SmileHigh in Nepal - Dispatch three from Julian Haszard

It is now four days since the dental team flew back to Kathmandu by UN WFP helicopter. The weather at this time of year is always somewhat of a problem and with so many important friends on the helicopter it was a tense one hour until we received the call that they had arrived safely in Kathmandu. I am very happy and proud of the way the SmileHigh dental team worked together in Samagon. Mingma’s leadership was a real highlight in particular the way he interacted with the local people. Mingma’s translation skills and empathy for all people was of huge value. Pasang and Sareena, our SmileHigh dental therapists worked extremely well and became good friends of all the team members. I am very grateful to them for their effort and commitment. I am also extremely grateful to Keith, Antonia and Shekha, I could not have had a better group of clinicians on this trip.

It has been a very interesting and compelling 10 days here in Samagon. The people here really do need help and they are very grateful for the help that we have been able to give. The conditions including the damp weather have made it difficult for us so you can only imagine what it is like to live here permanently. Mike and I have witnessed what it is like to be here when a medical and dental team is working and then leaves. The contrast is compelling. To go from having significant health services in one moment and then to having nothing highlights the real challenges for the people here. For example two days after the medical team departed I found myself suturing together a significant wound to a porter’s hand and the same day dealing with a puncture wound above a one year old child’s eye. My concern in both cases was to clean the wounds and allow healing without infection. The simple fact is that it is a hard 6 day trek to Kathmandu or a long very expensive helicopter ride. The people here are just so vulnerable to medical and dental situations which cascade out of control. Just imagine having your child or loved one injure themself and finding that all hospitals are closed and no doctors available- this is basically the feeling of desperation which people encounter here many times during the course of a year.

So as the dental team departed I realised that I have a long haul and big challenge in front of me over the next six weeks. It is five years since I climbed Mt Everest. Manaslu while not as high as Everest is still a challenging mountain. The conditions will be different which will make it a new experience for me. The Himex team arrived three days ago. To see that I have climbed with and know a number of the Sherpa team is a huge encouragement. In fact Sonum who I summited Everest with in 2004 is part of the team. My fellow climbing team are a really great group of people. Soren from Denmark has also been to the summit of Everest and Cho Oyo so we certainly have some common ground. Of course to see Russell and know that I am under his leadership is very comforting and as always inspiring. For me to climb like this again is a huge opportunity and something that can happen only a few times in anyone’s life. The motivation to climb Manaslu is different to the motivation I had to climb Mt Everest. The drive that surged through me to reach the world’s highest mountain is a unique drive. The drive to climb Manaslu is different, it is more about the pursuit of adventure, passion to climb high mountains, to reach my potential and also to bring support and awareness to SmileHigh. This will be an exciting six weeks.

So for now it is a matter of acclimatising and gently bringing my performance and focus back to 2004 Everest levels. It is also a time to get back into the expedition way of life. There is a lot of down time involved and most of you who know me will appreciate that this will be a challenge!!

Finally for now; I thank all of you for your interest and support in SmileHigh and this mission to Samagon and Mt Manaslu. I do urge any of you to consider making a donation to SmileHigh- every $50 redeems a ticket to win an Everest photo signed by Sir Edmund Hillary. For all of you that have made donations- I thank you and will be in touch on an individual basis when I am back in the UK.

With my best wishes to all of you in different parts of the globe,

Julian, Samagon Nepal

SmileHigh in Nepal - Dispatch Two (27th Aug 09)

By Shekha Bhuva

Hello from Samagon! The Smilehigh team have now been here for 5 days. A welcome addition to our dental team has been a team of medical staff from Kathmandu consisting of 2 doctors and 3 assistants as well as the World Food Program who are here to deliver food to the very needy local people.

Samagon, a village with a population of approximately 500 people, lies deep in the foothills of the Himalayas, overlooked by the magnificent peak of Manaslu. To say that Samagon is remote is an understatement. It is a 1 day bus ride and 7 day hike on foot from Kathmandu to get to this area. Houses are simple with one room functioning as a kitchen, lounge and bedroom for the whole family. It is thought that 90% of the population live in poverty with little or no belongings. There is absolutely no medical or dental provision in the area.

We have had a busy 5 days here, including a trip to the local school to give a presentation on oral hygiene instruction to the 60 children and 7 teachers studying there. It was lovely to see how excited the kids were to see us and how interactive they were during the presentation.

We have managed to set up a pretty well equipped and organised clinical area in the lodge, complete with variable speed handpieces, forceps, elevators and filling materials. All patients are recorded on pre-printed record sheets and after triage by Mingma sent to either the restorative room for fillings and scaling or to the extraction area to have teeth out. In total we have seen 400 patients extracted about 200 teeth and saved at least 100 teeth with preventive fillings. All patients have been given a toothbrush and toothpaste with instructions on their use.

I think as a team we have worked exceptionally well, each member has been able to bring different skills to the table to help the whole operation run smoothly. We all feel happy with the quality and efficiency with which patients have been treated. As well as all the dental work, we have all had time to have fun with each other as well as with the local people. One of our team members has been busy providing each of the kids with balloon animals, and this has really put a smile on their faces.

It is amazing to see how appreciative people have been to receive treatment. I think the whole team has been humbled to see how hard life is here. I was sad to hear that some people had to travel up to 4 hours on foot from surrounding villages to see us. It has definitely put my day to day hassles and problems into perspective! The need for medical and dental work here is high. For many people this was the first time they had ever had a dental check-up. Many had been suffering with abscessed and decayed teeth for years. Anyone who has ever experienced dental pain knows that is no joke.

We are planning on leaving for Kathmandu tomorrow after what has been a successful trip. I am happy to have been able to offer a little bit of help to try to improve the quality of life for these most deserving people. I would be keen to return to the area again in the near future to reinforce the importance of good oral hygiene and provide any further dental treatment.

Shekha Bhuva, on behalf of the Smilehigh team, Samagon.

Dispatch One – 23/08/09: SmileHigh’s arrival in Samagon, Nepal

I am writing this dispatch from Samagon village in the Gurkha region of Nepal at an altitude of 3800m. We have a satellite ADSL speed modem kindly supplied on loan by Russell Brice (Himex).

Our team of international dentists had arrived in Kathmandu by the 20th of August. After ensuring that the team was fully prepared with personal gear, we were lucky enough to attend a Puja, an important blessing ceremony before going into the mountains. This was at a beautiful monastery high in the hills surrounding Kathmandu. A blessing was given to each team member by a revered senior Lama who is originally from Samagon.

On the 22nd of August we assembled at the airport for our helicopter flight to Samagon. The post monsoon weather and high altitude and remote nature of the Samagon village caused concern as to whether the flight would be possible. SmileHigh was very fortunate to be able to collaborate with the UN WFP (United Nations World Food Project) to reach Samagon by helicopter. Without this, we would have had to travel by bus for a day followed by 6 days of trekking up to this highly restricted remote village.

The UN WFP uses Mi17 Russian helicopters which are operated by a private company and flown by Russian pilots. They are huge helicopters capable of carrying a load of 3500Kgs but due to the altitude we were flying at, the load was limited to 1500Kgs. To give an idea of the size of these machines, there was a total of 15 people on the flight which included our team of eight: a UN WFP representative, a sherpa (from Russell Brice's mountaineering company Himex), a liaison officer and four crew members. There was also a lot of gear on board yet the helicopter felt quite empty. The 50 minute helicopter flight was very exciting with views of some major mountains. The ride itself was very smooth and comfortable, there are not many 50 minute flights in an aircraft where you can have your window open!!

The region of Samagon is an amazingly remote area that has only been opened to mountaineers in the past 17 years. It is very hard to access and not frequently visited by tourists, like other areas of Nepal. The Samagon village is surrounded by mountains including the majestic Mount Manaslu (the eighth highest mountain in the world), low setting clouds you could touch and waterfalls. The people are of Tibetan ancestry and have their own language. They are very friendly and welcoming

On arrival at Samagon we were greeted by a large group of the villagers who were more than happy to help us move our load of gear to our lodge. We started organising our dental gear so that we could start working on August 23rd. We are staying at Phurbar’s lodge, the leader of the village, which is the biggest lodge in the village. It is similar to the lodges in the Everest region. There is power from a small hydro station which makes it much easier for us. We did have the option of using tents but we decided to set up our clinic within the lodge.

We visited the small Samagon school to tell all of the children that we would see them the next day. The school is very, very basic. While at the school someone from the village asked us to come and see their child as she had fallen down some stairs nine days earlier and her condition has been deteriorating with vomiting, blurred vision and pain. We went to their house and examined the child, the situation was worrying as she was in quite a bad way. We were able to give some pain relief, electrolytes and antibiotics. We confirmed a plan to evacuate the child the next day on the return flight of the UN WFP helicopter which was delivering the medical team working with us over the next few days.

Today, August 23rd, the team had an early start as most of us were finding it difficult to sleep anyway, probably attributable to altitude. The UN WFP helicopter arrived at 0930, with the medical team and Richard Ragan who is the head of UN WFP. We spoke with Richard and the medical team about the sick child and it was agreed that she would be evacuated to Pohkara and then to Kathmandu.

At 1030 our team delivered an oral health presentation at the school. This was well received and our Nepali team did very well to relay our oral health message. Seventy children from the school and even younger children from around the village were brought up to our makeshift clinic after lunch and we provided a dental screening and gave out toothbrushes and tubes of toothpastes to all the children that were seen. The clinic that we have set up is very basic. We are able to perform basic restorations. To prepare the teeth we are using electronic slow speed handpieces. NSK has kindly donated one unit which also has a speed increasing attachment which does allow removal of enamel and this is a huge leap forward compared with excavation using hand instruments. We are using FuJi VII and IX glass ionomer cement, donated by GC, to restore the teeth. As there are no dental services available within this region, SmileHigh has elected to carry-out extractions on this trip where teeth are infected and not able to be restored. This is not something that SmileHigh has done before. However the team has some very experienced clinicians at this type of remote field work. Today our American dentist, Keith, worked wonders performing extractions and keeping the children happy and distracted with his animal balloons. Our dentists Shekha and Antonia worked hard scaling teeth and providing restorations and of course Mingma as always was the key person with his excellent language skills and patient management. The two SmileHigh therapists, Pasang and Sareena, have both been working hard and it is impressive and encouraging to see how capable they are. In the late afternoon the team went for a small walk as the sun went down and the temperature started to drop. Tomorrow we expect to see mostly adult patients and the following day children from a village which is 3-4 hours away.

That is all for now from SmileHigh in Samagon.

Julian