Medical Ethnology: Little Sushma's Story (Satis Shroff)

Medical Ethnology I: Little Sushma’s Story (Satis Shroff)

The case history of a small girl named Sushma is typical for Nepal. Sushma was 6 years old when she was playing near an open fire, and wriggled into the fire with her feet and received third degree burns
on her feet and right leg. All the toes were burnt and the wounds on her leg
were infected. She was in a critical stage. The German-Nepalese team carried
out the initial life-saving treatment during the surgical camp. Since it was
impossible to carry out further treatment in Surkhet, the team decided to
transport the despairing mother and the suffering child to the Interplast
hospital in Sankhu.

In the following months little Sushma was operated five times and countless swabs had to be changed and her wounds bandaged. As the wound healing progressed, Sushma’s mother helped her daughter
take water baths. Sushma was discharged seven months later and it was a
wonderful case of assistance in a developing country through the mutual
cooperation between Germans and Nepalese surgeons. Sushma wears orthopedic
shoes now and modern medicine has given her a new life and hope, despite the
loss of all toes and a part of her foot.

It’s a delight to see Sushma laugh again with her mother. Wonders happen.

The Interplast idea was born in the USA, a project to treat people who suffer from injuries through fire, weapons in war and anomalies during the birth. Such operations are expensive and cannot be
carried out by the local surgeons in the so-called Third World countries. The
idea was to send plastic surgeons to these countries and perform operations
with the assistance of their counterparts. If no experts were available,
Interplast also did the job of training them.

In Nepal there’s a hospital for Plastic and Reconstructive Surgery in Sankhu, which is in the vicinity of Katmandu. The Nepalese counterpart is the Sushma Koirala Memorial Trust (SKM) and is run
since 1999 by the German surgeon Dr. Andreas Settje. The hospital has 50 beds
and the work is done with the help of Nepalese doctors and voluntary
specialists from Germany. Over 1,800 surgical operations are performed
annually. Additionally, there’s the 24 hour emergency service for the local
people of Sankhu, a dental ward, physical therapy for post-operative cases and
other facilities which the local people use.

Interplast Nepal has a teaching-hospital character and trains Nepalese nurses and physicians. This is an excellent example of helping people in a developing country to help themselves, and to
render medical assistance to poor people in the long run. The patients are
asked to pay whatever they can afford, but for people who don’t have any
financial resources, the therapy is free of charge.

The hospital manager is Ms. Christa Drigalla, the technical supervisor is Hein Stahl and Dr. Andreas Settje is the chief surgeon. Lilo Knörrich, who is a physical therapist, has worked many times in
the hospital. A regular visiting plastic surgeon is Dr. Hubertus Tikoru and he
is responsible for the training of Nepalese medical personnel. Professor Dieter Pape, surgeon, was the
first medical director of the SKM-hospital. A Nepalese surgeon Dr. Raju Pandey
also operates with his German counterparts. Dr.Sybille Keller, who is a regular
visiting dentist, coordinates all voluntary work of the dentists, and Dr. Klaus
Macher, a dental surgeon, takes care of the financial aspect of Interplast’s
dental department.

The surgeons of the SKM hospital travel to different part of the mountainous country where operation camps are organised. A team of workers go ahead as a vanguard and seek prospective patients for
operations, get their basic data and photograph the patients and their
injuries. A three-day jeep ride is normal in hilly Nepal, and the majority of
the people live in inaccessable areas where there aren’t any medical
facilities. In a surgical camp 80 to 100 operations are done. The hospital
staff organise free transport to the hospital in Sankhu when the patients have
to undergo major operations. One such regular camp is the district hospital in
Surkhet (Western Nepal), which is 650 km away from Katmandu. It takes two days
to negotiate this distance. The district hospital in Surkhet has only two
physicians and has to treat over 100,000 patients.

(In case you’d like to help other such Sushma’s in Nepal please make a donation by looking up:


Medical Ethnology II: Helping the Nepalese to Help Themselves (Satis Shroff)

Christa Drigalla is an amiable German lady, a hospital manager who worked at the Diakonie hospital in Freiburg (South-west Germany), where she did Nursing Management. Sometime back, this author had the
opportunity of going for a walk to the Emperor’s Chair (Kaiserstuhl), a
volcanic wine-growing area in the vicinity of Freiburg, with Christa.

‘I’d love to trek to the Rara lake. I saw colour transparencies of Rara shown by a Freiburger professor in St. Georgen and was so fascinated’, said Christa. She has been to Annapurna, Chitwan and
Langtang. ‘Springtime in the Himalayas is wonderful’, she said as she drank her
Nepal tea and mentioned names like Kanchan Gompa, Laurebina-pass and Sundari
and about 17 to 18 degrees centigrade temperatures in the month of November.
But she said she liked to brave it all and wouldn’t miss trekking a bit.

At the beginning Christa worked as a nurse at the Shanti Seva Griha, a leprosy clinic, run by a lady from Dortmund Marianne Grosspietsch, which is located in Pashupati, near the river. She helped where
she could, and was uncomplicated. The small 12-bed clinic, an outdoor Ambulanz.
In German ‘Ambulanz’ is not a car to transport injured patients, but a ward to
cater to the needs of the outdoor patients. An ambulance in the English sense
of the word is called a Rettungswagen. Shanti Seva also runs a school for the
children of the leprosy patients. There’s a coffee-shop, a tailoring-service
and a branch in Budanilkantha, which is open twice a week. The outdoor ward has
over 2,300 registered patients.

The poor, ill, blind, lame and lepers come from the miserable, smoggy streets of Katmandu and the temple complex of Pashupatinath, Nepal’s biggest and holiest gold-roofed hinduistic temple. The
sickly beggars are never too tired to beg for alms from pious people (Hindus
from Nepal and India), who are allowed to worship in the sancrum sanctorum
of the Shiva-temple.

The other curious visitors who are obliged to remain in the periphery of Pashupatinath are the digital camera-toting foreign tourists. Whether it’s coy and shy bathing Nepalese women in wet, sticky saris,
burning Hindu corpses and the mourning relatives of the deceased, hungry lepers
or agile Rhesus temple-monkeys, the dauntless tourists photograph everything
for their transparency, powerpoint, video and DVD-shows back home. The Shanti
Seva Griha takes care additionally of the white-haired, wrinkled widows, women
and children from the neighbourhood. There’s no social security and support for
the elderly in Nepal and many countries of South Asia. And the treatment is
free. The Griha also has a rehabilitation-centre near the Royal Golf Club
Nepal. It has a tailoring workshop where stigmatised Nepali lepers work in
peace. Lepers are still heavily stigmatised in Nepal, like the people with
plague in the Middle Ages in Europe. Today, it’s possible to cure the disease
by using an antibiotic cocktail.

Christa said that she put up at a small lodge near the Clinic, and lived sometimes with Nepalese friends near the Ring-road. There’s a German nurse named Irma who hails from Achern and she has
additionally a leading role at the Nursing Campus (Patan). Christa comes from a
hamlet named Albringhausen, with a population of 229yes""> in Lower Saxony, a flat state at an elevation of 14metres above

‘It’s all farms, corn-fields, meadows and windmills. More and more farmers are giving up their farms and the farms are in poor conditions due to the bad EU agricultural politics. It’s East Friesian
country with fishers, crabs, cows.’ She has a brother and a sister out there in
Lower Saxony but she lives the mountains. If she’s not trekking in the
Himalayas then she’s invariably wandering up and down the Swiss Alps or in the
Black Forest Mountains.

‘I have it in my genes, this Wanderlust,’ she says almost apologetically. Christa Drigalla has been running the Interplast Germany’s hospital in Nepal for a long time. Interplast is a US- German
undertaking which carries out plastic surgery on leprosy patients, which is
extremely useful for the poor Nepali patients, who are ostracised and shunned
by the Nepali society.

She talks at length about the corruption scandals in Kathmandu. ‘Everybody is pumping money into Nepal but where is it vanishing? The number of beggars in Katmandu, and Nepal in general, seem to
multiplying. I don’t see any structure in Nepal. There are so many NGO
projects, and there’s hardly any monitoring done.’ All the NGOs ought to be
coordinated by the new government’s Social Ministry. Every big foreign country
has, in addition to its official development volunteer programme, a bevy of NGO
projects. Even local NGOs are cropping up like mushrooms after a monsoon
shower. And all international organisations want to help the fifth poorest
country in the world to get up on its feet.”

Where are the priorities? For instance, most of the foreign projects have programmes in the educational sector, but they don’t dare to intervene and help develop new, attractive vocational curricula. They
just open or support existing schools, and let the Nepalis carry on with their
own anachronistic teaching methods and curricula. Only the rich have access to
modern education. What are Nepal boys and girls to do after they have done
their School Leaving Certificate? Who is going to finance higher education?
There are just not enough vocational outlets.

There’s no question about the need for NGOs but where does the money disappear? Isn’t it literally helping others to help themselves through the
aid-industry? The money and effort just doesn’t seem to trickle down to the
grassroots. Quo vadis development aid?

Christa Drigalla says, ‘‘A deep orthodox faith in religion is not good for these modern times. For now. It’s better to try and improve one’s present life(style) than to expect that it will be better in
one’s next life. I often hear paralysing fatalistic opinions like ‘ke garnu?
jindagi jestai chha
(What shall I do? Life is like that).
Or ‘ke garnu? upai chaina! (What shall I do? There’s no way).
Modern educated Nepalis tend to say ‘Where there’s a will, there’s a way.’
Perhaps that is the value of education.’

‘Practical steps are useful in pepping oneself up. When I was at Shanti Griha we constructed a shower for the staff and patients. She longs to see the friendly faces of Prabha the social worker, Hari
the sanitater, Krishna the physiotherapist, Dr. Singh the team-physician and

‘I’ve been expanding the plastic surgery hospital project run by Interplast at Salambutar, near Sankhu,’ says Christa Drigalla. This new hospital was opened officially in November 1997 and was
dubbed Sushma Koirala Memorial Hospital (SKMH) after the daughter of the former
Nepalese Prime Minister who burnt to death in her sari. The international
medical team of the SKMH is busy with operative corrections of patients who
have scars from burns, deformities from birth, or have lost a part of their
hands or feet through leprosy-infection. This medical area has been the
connecting link with the Shanti-Griha-Project with its leprosy patients.
Besides rendering concrete medical help to these Nepalese patients, the aim of
the ‘Interplast’ organisation in the whole world is to teach local surgeons
special operation-techniques, and to give their know-how to them so that they
can operate independently at a later stage. Other members of the medical-staff
like nurses, sanitaters, physiotherapists also receive special training and
instructions to take optimal care of the post-operative patients. The
Interplast-run hospital is, after a period of initial financial and
intellectual help, to be overtaken by the Nepalese counterparts.

Christa has been working for more than a decade in Nepal and has survived the revolution of the eighties, the nineties and now the Maoist take over at the recent polls.

‘I’m sure that this ‘help to self-help’ (Hilfe zur Selbsthilfe) is the most effective solution towards improving the situation of the patients in Nepal,’ says Christa Drigalla. She has always had an inner desire for a long time
to get to know Nepal not only as a tourist, but to live here and to experience
the entire seasonal changes of Nature, with winter and sommer, the dry period
and monsoon, to get to know and understand the people better and to do more
trekking’. And that’s exactly what she has been doing all these years and has
even built a wonderful house in scenic Nagarkot from where she can peer at the

One can only admire her courage, endeavour and the ability to assert herself and I’d like to wish her well. She is what we call in German eine gute Seele, a good soul, and is the personification
of togetherness, Miteinander.

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