A Fear of Flying

Terrain,  Weather ,Planes or Airports?

Every time there is an air crash in Nepal, a lot of theories, accusations and counter accusations make the rounds in local media .The international media have only one theory-The most dangerous and most challenging airports in the world, and frightening air safety standards.
There were 2 air crashes within 2 days last week in Nepal, and it actually might seem superfluous of me to write about it. I am neither an airline pilot nor an air safety expert-but I have travelled on a lot of planes starting from a   Vintage World War 2 DC 3, the DH Twin Otter, the Pilatus Porter and Cessna within Nepal, and I did feel I was risking my life a few times.
A few of the flights I have been on will always be etched in my memory-and they do not involve the relatively comfortable commercial air travel we undertake now. Apart from travelling in a DC 3 from Bhairahawa to Surkhet (yes, they actually had other airports as hubs in the 70s) all of the other trips within Nepal were made in STOL (Short Take Off and Landing) aircraft, to airstrips and airports that are far more challenging than the standard “world’s most dangerous” tarmacked Lukla  Airstrip, or even Kathmandu’s TIA.

Photograph of  Everest,Lhotse and Amadablam from a Pilatus Porter
Note the open aircraft door. 

In 1975,around the time the Japanese women’s’ Everest expedition was on their final assault of Everest, I was on a single- engined plane flying into lots of clouds en route to Syangboche(3,780m/12,400 ft.), the highest placed airstrip in the world at the time. The pilot was  the legendary Emil Wick, and the passengers were a motley bunch. A Japanese photographer was harnessed to the seat with the aircraft door open!  A world famous geographer  (who would perish in a helicopter crash many years later) was laughing at his wife who had her eyes tightly shut as the little Pilatus aircraft bucked and swooped, and she was holding on tight to me. Being very young, I thought it was a great roller coaster ride, and Emil flew dangerously close to the ‘rocks in the clouds”. A Sherpa, Ang Dorjee, who had never flown before, was alternately laughing and crying. The cargo consisted of a very large number of oxygen cylinders and other mountaineering equipment. It was a thrilling ride at the time, and there was no guarantee whether we would even be able to land .They might have followed flight rules, but all the other rules were being broken. It would save 3-4 days to ferry all the equipment and people from Namche Bazar and Lukla.That same year, Sir Edmund Hillary would lose his wife Louise and daughter in an air crash en route to Phaplu from Kathmandu.

Snowed out in Syangboche Airstrip

The other flight I remember vividly was one from Biratnagar to Tumlingtar to Lamidanda and then on to Kathmandu in a DHC Twin Otter aircraft. Tumlingtar airport lies in the Trans Himalayan Arun River Valley and it was monsoon already. The slush on the dirt runway  made the aircraft swing wildly while taking off .Being older,  I was more afraid than ever, and vowed to walk for  a week instead of flying in STOL aircraft again.
Most of the Airstrips in Nepal are challenging to say the least, carved in mountains and valleys, servicing areas that would takes days and even weeks to travel by road or by foot.  They range in length from 1400 ft in Doti to 2200 ft in Jomsom and altitudes of 1555 in Ramechhap to 12,297ft  in Syangboche. Flights from Pokhara to Jomsom ,which have seen a number of crashes like the one last week, in which 23 passengers and crew perished, take only 20 minutes and save 2-3 days of travel.

Most of the STOL Airfields cannot be classified as such; they should be classified as ALTIPORTS-with a steep gradient runway and only one approach for takeoff and landing. They cannot be classified according to international aviation safety standards.
The aeroplanes involved in the crashes have an excellent safety record outside of Nepal. The sturdy, low maintenance De Havilland Twin Otter DHC 6-400 has had its reputation destroyed in Nepal.Outside of Nepal, it has a reputation of safely landing in spite of engine failure,  is highly maneuverable, and can be flown slowly (150-300 km per hour).Out of the 25 Twin Otters  that were   operated at different times in Nepal,22 have crashed .Most of the crashes read like Jomsom- Lukla- Jomsom, and it is not just pilot error or controlled flight into terrain. It is also the topography and the weather. The 12% incline of the Lukla airport may  be one thing, but overloading,  pilot overconfidence, unpredictable weather and high mountains  are  also definitely factors that contribute to the hazards.

Lukla Airport ,the world's most "dangerous" airport.

A few years ago, It was actually a relief to walk back to Beni en route  to Pokhara when my flight from Jomsom got cancelled because of bad weather. I wouldn’t like to take a chance on a 20- minute flight, which the winds roaring  down and small rocks flying by through the Kali Gandaki River gorge. Even when the weather was clear on both sides, that small 20 minute flight could run into bad weather and poor visibility because of the microclimates existing in such terrain.
There is also a hue and cry over the 2008 decision to allow single engine aircraft to operate in Nepal, after a hiatus of almost 2 decades. The Pilatus Porter aircraft and other similar single engine aircraft like the Cessna were being flown right from the 1960s in Nepal. In western Nepal, it is economical and saves several days of travel along equally hazardous roads. The only consolation would be that if a bus or jeep tumbles down a treacherous road, there might be a few more survivors.
The Civil Aviation Authority  of Nepal -CAAN has a detailed listing of STOL ports, Altiports, grading of airports and stringent requirements for pilots to graduate to difficult airports. I wonder If the rules are being strictly followed, and I am certain that the on -ground equipment , like the rest of the government machinery is sub-par at best.
The argument here should be that instead of banning single engine or twin engine STOL aircraft, or declaring an airport “the most dangerous” or not allowing passengers to fly at all, we should improve instrumental and airport  infrastructure, introduce stringent  visual  flight rules ,regulate payload, and ensure that pilots can identify open fields to land in in case of single engine failure like the one that claimed the lives of the 2 pilots in the  Pacific Aerospace plane flown by Air Kashtamandap.
For now, I’m mulling over which route would  be safer for a  great adventure to the  Everest Base Camp , Rara Lake or  Upper Mustang. Maybe I’ll write a will and fly after the ban has been lifted… Or write a will and drive/walk… Either way, my fear of flying is well founded for now!

The Cost of Cancer in Nepal-Sushil to Sannani

 World Cancer Day 2016  

 “We can, I can”.

The cost of Cancer in Nepal-Sushil to Sannani

Last year ,  in 2015,as cyclists went around Kathmandu with banners  on February 4, I came out of a hospital with a cancer patient, and I could not help but compare the  absolute disparity between Sannani Thapa, an ordinary Nepali, and  Sushil Koirala ,the  Prime Minister of Nepal, who also  had cancer.

As World Cancer Day approaches yet again, I am thinking once again about the huge disparity in costs and treatment facilities available for ordinary cancer patients in Nepal.

Sannani with a new growth of hair

Sushil Koirala,the former
 Prime Minister of Nepal

Former Prime minister and cancer patient Sushil Koirala recently returned from yet another visit to New York, having resigned and spending most of his time outside the country, ostensibly for a “medical checkup”.  Meanwhile, Nepal went through an Annus Horribilis of earthquakes, political uncertainty and an inhuman “unofficial” blockade of all essential goods by India, virtually destroying the economy. There is still a shortage of essential medicines including morphine for terminally ill cancer patients.

Last year, at about the same time as  Sushil Koirala was being treated for  lung cancer, a woman in a village in Sindhupalchowk decided to journey to Kathmandu for a checkup for a lump in her breast that had been present for a few months. Sannani was also diagnosed with cancer, and the doctors suggested Chemotherapy for the first time , followed by radical mastectomy, a complete removal of her breast.

Sannani’s relatives were suddenly overwhelmed by the bewildering battery of medical tests, the costs and the treatments. Sannani had  to leave an old father-in law, a husband, and two small children at home: it was not an extended family any more. They had to think about the costs of travelling, surgery, medicines and whether to start treatment or to just give up and wait for her to succumb to her illness. There were no doctors available, and no nurses in the nearby health post. A man who ran a small pharmacy(‘medical’ the villagers call it)had convinced her the lump was nothing to be concerned about a few months ago. Sannani would travel from her home, a  2 hour bus journey and an hour’s walk to her home in Bhotechaur Village.

 Because Sannani’s sister lived in a doctor’s house,  they were able to avail of the 100,000 rupees (at that time-1,000 US dollars) the government provides to  the financially weak ,as recommended by the  Village development committee. The doctor helped  arranged a meeting with an oncologist and after numerous delays, Chemotherapy was started from July. All the expensive medicines were unavailable, so the grant from the government was of little use. Poor  Sannani came by bus, suffering from severe motion sickness, went hurrying to the doctors, got the chemotherapy, and  left for home the next day. Her father in law looked after the buffalo, the husband tilled the land, and  the 11 year old daughter cooked the food and tended the 4 goats. There was hardly anything to get off the land except green vegetables, the monkeys got to the rest.

By the time the operation was scheduled  in October,the cost of the chemotherapy had reached 300,000 rupees. The best surgery was done in Bhaktapur cancer hospital,so they transferred the government  papers once again and spent 50 thousand rupees . Sannani's relatives were doubtful that she would live and came to visit her; she recovered quickly and left for home a week later. Her hair had started to fall;she used a woolen cap to cover her head. No one in her village had seen a cancer patient undergoing treatment and wondered whether she would ever be cured.

Meanwhile in Kathmandu, in July 2015,the cabinet released  millions of rupees for the  medical treatment of Sushil Koirala (Rs 14.3 million) Rs 12.8 million  for  present Prime Minister KP Sharma Oli ,500,000 for Nepali Congress leader Siddharaj Ojha  and Rs 500, 000  for disgraced   former minister Govinda Raj Joshi .This was all done at a single meeting. We cannot even calculate the total cost of medical expenditure for ailing politicians. Airlifting to other countries, expenditure for routine tests , costs of contingents of attendants and relatives  accompanying virtually useless political leaders are bleeding our country dry.

Sushil Koirala underwent 5 rounds of radiotherapy in eight days in Memorial Sloan Kettering in New York while Sannani  was once more shifted for  radiotherapy from machines dating back to 1991.Frequent breakdowns meant she took 5 months for the radiotherapy to run the full course. Through it all, she has been stoic and pragmatic, and has had to endure the collapse of her house in the April 25 Earthquake, and the landslides that followed 3 months later. I  gave  her 10,000 rupees, clothes and slippers and a place to stay. She refused  an extra tarpaulin for shelter as she did not even have a house after the quake, saying she had  “enough”.She sold her land to pay her debts recently.

Sannani is finally persuaded to give up the cap!

The only difference in Sushil’s and Sannani’s cases has been that of privilege; how is it that in a “democratic” country, an elderly single man and a young woman with small children get such disparate treatment? Why couldn’t Sushil Koirala be treated by Nepali Oncologists in Nepal? Why couldn’t he have used or even ordered a radiotherapy machine for his treatment in Nepal? It would have cost less than all his treatments in New York-and hundreds (no-thousands) would have availed of the new radiotherapy equipment in Nepal. Why is the Government so appallingly shameless, frittering away the nation’s wealth in such an arbitrary manner? Why are there no basic medical facilities and doctors just 76 kms  away from Kathmandu? It takes Sannani 2 days just to get a blood profile.

According to the American Cancer Society , the cost of lung cancer treatment   in the US amounts to about $3000 (three thousand) a day. Compare this to the entire cost of Sannani’s treatment for this year at $4,000( excluding 1,000$from the government). 

There are a handful of radiotherapy units run by the government for the thousands of cancer sufferers in Nepal.The recent  economic blockade led to shortages of every kind of chemotherapy drug,and  morphine for dying cancer patients.

How could our leaders be so shortsighted and selfish? How could they neglect the cancer patients of the whole country? Cancer patients need a lot of care,time ,money and will power. Sannani has decided she can. She can get through this alive. I have decided I can help in any way I know. We can make her story heard.  Cancer patients can,I can,we can all shame the Government for doing so little, and I can question Sushil Koirala, the privileged cancer survivor.