Nepal: Katmandu

It took us 31 hours of non-stop travel to get here – but it was worth it.

We came to meet our partners who are doing extraordinary work saving children suffering with club foot and burns. It was one of the most inspiring trips I’ve ever taken.

The view from the plane was breathtaking – as is the poverty. About 30 million people live in Nepal on an average income-per-capita of less than $2 a day. That’s average — our patients live on much less. Nepal is one of the world’s poorest countries. The first day we saw slums as bad as anything I’ve ever seen in Haiti, Calcutta or Somalia.

Row after row of shacks surrounded by dirt, dust and rubble. Half-naked children wandering around. Wild dogs roving. A polluted, clogged river. Smoke rising from smoldering heaps of trash. The stench was overwhelming. And so many flies you had to keep your mouth shut when you walked.

We watched a garbage truck back up onto the riverbank in the slum. The driver got out and sat on the roof and watched. Within minutes, dozens of peasants swarmed the truck.

Armed with shovels and poles with giant hooks, they frantically stabbed, shoveled, sifted and searched the garbage, looking for food, clothing, empty plastic bottles, anything of value.

In this photo, the woman in the pink skirt was at least 80 years old. It was a horrific scene to witness – and it happens every day.

The first club foot clinic we visited was inspiring. Our partners are doing innovative and amazing work helping children no one else will help. Club foot is a major medical problem in Nepal and throughout the developing world – more than 3 million children are waiting to be helped. The only good thing about club foot is that it has a miracle cure.

For decades club foot has been treated through surgery that is painful, expensive and not always effective.

The young girl we met on the right, underwent surgery on her left leg. Note the contraption with pins through her leg and foot with screws that twist and tighten. This will eventually straighten her foot but it’s a long and painful process and years from now, this foot may regress.

Today, instead of surgery, there is a miracle cure for club foot that uses a series of casts on the legs that straighten feet just as braces straighten crooked teeth.

It usually takes just a few weeks to straighten the feet, and then the child wears leg braces for a few years to keep the feet straight.

The success rate of casting is 92+% with a lot less pain, expense and suffering than surgery. This miracle cure costs just $250 and it can save a child from a lifetime of pain and suffering.

We’re working with club foot partners around the world to help them increase the number of children they help and to improve the quality of care.

Our visits to the burn wards were very different than the club foot clinics. While club foot can be solved fairly easily and cheaply, most burns cannot. With burns, the suffering never seems to end.

For children, burns can mean a lifetime of suffering. Some of the teenagers we met had been 10 years earlier and still needed additional surgery. Some had been burned days before and their suffering was just beginning. A few had burns that were so severe, they may not be alive by the time you read this.

We went from bed to bed, listening to their stories. One of the saddest was of this little 5 year old girl below. 3 years ago her mom left her home alone. In developing countries children are often left alone at home because both parents have to work. Inside most homes is an open fire used for cooking, heating and lighting. These fires cause millions of burns.

This poor girl crawled right into the fire, face first. After the accident, her mom ran away. Her dad works in Saudi Arabia as a day laborer. (In Nepal, unemployent is 50%.) The woman in the photo, her grandmother, now cares for her. Our partners provide free ongoing surgery for this girl. She and her grandmother barely have enough money for food. They built eyelids for her so she can close her eyes when she sleeps and to save her from going blind. They provided skin grafts and restored functionality to her hands and fingers. They’re doing everything they can to prepare her to survive in a country where burn victims are treated as social outcasts.

We quickly learned there are a million ways to get burned in a developing country.

Scalding is very common, when a child tips over a pot of boiling water or milk. One little boy found a container he thought was filled with water and tossed it in his friends face – it was acid. The boy below was flying a kite.When he tried to free it from electrical wires he was electrocuted. His right hand was amputated. They said this happens all the time.

We met a boy who had an epileptic seizure and fell into a fire. And many more kids who had fallen into open fires.

The adult stories were just as heart wrenching. We met women whose husbands had thrown acid on them. Men who had been electrocuted while trying to get electricity for their homes. Women who tried to kill themselves through “self-immolation” with kerosene. Women that suffered from gas explosions when there was a gas leak in their homes.

Please know I am only showing you only the least upsetting photos. Most are just so heinous, I will never show them to anyone.

Amidst all of this tragedy and suffering, we met surgeons and nurses who are unbelievably heroic and committed. At most hospitals, burns are at the bottom of the ladder. Burn patients are allotted little O.R. time, little attention and resources.

Even their own families and friends desert them.

One surgeon told us how his staff contributed their own money to a pool to pay for dressings for a poor child whose family had abandoned her. (In Nepal, surgeons make $300 a month, nurses make $25.)

You could hear the frustration in the voices of the surgeons who try to save these burn victims every day. They explained that many patients die not because of their burns – but because of their poverty.

They can’t afford the dressings, the medicine or the treatment they need. One surgeon told us about a little girl whose dad made $200 a year and his daughter needed $2,000 worth of treatment.

“She will die,” the surgeon said shaking his head, “ Because the family is poor.” He shrugged looking down, “There is not much we can do.”

But there is a LOT we can do. Burns may be a bigger problem than TB, malaria and AIDS…but we can make a difference. Coming home, I had a 13-hour flight to think about this problem and what we learned.

Club foot and burns are huge problems. The clinics we visited were packed. All the doctors told us how much they need and appreciate our support. Both problems have been ignored by the global health community. Today, there’s not a single other major club foot or burn charity in the U.S..

And though the cure for club foot costs $250 and reconstructive surgery for burns costs $500, poor children in these countries can’t afford them and they will never be helped.

Unless we help them.

I must admit, the sheer size of these problems is daunting. 3 million children have club foot. 15 million children have burns. That’s a lot of surgeries. But we’ve been here before.

In 1999, when we started Smile Train, no one knew or cared about clefts either. We started out with just 2,000 surgeries our first year. Then we worked hard to raise awareness, raise money and scaled up surgeries to 120,000 a year.

20 years and 1,500,000 surgeries later, Smile Train has eradicated the suffering of children born with clefts in 90% of the developing world.

We can do the same for club foot. We can do the same for burns.

Of the 2,000 photos I took, this is my favorite. All over Katmandu, there were giant bamboo swings set up for Dashain, Nepal’s biggest festival. It celebrates the triumph of good over evil.