In April 2003, MSF initiated a second program, in Nepal's Jumla district, to address psycho-social health and basic health care needs for the 100,000 people living in the northwestern district, where health care is of poor quality and often unaffordable. Many people in the region were traumatized in November 2002 by the battle in Jumla town, when 10,000 Maoist rebels attacked the city and killed approximately 400 people.

Nestled in the valley at the foot of the Nepalese mountains, the Rukum Hospital was in great need of major logistical and medical support. Kathryn Roberts, a young paediatrician, spoke to us about the time she spent in a project on top of the world.

"It was my first mission with MSF," smiles Dr. Roberts, a young doctor who spent five months at the Rukum Hospital in Rukum, Nepal. In the western part of the country, in a region between the government zone and the mountains controlled by the Maoist guerrillas, the Rukum district is home to approximately 200,000 people.

"It's a rural region dotted with highly isolated villages. Often patients must walk for two days to get to a hospital."

Another particularity: at the foot of the Himalayas the diseases are not the same as in the tropical regions.

"We're lucky; we're too high up for the mosquitoes so there is no malaria. However, we had to treat many cases of pneumonia in children."

Ambulances on the backs of men

In this very steep landscape, falls are common. A young boy was brought to the hospital after falling from a tree, and then onto rocks - a total fall of eight metres. Transported on the back of a man in a large basket, the child had lost a lot of blood by the time he reached the hospital.

"He had completely broken his nose and had a hole in his palate. He had to be stabilized before we could rush him to a modern hospital in Kathmandu, the capital," Dr. Roberts recounts.

A few weeks later, the child returned, fully healed.

"I saw his mother, his three little sisters and him, in their best clothes, really happy, really appreciative. I believe that this will be one of my fondest memories," said Dr. Roberts.

No glass panes at 1,800 metres

"Along with medical activities, logistics helped us completely renovate the hospital, which first needed a thorough cleaning. Broken equipment, obsolete surgical equipment were piled up in many rooms. We had to get rid of all that," Dr. Roberts explained.

Her team went ahead with more daunting work.

"We had to put glass in the windows," she continued. "Until our arrival, there were only wooden shutters. Can you imagine winter at 1,800 metres? You had the choice of either freezing or staying in the dark. When you're sick, neither of these solutions are really acceptable."

Other, more costly work carried out was restoration of the pharmacy to its original condition as well as the X-ray machine. Then the cleaning teams had to be trained to respect basic hygiene rules needed in the hospital.

During her five months in the field, Dr. Roberts saw many changes including political ones.

"I arrived on January 30, 2003, the day the cease-fire was signed between the Nepalese government and Maoist rebels. The military situation remained calm until I left at the end of June, when new tensions arose."

With the renewed political problems, MSF decided to wait a little longer before determining which dispensaries, in the mountains around Rukum, needed the most medical and logistical help. That is the next objective of the MSF team in Nepal despite the growing tensions between the government and the rebels.

As for Dr. Roberts, she is now hard at work in Sierra Leone.