My trip to Manthali, June 2014

short version

several months ago I got contacted out of the blue by an American MD who was planning to go to Manthali Nepal to volunteer her services there. This happens every now and again since I have such a robust presence on the internets. She invited me to spend some days there.

Why not?

It turns out that Tamakoshi Sewa, the hospital at which she was volunteering, was a very interesting place indeed. It is a small place – there are fifteen beds but the inpatient census was three. The main thing was to see how they address the health needs of their region. They serve about 120,000 people in a very mountainous area.


Tamakoshi Sewa Hospital in Manthali, the main town of Ramecchap District.



I really only spent two days there. One of the mornings I sat quietly in the corner and observed as one of the doctors was conducting the OPD clinic. This was open to all comers. I simply don’t get involved in primary care much these days so it was very interesting to see who came in next.

Doctor Suman Karmacharya, MD is the main guy at Tamakoshi Sewa. On my last evening there, he gave an overview of the services they provide.


Tamakoshi Sewa Hospital employed a small crew of regulars and I did an abbreviated segment of my training with them in the afternoon.



They are involved with a wide range of projects including safe drinking water and toilets.

They partner with World Neighbors for many projects.

Though they mostly do primary care, much of the annual activity is given over to the periodic camps they conduct. A camp typically involves a team of doctors and nurses from other parts of Nepal or even other countries, who set up shop for a limited time to provide a specific purpose. There is a lot of logistics involved. Obviously, the team needs to bring all their equipment and supplies; but also, somebody has to screen the patients and get them to show up on the appointed day. At the village level, there is a “VDC” ( Village Development Committee) in each of the hamlets, and these are enlisted to help.

Uterine Prolapse Camp


Suman Karmacharya, MD is an example of dedication. see story below.

Dr Karmacharya told me an amazing story: he was in touch with a German NGO that was willing to do a visit for the specific purpose of surgical repair of uterine prolapse. Okay, that’s good. But – in order to gather the patients for this, a qualified person needed to examine every candidate. which meant – him. So, he embarked on a 45-day walking trip through the roadless part of the district, and at each village he would stop and examine every one ( not just for uterine prolapse, but for other conditions as well). He  found more than fifty cases, and set up a system for every to appear the week that the Germans were in town.


There are some other remarkable things they do at this place, but I thought this was a prime example of the dedication it takes to meet the health needs of the people in a remote area such as this.

One more thing

The hospital has a small Guest House which is clean and inexpensive  (600nrs per night) and at 8 PM every evening they serve dinner under a bamboo awning near the detached kitchen. Evening conversation was very pleasant indeed.



About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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