Hello

Hello to our friends, supporters, and visitors. I spent a good part of November, 2011 at our project sites and want to give you a field report. Here are some highlights of my visit:

1) I participated in the international advisory board meetings of the Patan Academy of Health Sciences. It was a privelege to be involved in this process, helping plan the curriculum and develop this young Nepali medical school dedicated to rural health care. There were many distinguished particpants from Europe, Asia, and elsewhere. My participation helped to solidify the Academy’s relationship with the mlnfhe. We will have the opportunity to play a significant role in this process, and this medical school will be of great value to our projects in khotang.

2) I went to khotang with Namgyal Sherpa to evaluate the current status of projects. things are slow (as expected!), but very positive:

A) The hydroelectric project in rakha is ongoing.

B) 15 of the toilets are nearing completion in Dipsung . I have visited some of these with namgyal. i have been assured that the project will be completed by mid march 2012. By the time they received our financial support the monsoon season had started, extended the toilet project through September. CPS - the nepali ngo from rakha- has been managing this project. They have been running education and awareness inservice trainings in person, and broadcasting informaton several times weekly on the local radio! Our communication could be better, and cps told me that they will provide me with monthly status reports.

C) The school in dipru has not been started. The land was purchased by MLNFHE. The government is expected to build the basic structure, and then we will work on "upgrading" it's status. Arecent earthquake significantly harmed the old school, so all efforts were directed at rebuilding it. Furthermore, the government has not yet come through with the funding for the new school. However, the Dipsung village committee members have informed me that, with or without the government funding, they will complete the first structure by march 15 2012. furthermore, they have submitted a proposal to the dzi foundation- our mentors- for additional funds.

D) We still have our two children from Shim Kharka sponsored in their local school.

E) Our medical initiative is progressing wonderfully. we had two faculty from patan academy of health sciences (PAHS) join us on the initial part of the trip, Sudaresh and Samir. Together, we comprehensively evaluated the district hospital, met with the district government representative, and interviewed health post workers from the posts in the immediate vicinity of the district hospital. Sudaresh has a masters of public health (trained in india), and Samir has a MD degree from Nepal and a MPH from Oxford, England. They are both bright and talented, and a delight to work with. they have generated a compredhensive document regarding this trip which is currently being evaluated by their department chair. I will obtain a copy and circulate it. The tentative plan is to go with them to khotang every 3 months and continue to workon building the infrastructure and capacitance over the next two or three years. We should then be able to accomodate their senior medical students for six month rotations in khotang. Theirresponsibilities will include working/teaching at the district hospital, and going further into the field (with our support) to perform research projects, and outreach education for the locals and the health post workers. this will all be done with the involvement of the ministry of health so that they can stay in tune with our goals and expectations. Our medical initiative would also involve sponsoring students from khotang to go to medical school at PAHS, a cost of $50,000 over five years, plus expenses. During medical school, they will spend part of their time in Khotang, including a six month rotation in their senior year. At the completion of medical school, they will owe us 4 years of service before they are given their diploma, and this will be spent in khotang. If we decide to sponsor one medical student every four years, we should be able to have one of these graduates in Khotang at all times.

Having medical students in the village health posts is important because more that 90% of the villagers are multiple days walk from the district hospital, and are therefor seen in health posts and sub health posts. Presently, these posts are manned not by doctors, but mid level health care workers (auxillary health care workers, health assistants, nurse midwives, etc.). We will be involved in training de novo health care workers, and "upgrading" the education and abilities of existing health care workers.

I met with Dr. Mark Zimmerman, the director of the Nick Simons institute (NSI), this trip (and on the last trip too). we continue to build a relationship with Mark and NSI. NSI is an amazing institute that is dedicated to training and continuing medical education of midlevel health care workers at the village level. Mark has reaffirmed their commitment to serve as consultants to us (an amazing opportunity for us), and to help with the training of the health care workers. They are also involved with the training of MD general practitioners. These are medical school graduates whoreceive three additional years training geared to being able to provide a broad range of care in the rural setting. I would like to encourage and financially support our sponsored medical students in PAHS to pursuethis additional training. It would be a great asset for khotang if they will practice there. The medical staff at the district hospital are recent graduates of medical schoolwith no ability to perform surgical or gynecologic proceedures, etc. If we can train some MD GP's , it would be an important piece of the puzzle.

At our next board meeting we on December 8, 2011, we will discuss the medical initiative. This is clearly becoming the focal point of our foundation, and will be where we can make the biggest impact. It is an ambitious plan, but i am 100% committed. We will be able to publish articles in poublic healtlh/medical journals regarding our work, help train medical students, train mid level health careworkers, train MD GP's, and provide education regarding public health and health care to the villagers. We will develop a comprehensive long term plan, and present this to the ministry of health. Iwould hope that our model could be applied to some/all of the other 75 districts in nepal, or even serve as a model for other developing countries. the fact that we have partnered with a medicalschool with the mission that PAHS has, and with NSI, Tzi, etc.... is amazing. this is big.

3) Namgyal has been interested in starting a hostel in kathmandu. It would accomodate 12 children, and would provide their daily needs of living, and would also include sending them to private school. It is important that we discuss this because, once this process is inititated, we are committed to these children are ongoing. They will be far removed from their villages and any family, and all responsiblities will lay with namgyal and the Foundation. Some of the children will be orphans, some will have disabilities, etc... i have visited the prosposed living quarters and school. We will formally present this proposed project at our next meeting and take a vote.

4) i met with Ben Ayers , director of the Dzi foundation, our mentor organization. We had a great meeting. Dzi, and ben, continue to be at our disposal for help and advice. We are so fortunate. and Ben isimpressed with our progress. He believes we need to continue to narrow our focus, and feels our medical initiative will be our strength. HGe would like to collaborate with us regarding our medical initiative. We discussed the fact that next trip we will plan on taking the med school faculty to the posts in Rakha, Dipsung, and Sungdel. These are remote subhealth posts in some of the areas we areworking. Ben has proposed that Dzi potentially would be responsible to rebuild these health posts, and we would continue our work as outlined above to compliment this. This would be truly exciting, and what a great opportunity to work with dzi.

5) At Bane Lake I participated in the completion of a chorten, a large stone structure, erected in the honor and memory of Miles Levin. It was an all day affair and many dozens of people came from surrounding villages, carrying food and supplies for the event. There was music, chanting, hospitality, dancing, and prayer for hours while the work was completed.

6) As you know, the fundraiser and auction were a great success! What an accomplishment for our first year! We raised about $50,000 from tickets and donations, and about $25,000 from the auction. A special thanks to so many people, especially Tess, Drew , and Betsy. This money, plus what we raised during the year, puts us at over $100,000! I could not have done this without all of you. At our upcoming board meeting we will discuss the use of these funds and how we want to proceed from this point forward. I welcome your input. You may respond on the blog at this website or contact me by e-mail at keidan@comcast.net.

Finaly, we welcome two individuals who have offerred to help with the foundation - Jeff Surnow and Ru Pevzner - who are invited to the Board meeting. We continue to attract wonderful people who want to be part of this.

Most sincerely yours,

Richard