Eastern Hills and Limbuwan

Trip to Limbuwan State [Province 1]: Eastern Hills of Nepal
August 2-6, 2019

It was our official trip to Taplejung for an assessment related to electronic health records [EHR] pilot project that Nick Simons Institute ([NSI] is funding in 4 primarily hospitals. On Friday the 2^nd August, 2019, we [Nabaraj, Susma, Bindu and me] flew to Bhadrapur [via Buddha air] as usual with a bit delayed schedule. The flight was smooth and we landed at Bhadrapur airport safely. Then, we drove to Birtamod to pick “Samridhi” a 4-year-old girl whose parents live in Taplejung trading cash crops [cardamom, fruits and vegetables].

We again drove towards Ilam, via Mechi Highway, just before Charali, we witnessed a deadly road traffic accident [RTA] involving a motorbike and a passenger van over a small bridge of a tiny stream. The bikers were injured very badly and we helped to send them to the nearest hospital, before the police came to the scene. While, we had to take an alternate route to continue our journey to Ilam due to the road blockade.

As we started climbing up to the hills after Buddha Shanti palika, Burne and Hurhure tea estates, it was all green and fresh air, but the weather in the hills suddenly changed, it was muggy and cloudy. Around Rhong palika, besides the tea; we saw plenty vegetable farms- cucumber, chayote and others, as Ilam is very popular for cash crops mainly aduwa [ginger], amriso [broom grass], alu [potato], olan [dairy products], alaichi [cardamom] and akabare [Ghost peeper/chili]. We stopped at Harkatte to have some snacks. We learned that a lot of people from Jhapa drive up to there for the fresh air, food and fun on Friday afternoon. We saw huge consumption of alcohol too. We noticed the new metal stumps with reflective light were installed on the winding roadsides, for safety reason. Perhaps, it is the newest type of safety measure used in the hills of Nepal.

We reached Ilam by the evening and checked-in to Summit Hotel, the best one in the town. I talked to the owner Mr. Tul B. Dewan, a retired British Gurkha serviceman, but currently engaged in other tourism related businesses in Pokhara and Kathmandu. He was happy to talk about his career and hardships but willing to do something in Nepal, as his whole family resides in UK.

2^ndday, we went for a morning walk around the tea estate, took some photos, but the tea garden was not well managed. We trekked down to the bus park and walked all the way up to the hotel. We stopped by the hospital, chowk bazaar on the way.We were offered the complementary but very limited breakfast by the hotel. We then drove to Suntalabari, had more food- fruits and tea before leaving for Panthar. It was my sister’s house, we met with the family briefly.We tried to visit Maipokhari but due to the road condition and since our vehicle had no 4WD, we gave up.

We traveled to Pheden the HQ of Panthar [Panchthar] district. Phe=plain, den= land, in Limbu language], aka Phidim, was the capital of Panthar kingdom. There was a huge gate built with welcome banners in English, Nepali, and Kirant languages. It was already a symbolic to stronghold of Kirant nation [Limbuwan State] kingdom, formerly known as Pallo Kirant during 17/18^th Centuries. On the way, at Ranke, there was a very dangerous landslide, frequently blocking the highway, obviously very risky. So, there were security [police personnel] and heavy equipment deployed to monitor the situation regularly and manage the traffic movement safely.  It was Saturday, Pheden market was mostly closed, we did not have a place to eat lunch, we managed to have some snacks. We proceeded to Kabeli, tried to have locally fish [very popular] but it was not available. Finally, we reached to Fungling bazar, the HQ of Taplenjung in the evening, checked-in to Mewa Khola Hill Resort by the bus park road before reaching the main market area.

On the 3^rdDay, in the morning, we went to the hospital, met with Dr. Soning Lama [MeSu] and the team, all were young and energetic. OPD was crowded as it was Sunday morning, all services were functional, with a smaller but effective team. The HDC has 7 members. The new building for CEONC is just completed but not yet operated due to some leaking and sewage issues. There was a small eye clinic within the hospital premises, supported by Netra Jyoti Sangha and a local donor [service foundation]. We also observed other local doors and charitable hands were mobilized for constructing the resting places, children ward [part of hospital building]. Taplejung district has no health insurance scheme implemented yet. The DPHO is separate with district hospital.

We were able to conduct both programs, the routine NSI follow up and the assessment simultaneously. The hospital team; majority being youth, were found that they were very enthusiastic towards implementation of EHR. Backup power, can be an issue. A new generator has been purchased but need to install. Insufficient staff and computer incompatibility were the major issues identified.

On the 4^thDay, in the morning we still had a brief meeting with the hospital team, thanked them for the cooperation, collected back the survey forms, but also engaged in some question answer session. We also had tea and snack together with all staff. Ultimately, we went to Suketar, the hill top, very beautiful place, colder than Fungling. There is a newly black topped STOL airport but due to weather and other issues, there were no flights scheduled. Generally, the air service operates after September for few months. Only Nepal Airlines and perhaps some private airline fly there occasionally. We spent some time at the Hilton Resort, had hot thukpa [soup noodles] and other stuff. We had no time to go to Pathibhara temple, the weather and the road condition can be blamed. We came back to the hospital in order to collect the remaining survey forms. We had tea again with the senior/medical team at a tea shop by the hospital. Then, we drove to Ilam, and again stayed at Summit. Perhaps, due to the food, my stomach got some problems.

Fifth day, after the breakfast, we traveled to Kanyam, the weather was extraordinarily great and sunny.  We were able to take millions of snaps at and around the Kanyam tea estate. We then reached to Bhadrapur airport on time, checked in to fly to Kathmandu. We got extra luggage due to green vegetables and fruits we purchased. We paid extra for the cargo.

My stomach was constantly giving me trouble. I had to go to restroom just before boarding in to the craft. I did go to the lavatory during the flight and also could not wait until we landed. Before we got our luggage, I again visited the rest room. We took the pre-paid taxi, to go to NSI, then we drove to go homes.

On the whole, this trip was very successful and memorable. The hospital staff including the Medical Superintendent cooperated and participated in the assessment actively. Moreover, they were found very enthusiastic about the EHR system, and willing to learn additional skills to operate it. In terms of our team, it was a very friendly and bonding team, Susma Lama, our own NSI DHS Officer was instrumental in making our trip a memorable one. She had worked in Taplejung before, perhaps has visited most villages and good relationships with not only the hospital but also general public in the area. While I had my own relatives and history of going to high school and getting married in Ilam long ago. It was also great to visit a historical state, in which besides Limbus, Brahmin/Chhetris, and Dalits, major ethnic groups also co-exist and live in harmony, such as Newar, Tamang, Rai, Gurung, Sherpa, Lepcha etc.

Suresh Tamang, PhD

Lalitpur, August 14, 2019