During my visit to the Jana Jyoti Primary School I was told that one of the sponsored children did not attend school for about half a year, because she had been falling and could not walk properly anymore. That was Domini Sherpa, who already had a walking problem, because she cannot bent her right knee. With her father she had been to the hospital in Okhaldhunga, but doctors could not help her. Her father had carried her to the school and she was standing there leaning on a stick. You could see that the leg was hurting. During the next days this problem did not leave my mind. Normally a child recovers quickly from a fall and a bone fracture should have been detected in the hospital in Okhaldhunga.

The objectives of the foundation do not mention medical care, we care for the education of children. However to get education you should be able to attend a school.
At parting from the porters, in Sangutar, I asked the father if he was interested in bringing his daughter to Kathmandu for a medical examination. Depending on the result we then could decide about a possible treatment and in what extend Stichting Milijuli could sponsor that treatment. He gladly accepted this proposal and I gave him money for the travel expenses. Back in Kathmandu I will prepare for their visit and go to Chitwan according to my travel plan. While I am in Chitwan he will bring Domini to Kathmandu.

First thing to do in Kathmandu is of course choosing a hospital. Incidently, there is an orthopedic hospital, not far from the spot where Kame is living in Kathmandu. He had no personal experience with it, but according to him, that hospital had a very good reputation among the local population. Furthermore, Domini could stay in his house, in Kathmandu, as long as necessary. He lives with his family in two rooms. In my hotel it is confirmed that this hospital is a good one. Therefore I decided to go there and have a look. I can not judge the quality of the hospital but I can see if it is clean and get an impression whether it is orderly or not.

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Furthermore, I need to learn about the administrative procedures when you sponsor a patient. I dare to make me guarantor for the cost of an initial investigation, but after that comes, if possible, a treatment and that treatment can be unexpectedly expensive. I must, after the proposal for a treatment, decide whether it can be executed immediately or that we first have to raise funds.
The hospital is at some distance from the main road in a park setting. Everything looks well maintained. In the hall, at the entrance is a bustling, but everything has its place, and most patients or visitors sit in a chair waiting for their turn. A few people are walking around and move the curtain aside from a surgery to look inside. It is difficult when you can not read the signs. Eventually they reach the reception where they receive instructions.

Looking around, I see a plaque, which states that this wing is built from the money that was donated by a Dutch foundation.
After not too long I can contact a doctor to tell my story and after helping a few more patients he brings me to the financial director. Along the way I see that the hallways are clean and free of obstacles. The doctor – sorry I forgot his name – also tells me about the wing, which was built from a gift of a Dutch foundation. He also tells me about a Dutch lady, Ocky Pladet. She is already in her seventies, but she still comes to the hospital each year, for three months, to help and to train nursing staff. If you like to know more about this lady, you can look athttp://www.stichtingkinderenvankathmandu.nl [sorry, I did not find a site in English language].

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The director interrupted an interview with two other people to talk to me. I was very surprised about what he told me – the first consultation costs 70 rupees, necessary laboratory tests, however, have to be paid separately. The proposed treatment could be discussed at any time. Relieved, I left his room and put my shoes back on.
On my way back I peeked inside the “Children’s Ward Ocky Pladet”.
With Kame Sherpa, I then agreed that he would ask the father of Domini to bring Domini on or before December 4 to the hospital. According to my schedule I will return from Chitwan on December 5. The next day we can go to the hospital to be informed about the proposed treatment and we then can decide how to proceed.

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December 5:
On arrival in Kathmandu I first went to Kame’s home. There, I also met Domini’s sister Pemba, who came with her because Domini needs care. Domini has been in the hospital. Laboratory tests have been performed and a x-ray of the knee has been made, but the results are not yet known.
They have a patient booklet, a large envelope with a X-ray photograph and a few receipts of paid bills (NRs 805 for laboratory tests and NRs 225 for the X-ray photograph).
On Monday, December 7, 11 o’clock we can go to the hospital to be informed about the results.

December 6:
I had planned to go to Pharping, but the maoïsts had declared a banda, a strike. Trafic, even by bike, is not possible.
I make good use of this situation and go to make pictures in the city, without the hassle of cars. In Thamel it is proved that the world is small – I meet Simone and Erik, who I got to know during my Helambutrek last year. This time they had a short hike north of Syabrubensi in Tamang area. Only three years ago this area was opened for trekking and tourism has not left negative traces yet. They highly recommend this trek.

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December 7:
Before we can talk to the doctor, we must first go to the lab for the results of the tests. These results are copied into the patient booklet. The doctor tells us that he is 80 percent sure that Domini is suffering from tuberculosis. For more assurance he wants a X-ray photograph taken from the lungs and a sputum test.

The standard treatment in such cases, is a medication regimen of 6 months, slowly force the knee in a right position and fixate it. Domini will never be able to bend her knee, but should be able to cope and will not die of tuberculosis.
The drugs to combat tuberculosis, will be fully paid for by the government. He gives us prescriptions for the chest X-ray and for the sputum test.
The sputum test is performed at a different location in the city, but the chest X-ray can be made here. With the prescription for the X-ray we go to a counter to pay and with the receipt we go to the radiology department, where it is soon her turn. After fifteen minutes an employee of the laboratory brings a stack of photographs, which he puts into big envelopes and issues to the patients. We bring our photo directly to the doctor. Domini was often carried. I had helped her as many times as possible and I was surprised that nobody had given her a set of crutches. So I asked the doctor where I could buy crutches. In response I got a recipe, with which I could go to the pharmacy here in the hospital. Since it proved impossible to find good size wooden crutches we bought the aluminum ones. Its price was 850 rupees. Wooden crutches would have cost 500 rupees. Domini could handle them quickly and was pleased with the improved mobility.
The sputum test could not be performed today. The test involves that a jar with some saliva is returned three consecutive mornings. The results will therefore only be known when I’m home again.

_________________________Information received by e-mail.

December 12:
A surgery is scheduled for tomorrow to assess the state of the bone and to get a biopsy, which is needed to determine exactly which bacterium needs to be killed. So, the diagnosis is not yet final.
The hospital asked a deposit of NRs 8000 for the operation and another NRs 3000 for drugs.
A hospital bed costs NRs 250 per day.December 14:
An operation was conducted yesterday, in which the condition of the knee was examined and a biopsy was taken. The biopsy is sent to a laboratory in India. The presumption of the doctors that Domini, even after surgery, will have a malfunctioning knee is confirmed. They indicate that an amputation might be the best solution. It was agreed that this matter will not be decided on without first consulting the parents. The parents will arrive in Kathmandu tomorrow.

December 18:
Domini’s parents are in Kathmandu. Surgery is scheduled for Sunday. A steel frame will be mounted around Domini’s knee.December 22:
The political situation in Kathmandu caused a postponement of the surgery.December 30:
Surgery will be today or Friday. The laboratory in India confirmed the diagnosis and has determined the exact tuberculosis bacterium.
Hospitalization might be up to six months.

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January 2, 2010:
Again, the surgery is postponed and is now scheduled for January 3.

January 8:
The operation was finally performed on January 5. Kame Sherpa has made the following photos of the Domini. She has a lot of pain.
I ask Kame to buy a present for her, to show that we sympathize with her.

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January 14:
Domini is discharged from the hospital on January 12. This was possible because she lives so close to the hospital. Every 3 to 4 days she must go to the hospital for adjustment of the steel frame and changing bandages. With the crutches she can already move properly. Kame bought her a sweater, because it is often cold now in Kathmandu.
The total cost up to December 31 were NRs 29.971, -. Because she now lives in Kame’s home the cost will go down now. Boarding for her and her sister amounts NRs 200, – per day per person.

February 5:
A X-ray photograph has been made. The doctors assume that Domini will be fully recovered in 3 to 4 months.February 13:
Everyting OK with Domini.
The costs for January were NRs. 43,444,-.
That includes NRs 8.000,- for boarding Domini and her sister Pemba.February 23:
Domini needed extra clothes. Kame bought her, for NRs 700, trousers and a shirt.
She is well.

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March 12:
Everything OK. No complications. Within some days a new X-ray will be made.
The costs for Februari were NRs 21.234,-.

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March 30

Anita, Jan and I, Ton, had the opportunity for a short stay in Kathmandu.
Of course we went to see Domini.
She’s in good spirits and cheerful. Her leg is forced right slowly.
I’ve now learned that the blouse and trousers, Kame bought her last month, and which she bears on the pictures, are called a kurta sulawar.

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May 11:
Everything OK; no complications.
The costs for March were NRs 13.146,-.
Those for April NRs 12.300,-.

June 4:
On June 2, Domini was admitted in the hospital for next day surgery to remove the steel rods from her leg.
She now enters the last stage of her treatment, the revalidation – curing the wounds and learning to walk without crutches.
The costs for May were NRs 13.305,-.

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14 juni:
Everything is OK. No complications.
Domini left the hospital and will only report back if a problem develops.

1 augustus:
On July 20th Domini left Kathmandu, together with her father, to go home.
Inside the house she is not using crutches at all. Outside the house she uses the crutches only on longer stretches and when she is feeling not comfortable on a more difficult path.
For the time being she will take the crutches with her when going to school in Duble.
The costs for june were NRs 26.250,-.
The costs for july were NRs 8.050,-.