JAPAN OVERSEAS COOPERATION VOLUNTEERS - JOCV

THE HEALTH & EDUCATION MINISTRY, HEALTH DIVISION

YEBILAPTSA REFERRAL HOSPITAL, LAB TECHNICIAN, M. MAEDA

### The impression of my assignment place ###

My duty place was the village almost a deep jungle inside where taken approximate 10~12 hours by vehicle from capital city Thimphu. There was very poor village with two grocery shops, maize, banana, orange and the other some kind of vegetable fields only. There was the city Gelephu, taken by public bus approximate 6 hours from the village. But there was very close to nation border to India. There hidden some of Indian terrorists called ULFA. Sometimes vehicle roads were closed that transferring daily necessities, foods, daily things used to be lacking. Comparing with capital city, here I was located in the southern side of Bhutan. Belonging to semitropical area continuing rainy monsoon season up to October, it used to get a tap water muddy brown color, soil and some insects penetrating. Electricity (power supply) stopped all day, sometimes water supply was also stopped. Vehicle roads used to be closed for land sliding, so then here was finally got the state of the lonely island in the land.

On the rare sunny days, it was getting 40 degree and 80~90 % high barometer. Owing to it, sanitary state easily got worse. Out patients were increasing for typhoid, malaria, the other kinds of parasitic infectious disease, etc. So then, with numbers of pediatric infants, patients used to increase and overflow across this hospital. Bhutanese used to give birth even in around 15 year olds. It is ordinary situation for them to have 5~7 children. Most of them, children and adults, are ordinarily malnutritional physical state with abdomen swollen. General diet here was rice, and some kinds of vegetables. And they could get some of cattle meats from village around occasionally. But it supposed to be very rare. They were estimated to have low protein malnutrition. Neighbor village Tintibi was parted two hours from here. Actually there was a placard of Sabji Bazar, but I have never watched that vegetable market opened. To tell the truth, they relied on daily things from India, through Gelephu only, because here was very narrow place to cultivate. Therefore if vehicle roads were closed by landslide, the folks here were unable to get anything actually for instance even vegetable rice also. Here, comparing with north Bhutan capital city, there were numerous numbers of worms, insects of semi tropical monsoon forest. I was bit by many worms across my body and got rashes all over my back usually. So then sometimes I applied anti histamine ointment and oral internal medicine for a month. Consequently it was recovered. There supposed to be numerous insects around my living environment.

### Regarding local people life ###

Villagers were living in poverty generally. It would be said like homeless people living in railway station in Japan. Because of their bodies smell, it was very stinky like them. I felt most of them could have taken a bath at all for several months. The housing of hospital staffs were called Quarter. Their sizes were ordinary spread out approximately two rooms of 4.5~6 tatami spaces. Another was included dining with toilet and a storeroom. It is like a "tenement house" of ancient Japan. But there was installed no showers and bathrooms. Sometimes I watched the villagers wearing wet damped clothes. Because of that, things could not be dried outside of rooms during monsoon term. There were many numerous kids living in dirtiness, their limbs bitten by flies ticks. So they have many black spots on their limbs.

A certain boy living with the neighbors was crushed half of his face by a bear in jungle. Folks here used to be bit by snakes also. The water resource of tap water was kept on the hilltop of Yebilaptsa village. It stored spring water in the tank. But during monsoon season, it was easy to be intermixed by a heavy rain. Moreover there were many pinholes on water pipes, so tap water was sometimes muddy. Therefore I often experienced muddy water on it. During rain term, because of roadblocks by large scaled landslides of sharp-cut cliff beside road, main vehicle roads were sometimes blocked. Lack of daily goods continued, like potato and garlic only during two months. On the other hands, one month power cut also happened on July 1998. I could be one of very rear J.O.C.V. experienced who original Bhutanese local life. Through such like terrible, horrible, unbelievable, awful, dreadful was life in Yebilaptsa, compared with city side J.O.C.V.

### Regarding to my assignment post ###

I belonged to the Health and Education division. My assignment post, Yebilaptsa Hospital, was one of the most remote regional general Hospitals. It was constructed on a hill inside deep primeval forest, Zhemgang district, in southern Bhutan. They said, approximate a decade ago, it was constructed by Swiss N.G.O as Christianity charity hospital for leprosy mission first. From that time on, international volunteers from Canada, Netherlands, German etc. followed in duty. Consequently, Bhutan government received and administrated it, until now. Many white western volunteers have worked here in the past. But now, there were working with Bhutanese (included Nepalese) only, to continue medical activity here.

### My planned duty content (on my newly appointed term, May 1998) ###

1. Grasping this hospital's responsibility, accountability in the area.

2. Grasping of Lab duty.

3. Grasping of each patient's number of every exam items and his statistics.

4. An approach to Q.C.

5. Epidemic investigation on remote place residents, and an approach to hygiene and health education.

### The activity on my duty and current planning duties. ###

1. My first impression to this Laboratory Room was expressed by only this word "dirty". So I attempted cleaning, sweeping all the rooms. I facilitated to put in order and to keep them clean spontaneously to be recognized for their "cleanness".

2. I guidanced against my C/P to use "Blood collection arm band", to disinfect anything using spirit cotton, and to use an arm rest for collection.

3. I showed how significant it was to keep a chemical reaction time of exams by my performance.

4. By one of activity on ANH, regularly HP staffs (nurses, BHW, etc) going on remote places in jungle. I accompanied them and supported their health administration programs on conception girls and nutrition instruction, etc. I thought there lived numbers of Nepal refugee around here. Sometimes racial discrimination struggles were happening, so they were living bad sanitary state there. I planned to go and research their health matters.

5. Since portable biochemical photometer was introduced in this laboratory, I planned to do Q.C. That purpose required reforming Laboratory Exam registerbook.

### Currently facing subjects & problems on duty. ###

For native folks here, I was the first Japanese. Therefore primary things to do for me, I supposed how to get them to understand me. For that, anyhow, I made effort to do it. But due to very remote place here, it was so hard without any items to introduce from Japan. I struggled by myself.

### Regarding to keeping company with local folks. ###

I supposed the elementary racial characteristics of Bhutanese were similar to Japanese. Due to same kind of mongoloids, having belief deep to Buddhism, diet life with main stream in rice, and farming race nation. Owing to the above mentioned, we could be having something in common with racial characteristics comparing with any other host countries of J.O.C.V. But Bhutanese generally view seemed to be that which urban side was like before the world war II. The regional side and remote area were like 200~300 years ago in Japan. Bhutan was opened itself to the international society around approximate 30 years ago. After that many kinds of foreigners used to visit, so now, here Bhutan was to change from anachronistic feudal society at last. Therefore it seemed to have happened that unbalanced development on the urban side was due to acute modernization.

Regional differences were between urban and remote side, life view and generation consciousness gaps between youth & senior age. I felt Bhutanese acquaintances at Thimphu (capital city) was the folks accustomed to get along with tourist foreigners. Because of most of them were fluent English speakers. It seemed that ostentation culture copies the surface of advanced countries. Nevertheless most of youth were working steady, but I met some young folks like children of wealthy people used to loiter at Discotheque, Night clubs, etc, on the week end. I felt youth generation could be same in any country, but it seemed that murder crimes also happened at there sometimes on quarrels by knives, hand guns, etc. On the other hand, in my place Yebilaptsa, such serious crimes didn't happen. Here was no leisure amusement like at Thimpu, played some kinds of school culture shows only. People used to work on farming labor usually.

Generally said Bhutanese were modest folk and polite at Yebilaptsa. People used to speak in Sharshoka, Kenka, and Nepal usually. They didn't use so much in English as in Thimphu. I sometimes played with children around here in my spare time. Around half of the population here was children. Yebilaptsa residents were divided with two kind races of Mongoloid Bhutanese called Dukpa and dark complexion Nepalese. I felt Nepal language was major as their common tongue. My c/p name was "Tshommo", but she didn't have her family name. Because Bhutan was heavy Buddhism country, the people used to be named by Monks only. So their every names were related to Buddhism. And conception of family system seemed to be nothing because of the folks recognizing this country was one of family, so they have no family name. Regarding to Bhutanese girls, in the event of my going to Thimphu on a duty, when I roamed for window shopping on the street, sometimes young clerk girls called me out from shop inside. Most of Bhutanese were friendly with Japanese. J.O.C.V. was famous anywhere and well known.

### Regarding the professional average of Bhutanese staff ###

I was surprised at how shabby and poor was this laboratory of Yebilaptsa Hospital, when I looked at first. After some days of training in Thimphu HP, when I dispatched here, there were laboratory instruments of centrifuser, microscopes and incubator only, with no other laboratory analyzer instruments. Here was it managed by manual exam means only. Bhutanese laboratory techs were good at blood collection like nurses in Japan. Laboratory techs used to do blood collecting for medical check and blood transfusion. But I felt most of laboratory exam means were like the old-fashioned ways only. And through observing their way of handling things on duty, sometimes I felt anxiety of hygienically, sanitary operation, disinfecting, cleanness of instruments and tools. They used to wipe anything with dirty cloth sometimes. Nevertheless by my male view, my c/p way was looked dirty. In Japan, they say, "J.O.C.V.'s mission is technology transfer". But in front of this was the elemental dirtiness of Bhutan, so we supposed to be helpless. I felt it was impossible to get a person unknown to true cleanness to be hygienic. It was unreasonable, impossible that the HP that used to forgive penetrating of stray dogs, snakes, sheep goats, cattle continued keeping sanitary, I estimated. Anyway I had many questions on the request sheet by Bhutan's authority to JOCV, because my professional skill could be different from Bhutan Government's requisition a little.

Sometimes I watched villagers children run around there with bare foot. They didn't get injured in spite of cutting their foot sole. Maybe they could be having a strong immunity through such a long wild life. It may possibly be they were not to disinfect so much for it. One day, rural mountainside community fellow came here to ask to send an ambulance vehicle. He was from the place without a telephone or wireless talkie. Local folks used to arrive at HP by walking several days through a beast-road only. Sometimes people would die on their way. Most of roads around here were narrow for frequently landslide and rock falling. Besides the surface was uneven and difficult to walk. Supposingly JOCV's cooperation necessity fields in environmental infrastructure. I would estimate the primary thing living here was keeping my own security like not to be bit by poison snakes rather than duty, here at remote places. One day, when I collected a patient's blood in ward, a Bhutanese behind me cried suddenly "Snake!" Looking back over my shoulder, one of brown-colored poisonous snake was moving. There used to be poison snakes coming in spite of HP inside. So then, I could encounter snakes while my walking in grassy path around here. I felt I have to watch out anytime for my security. Regarding to official report, in the event of annexing of photograph, data materials, they were difficult for no photocopier and no photo shop is here.

### General viewing of my duty contents ###

----- Differences from assignment fields research report for JOCV -----

### Regarding to the purpose and the reason of requisition ###

According to facility extension of regional hospital. Since was this increasing of out patients, numbers and kinds of disease were predicted. It was expected improving of laboratory function by proceeding engineering cooperation. It was requested introductions of new introduced analyzer's operation.

### Regarding expected concrete activity contents ###

Due to regional HP character, the person who had general engineering rather than specialist was recommendatory. He was supposed to have some kind of maintenance knowledge, if new instruments were introduced. And it was hoped instructing c/p regarding administrative management of laboratory. I was very anxious first, as the first JOCV here, and did not get much concrete local information before entry Bhutan. I estimated it was so difficult for young Japanese girl to live here at this inferior, poor circumstances rather than on the urban side. There were undergoing construction of eye clinic, medical storage, and guesthouse for OPD-relations. Indian companies continued rushing the work using Bengali labor who managed the construction. Their operations had been done by manual way only, except using very simple tools. It was human wave tactics, not using machine so much. But sometimes their operation way attracted me for their dexterity. Especially the manual operation of flooring was incredible! I heard this eye clinic could be able to operate on eyes also, by the donation without compensation of a charitable German person. (But even at my JOCV term end also, it was not completed.) But I had the question that a very rare oculist of Bhutan available to come this rural place in spite of lack of manpower. On macro sight, there was very bad transporting access to Yebilaptsa from around residential places. I felt however HP was improved, out-patient numbers increasing were supposed to be difficult in the event of rural villager's OPD coming by walking on forest beast paths only for several days.

### Regarding to laboratory exams ###

We currently were carrying out the Labo exam hereunder -

Hemoglobin, ESR (erythrocyte sediment rate), TLC (total loicocyte counting), DLC (differential loicosite counting), Malaria screening, Urine general check, serum test of latex slides agglutination way, TB smear screening, stool check, Widal reaction, pregnancy test, skin scratch for fungus, etc. Initially, we were to introduce digital system portable photometer (BM 5010), but it was actually second-hand thing of Mongal regional HP. The system printer part was broken and could not be repaired. So, it could not be got currently. Nevertheless doctors wish start to practice bio-chemical test using it, besides here was generally out of condition of power transfer. Monsoon term was likely to have long continuous power failure (electricity down). Furthermore even dry term also, was likely to have unstabilised power voltage. I felt it was difficult to use a precise machine at the situation. I supposed it was necessity to improve the basic inflastucture like vehicle roads, electricity system and water supply. Oherwise if laboratory facility only progressed, total circumstances could not work accordantly.

### Regarding current used laboratory instruments ###

I examined Indian made laboratory products catalogue to get them renewed, but Bhutanese superior staff said "We had not better buy Indian products, because of easy to break and available to use only around 3~6 months. Bhutanese generally evaluated against laboratory machine made in Japan or Germany only. But it could be difficult to use Japanese thing here for voltage difference, after maintenance service. So then I was perplexed to do or not to do. I considered my c/p might be unable to carry on with them after me leaving here. She was young, unskillful with analyzers. And besides, she looked like she hated to work here. Finally I considered not to introduce Japanese analyzer machine for JICA's support donation budget.

### Regarding my colleague's technical level ###

Most of laboratory routine work was carried out by manual means. It was like my medical college's practice, so I felt the acknowledges of such like manual ways were advanced by Bhutanese rather than us. But they were generally a little bit rough to carry out anything. I felt their manual ways were random for lack of being careful. So then, if quality control was carried out, the data could be entirely bad. Before JICA's inspector brigadiers came here, they suggested to manage a work shop for inter HP institutes Q.C. But I felt it was a hard issue here. The corresponding way also was not sufficient. Especially this HP had no telephone line. Nowadays I make effort to get former J.O.C.V's laboratory English manual for use on each task of on the job training.

### Regarding my C/P technical level ###

My c/p's profile was studied in RIHS (Royal Institute of Health Science), clinical examination for two years after 8 years educated in school. Her blood collecting skill was incredible like Japanese nurse, and was doing blood transfusion collecting also with a large gage syringe needle like 18~19G. But I doubted that it was one of medical behavior, and should be forbidden to medical technician. On the other hand, the specimen process was likely to be missed. I felt it was not systematic like Thimphu HP. Here was as regional rural hospital, laboratory tech duty was overlapped with doctor and nurse's duty. Concerning laboratory data and register books, currently we were using several kinds of books for each exam item. But that way was felt unreasonable and complicated due to manuscripting. On our Japanese penmanship view, their description looked like "scribbling off'. But I felt it was difficult for them to get their letter to write gently. The laboratory exam methods currently here were most of them entirely old-fashioned, out-of-date already in Japan. So then, anytime I was instructed them by c/p conversely. On the view of technical level, we could not compare with them due to old ways. Anyhow, I facilitated here, to manage cleaning away and putting in order by herself after duty. There was a saying in Japan, regarding laboratory tech, "the person available to wash things perfectly is coming of age". But on that view, she was not complete yet.

### The impediments and counter measures on duty ###

One day, when I checked my c/p's Hb, it was only 7.5 g/dl, chronic malnutritional anemia. At her residence when I introduced her dinner, the ordinary menu was rice, potatoes, something of grass, chili, and dal bean soup. Sometimes there couldn't watch meat entirely for several months at Yebilaptsa. At the circumstances, even me also was likely to be admitted HP. Actually that was a real true developing countries view, by most of the people unknown. Maybe most of urban side of JOCV member couldn't know and recognize this fact, I estimated. There was Tintibi village around here. But there was very hard to go down there for I had no vehicle. I had to walk by my legs only for approximate two hours! Here was a quite short information place for the only one national news paper of Bhutan, KUENSEL. Also it was likely to be delivered 2~3 weeks delayed. So I introduced CSTV (communication-satellite-Television system) buying it at Bangkok on my journey, to get current information. On the view of engineering transfer from Japan, if we worked to help Bhutanese to progress with all our might, however they were not looked to wish getting such high technology. I supposed the person who didn't know what was beautiful could not be recognizing a real beautiful thing, nevertheless if we teach them what was beautiful.

I felt actually, unless their common sense changed, it supposed to be no use for them, like a "high pressure sale of kindness". For instance if one certain old-woman was admitted as serious mulnutritional anemia and was treated, anyhow or somehow. But it may possibly be the patient thought her own disease was cause of "Evil". Inspite of our treatment, she would be dead. Actually it was one of essential issue of medicine. We as J.O.C.V. were likely to meet it in developing countries. So then, sometimes that kind of emotion made me gloomy. It may possibly; no modernization by our technology to Bhutan was better, for instance, like for introducing our Japan made machine, I guessed.

### Regarding J.O.C.V. support expenses and designing ###

Daily necessities supply by road block during monsoon term, long time power failure, no tap water, unsanitary unhygienical water resource, so much kinds of watery infectious diseases, etc. If I thought up the impediments on duty here once, they could be endless. It was significant to study how to adopt it on local people's viewpoint rather than deploring them. I felt there were numerous folks who living on how to feed every day with their family, only rather than Thimphu. Most of residents here was fighting to "hunger" (available to watch many children having malnutritional swollen abdomen, here) I thought it made a wrong guess for Bhutanese to introduce high tech machine, the latest means on duty, what is Q.C. etc. Basically, simply, it couldn't make attract to most of HP staffs on small salary incomes. My own belongings of electric appliance articles also looked like expensive things for them. I felt, the situation of Japanese only one living here remote place, maybe looked for them a big incompatibility. No English talkative locals like a child, staff's wife may feel me as incompatible. Bhutanese couldn't be interested with the other cultures rather than Hindi culture. Before when I showed Japanese films, English programs on CSTV, they were looked not to recognize it actually. So then, I felt sometimes their glances like "Why Japanese want to work so hard?" on my working here steady anytime.

### Regarding my planning and report of J.O.C.V. support budget ###

1. electronic hot bath

There were as laboratory equipment, centrifuser, boiled water maker, microscope (the other 3 broken ones), auto clave, dry-heat sterilizer, incubator, etc. Currently, incubator was unavailable to use properly with a broken thermostat, so then as that dysfunction also, offered a electronic hot bath.

2. microscope

Currently available to use only one within four (made in India). The other ones couldn't be used properly for fungus on optics system, and covered with rust on bearing parts. I heard it was impossible to cure at Bangkok with sending. Due to the thing used currently was made in India not good, I hoped to introduce a thing made in Japan like an OLYMPUS. At last I introduced a hot bath only as new equipment from Japan.

### Regarding necessity of my successors ###

Anytime I could remember impact I watched this Yebilaptsa village first. I wondered completely, entirely, how people could lived the place like inside a jungle! I estimated if young Japanese girl come live here on J.O.C.V., it would be so difficult and hard. In fact, on April 24 1999, this hospital's only one ambulance vehicle conducted big serious traffic accident including a dead driver and one boy seriously head injured, on the uneven road without guard rails. So after HP function was paralyzed, disposal necessity supply was stopped long time. As I used to get on it also sometimes, it made me terrible, horrible, awful, unbelievable, dreadful, etc. I guess around several years in future, telephone line coming, power relay transformer station completing, even HP function also enriching. On the other hand, during a monsoon term, this place did often chang into an isolated inland for inconvenient traffic. Anything got in shortage, any kind of beast appeared. If there was a courage minded person, I wish that he come here to follow it.

### Regarding matters of investigation and consideration ###

I felt some differences in sense of values in the event of working at this YHP, regarding C/P's way of duty, service attitude, value sense to duty. A private company I served in Japan before, usually main purposes to gain profits. At Bhutan, most of people except of farmer used to serve governmental corporation, what are called "civil servants". HP staffs around me were all civil servants for gardener, sweeper, and ward girl, etc. So I felt some of them were working lazy a little. Roaming inside hospital anytime, sitting and chitchat only on spare time not much work hard at all. There were glanced such like staff anytime. The more such like fellow, the more overly to me. So then when I was busy on duty, those fellow made me irritate sometimes.

One day I attempted to instruct how to conduct quality control to my C/P. On the event, applying Salhi method for Hemoglobin, I practiced an experiment of getting her to do it first. After me doing same thing, comparing with both of data. Consequently around 7 data was entirely different from within 10 data. This mean used to be practiced in my medical school in Japan also. So, it was not likely to be used daily routine works, cause of no good quality. In spite of that, I was surprised with so bad quality, anyhow! She was likely to make low degree data, due to difference of regent amount, hurry measuring, shortage of response time. During my local training term at Thimphu HP, I heard some Bhutanese staff say, "She sometimes broke equipment. Her handling way was a little bit rough." Anyway, basically, Bhutanese look like broad minded, lordly or my pace characters. They were likely to miss to do something not to think sufficient, like hasty-tempered. They seemed to be short of a public spirit, a sense of public morality, for instance, like that keeping one own residence clean rather than office, OPD wasn't likely to keep order, etc.

There was a traditional doctor called Drungtso Hmempa compounder, used to cure patients. They were like a Chinese herb doctor, but didn't do medical practice like accupuncture or moxibustion. The anatomical chart of human of their medicine looked like very curious, due to a part of intensity was a sea, blood vessel was river, lungs were filled with rainy thunder clouds, and Bhutanese gods dancing in brain.

There was likely to be found typhoid often and rare raratyphoid. It was water infectious, so then I went observe check a water resource of Yebilaptsa village around 0.5-Km was apart from HP inside mountain. (Despite of Bhutanese used to walk easy, but I was hard to walk on narrow and uneven path.) A water reservoir was covered with a concrete lid. It looked like waterproof anyhow. But during a monsoon term, muddy water was likely to penetrate in, organic, germs were easy to propagate, I felt. Doctor also sometimes complained, invoiced necessities of bleaching powder (chlorine) disinfectant. But even bleaching powder supply also was difficult here. Water infectious disease happened usually.

The HP staff were likely to be absent long term, for personal training ordinary, even DMO (district medical officer; like a super intendance) also was likely to be absent from here for official visit, like not a HP physician, but a politician. During night duty term, sometimes I watched serious OPD, carried on a bamboo ladder in ward. Most of cases, as they were to come after getting worse, the patients were likely to die in ward. Once I watched an infant patient die for meningitis because of its mother's careless neglect. Local folks were supposed to be having lack of medical common sense - it's unbelievable in Japan. One day, I encountered a watery head infant patient in ward. It is due to one sort of blood parasite "Toxioprasma" infection, in corpus callosum, lifting up its scull bone, swollen cerebral. The spinal fluid was stagnant. Such kind of patient was likely to die within several years. On the same day, I encountered, cysts form of dysentery amoebae also from water diarrhea of a patient. This also was one of rare disease in current Japan. They got me study well. And besides, I met children that had swollen testes, due to filarial infection. Most of them live a mountain inside from here walking in 2~3 days. Nevertheless I want to go, inspect there, it was forbidden by our headquarter due to India terrorist existence. We could be watching a primitive life like "stoneage".

On the posting of 1999, new three doctors left for their new posts. Two of them were a couple; they looked like diligent, hard working. So, a major operation room was getting busy due to they started to work hard. It brought with laboratory exams increase also. New gynecologist was wishing biochemical practice by introducing a portable photometer of Mongal HP's second hand. But I estimated it was hard for a frequent power failure during monsoon term, felt it was primary to adjustment infrastructure around here like electricity, water supply rather than HP adjustment. Otherwise laboratory exams that doctors wish to practice couldn't come true. There was a passage on "An Essay on Happiness" by Sir Bartland Russell, Philosophist, described "the more a country developed, the more unfertile, but the more country undeveloped, is the more prolific". Bhutanese were generally reproductive, kind and friendly. First when I came here, I hustled, like I would be able to do anything, but looking back on my living here, I was overwhelmed by "the natural menace" so much only, I could protect myself only. My impression that living time here went by that only, for awful big and deep Bhutanese mountain.

### Concerning how I attained the plan of cooperation in activity ###

First when I came here, I planned and designed my cooperation program as following.

1. Grasping of what sort of duties going on the laboratory.

2. Assessment of exam items

3. Grasping of average order numbers on each items

4. Strict enforcement of cleanings of rooms

5. Instructing of significance in cleanness

6. Applying laboratory manuals by former JOCV on duty

7. Making a systematic procedure of the administrating and ordering of duty daily necessities.

8. Instruction of stored goods administration

9. Instructing of new exam items

10. Being thorough disinfectant

11. Approaching to Q.C

12. Introducing of bio-chemistry practice

13. Putting a personal computer to practical use

14. Rearrangement for register books efficiently

15. Suggestion to administrative management of laboratory

16. Introducing JOCV support budget expenses items

17. Holding of work shop

18. Instructing Japanese language etc

I had continued the things above mentioned. If they were evaluated with real Japanese viewpoint, they could be estimated very few. I made effort on how to sympathize with local folks to make me associate their original life, rather than grappling with duty. So then, it could be evaluated marked 70~80 %, concerning behaved organicaly with Bhutanese stand on their sense of duty value.

### Concerning cooperation behavior result during whole term ###

I recognized significance for me as first JOCV here, to correct a local valuable information as much as possible. Here is a located rural place above all, especially in Bhutan. Here could be watched like this village hidden in a dense gloomy jangle. Trees had grown luxuriously, when we looked down it from on the way to a neighbor village. The villagers said there were a number of beast in jungle like jaguars, leopard, tiger. Really? A Netherlands fellow of SNV also said once, there were Bengal Tigers in Black Mountain north of here. Actually I spent my time for how to live here for safely around a year. It seemed to be only one year for my practical behavior on duty.

Meanwhile I could get improved my conversation skill in English so much. But it has been so hard for me to communicate with folks talkative local language only. So then I guessed Bhutan was wholly like a community with diversity of dialects. A HP staff said, Bhutanese also couldn't recognize here the local Kenka dialect properly sometimes. At the circumstances, I abandoned to get local dialect and devoted myself to laboratory duty only.

Due to heavy rains in monsoon term, road blocks for land slide, there was no opportunity to visit the other domestic places. Also regarding terrorist problem, or hardship on getting road permissions, I used to work on YHP only, through whole my term, shut up in Yebilaptsa. But I had belief in could communicate the folks here instead, on the contrary rather than urban side JOCV member. It was my respective rare experience to get my whole body and soul soaked in their local life, and not to have anything to do with any other Japanese for two years. My impression to the generally way of how Bhutanese to work was unskillful if it was said in a term. But on the other hand, due to no auto-analyzer here, as every exam were managed by manual means only that courteousness was very important for how to keep precise, accurate data. So I instructed, noticed persistent to operate politely on procedure. But in spite of that not much improved on them. If the programmed photometer introduced here, I could teach my C/P a conception of Q.C and on the job training.

### Concerning requestions to my successor ###

Bhutanese around me generally said a foreigner could be hard to live here for a certain term, nevertheless even locals was likely to feel hard to live. So I actually got a sort of confidence for living two years at such like place for only one Japanese. If there was a person who had courage, love for humanity, and highly motivated mind, I wish he were arriving here. Moreover it was recommendatory for the candidate to study one kind of local language in Bhutan before hand. Now JOCV Bhutan candidates could be study English main, but it was not useful much (because of local language skill of Japanese would help him on daily life at assignment place). To tell the truth, on account of only one JOCV in this place, it would be more important rather than duty. I wish, Bhutanese local tongue instructor go, teach it on Japan. For the other hand JOCV, there could be remaining work fields for oriental herbal practitioner, electronic technician, schoolteacher, etc.

### Concerning cooperation outlook and prospect in future ###

Bhutan is the country starting modernization around 30 years ago. When I first visited for official salutation to each government office, an executive officer said, "Bhutan is approaching to disperse regions each of developing program, but it is so hard to proceed developing, due to regional land was like a point between mountains as for Himalayan country Bhutan." Moreover we couldn't do large scaled development to aim environment conservation type development accompanied with UN. So then rural districts were not likely to change. On the JOCV tour, a year ago, I watched numbers of not working, broken, and so expensive analyzer equipments from Japan government aide at medical university institute in Nepal. Nevertheless they were donated anything from Japan, but couldn't fix maintenance the machines due to no engineering skill. To avoid the same mistake in Bhutan, we had better grasp what is a significant thing in our cooperation activity at assignment places, as soon as possible.

I felt it was important that we should not only have technical engineering cooperation, but mind cooperation also. Mix with the local folks as much as possible, not to expend much, to think out by oneself. There was the matter that I took care overnight serious patients on the account of HP staff traffic accident. At the HP filled dire confusions, for most of victims were staff family, I behaved cool, but not to forget tears with sorrow for them. It seemed that such like thing was a real taste of JOCV. To exert myself for the other ------- What a comfortable thing it is! It was one of impression in JOCV activity. I believe there was a certain satisfaction in my soul made for relationships with Bhutanese locals. It supposed to be suggesting a new good motivation for the rest of my life after my repatriation.

Note: This report was edited for easier reading. The original report is found here.