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To the Ends of the World: Outreach in Nepal

Shankar Lama walked 18 hours straight, simply because there was no place to stop

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Kathmandu — Program Associate Zach Shuster writes about the astonishing efforts of B&B Hospital's outreach team.

Without their willingness to seek these patients out through sheer dogged perseverance, Smile Train’s mission to reach every child with a cleft would go unrealized.

I recently got back from a trip to Nepal, where I traveled with South Asia Program Director Mamtaa Carrol as she interviewed prospective treatment centers and checked in on well-established Smile Train partners. Smile Train has sponsored surgeries in Nepal since 2001, when a joint partnership with ReSurge International produced 74 surgeries at six treatment centers in one year. Since then, Smile Train’s presence has grown dramatically; over 1,500 surgeries were funded last year, and regional staff has been pushing to increase overall coverage.

One of the country’s most active treatment centers is B and B Hospital in Kathmandu. Their surgical volume is due in large part to the efforts of their outreach team, a band of young Nepalese men with boundless energy and a sense of purpose that compels them to serve their country.

At the country level, Smile Train’s efforts rely on multiple layers of dedicated individuals all working together to connect cleft children with the doctors who can help them. Oftentimes, the hard work of finding cleft patients falls to outreach teams like the one at B and B Hospital. Nepal is a country with highly variable topography and wild shifts in elevation, which is a major draw for adventurers and trekkers, but it presents a unique set of challenges to surgical teams. Dramatic, mountainous terrain means isolation, and remote communities often lack access to medical care and information, which means that a child born with a cleft might never receive the medical treatment they need. Parents may not even realize that their child is afflicted with an easily treatable medical condition because they may never have seen another person with a cleft lip or palate.

It is in countries like Nepal that outreach efforts are crucial. Mamtaa is fond of saying “surgery is the easy part. It’s getting kids in the door that’s difficult.” B and B Hospital’s outreach team takes this message to heart as they travel for days at a time to reach some of the remotest parts of the country and bring the patients they find back to Kathmandu. When we visited the hospital, Mamtaa and I sat with the guys as they described their experiences. Since they started going on outreach treks, they’ve contended with leeches, landslides, torrential rain, and an absolute lack of amenities (read: bathrooms). Team leader Shanker Lama described walking for 18 hours straight simply because he had no place to stop. It’s no wonder remote populations don’t know about free surgery in cities like Kathmandu; they may never have been there in their entire lives simply because the trip is too daunting. Without the dedication of outreach teams and their willingness to access these populations, there are literally thousands of cleft patients around the world who would go untreated simply because they haven’t been reached.

Watch interviews with the Smile Train outreach team members.

I couldn’t help but notice the enthusiasm with which the members of B and B’s outreach team described their experiences. With huge smiles on their faces, they told stories of the hardships they faced by trekking to reach patients, sharing tidbits like the secret for keeping leeches out of your shoes (“soak your boots in tobacco overnight”) and the best place to use the bathroom (“the river”). The reason for this enthusiasm is simply the pride these young men take in being able to help their country’s people. A young outreach worker named Ayush summed up his motivations best when he said, “I’m just doing it for my country. That’s it.”

As Smile Train’s programs grow, outreach teams like the one at B and B hospital will become more and more crucial to the mission of eradicating untreated clefts worldwide. Hospitals are more common in cities, where awareness efforts tend to rely on urban infrastructure – media like TV and radio, flyers in public places, and word-of-mouth shared among a densely concentrated population. As urban cleft patients receive treatment, the backlog is increasingly pushed to rural areas, and the outreach teams that strive to reach patients in remote communities become the real heroes of Smile Train’s efforts. Without their willingness to seek these patients out through sheer dogged perseverance, Smile Train’s mission to reach every child with a cleft would go unrealized. We need more teams like the one at B and B hospital because they are the backbone of Smile Train’s efforts, and they will ensure the success of its programs for years to come.

Program Associate Zachary Shuster visited Smile Train's largest partner in Nepal and gathered information on their amazing outreach program.


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