48 Hours in Taplejung

48 Hours in Taplejung
By Maggie Vizcarra, Program Grants Coordinator
Featuring photographs by Rebecca Gaal

Becky spots us pretty easily at the airport in Kathmandu. No international flights leave from this terminal, so the small baggage check area is peppered with only a few Westerners and we are the only ones who aren't decked out in trekking gear. She finds us in the corner enjoying our morning snacks and milk tea with Seva Nepal Program Director, Mr. RP Kandel, captivating us with another masterclass in storytelling.

Rebecca Gaal is a photographer who volunteered to travel along with me, Kandel-ji, Leslie Louie (Seva's Deputy Executive Director) and Heidi Chase (Seva's Innovation and Sight Program Director) to document an eye camp at Dechen Dongla Memorial Primary Eye Care Center (PECC) perched high in the mountains of Taplejung, the Northeastern-most district in Nepal.

The eye care center was established in 1998, with support from Seva to construct and equip the facility and train staff, including previous support in Ophthalmic Assistant training for the Clinic-in-Charge, Mr. Kaji Gurung. Over the nearly two decades since its inauguration, Seva has continuously supported outreach activities, staff trainings, equipment and eye camps at Dechen Dongla PECC. Additionally, the PECC is located near the hometown of Seva's Medical Director, Dr. Chundak Tenzing, and named in honor of his sister. Because of this history, visiting the PECC feels like going home.

After a short flight to Biratnagar airport, a day spent with partners in the area and two button-popping dal bhat meals, we are lulled to sleep by our full bellies and the luxurious hum of the air conditioner.

View of the Itahari skyline the night before our drive to Taplejung from the rooftop of Mr. Shravan Kumar Chaudhari, Seva Nepal's Administrative Manager. Shravan-ji and his family invited us to their home to share in the best dal bhat I had in Nepal.

Early the next morning, we strap our suitcases to the roof and pile into the car for our “eight-or-so” hour journey up the mountains. After getting used to the hairpin turns, the ride up the winding mountain roads is mesmerizing. Expansive views of tea gardens are followed by terraced rice paddies, all of which are eventually dwarfed when the Himalayas appear around a bend, glowing bright in the setting sun.  I never tire of the view, even when we hit a particularly precarious patch of road and even when eight hours turned into thirteen.

The ride through the mountains took us past vast tea gardens of tightly packed together bushes. Rice paddies are also a common sight. Farmers who manually thresh rice are vulnerable to eye injury from flying rice husks.

The view of the snowcapped Himalayas through our car window.

We finally reach Taplejung municipality. I haven't quite adjusted to the drastic temperature drop between Biratnagar and the mountains, so I clutch a glass of hot water in one hand and lazily eat another round of dal bhat with the other. Tired from the ride, full of rice yet again, and armed with hot water bottles, we bid each other goodnight and head to bed.

We are all up early the next morning, eager to head to the eye camp, which won't begin for another few hours. Kandel-ji and Kaji-ji take us a dozen more kilometers up the mountain so we can take in the Himalayas before heading to the PECC. At 8,000 feet, I'm not sure if it's the view or the altitude that's leaving me short of breath.

Finally, we meet up with Dr. Nanda Gurung, an ophthalmologist from Lumbini Eye Institute who traveled to Taplejung to examine patients and perform surgeries over the next few days. As we walk into the PECC, we are greeted by a crowd celebrating the start of the eye camp. They adorn us with bright yellow Nepali greeting scarves and marigold wreaths, the colors of happiness, and endlessly snap photos.

After Kaji-ji and his wife (not pictured) warmed us up with a cup of tea and fresh roti, we headed to the roof. The sun in Taplejung is exceedingly bright. L-R: Heidi Chase, Leslie Louie, Dr. Nanda Gurung, Mr. Kaji Gurung, Mr. RP Kandel, Maggie Vizcarra with Becky behind the camera.

Taplejung from Kaji-ji's rooftop.

Heidi entering the gates of Dechen Dongla PECC, greeted by community members, PECC staff and eye camp attendees.

After the celebration subsides, Kaji-ji, Dr. Nanda and the PECC staff quickly get to work. Becky and I get acquainted with our translators, Kaji-ji's teenage daughter, and her friend, and we start touring the camp and meeting patients. Near the entrance gate is a registration table where patients and their families check-in.

A family waits by an eye chart for the next step in the examination process.

We learn that many patients live in nearby villages, but some have traveled a few days to attend the eye camp, which happens annually at Dechen Dongla Clinic. PECCs are staffed by ophthalmic assistants who can diagnose and treat a wide range of eye conditions like refractive error or infections. However, for people with cataracts, eye camps provide the opportunity to be examined by an ophthalmologist and undergo surgery that can restore vision.

Mr. Dona Raj Gurung (right), an Ophthalmic Assistant (OA) who usually works at Dr. Ram Prasad Pokharel Eye hospital in Dhankuta, examines a patient using a keratometer, an instrument that helps assess the extent and axis of astigmatism. Seva sponsored Dona Raj-ji to undergo OA training at Lumbini.

Dr. Nanda examines a patient using a slit lamp. The slit lamp is an instrument with a high-intensity light source that focuses a thin sheet of light into the eye. The lamp facilitates an examination of many parts of the eye, including the eyelid, sclera, conjunctiva, iris, natural crystalline lens, and cornea. A second, hand-held lens is used is also used with the slit lamp to examine the retina. Slit lamps are vital tools in enabling eye care providers to identify, diagnose and treat eye conditions.

Alongside the registration table is an eye chart mounted to the side of a building. PECC staff and volunteers make quick work of testing visual acuity. After this initial screening, eye camp attendees wait on wooden benches lining the courtyard until it's their turn to undergo additional examinations. Patients are shuffled among exam rooms, where OAs and Dr. Nanda squint behind slit lamps to peer into their eyes. Those patients who will require cataract surgery are counseled and escorted down a set of stone steps. By the afternoon, over twenty patients are waiting in the corridor outside of the operating theater. Dr. Nanda finally finishes her examinations for the day and prepares to perform the surgeries, which will continue late into the evening.

A patient's cataract glows bright when illuminated. There is a higher prevalence of cataract among people who are exposed to harsh sunlight. In the Himalayas, the sun is incredibly bright and the days are long. Additionally, high altitude has both short-term and long-term effects on the eyes. The short-term effects include high-altitude retinopathy, change in corneal thickness, and photokeratitis. Long-term effects include pterygium, cataract, and dry eye syndrome.

Community Medical Assistants (CMAs) Mr. Dipendra Rai, Ms. Srijana Budhathoki and Ms. Mamata Bardewa take a break on the courtyard benches late in the afternoon. CMAs complete a one-year basic course in clinical support work. These three are completing six months of on-the-job training at Taplejung District General Hospital. They provide vital support at the eye camp by helping with patient intake, measuring blood pressure, blood sugar, patient counseling, assisting in the operating theater, bandaging patients after surgery and many other important support functions.

We return to the PECC very early the next morning. Patients who had received cataract surgery and stayed overnight at the clinic are seated in the courtyard. Becky and I spot each of the men and women we had talked to the day before. There is quiet anticipation in the air as we eagerly wait for eye patches to be removed. PECC staff attend to the patients one-by-one, carefully unwrapping gauze and dabbing eyes with cotton. And one-by-one, patients squint and blink to adjust to the bright sun. Recognition flashes across faces as each person realizes the change in their vision. Some patients smile to themselves and others gaze intently at their hands or their neighbor's face, examining the lines that have appeared since they were last able to see.

Patients who received cataract surgery the night before sit together in the chilly morning, waiting to know the result of their surgeries.

A patient leans on his cane and gazes into Becky's camera.

A patient takes in the PECC's courtyard after her bandages are removed.

By the time the last patient has her eye patch removed and Dr. Nanda and the staff finish making their way through the rows checking patient's eyes with ophthalmoscopes, the mood in the courtyard has relaxed. The sun sits higher in the sky and warms our faces. The space buzzes with chatter and patients smile at their families across the courtyard. Kaji-ji and Kandel-ji are talking with a man about his newly restored sight; their joyful laughter bounces off the three walls of the buildings surrounding us.

Ama-ji sitting on the ground, showing thanks to Kandel-ji and Kaji-ji.

Ama-ji presenting her gift of yak yogurt.

As we chat with patients with Becky's shutter snapping away, a diminutive figure shuffles over to us. What she lacks in height, she makes up for in verve ten-fold. I learn her name is Ama and that she was a patient at an eye camp held at this clinic four years ago. One of her eyes was permanently damaged by an injury and the other had a mature cataract. She could not see the doctor's face when she first arrived at the clinic those years ago. She received surgery on the reparable eye and had her sight restored. To show her thanks, she returns to every eye camp to deliver gifts to Kaji-ji and Kandel-ji. Today she brings yogurt she made from her yak's milk in reused soda bottles. Her charm elevates the courtyard's atmosphere even higher.

Kandel-ji, Ama-ji, Kaji-ji stand together. Behind them, photos from the previous day's celebration are displayed on a cork board.

The immediacy of sight restoration through cataract surgery is a magical thing to witness. I know I speak for Becky, Leslie, and Heidi when I share my overwhelming gratitude for these 48 hours spent in Taplejung. I am humbled by Kaji-ji's hospitality, awed by Dr. Nanda's skill and passion, and filled with warmth by Kandel-ji's laughter and stories. I am grateful for the tiny part I am able to play in expanding services around the world so that we may all share in the joy we feel in this courtyard.

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