu. Its aims to break the isolation in which health professionals are confronted with in remote clinics. Moreover, telemedicine also helps with their in-house training.

Françoise was welcomed with great "warmth" and simplicity by Mr Pun, one of the directors of the hospital and Dr. Dhital. Dr. Dhital warns against the first purely technological issues and emphasizes the role of human relationship, which must be preserved in the consultation. He summarizes his thinking : "a house is not a home".

The new computing technologies open new forms of education and care that concern us also ( in France. I’m (Françoise is speaking) thinking of Professor Schlienger and the e-learning sessions for GPs in Alsace. I’m thinking of Professor Jacques Marescaux, the specialist of digestive and endocrinal surgerywho, by the judicious use of computing and robotics, has developed the tele surgery: in 2001 he operated, from New York, a patient who was in Strasbourg. He also founded the first virtual surgery university (websburg.com) and works for the training of surgeons on the Internet. I’m thinking of Dr. Charles Nsemgiyumva, founding president of the association Medical Mutual International Aid, whose mission is training African doctors and in this respect could be interested in telemedicine.

Saturday, December 11 :

It is time to return to France, rich with memories, encounters and moments of exchanges.
We are delighted with our stay and with the way Mr. Ganesh Gurung has organized the logistics of the hike.

It's time to take stock.

First, we have noted a real increase of the cost of living ; this raises the question of the revaluation of the scholarships.

Our cooperation with Mr. Maskey works well ; with the partnership with Ganesh Gurung, we can think of completing the training program for nurses with a support program for the care facilities in remote areas, in practice in Lapu and Gumda.

The programs of tele-medicine created by Mr. Maskey and the Model Hospital must be followed ; in the context of Nepal, their development can provide a real support for nurses in clinics and can be a progress in the care required by patients. The quality of the collection of symptoms and the human support to the patient will nevertheless still
be paramount.

For the school in Jiri, the question of continuing the program should be resolved in agreement with Mr. Upadhyay.

A suivre...