Friday, December 21, 2012

The beautiful and strange reproductive system...


Recently, I’ve learned all about the joys of the reproductive system here in Nepal.  It started with a yearly family planning program at my health post.  This program had several parts.  The first was just general information.  The second, a screening for uterus collapse.  The third, birth control injections for women who volunteer for it, and lastly, a vasectomy for any male volunteers.

Many women came for the screening which was good.  I didn’t take part in that because I think the screening was a bit invasive, and the women probably wouldn’t be too comfortable with a random guy watching, even though they all pretty much think I’m a doctor.  I don’t think they found any collapsed uteruses, and I don’t even know what that is exactly, but it sounds bad and I’ve been told it requires surgery.

This next bit I am very proud of myself for doing, especially if you know how good I am at dealing with needles.  I watched the birth control implants being injected.  It took me a couple tries for me to make it all the way through the procedure without feeling bad and having to take a break.  The first one, I watched the numbing injection go into the arm.  This wasn’t quick; the lady doing the procedure inserted the needle and the moved it around a whole bunch under the skin until she found where she wanted it and then slowly injected the numbing agent.  Needles to say (pun intended) I got light headed watching that thing being moved around under the skin.  I took a break and came back to watch the lady cut a small slit in the arm with a scalpel and then she took this big ass needle with a small (about half the length of a toothpick, but same width) implant in it, and stuck that into the slit.  She started moving this around a whole bunch to get it positioned just right.  At this point I had to leave again.  I took a longer break and came back to watch the next procedure.  This time I made it all the way through.  The numbing, cutting, and then inserting the implant… but wait there was not just one implant, but two!!  The first, the lady pushed out of the huge needle with the plunger part of the needle thing, and then she moved that needle a whole bunch more under the skin to get the second implant lined up.  I could see that huge needle moving around under the skin very clearly.  But basically, I just really need to nut up when it comes to needles so I forced myself to watch.  Then the plunger was removed, and the second implant slid into the needle, and then plunged in just under the skin.  Then the cut was patched up, and the lady was told to sit for a minute or two, and then out the door and time for the next lady.  The implants are good for five years, and the women were told all about it before they signed up for the procedure.

This program seems pretty good to me.  All of the women who came were a bit older; like late twenties or early thirties, and I think they just don’t want any more kids.  Also, the surgery conditions weren’t ideal, but a very good effort was made to keep everything as sterile as possible.  They had big sterilization pressure cookers that all the instruments came out of before being used.  All of the doctors came up in a truck from the district capital with mobile medical supplies so all of the complicated procedures (the screening and vasectomy) were done by actual MDs, and the insert was done by trained nurses.  I was impressed.

I also watched a vasectomy…or at least half of one (meaning the tubes of one testicle being tied).  I was standing outside and this guy walks up who has no idea who I am, and asks me if a vasectomy is a good procedure.  I say, “Yes.”  And he says, “Okay, thanks for that.”  Then he walks into the “surgery room” takes his pants off and the process begins.  First, he gets his testicles shaved, which I was still outside for, then lies down on the table.  At this point, someone asks me if I want to watch, and I’m thinking, “Hell NO!!”  And say, “Yes.”  So I walk in, and stand back against the wall at the patient’s feet which meant that the patient could see me, since his head was propped up a little bit.  This put quite a bit of pressure on me not to cringe because I think the guy was already pretty nervous about the procedure, so the last thing he needed to see was someone who he thought is a fancy western doctor making horrible faces.  This was really tough for me because the first thing the doctor does is whip out a big ass numbing needle and put it into the guy’s testicle.  I assure you every part of my brain was screaming, so I just narrowed my eyes in what I hoped was a very critical and thoughtful look.  It probably looked like a cringe though. One of the assistants turns on a mag-lite and shines it on the testicle at this point, and holds it for the rest of the procedure.  Next, the doctor cut open the testicle, uses a hook thing to pull out the tube, ties string around it in two places, and then cuts in between.  After that, he cleans up the string, and puts the tube back in.  That was it.  I decided to bail for the second testicle because watching that go down wasn’t that awesome, but good for my pansy-ass tendencies to be light headed around needles, and also a good learning experience.

Overall, we put implants in four women, and four guys volunteered to be snipped.  That’s not too bad for rural Nepal, and considering neither of procedures looked very fun.

Then, another day I had a “Nepali culture experience.”  It was something we were made aware of in training, but I still found parts a bit shocking.  My host sister got home late from work, said hi, and then sat down on a stool outside the kitchen.  Then my sister’s friend, who stays at our house all the time, hands me a plate of food and says, “Give this to Sarmilla.”  (Sarmilla is my sister’s name).  I thought this was pretty strange they never have me bring people food.  Sometimes I’ll go fetch someone from their room when it is dinner time, but I don’t usually bring food.  I walk out of the kitchen, and I figure it out: She is menstruating.  We had learned that it is not uncommon for women to have to eat separately when menstruating, and in very traditional families the women have to go to a shack for the duration.  Earlier my sister was sitting by herself and I walked up and asked, “What’s up?”

“I’m sick,” she said.

“With what?”

“Typhoid.”  After which I laughed and then she said, “Blood cancer.”

At that point, I thought that she was being really weird, or she was using a very disturbing code for being on her period.  But then I put it from my mind until I brought her food.  When she was done, she went into the bathroom and washed her dish, and when I went to grab the plate to bring back to the kitchen she yelled, “NO! You can’t touch my plate!! It’s Nepali culture.”  I asked a few questions to make sure I knew what was going on, and then said I thought it was strange because in America things are different.  I made sure to express my displeasure at her being forced to eat alone, and also I was a bit saddened because the way she almost panicked when I went to grab her plate makes me think that she truly believes that she is dirty or that something is wrong with her when on her period.

I also found it strange that they draw so much attention to something that they are all clearly think is somewhat disturbing.  Why make her eat outside?  Do they think they are going to catch her menstruation?  In training we were told that people just think it is unclean, but they all wipe their asses with their hands…I am definitely missing something when it comes to this.  Yes, Americans can also be very weird when it comes to menstruation, but here in Nepal it is just one more way that women are kept down.

Maybe I found this such a bummer because I feel so bad for my host sister.  She is (as far as I can tell with my limited Nepal) a very, very nice person.  She works super hard in the house, and also has a regular job.  She cooks, cleans, and is generally smiling while doing it.  And one day she was working in the kitchen and this little Indian man, who is the local carpenter, walked in and started having a conversation with her.  She laughed and then shook her finger at him and pretended to hit him.  I thought they were joking around.  The Indian man is not Hindu, but Muslim; however he is also very influenced by the Hindu culture, and both religions have some very anti-woman tendencies.  The man who is renting a room for several months and speaks English very well translated for me: “He was telling her how he was brought up to believe and now believes that women are the dirt on the bottom of your shoe.”  (A big insult in a culture where even showing someone the bottom of your shoe is an insult).  Anyways, she laughed at him, but I could see in her eyes just how much that cut.  I mean, to be told in all seriousness that you are worthless must really suck.  And when your whole culture backs up a statement like that…ugh.  Just the disappointment that people have when they give birth to a girl must be so detrimental to every girl’s psyche. 

Recently I went to a local school and taught for a day which was very fun so I’ll be back.  A student in the 10th grade class I taught for a period asked me what is the most important thing Nepal should do to develop.  I thought for a second, and then with my sister in mind I said, “Eat a lot of vegetables, and send every girl to school.”

At the school I managed to get some good stuff into my lectures.  I taught 8th, 9th and 10th graders.  In 10th grade English class we talked about AIDS and trash cleanup along with learning some new vocabulary.  In 8th grade Health class I was handed the health textbook which mostly contained statistics about how many hospitals there are in Nepal…really useful stuff.  As I was scanning through I noticed a discussion question that said to talk about health problems in the community, so I skipped right to that question.  They listed a bunch of problems and diseases, and then I asked,” Which of these diseases and problems is preventable?”  I helped them figure that out, and then we talked about how to prevent them, and I hurried us along to diarrhea because I decided I wanted to focus the class on handwashing.  I asked how many children under 5 die from diarrhea in Nepal each year, and they gave a few guesses from 200 up to 1000.  I told them,” 75,000!!”  This really blew their minds, and then I asked the best way to prevent diarrhea.  We arrived at handwashing eventually, and as statistics suggest I told them, “Handwashing can prevent 90% of deaths from diarrhea in children.”  I then had them do the math themselves and discover that just by washing hands properly 67,500 children’s lives could be saved each year in Nepal.  This is where class ended, and I felt pretty good about the lecture.

Also, at the Health Post I’ve become the wound care guy since I know a fair amount about that.  It started when a kid came in with a dog bite, and one of the workers dabbed some iodine on it and was getting ready to bandage it up when I stopped him.  “No, no, no.  Dog bites are very dangerous.  This has to be well cleaned,” I said.  And then brought the boy to the water tap and asked for some cleaning pads and some soap.  Then I told the boy, “This is going to hurt.”  I scrubbed the shit out of the bite, and discovered that the dog had actually pierced pretty deep.  I had the workers ask the mother if the dog looked rabid (No, thank goodness).  Then I bandaged up the cut with some iodine (which is the only wound treatment antibiotic we have), and told him to come back in two days.  But first he got a tetanus shot.  The kid was brave.  He cried a bit with the shot, but the whole time I was digging broken chunks of skin out of his blood he really nutted up.

Recent adventures and a training (long)


This blog may be a bit long, but I’ll try to keep the words down and keep the focus on some of the rad pictures I was able to snag recently.  The first week I was here there was training at my health post about mother and child nutrition.  It lasted for five days and was run by SUAHAARA which is the NGO I am working with here.  It was given to 10 Female Community Health Volunteers.  The FCHV’s are the medically trained people in the communities around here.  The hierarchy for my area is as follows: I work at a Village Development Committee (VDC) health post which has a boss guy (my counterpart) and 3-4 FCHV’s.  Each VDC is broken up into wards, and in these wards there are sub-health posts where the women who were in the training work.  The FCHV’s are paid a nominal amount to deal with mild health problems and give advice about various health topics such as mother and child nutrition.

Overall, I was very impressed with the training.  After seeing how competent the SUAHAARA trainers are, I sort of questioned why I am even here.  They knew their shit, and I learned quite a bit just sitting in on the trainings.  I did, however, lend the trainings some credence being the local white guy.  Also, the women asked me if I was so big because my mother followed these steps when I was a baby.  I said yes.  This is probably partially true, but also Nepalese are just short people.  I tower a good foot over the average Nepalese man, and even more over the women.

Anyways, they covered all the important parts of what is called the “First Thousand Days” which is from inception to two years old.  And they had a lot of good visuals and hands on activities such as making a baby doll out of cloth, newspapers, and rubber bands and then using it to practice proper baby holding position for breast feeding.  Here are a couple pictures from the training:

The group of women being led by the lady in the black coat

Learning Materials

Zoom in!

The SUAHAARAA trainer in action
 

I also went for a quick overnight trip with my host sister and her friend to “Tatopani.”  Tatopani means hot water, and as you might imagine the name describes what is found there: hotsprings.  Now, saying I went with my host sister is only half truth.  We walked down to Beni, wandered around for her work, and then we all got on a bus to Tatopani.  The ride was beautiful.  The river was its usual beautiful glacial blue, and there were some pretty rad waterfalls which I really enjoy.  We arrive in Tatopani and she says, “Get off here.”  I do, and she hands me some bags through the window, and then the bus starts to move and my host sister says, “See you tomorrow!!  Stay here with that guy (points), and we’ll meet you tomorrow.” And the bus is gone.  I’m like, “What the fuck just happened?”  I turn and say hi to this old guy who is my older sister’s husband’s dad.  He leads me to a hotel, gets me a room, and then takes me down to the hot springs pool.

My sister may have told me that we weren’t all staying in the same place and I just didn’t understand, but that was quite a surprise and made the whole experience quite a bit different.  It was a lot lonelier.  I get along well with my host sister, and was expecting to sit around and chat with her and her friend in the evening as we usually do, and so didn’t even think to bring a book or journal or anything along.  I attempted conversations with other people but they just weren’t interested.  Also, my usual game was a little off from being out of my element (which I enjoy, but it probably doesn’t help my friend making skills).  So I ate and went to bed around 7 and fell asleep at a normal time of 9 or so.  Luckily, I got really good at staring at the ceiling and thinking in Mali, so I passed the time pretty easily.   Also my older sister called me and asked where the younger one was.  I truly had no idea and told her so.  Apparently, they stayed with a friend up the road a ways who came back with us the next morning.

The hot springs were very nice.  It was just a big pool that had been built out of flat stones with a rope across the middle: one side for men and one for women.  About ten seconds after entering the pool I managed to find the little ditch that ran around the rim for drainage with my ankle, and gashed it open nicely.  I couldn’t see anything under the water because it was pretty murky, but should’ve just walked more carefully.  Anyways, it’s not infected yet.   After a nice soak, you can take a bucket bath outside using hot water that pours out of a pipe in the ground.  This seemed nice, and also like a good idea after sitting in the grungy water.  It was the first hot bath I’ve had in a while.  Very nice.  A lot of people were drinking the water.  I wasn’t up for this, but when I got back pretty much everybody asked me if I drank it.  They say it is good for your stomach, but I don’t know.  Sulfur water just doesn’t seem appetizing too me.

The next morning, having no idea what the schedule was or when my sister was coming back, I was getting ready to go down to the hot springs again when my sister called and said they were on the road and would be there soon.  They came, and seemed very much in a rush.  They kept telling me to hurry, and that they didn’t have time for tea or some food.  I grabbed my stuff and we walked out of town.  At the last shop, we stopped and got…you guessed it, tea and some food.  I just started laughing.  I’m still not sure what the hell was going on.  We jumped on a bus, which a little ways down the road hit a motorcycle.  No harm done to people, at least.  The motorcyclist was stopped and the bus was going its average of 3 MPH on the bumpy dirt road.  The motorcycle was pretty thrashed though. 

Back in Beni, I followed my host sister and her friend around at their money collecting job, and then in the afternoon we all went to a wedding a couple kilometers up the western valley.  It was pretty fun actually.  I danced a lot, and no matter what I did everyone cheered because once again I was the token white guy.  They really did not like it when I needed a break from the dancing, and I managed to convince my sister and her shy friend to dance which at first they were pretty adamantly against.  And the food was good.  My sister was going to stay in Beni that night so she sent me up the 1000 feet of stairs with some middle aged (for Nepal, meaning 30’s) women.  This was also pretty nice for me as the entire way up they just told me how handsome I am, and that I should marry one of them (even though they have husbands) and take her to America where I can promptly divorce her, and return to Nepal for the next one.  Sorry, the gument already thought of that one; gotta be together for like 5 years before you can be official.  Also, I carried a five year old kid on my back the whole way because he sure as hell wasn’t going to make it.  The ladies were very concerned for me, but I just saw it as good training for playing in the mountains.  Gotta whoop these here legs into shape!

Unfortunately, I managed not to take any pictures of the hotsprings or the wedding, but I’m sure I’ll go again.

The final chapter of this post is about the hike I took recently.  I decided to give my mountaineering boots a test run on a nice hike.  As I figured, it was very similar to walking in ski boots.  Those bad boys have very little give.  But since I am pretty stoked on hiking in ski boots it was a good time.  Actually, they aren’t even that bad.  They’re heavy and stiff but manageable.  It was a great success because 1) I was able to figure out a pretty good lace tying scheme, 2) identify hot spots to pad with tape and pressure points that I’m just going to have to deal with, and 3) got some awesome views and pictures of mountains!  I hiked up to a saddle on the ridge to the east of my house which was a whopping 7,300ft (2,200m).  My house is at 1,200m, so not a bad elevation gain all told.  Now check out the pictures of the Annapurna range!  (Annapurna III is a goal of mine in the next few years, so it was nice to finally see it).
Looking South down the valley early on in the hike.

A Quaddle of Monkeys hanging in the rice paddies.  I spotted them on the way home late in the afternoon.


A Monkey Puppy! (behind his mommy)


Cool and very old stonework along the road

An ancient wall in the middle of the forest

Dhaulagiri on left, looking North towards Mustang Valley

Some very impressive mountains in the Annapurna Range

Close up of the summit bloc of Annapurna Dakshin?  Cool glacier action.  The little point just above the massive cliff with the shadow on it is actually a seperate mountain.  Annapurna I maybe.


Annapurna III possibly?

Smaller peak to the west.

I was told the name of this peak as well, but I've forgotten.  East of Dhaulagiri.

III?

The South Face of Dhaulagiri

Annapurna Dakshin

What looks a lot like Macchapucchre, but based on where I was standing could also very well be Annapurna II.

I like this peak a lot it seems...lots of pictures

Dhaulagiri, the twin summit peak pictured above is on the right hand side of the photo.

I've struggled to identify these mountains because the one on the right looks so much like Macchapucchre, but based on the map it should be Annapurna II from where I was standing.  If that is Annapurna II then my best guess for these mountains from right to left is: Annapurna II, Machhapucchre (little point to right of center mountain), Annapurna III (in center), and then Annapurna Dakshin hiding Annapurna I.  But if that is the case, then Annapurna III should be behind Dakshin more than it is.  Or maybe these peaks are just so big that they really give you some good optical illusions.  I'll take any help in identification I can get.

On the walk up, this was the first view I had of the Annapurna range.  This is the big mountain in the center of the above pics.

Dhaulagiri on the right, and the range to its west.

More zoomed out view of the above photo.

Annapurna range from a different angle.  Late afternoon storms hitting the summits.

 

Before I left my host father told me not to go far, and when I got back and told him where I went he had a good talk with me.  “I told you not to go far, and you went far!  This isn’t America.  You have to be careful.  People are going to think you have a lot of money, and there are thieves and drunken people.  If you want to go far I’ll go with you sometime, until you’ve been here a while at least.”  I thought of arguing, but that would have been fairly pointless, plus I was angry about this “talking to” I was getting, and I’m not as good at getting what I want to say across when I’m annoyed so I just let it pass and said, “okay.”

Now, he is right, this isn’t America.  America on average is way more dangerous.  There is way more murders per capita etc.  No one here has guns, so thieves would also have a pretty hard time because as I’ve said I outweigh most Nepalese by half again as much as they weigh.  I guess if I run across a well-armed gang of Nepalese who survive off of the one lone white tourist who passes by their rural village every five years then that is just bad luck.  Of course, the point is to avoid trouble which I understand, but 1) being their equivalent of a yeti avoids trouble, and 2) I met quite a few older people on the road who I would start a conversation with and then they would walk with me for a while.  And when I got to the village on the saddle of the ridge, I was approached by an older woman who asked about me and where I was going, and then told me the names of all the mountains that I could see, even the smaller ones.  I forgot the names, and I didn’t have a paper to make a little map with, so hopefully some of the names show up on Google Earth.  I’m still working on identifying the mountains in the pictures because after looking at a map I think the names the lady told me were correct, but for the wrong mountains.  It was very nice and Nepalese of my host father to be worried, but his worries were largely baseless, and also I’m a big boy so if I want to walk far by myself, I will.

Friday, December 7, 2012

My New Place and Swear In


It’s been a little while since my last post and a lot has happened!!  We had our swearing in ceremony last week which was very nice.  I seem to have managed to delete the photos I had of the ceremony, but there are plenty on the facespace.  I was chosen/volunteered to give part of a speech in Nepali because at the time we had to choose who was doing what at the swearing in ceremony I had some of the best Nepali in our group.  Though, my last test scores certainly didn’t reflect this… I think I lost motivation on the whole studying thing which is not an uncommon phenomenon in my life.

Anyways, the speech went pretty well, and I once again officially became a Peace Corps volunteer.  And again, I looked properly ridiculous, though many people described it as “sharp.”  The week preceding the ceremony was spent in some hellaciously boring sessions, but we were finally free at nights to go do whatever we wanted which generally consisted of going to bars in the Thamel district of Kathmandu which is basically the trekker/tourist district.  There are a lot of western style bars, restaurants, and mountaineering shops which I checked out very thoroughly.  There is a lot of knockoff gear available, but also a fair amount of legit stuff, though a lot of the legit stuff is really old.  I found tons of old ice axes and stuff from what must have been the early 90’s or something.  That’s pretty old for mountaineering gear.

My favorite bar is called Purple Haze.  It is basically a huge warehouse that they built a very large stage at one end of, on which they have live music every night.  The music is just covers of oldish popular rock songs…so obviously I freaking love it!  The last night we were in Kathmandu a bunch of us went there and a very angry small Nepalese man decided he didn’t like me and spent probably a good hour trying to pick a fight with me.  Obviously, I wasn’t going to take the bait, but I’m sure it didn’t help that I had a smirk on my face the entire time because I found the whole situation so entertaining.  I kept telling myself, “If you would just stop smiling like an idiot then he would go away.”  But every time I tried forcing myself to have a straight face it would make me smile more.  Isn’t it strange how that works?  My face kept contorting in an attempt to look serious, but I knew just how ridiculous that looked and so would start smiling or laughing.  This did not help the situation, but eventually his friends dragged him out of the bar when they realized he wasn’t going to back down.  And even more importantly, earlier that day I ate enchiladas for lunch and pizza for dinner!  YUM!!!

The next day we all got on chartered buses and headed for our respective districts.  It took us almost 12 hours to reach my district, Parbat.  My group of Parbat volunteers stayed the night in the district capital, Kushma, and the next day had bunch of brief introductory meetings with various government officials.  Kushma also contains the longest suspension foot bridge in Nepal.  It is 344 meters, and I walked across it for fun.  It’s pretty high up too.  One of the volunteers with me does not like heights and was not very happy on the bridge.  It’s probably 300 feet high or so.  The drive from Kathmandu to Kushma was slow, but also pretty.  I got see the evening sun light up the slopes of Macchapucchre which is a very large mountain outside of Pokara.  And most of all it was nice to get out of the pollution of Kathmandu.  I think I am still coughing and sneezing black shit out of my lungs from all the heinous pollution.  I don’t recommend Kathmandu to anyone really.  Most of the luxuries can be found in other cities, and it is just too gross to handle for any period of time.

After the meetings my nearest site mate and I rented a truck to get us to our sites since I was told that a normal car couldn’t make it to my site.  We dropped my site mate at his place which is sort of on the “main” road, and then we turned off it and rallied the crap out of that truck to get to my site.  Unfortunately, the truck was two wheel drive so didn’t have the benefit of low range gears.  The road to my site is very steep, sandy, muddy, and has a nice sprinkling of large rocks to get over.  In the states it would be describes as a four wheel drive road, but here, it’s just a nice suburban street.
This blog is going to get long, I can tell… So I arrived at my house and holy crap it is so, so POSH!!! It’s got a real kitchen complete with a sink, two flushing squat toilets with showers, as well as another shower room. My room has electricity and a ceiling fan. And looking from my house I have a nice view of the Himalayas and most prominently Dhaulagiri, the seventh tallest mountain in the world. Here’s the view from my roof:
Dhaulagiri catching the last of the evening.  The other peaks have already lost the light, but Dhaulagiri is freaking enormous.

Dhaulagiri up close

 
My room

Looking the other way in my room

Looking out of my hallway

The ever important crapper

Shower

The kitchen

Looking the other way in the kitchen (swastikas are everywhere here, which takes a little getting used to)
 

I’ve spent a few days hanging out at the health post which is my office and just chatting with the very nice young ladies who work there.  I’ll talk a little bit about the health post situation a bit later.  I also went down to Beni with my host sister, who is also really nice, and just followed her around at work, and met a bunch of her friends who took me to lunch.  My host sister collects money from a bunch of little shops from this area and then deposits it with a cooperative which gives business loans to the businesses she collects money from and other businesses involved in the co-op.  She walks down to Beni and back up to my house every day.  It is literally 1000 vertical feet or so of stairs that have been built into the side of the cliff/hill.

So far, I am really, really happy here.  Until the end of Mali, I don’t ever remember being this happy.  This place just fits me so well I think.  I really, really enjoy sitting around with my family members and attempting to communicate.  I love eating with them, and recently, I helped my mom and dad cook dinner.  My sister asked if I would make pasta for them tomorrow.  Sure!!!  I also showed them the beauty that is a peanut butter and honey wrap made with roti (Nepali tortilla).  Of course, this is still just the first week, but I remember my first week being one of the hardest I went through in Mali.  Here, it has been the best I’ve had so far.  In training, I got along well with everybody, but the best friends I made were the Nepali staff.  I got along so well with my language teacher, and all of the other teachers.  My language teacher still texts me to see how I am doing at tell me about her day.  I can’t explain this place, but it works with me…so far.  I’m sure I’ll struggle at some point, but so far I couldn’t be happier with my village.  And… THERE ARE MOUNTAINS!!!  In Mali, I would try to see how long I could make it at site before going and seeing other Americans, here, I don’t even want to leave, except to go play in the mountains.  I’ve been scoping routes up some of the smaller mountains from my roof.  I’ve pretty sure there are some totally doable climbs that aren’t glaciated that are probably in 20,000 ft range.  I’ll have to do some more research.

Okay, now about the health post.  Nepal is way more developed than Mali.  My counterpart is the head of the health post and under him work four Female Community Health Volunteers.  They have had some training, and are given a small salary (about the same as me), to treat common things at the health post like colds and diarrhea etc.  The problem is that the health system is really focused on treatment and not prevention at this time, and the medicine is free provided by the government.  On top of this the workers aren’t overly knowledgeable about the medicines they are giving.  I’m guessing fewer people are dying from diarrhea and stuff now, but the next step is prevention.  They give every person that comes in with a cold Amoxycillin, and every person with diarrhea Ciproflaxin.  I think we know that over doing antibiotics is not good; on top of that Amoxy does nothing for colds.  I tried explaining this today.  I reminded them what bacteria are and that antibiotics kill bacteria, both the good and bad so don’t give it all the time.  I made up some basic rules to follow, like only give Amoxy for strep, which they know about, and only for colds if people’s snot is green and yellow and they have a fever.  Anyways, hopefully I can make some progress on that front, and hopefully some of the trainings I have in mind will help with prevention.  We’ll see.