Posted by Duncan Maru
After a long process of being frustrated by government bureaucrats, it was refreshing to finally be able to start working with the local government officials with whom we would actually be working.
The district capital is in Mangalsen, which is situated only about 10km as the crow flies from Sanfe Bagar but over the rugged terrain it takes 3-5 hours by jeep or by foot. The jeep route doesn’t save much time, so typically walking is the preferred mode of transit. Rajan, Dr. Bishnu, and I set out a little later than we should have so we arrived late to Mangalsen. The trip took six hours because pretty much every person we passed on the road knew Rajan. Such is the life of a politician in a rural area; for Dr. Bishnu and it made the journey more relaxed. We had brought along our CDMA fixed wireless terminal and opined the whole way about the wonderful signal we could get—without the 12 dB antenna that we have at the clinic—in the surrounding villages except Sanfe. My enduring image of Rajan (aside from making streetside speeches to crowds) is him walking around with the terminal in Sanfe or wherever praying to the heavens for a little extra signal. That image endures particularly when I talk with him from Kathmandu and the I can catch every fifth word since the signal is so bad. That has pretty much changed fortunately with our antenna, but the image remains. When we reached Mangalsen near dusk, we went to the printing press (owned of course by a Rajan acquaintance). There we ordered out all the patient clinical record forms. We then went to a regular photo copy shop to print the necessary forms and letters for the meetings the next day.
Our first meeting was with the Chief District Special Police officer. He was a friendly gentleman; there wasn’t much substance to that meeting other than delivering him the letter and informally requesting that he post a few officers at Bayalpata once we get started. The meeting with the head administrator of the district, the Chief District Officer started with somewhat more antagonism and I started to regret that I had come. Again the videshi and international NGO was coming back to haunt us. After some diplomacy on the part of Dr. Bishnu and some politicking by Rajan, things calmed down and by the end of it the CDO was ready to work with us and sign any proposals necessary.
The highlight of our Mangalsen diplomatic mission was, as anticipated, our meeting at the District Hospital. Dr. Purusotam Sedain, the District Health Officer, is a soft-spoken, intelligent, and dedicated District Health Officer. With the SWC agreement in hand, he was ready to welcome us to his district and start collaborating on the project. He was particularly interested in how we might incorporate our epidemiological monitoring into the Health Information Management System currently being developed by the Ministry of Health. We provided him with our estimates of utilization of essential medicines that he would supply to us during the first three months. There was some hesitation over some of our estimates; for example, our chlamydia prevalence was too low and our herpes estimate was too high in his experience. Ultimately, however, we all felt positive that we would be able to proceed quickly with the project. In his mind, the only final hurdle was receiving approval by the District Development Committee (DDC). He assured us he would do what he could to see its timely approval.
After dropping off a copy of our SWC agreement to the DDC office along with a letter of introduction, we set off at dusk back to Sanfe Bagar. The trip back proved to be only four-and-one-half hours even though most of our travel was in the dark. At night, Rajan came across fewer people he knew and we were in a hurry to get back for dinner.
