TSUM VALLEY IN NEPAL A STATE OF HEALTH photos: Nick Dawson Report prepared for the GLK Himalayan Sangha Project Frances Howland Kathmandu Nepal 2005 2 Contents Executive summary Page 3 1. Introduction Page 3 2. Context Page 4 Health problems of the Sangha Page 4 Health problems of the Tsum pa Page 5 Pregnancy and childbirth Page 7 Child health Page 9 Existing health care workers Page 12 Treating people with acute illness Page 14 Future health care workers who can be trained Page 14 Proposal for the next step. Page 15 3. Conclusion Page 16 Appendix 1 - Health Assessment Questionnaire Appendix 2 - Results of each Health Assessment Questionnaire (If interested in Appendix 2, please contact Ani Fran at [email protected].) Appendix 3 - Medicine list Appendix 4 - Record of illnesses and people seen Appendix 5 - Health and Hygiene talk Tsum Valley – A State of Health. Frances Howland 2005 3 Executive Summary This report follows a visit in June 2005 to Tsum Valley known as Beyul Kyimolung which translates into the Hidden Valley of Happiness. The Upper Tsum Valley (called Chekampar in Tibetan) is located in the northern most region of Gorkha District, Kandaki Zone, inside the Manaslu Conservation Area. It lies north of the Ganesh Himal and is surrounded on three sides by Kyirong, Tibet. For centuries people in this remote border area have depended on subsistence agriculture, grazing herds of yak and dzo and barter trade across the border to Kyirong. This cross- Himalayan trade of Tibetan salt for rice and other goods from Nepal, which has been an essential source of income since time immemorial, has given way in recent years to one sided trading. Even rice and vegetable oil are now cheaper when purchased from Tibet. The exception is the annual yarsa gumba (caterpillar fungus) trade that is traded from Tsum to Kyirong every summer; this gives vital income to the Tsumpa. Tsum which was almost completely neglected by government development efforts in the past suffers even more so nowadays due to the Maoist insurgency which controls much of the area from lower Tsum along the Budhi Gandaki river towards Kathmandu. The situation in terms of health, sanitation and education, where government intervention is essential, is catastrophic and the area remains one of the poorest in Nepal. The estimated population of upper Tsum is 4,000 1 The purpose of this report is covered by the terms of reference for the visit. Health Advisor Terms of Reference (TOR) a. Conduct a health survey to assess the health care needs of the Tsum pa. b. To visit and assess existing health care workers and facilities. c. To provide medicines for the treatment of acute illnesses. d. To identify future health care workers who can be trained. e. To make a proposal for the next step. As this report will show a number of cost effective strategies can be put in place to improve the overall health of the Tsumpa. 1. Introduction GLK Himalayan Sangha Project- Founded in 2004, this is a project of the FPMT International, managed by Kopan Monastery in Kathmandu, Nepal. 2 1 Stefan Priesner, Deputy Chief of SURF, a UNDP regional office. Article in Nepali Times issue # 201 June 2004 2 www.fpmt.org/projects/tsum Tsum Valley – A State of Health. Frances Howland 2005 4 The primary aim of the project is to improve the living conditions, health status and education of the monks and nuns living in Mu Monastery and Rachen Nunnery. The journey to Tsum was by helicopter from Kathmandu, a thirty minute journey. The visit took place from June 9th to June 19th 2005. The helicopter was loaded with cargo for the building work at Rachen nunnery. The health survey team comprised Health Advisor - Frances Howland, MPH, RN, RM. Interpreter and assistant - Venerable Chodak, a monk, originally from Chokang village in Tsum, he is a graduate of the Sarnath Buddhist Institute in India and presently the school principle at Kopan monastery, Kathmandu. Photographer - Nick Dawson, a free lance professional photographer. Interviewer for the Health Assessment Questionnaire - Gisele Dawson Other members of the group were from Kopan monastery. Gelek Gyatso Rinpoche on his second trip to Tsum this year, continuing supervision of the nunnery building work. Construction was already underway on a dining room, kitchen and class rooms, due for completion this year. Venerable Jigdol assistant to Rinpoche. Venerable Fran Mohoupt who assists with the international promotion and fund raising for the project. 2. Context The health assessment mission covered the five areas of the terms of reference. a. Conduct a health survey to assess the health care needs of the Tsum pa. Eighteen questionnaires were completed. For details see - Appendix 1 - Health Assessment Questionnaire Appendix 2 - Results of each Health Assessment Questionnaire HEALTH PROBLEMS OF THE SANGHA Rachen Nunnery Established in 1936 there are now eighty nuns living here, the eldest is 73 years and the youngest 7 years. The nunnery school has 50 students who are school age nuns and five village children including four boys. There are three classes covering grades 1 to 6 taught by one teacher, Mr. Samten Dorje. Geshe Chokli, a Tibetan Lama who studied in Sera monastery, South India arrived in March 2005. Geshe la divides his time teaching between Rachen Nunnery and Mu Monastery four hours away. Tsum Valley – A State of Health. Frances Howland 2005 5 The nunnery manager is Kopan monk Tenzin Lhundup who has been there for one year and will stay for one more year. See Appendix 2 for details of the school teacher and nuns' answers to the Health Assessment Questionnaire. Mu Monastery Established in 1921 and located four hours North of Rachen nunnery, the monastery is located at an altitude of over 4,000 meters (12,000 feet). It is two days by horse from the Tibetan border. There are nineteen monks living here, seven are older monks, over sixty years. The monastery cook and school teacher are not ordained. The young monks attend classes in Nepali and English language. Geshe Chokli travels between Rachen nunnery and Mu gompa. Summary of the questionnaire’s findings for the sangha Many of the complaints were chronic and had lasted many years. The most common health problems were - i. Gastritis, indigestion, stomach pain. iii. Arthritic type joint pain iv. High blood pressure v. Eye problems. Reading glasses needed for those over 40 years old. Cataract older people. vi. Headache vii. Diarrhoea Some of the nuns and monks had been to Kathmandu the previous winter and received a medical check up and were subsequently taking medications for chronic illness, including high blood pressure. HEALTH PROBLEMS OF THE TSUM PA There were very few young men in the villages. It was the height of the annual collection in the hills of yarsa gumba (this ‘winter worm summer grass’, Cordycep Sinensis is a caterpillar fungus) prized for its medicinal qualities. The yarsa gumba is then traded in Kyirong, Tibet for high prices and many families depend on that income throughout the year. Summary of the questionnaire’s findings for lay people See Appendix 2 for details of the answers to the Health Assessment Questionnaire. Many of the complaints were chronic and had lasted many years. The most common adult health problems were - Tsum Valley – A State of Health. Frances Howland 2005 6 i. Gastrointestinal complaints were the most frequent and ranged from indigestion, burning stomach pain; most likely either gastritis or gastric ulcer disease. These symptoms are exacerbated by the large quantities of home brewed alcohol (rakshi) consumed by both men and women. ii Diarrhoea, lack of hygiene and access to clean drinking water. iii Itchy and burning eyes, exacerbated by living in smoke filled houses. iv Joint pain, arthritis. v Headache, this could also be exacerbated by smoky houses. vi Tooth pain, gum disease and decaying teeth, visible in most adults. vii Accidents. A number of adults were seen who had broken bones and other injuries sustained in accidents and injuries sustained while drunk. viii Cataract, elderly people complaining of cloudy vision. ix Cough Interview with the Rachen school teacher Samten Dorje. He dispenses some western medicines to sick people from the nunnery and from the nearby village. See his interview Appendix 2 Most serious health related problems Lack of sanitation. Two to three times a year young men are injured fighting with knives, usually they are drunk. Children Cough, headache, worms are the most common. Women Noticed that nuns are absent for one or two days per month for the “monthly disease” menstruation, “but they don’t speak about it”. What are the priority needs for Rachen nunnery Toilets Washing facilities. Interview with the Health Assistant in the Chokang government Health Post See his interview Appendix 2 Main reason people visit the Health Post Diarrhoea – in the hot season Cough – during the season change. Tooth pain – the health assistants are unable to extract teeth, they give painkillers. Tsum Valley – A State of Health. Frances Howland 2005 7 Tuberculosis (TB) and Hepatitis TB – Health assistant had not seen any cases recently, there was one in another village. They do not have any treatment for TB in the Health Post. Infectious viral hepatitis (hepatitis A & E) – no cases documented. Interview with the two Traditional Tibetan Medicine (TTM) doctors in the Nyile clinic See their interview Appendix 2 Main reason people visit the clinic for Tibetan medicine Cough, fever, knee pain, tooth pain, diarrhoea and vomiting. Tuberculosis (TB) and Hepatitis Very little tuberculosis. No infectious hepatitis seen. Other important adult health issues. Hypertension A high incidence of high blood pressure amongst the adult population.