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Posted by Gregory Karelas

This morning, our nursing staff greeted me with a phrase that has become too common at Bayalpata Hospital: “Gregory. We have no pani.” Translation: “Water is out again. We don’t know what to do.”

As mentioned in previous stories and updates, water is a delicate and ever-unreliable commodity here at Bayalpata Hospital. Our need for it has only increased over the years. Yet its supply has dwindled in the last few months. Thus, I’d like to devote this post to examining the questions and ruminations that have helped me to deal with the greetings above.

The first question that comes to mind is “Why?”  Why has every day of the last few months felt less likely to have water than the last? Water exists in Achham. It’s accessible. In fact, it’s available from a public tap just 20 minutes up the road and at every tap on that same line for kilometers in either direction. Yet none of that water seems to be reaching our hospital, its staffs or the patients they serve.

One explanation depicts a young shepherd walking his goats through the woods. He’s thirsty. As the sun beats down upon his perspiring head, he sees a green, plastic and rubber amalgam in the shape of a pipe. The shepherd realizes this pipe shape might carry water. He knows that water would quench his thirst and quickly gets to work. The shepherd removes the knife from his back pocket and cuts ever so vigorously into the pipe before him. Victory is soon his. Yet within six hours, Bayalpata Hospital’s water reservoir will be empty. At that time, it will be forced to send another staff member to collect six large buckets of water to float it (pun intended) until another staff member can walk the pipeline, identify the line break and patch it up.

Another scenario might include Naresh, a fictitious young Achhami gentleman, who walks by the Bagheshwor water source every day on his way to school. Whether Naresh knows that the Bagheshwor source supplies Bayalpata Hospital with over 75% of its water is debatable. But he definitely knows that the Bagheshwor source serves as a convenient receptacle for the plastic bags of the processed food snacks he eats en route to school every morning. And so, he throws. He is a child and likely doesn’t realize that that sack will lodge itself somewhere in the pipeline, blocking Bayalpata Hospital from the water it needs to wash its floors or feed its staff. Yet his throw follows that very trajectory and indeed makes an impact on countless staffs and patients that day.

In our third scene Ram, another fictitious Achhami resident, plays his hand at sabotage. One afternoon, after a couple glasses of local moonshine, Ram makes his way to the Hospital’s water source and develops a strategy fueled by the resentment he holds for Bayalpata Hospital it did not select him for the Health Assistant post he applied for last week. He decides to block the Hospital’s water line with rocks and any debris within reach. He knows that his efforts will not permanently cripple the Hospital. But he rests assured that it will cause some distress there while the Hospital figures itself out of another daily drought.

The above scenarios are real and happen often.

Moving on from the question of “Why,” one might ask: “What does the Hospital do when it has no water?” The first step is to find the Country Director immediately or, in rare cases when the Country Director is not present, wait until the Country Director is present and ask him to fix the problem. The next step is for the Country Director to send the ambulance driver and at least one groundskeeping staff member to fill as many large buckets of water as possible from a reliable source approximately two kilometers away. The third step is for the Country Director, or some other eager-to-help staffs, to send someone to walk the pipeline, clear its obstruction or seal the break releasing its water. There is usually a combination of ancillary responsibilities accompanying these processes to solve the problem. Yet, the steps outlined above are pretty standard. And, somehow, they work every time.

The third question one might ask is “How does the Hospital plan to fix the water problem permanently?” Its answer is, unfortunately, not as easily derived. To date, the Hospital has forged contractual agreements with the community to protect its water, hiring staffs to regularly walk and maintain our water pipeline and lobbying the district government to build protective walls for the Hospital’s water source. Each effort has been successful. Yet not a single one has ensured reliable water flow. New ideas include the installation of a metal pipeline, burying our existing pipeline in a 1-meter-deep ditch, supplicating the community through smaller meetings with its leaders, and radio announcements drawing attention to the Hospital’s water plight. Each suggestion brings its own advantages and drawbacks. But we plan to undertake all of the above until something works, because waiting for a magic bullet will get us nowhere.

I often wonder why the nature of Achham appears to be defined by patent destruction. There is no reason to cut our waterline. Everyone in the Region knows of our Hospital and everyone for three Districts seems to know which pipeline is ours. Yet our well-known Hospital has endured almost one half of the last month without water. Why? That’s what I ask when I hear rumors that the community had poisoned our Hospital’s campus dog. It’s what I ask when a local political party member screams accusations that our Hospital hates Achham’s citizens as he waits for his son to receive free treatment in our Emergency Room.  And it’s what I ask when staffs greet me on yet another morning with the announcement that we have no water.

A dear friend recently told me that behaviors like these are not exclusively endemic to Achham; that they’re a part of the world. Restricted water has spawned wars in Africa; no one would bat an eye with the news of a poisoned dog in West Baltimore; and white-collar politicians cram our airwaves every day with hypocritical condemnations of the systems that serve them and the people who sacrifice for them. Yet somehow in Achham it feels different. Perhaps it’s my eyes that too thoughtlessly blame these problems on a remote and formerly war-torn region of the world–allowing a part of the Earth with so many problems to absorb yet another; an association that I’m quite ashamed to admit.

I can attest to living in conditions where one’s neighbors deliberately destroy and regularly the Earthly staples I consider to be human rights. The explanations people give for that destruction run the gamut from “ignorance”, to “malice” to the development industry’s age-old favorite “poverty”.  Perhaps it’s all of the above. Perhaps it’s none of them. Perhaps Hobbes had it right, for if Achham has taught me anything it’s that an unsupported life is indeed nasty, brutish and short. Or perhaps the explanation just doesn’t matter, for nothing could make disregard for life acceptable.

Thus, until a day of universal empathy—one that defines political structures, drives human interactions and inspires compassion—people will continue to hurt, disappoint and disrespect the world around them, for we are all human and we are all flawed. Complimenting efforts to serve the poor is obligatory in most social circles. Yet truly feeling what that care actually means–deeply meditating on the toils of life without water or the efforts it takes to run a hospital without it—that is a more obscure compliment. And it is a more permanent solution.

We work with the hope that someday, someone might feel the meaning of their words when they say, “It must be so hard to work in such a remote area.” In fact, it’s what I believe will change the world.


Gregory Karelas is the Country Director of Nyaya Health.  He graduated with an MSc in Medical Anthropology from Oxford University

2 Responses to “Water, Water Everywhere, but not a Drop to Spare”

  1. Madhuri says:

    What you described here is really not an uncommon phenomena. I witnessed this while doing my field work in rural village in Nepal, saw it in Africa and now I leave in one of the advanced countires in the world I see not much difference. Just the way it is expressed is different. I had this notion that in America things will be different as everybdy is educated and all that accompanied with it but not really.
    My one question to you is does the community own the clinic in the sense that they feel it is their own and they must do everything to make it a vibrant place for people to get primary health care and other treatment. There will always be a bad apple somewhere but the important thing is to bring them to your fold as they say keep your friends close and the foes closer. The case of a little shepard boy is nothing malicious I think but he needs to be invloved too when you have a big community meeting. We tend to ignore children while holding such meeting thinking that their parents speak for them too. I found it while working in Africa that this is really not true. Children could speak their own mind and how they see things around them. Children could be your eyes and ears!

    It will be a tragedy when you leave the clinic ( Achham) you have gained tremednously in terms of cultural knowledge and how to make a difference in health of a poor rural village but the villagers themslevs have not really got a gist and slowly dismantle the whole thing that you have carefully built with so much hardship and passion. Trust you will make sure that the clinic will continue lg after you have left and people are able to run the clinic themselves.

    I commend your work no matter what and wish you all the best in your endeavor.

    Thank you for being there for people of Achham who otherwise would have gotten no health care.

  2. neelam adhikari says:

    Have you investigated rain water harvesting? You could look for “smart Pani” at internet. They have solved problem for many houses and organizations.

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