In April 2012 I visited Namche Bazaar several times while trekking in the region.  During these visits both of our porters utilized the Namche Dental Clinic.  I met the dentist at our hotel and decided to see what kind of clinic she could be operating in a remote area like this at an elevation over 11,000 feet.  While I was visiting the clinic, a woman in her late 40's or early 50's came in with two abscessed teeth.   Watching Nawang work on this woman was amazing.  It was probably the woman's first visit to a dentist in her life.  Yet, after about 15 minutes, the lady left (minus the two teeth) but trying to smile.

This clinic is the only dental clinic in the Sagramatha National Park / Khumbu Valley / Mt. Everest region.  This is an area in excess of 1150 square kilometers.   Not only are there over 130,000 residents in the Khumbu Valley is visited by more than 35,000 visitors annually, and the number of visitors is growing significantly each year.  All these people are currently serviced by only one dentist, Nawang at the Namche Dental Clinic.   It is not unusual for patients to walk 4-5 days to reach this clinic for dental work. 

The American Himalayan Foundation has done a great job in supporting this clinic and keeping it operating for over 20 years, but it is time for a complete replacement of equipment to bring it up to modern standards.

 

HISTORY OF THE CLINIC

Dr. Brian Hollander's first excursion to Nepal took a fateful turn when he was hanging out in a Peace Corps office in Katmandu, Nepal's capital. A volunteer showed up in need of a root canal. Usually, at that time, westerners in Nepal would fly to Bangkok, Thailand, for serious dental work. But Dr. Hollander, a dentist schooled in Oregon, said there was no need for that. He'd take care of it.

U.S. diplomats stationed in Katmandu saw a good thing in Dr. Hollander. They set up a dental clinic near the embassy and installed him as its sole practitioner.  He stayed for 10 years, filling and crowning the teeth of foreign service workers and other non-natives living in Katmandu. There, he also met his wife, Judy, a former volunteer in a Cambodian refugee camp.

One day in 1981, a Sherpa woman and her little boy from a village high in the Himalayas showed up with two mouthfuls of cavities. "The boy was 7. He had numerous decayed teeth. His mother had seven decayed teeth. Hollander knew more than a little about oral hygiene in poor countries, having worked once for a volunteer program called Dental Health International in Cameroon, West Africa. So he and a friend traveled to the boy's village, Namche Bazaar, and surveyed the oral health of the local children. They visited two schools, shone flashlights in the youngsters mouths and just looked around. "You could just see holes," he said. In one school, 76 percent of the youngsters had cavities. In another, 56 percent did.  The reason was clear: Candy from the West.

Dr Hollander found that Sherpa children on the Everest trail had four times the degree of dental decay than children off the trekking trail. The Sherpa men had gotten into the business of hauling provisions on their backs and by yak. The Sherpa women set up and operated guest houses where the travelers could sleep.  They also stocked stores that catered to the Western appetites and the sweet tooth’s of trekkers weary of bland trail cuisine.  These trekkers couldn't resist the smiles of the Nepalese children and many cavy them sweet snacks which they could not afford to buy. The results were mouthfuls of cavities.

Dr. Hollander’s dream of a modern dental clinic in Namche Bazaar became a practical possibility when the town received electricity from the hydro plant at Thamo.  A location was found and a building was constructed for the clinic.   The building was paid for by the Everest Marathon Fund and the American Himalayan Foundation, Brian installed modern equipment (most donated by a Rotary Club from Oregon). and the clinic opened in February 1991.

 

The growth in tourism that followed the first ascent of Mount Everest in 1953 spawned an economic boom in that village of 1,000 people, the last outpost along the trekking route to great peak.  In the last 59 years the permanent population of Namche has almost doubled.  New construction is now almost constant in the summer months.  Every year there are more bakeries and stores selling sweets.

This year over 35,000 trekkers will pass through Namche and the numbers are increasing significantly each year. Most trekkers spend at least 2 nights in Namche on their way up the mountains and one more night here on their way back down.  The town is now not only filled with lodges & guest houses, but it has numerous independent restaurants, bakeries, groceries and even pubs.

      

To address the problem of preventing dental decay and gum disease, Brian initiated a school dental health program in 7 Khumbu schools in May 1994 and this is now operating in 11 schools. The program involved the supervision by teachers of daily oral hygiene procedures, the administration of fluoride to combat decay and coating secondary molars with sealant. There has been a significant reduction in dental decay. Until 1998 this school program, which cost $2,200 per year, was financed by the Everest Marathon Fund.  Sadly, this outreach program is only still effective in the schools in Namche.  With only one dentist, there is no time for anyone to travel to other schools in the region and make sure the children are being properly trained.

According to the Everest Marathon Website page on the dental clinic, "the number of patients is gradually increasing but the clinic is far from being financially self-sufficient. The American Himalayan Foundation pays salaries but money is required for building repairs, new and replacement equipment, expendable dental supplies and travel expenses to other villages and Kathmandu."

Since autumn 1998 the Everest Marathon Fund has paid for several building improvements. The treatment rooms have been moved upstairs where a huge skylight and secondary windows have greatly improved the heat and light. An electric geyser was installed to provide hot water, solar panels for room heating and a water distiller. The building also required a new roof and compound walls. To attract more donors and patients, Nawang produced a small leaflet in English and Nepali.

In 1999 a second dentist started training to work in the Namche Dental Clinic.  He attended a dental school in Fiji for 3 years.  He then worked for more than 2 years as an unpaid internee at the National Dental Hospital in Kathmandu before his qualification was approved by the Nepal Medical Council in November 2005. The Everest Marathon Fund paid for his tuition, traveling costs and living expenses, and his salary when he finally returned to the Namche Dental Clinic. Unfortunately, after a short stint in Namche, he moved on leaving the clinic again with only one dentist.  Now that training facilities are available in Kathmandu, there has been talk of training another dental therapist.

The clinic provides rudimentary dental care for the local population and attempts to care for the surprisingly many serious dental problems for western visitors/climbers and trekkers. The Canadian Dental Auxiliary training designed of aiding the remote Inupiat and Inuit tribes has been adapted to provide dental health education, simple fillings, extractions and single rooted root canal therapy.

Small x rays can be taken, ultrasonic dental cleaning carried out and there are blue light cure fillings and adhesives used.

The center closes through much of the winter as the water supply freezes. Its very cold at 12,000 in the Himalayas in winter, and travel form the surrounding villages is at times very difficult.  This is an extreme and remote location in which to provide a dental service. Standards of care, materials and their use, cross infection control is maintained within sight of adequate western standards - to the great credit of those who work here.

The clinic was set up with ADEC units that are robust and largely mechanical without microchips, solid state circuitry and solenoids. Almost all maintenance could be done locally with rudimentary technical knowledge.  But, this equipment has been there since Brian established the clinic.  Time and thousands of patients have taken their toll and now the clinic desperately needs upgraded.  In my opinion it is time to outfit the clinic with modern equipment like digital x-ray technology.  Any equipment needing servicing can now be sent out to Kathmandu by helicopters which service Namche Bazaar daily during the trekking seasons.

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Here is a nice blog on the Namche clinic by David Geddes. Some pictures at the end of the massive cavity problems that Nawang sees on a routine basic.  BLOG LINK

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NOTE: A new Swiss supported dental clinic is coming to Lukla, but with a dentist in training now, it will be 3-5 years before this clinic is fully operational and capable of picking up some of the workload.

 

NAWANG DOKA SHERPA

Nawang Dhoka, a Sherpani from Namche.  Her father, PK, was a famous Sherpa porter and her mother established one of the first guest houses in Namche Bazaar, the Khumbu Lodge.  The Khumbu Lodge is still one of the most popular accommodations in Namche and it is still run by Nawang's family including her mother.   Nawang was trained as a dental therapist in Saskatchewan, Canada.  She graduated in June 1991.   She has been at the clinic since it’s inception.  She is married with two children.

NAMCHE BAZAR INFORMATION

Namche Bazaar is located at 3440 m and is the main gateway to Mount Everest Base Camp. It is the administrative centre for the Khumbu region and has a police check post, the headquarters for Sagarmatha National Park.

It is the location of the world's highest dental clinic and also the weekly Saturday Market.  Namche Bazaar also has most facilities of a major city such as post office, a medical center, cyber cafés, visitor information center, pool houses, bars, grocery shops, bakeries and many souvenir shops.  There is also a Sherpa museum established by a local entrepreneur.

Historically, Sherpas were herders and traders. Namche Bazaar was the staging point for trading over the Nangpa La into Tibet with loads of manufacture goods from India. Trekkers are advised to spend at least one day acclimatizing before proceeding to higher destinations.

 

WHERE TO STAY IF YOU ARE VISITING NAMCHE

  

Khumbu Lodge: For me, the obvious choice is the KHUMBU LODGE. This was good enough for President & Mrs. Jimmy Carter and numerous other famous visitors to Namche Bazaar.  Additionally, it is the lodge and restaurant operated by Nawang Doka Sherpa’s family.  You can find Nawang supervising the kitchen/restaurant daily from 6:30 am until late at night daily (except for the hours she is up the hill working at the dental clinic).

Khumbu Lodge, the oldest family run hotel that is situated in the heart of Namche Bazar, the hub of Khumbu region. Ever since it was established in 1975, it has become quite synonymous with the trekkers and climbers and has been successful in setting a superior standard of hospitality service in Namche under one roof.

Recently Khumbu Lodge extended its new wing with additional 20 rooms with attached bathroom on top of 26 private rooms.  Room prices range from Rs 200 (about $2.50) for a room with a community toilet on the same floor to $25 for a room with an attached bathroom.

Khumbu Lodge has its own history and reputation from its past successful years that can be seen on the corridor of lodge hanging on the walls. Because of its friendly service and history for serving more than 3 decade, this lodge is very popular for free independent travelers (FIT).

 

 

Khumbu Region

The Himalayan Kingdom of Nepal is famous because Solu Khumbu region is the land of spectacular mountains that holds the world’s ten highest peaks including Mt. Everest the world’s highest peak (8848m.), "SAGARMATHA” in Nepali-“Higher than the sky” and “CHHOMOLUNGMA” in Sherpa “Mother Goddess of the Earth”. Solu Khumbu is justifiable famous, not only for its proximity to the world’s highest mountain but also for sweeping glaciers, magnificent mountains, forests, animals, birds, monasteries and is the home of the world famous Sherpa people. Khumbu region lies inside Sagarmatha National Park and Buffer zone that is rich flora and faunas but the existence of the Yeti remains a mystery.

Khumbu region inside Sagarmatha National Park is famous for trekking and mountaineering since the first attempt of Mt. Everest in 1953 by Sherpa Tenzing Norgay and Sir Edmund Hillary and is equally important for trekking that combines the classic close up views of Everest, dazzling Gokyo lakes and stunning high Himalayan Panorama and to observe the natural and cultural heritage of the Sherpa land.

 

Sagarmatha National Park

Sagarmatha National Park (1,148 sq. km), established in 1976, is located in the Khumbu region for the protection of its unique natural landscape containing the world's highest mountain of Sagarmatha (Mt. Everest) at 8,850m. above sea level. It encompasses major Himalayan ecosystem and shares boundary with Makalu-Barun National Park in the east, and Qomolungma Nature Preserve of Tibet Autonomous Region towards north.

Most of the Park is steep and rugged, the terrain broken by deep gorges and glacial valleys, but in its major valleys, there are some relatively flat areas, which are used for growing crop and grazing by the Sherpa community. These village area are officially excluded from the Park and do not come under its authority.

UNESCO declared this National Park a World Heritage Natural Site in 1979 in recognition of the significance, of the World's highest mountain, its sub alpine types of flora and fauna, together with the unique cultural heritage of the Sherpa people who are the local residents.

 

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  • TRANSPORTATION: There is no vehicular transportation in Namche.  Everyone must walk.  For those that cannot walk it is possible to hire a pony.  These are small compared to USA horses, but they are very sure footed on the loose rocks.  Very few ponies will come equipped with a western style saddle.  In some areas it is possible to ride a yak.

    

  • GETTING THERE/GETTING SUPPLIES THERE:

·         VIA LUKLA:  Regular flights from Kathmandu to Lukla take about 30-45 minutes. From Lukla it takes roughly two days to arrive at Namche The first day walk from Lukla to either Phakding or Monjo is roughly a three hour strenuous hike. The second day walk from Phakding to Namche is a bit more strenuous and it takes about five hours.  All foreign nationals must stop at the Sagarmatha National Park entrance just past Monjo and get a Trekkers’ Information Management System (TIMS) Registration Card and pay a small fee.

o   HELICOPTER:  Chartered helicopter takes about an hour from Kathmandu direct to Namche.  The helipad used is on the opposite side of Namche from the dental clinic.  Visitors arriving by helicopter to visit the clinic should be prepared for a 30+ minute walk.  Due to the thin air at this elevation, the climb from the village to the clinic might make this walk considerably longer.

 

 

o   STOL AIRFIELD:  The Short Take Off & Landing (STOL) airfield is located about 300 meters elevation above downtown Namche.  It is an uncontrolled airfield that is serviced by charter STOL aircraft and helicopters.  Airfield is reported to be only 1330' x 98', but as an airfield specialist it looked longer than that to me. (more photos available on request).  It is a 1+ hour strenuous walk from Namche proper.  The walk from the airfield to Namche is all downhill and takes only 20-40 minutes depending on your walking speed.  The hill is steep, so a walking stick (or two) would be recommended for those not used to trekking in the mountains.

  

 

  • ELECTRICITY:   The electricity supply is surprisingly reliable for the area, yet brownouts are not a rare occurrence.  A generator would be desired, but not as essential as other equipment as a new power project sponsored by India should bring more reliable power in the next 2-3 years.

 

WHAT IS NEEDED

  • MODERN EQUIPMENT:  I have no background in dentistry, but even my unskilled background could tell that this clinic is using equipment that was obsolete 20 years ago.  XXXXX who is more qualified several years ago said: “The equipment in the clinic has been there since Brian established the clinic, time and thousands of patients have taken their toll and now the clinic desperately needs upgraded.”

  • SECOND DENTIST: Currently Dr. Nawang Doka Sherpa works at the clinic six days a week.  The clinic is closed on Saturday’s which is the traditional day off in Nepal (similar to a Sunday in the USA).  Since this is the only dental clinic in the Khumba region it isn’t unusual for an individual to walk 4-5 days to seek dental treatment.  Should she become sick, have a family emergency, or Lord forbid, desire to take a trip to Kathmandu, patients would have to wait for her return.
  • PERSON AND FUNDS TO SUPERVISE/ADMINISTER OUTREACH:  To address the problem of preventing dental decay and gum disease, Brian initiated a school dental health program in 7 Khumbu schools in May 1994 and eventually expanded this to 11 schools. The program involves the supervision by teachers of daily oral hygiene procedures, the administration of fluoride to combat decay and coating secondary molars with sealant. There was a significant reduction in dental decay. Until 1998 this school program, which cost $2,200 per year, was financed by the Everest Marathon Fund.

Due to the lack of a second dentist, no one is available to travel to schools outside of Namche without closing the clinic.  Therefore, this outreach program is only being conducted in the Namche school.  And even in Namche the clinic should have annual supplies of tooth brushes and fluoride.

  • FUNDING FOR SALARY INCREASE FOR CURRENT STAFF:     Nawang Doka Sherpa had been the primary doctor at this clinic since it’s inception in 1991.  Her assistant, earns less than 1/6th of the salary required to send one of his seven children to school each year.  Both are probably overdue for a cost of living increase.
  • CONTINUATION TRAINING:  Some funds should be set aside for annual continuation training for Nawang during the winter months when she is often in Kathmandu.
  • TRAINING ON ANY NEW EQUIPMENT: Some training will be required on operating and repairing any new equipment sent to Namche.  If similar equipment is available in Kathmandu, she could be trained there or an individual from Kathmandu could travel to Namche.  If equipment isn't available elsewhere in Nepal, video files or a trainer will need to be sent to Namche.
  • Expendables:  Right now it appears that the clinic has sufficient stocks of expendables. I was unable to determine if this comes from patient fees or donations from the American Himalaya Foundation and The Everest marathon.
  • generator:  This would be at the bottom of my list, but still desirable to prevent stopping in the middle of a procedure.  This did happen to my porter during extraction of a wisdom tooth. They had to stop half way through the extraction and finish when the electricity returned.
  • posters in nepalese:  For a small fee 100-200 posters could be printed in Nepalese to be put in the cities in the Khumbu valley letting everyone know where they can go to see a dentist.  Although most people were aware of the dentist clinic, I did talk to people in Namche and on the trail that were not aware there was a dentist in Namche.

WHAT CAN YOU DO?

  1. Do not take candy or buy sweets for the kids in the mountains - give them childrens toothbrushes and toothpaste.
  2. If you are going through Namche, takes some packs of childrens toothbrushes and toothpaste and drop them at the Dental Clinic or with Nawang at the Khumbu Lodge.
  3.  If you can assist in funding any of these items for the Namche Clinic, or if you know anyone that might donate usable dental equipment, contact jcc@theville.com.   I will arrange shipping for any donated items.