Boulder Magazine Fall 2007 :: feature articles

The Doctor Is In ... Nepal
By Anne Keala Kelly
Photographs by Tony Makepeace and Anne Raup

Assisted by CU engineers, a Boulder physician helps a Nepalese valley achieve its 100-year vision

At dusk, the Kathmandu skyline shows water tanks on buildings. (PHOTO BY TONY MAKEPEACE)

Far from the open horizons of Colorado, Nepal reaches upward with sharp, jutting mountain ranges cut by countless valleys. In square miles, if you were to flatten the Himalayas and stretch everything out, Nepal is roughly the size of Colorado. But while Colorado has a population of 4.8 million, Nepal is home to 27 million people from more than 100 ethnic groups who speak some 150 languages. It is a land of extremes where cultural wealth is juxtaposed with material poverty.

From valley bottom to peak, any land that can be cultivated has been terraced and planted with rice, tea, beans, and grass for cows. Most people in Nepal lead subsistence lives, and the infrastructure of rural areas lags a century behind Western standards. As a result, many children and adults contract waterborne illnesses that seriously impair their quality of life. A 2001 MIT study concluded that 44,000 Nepalese children under 5 die every year from contaminated water.

Boulder resident Dr. Barry Bialek may be retired, but he hasn’t stopped working. A former emergency physician at the Fort Apache Indian Reservation in Arizona and current lecturer at the University of Colorado’s Engineering for Developing Communities program, Bialek is undeterred by the scope of Nepal’s challenges, or any failures in the system of governance or volunteerism. At 56, he has believed for more than 30 years that dedication can and will alleviate at least some of the harsh realities associated with Nepalese rural life.

Left to right, back row: Bernard Amadei, Barry Bialek, a Tibetan monk, Sean Mitchell, Alena Bennett, David Blatz, David Sparkman. Front row: Frances Fierst, David Dani, Christie Chatterly, Sherelyn Jackson. (PHOTO BY TONY MAKEPEACE)

Crossroads: Wyoming or Nepal?

Bialek first went to Nepal in 1974 as a Peace Corps volunteer. “I was 23,” he says, “and I didn’t know where Nepal was. I only knew I wanted to live in the mountains in a non-English-speaking community so I could learn a new language.” After graduating from the University of Michigan at Ann Arbor, he spent a year working on a dude ranch in Wyoming. His job prospects were Nepal or a one-room schoolhouse in Cody, Wyo., where he would be snowed in for three or four months a year. "It was actually a hard decision, but I decided on Nepal,” he says.

Bialek was stationed in the District of Ilam’s Namsaling Valley, where he built the first pit latrine, which is essentially a hole outside the house to squat over. “Today they have 400 latrines,” he says, “and they need 700 more so that each house has one. That project will take us about 20 years to complete. But in Nepal, it’s all about process.” The process Bialek started as a young man continues today with a new generation who are determined to improve conditions for the 6,500 people in the Namsaling Valley. “We don’t have a template; what we have is a process of working in and with the community, and sometimes it’s two steps forward and one step back.”

Last May, Bialek and Bernard Amadei, founder of Engineers Without Borders–USA and professor of engineering at the University of Colorado at Boulder, led a group of eight CU engineering graduate students to the Namsaling Valley, together with 10 Nepalese students and engineers. They spent the summer testing water supplies for contamination by E. coli and other pathogens, taught villagers safe testing techniques, erected a machine to condense pure water from fog, and aimed to build 10 new pit latrines.

A Hero’s Welcome

Every trip to Namsaling is a kind of homecoming for Bialek. The Nepalese call him Dr. Barry (pronounced Docta Bear-dee), and he always gets a hero’s welcome. His friends greet him first with a dot of traditional red tika applied to the forehead as a blessing, and then with a cup of sweet, milky Nepali tea; both tika and tea are omnipresent in Nepali life. The students are likewise greeted and welcomed into homes throughout the bazaar.

Although life in Namsaling isn’t easy by American standards, this valley is considered one of the prosperous parts of Nepal. Houses are still made of stone, mud, and wood or bamboo, but their traditional thatched roofs have been replaced during the past 20 years with corrugated tin. Most houses in the bazaar have electricity. The current is unreliable in the summer monsoon season, though, and when night falls, the valley is black without the glow of electric bulbs.

Daya Ghimire holds 2-month-old Nona early in the morning. Daya, her husband and their two small daughters live and work in the Namsaling district of Nepal. They’re lucky to have running (though untreated) water at their house many hours of most days. The hose can be placed to run into the kitchen area, the dishwashing area or the latrine and laundry area. (PHOTO BY ANNE RAUP)

People in the valley go from place to place on a web of steep, curving footpaths that turn to mud when it rains. Many houses divert water from springs, streams and cisterns through a network of rubber hoses to outdoor faucets. This cobbled-together system is prone to leaks and vulnerable to contamination from human and animal waste. Even though they were careful not to drink untreated water, half of the Americans developed an intestinal bug within the first few weeks of the trip.

A 100-Year Plan

For Bialek, the Peace Corps experience led to medical school. “My first-aid kit, with nothing stronger than Tylenol, contained more medicine than anyone else had. People with serious ailments came to see me, and I would send them to the British hospital ... I realized I enjoyed it.” During his medical studies at George Washington University, he and a group of Nepalese graduate students there began a study group. “We realized that the way to help the people of Nepal was to ask them to look far into the future, beyond their own life expectancy,” he says.

By the end of 1984, Bialek was back in Namsaling, helping villagers envision how they wanted their village to be 100 years in the future. “They talked about health, water, energy. They came up with all kinds of things,” says Bialek, “—a hospital, roads, but also latrines in every home, opportunities for women, healthy children.” The community set up committees, dividing the work into what they could do on their own and what they needed help with.

Namsaling residents and CU students inspect a recently dug latrine pit in the village. (PHOTO BY TONY MAKEPEACE)

Their ideas led to the establishment of the Namsaling Community Development Center, which has focused on developing infrastructure and improving the quality of the water supply in the valley. In addition to building latrines and water pipes, it is working to build a road from Ilam to Namsaling, and to bring wireless technologies to the valley to make possible a remote health clinic where doctors from far away can diagnose patients over the Internet. The work Bialek has set into motion with Amadei and his students is moving Namsaling closer to its 100-year vision.

“This has been the best EWB trip so far,” Amadei said in June, comparing the project to others he has worked on in Rwanda and Afghanistan. “I am very hopeful about continuing to work with the community in Namsaling. By the time we leave, we will have mapped all the springs of Namsaling with a Geographic Information System [GIS]. We can try to work out a safe water plan for the entire village, and we are hoping to get a Boulder-based civil engineer to act as the mentor to create a safe water plan with a solid-waste management component.”

Barry Bialek was one of the leaders of the Engineers Without Borders trip to eastern Nepal. During a village welcome celebration, Bialek and all the volunteers received red tika marks and flowers. (PHOTO BY ANNE RAUP)

The Road Ahead

As troubled and impoverished as Nepal is after a 10-year civil war that ended last March, there is a richness that emerges in such a complex society where things have been done the same way for hundreds of generations. It’s a place where drivers slow down to honk the horn and bless themselves as they pass a shrine hidden in the rocks that is dedicated to one of many local deities. It’s a place where women cut and bundle grass on the terraced hillsides to carry it home and cook it for the family cow to eat.

Imagine this village, locked in ancient ways, jumping into the 21st century’s information age and you might sense the overwhelming changes just around the bend for Namsaling Valley.

Anne Keala Kelly is a native Hawaiian journalist and filmmaker who spent last year at CU on a nine-month Ted Scripps Fellowship for Environmental Journalism. She was a member of last summer’s expedition to Namsaling Valley.