During our fieldwork in Zhemgang I was struck by how children live in remote areas, and I now better understand why many families of children with disabilities move to Thimphu for their care. I want to share the story of two siblings, a 17-year-old sister and 13-year-old brother with cerebral palsy, who attend school in a tiny village an hour from Panbang. Since their home is even more remote with no school, the parents built a temporary hut near the village so the children could study until they enter boarding school next March.
Both siblings have CP and struggle to stand and walk because of muscle weakness and poor coordination, and the hut’s uneven entrance makes falls frequent. I assessed their environment and saw that neither wheelchairs nor walkers with wheels could work on the rough paths and thresholds.

After a while of examining and discussions they suddenly mentioned that the girl has axilla crutches for outside and that with those she falls much less often. But they didn’t think of mentioning it earlier when I asked how she moves around inside and outside. In the end we decided that for outside those crutches are the best option with what is applicable and what is available. But for inside the house we gave her and her brother a walker. Which they could try out. Both of them could walk well with it, but found it very strange as they aren’t used to it and therefore were a bit sceptical. 
For the boy we will also get crutches in his size so that he won’t fall so often and be at risk of a severe injury. The boy didn’t think it is necessary to get an assistive device for him. He want’s to do it by himself. But he doesn’t see the risk of what happens if he falls once and injures himself seriously. With time he will also get used to using the crutches and see their benefits. 

The audiologist also noticed that their hearing decreased drastically because of a genetic reason but no one has really noticed because they adapted so well. Therefore the audiologist equipped them with hearing aids. 
I marvelled at how well those two children just adapted to their situation even though they never had therapy or any professionals to show them what to do. They fight through their challenges with their family and also have a lot of support from their peers. The teacher told us that their friends always come very early to help the two siblings get to school. These children just adapt and make the best out of the situation with the resources they have and they all truly have a fighters spirit!

Last week the program manager plus an audiologist from Thimphu hospital and me started a week long trip to do field work in one of the most remote districts in Bhutan, in Zhemgang. From Thimphu it took us about 8 hours by car just to get there - even though the actual distance on the road is just a bit over 250 kilometers!

We went to Zhemgang to finish a program which had started in 2022, visiting remote places and assess the children with disabilities and figure out what assistive devices could really help them. Most of them have no access to therapies of any kind and no assistive devices to help get through their daily life. Children with CP often just lie on their back the whole day as the parents have no knowledge of what would be important for them and have no means to get assistive devices. 

The places we went to in the district were even more remote and often we had to drive over an hour just to reach the next small village. As soon as you leave the main road there are only gravel paths. Therefore it took us 2 hours to cover 42 km to get to one village where we stayed for two nights. The first places we stayed at had a similar climate like Thimphu, but as soon as you went a bit higher up it got colder especially in the mornings and evenings. But for the second part we were just a bit more in the south and at a lower altitude so the climate immediately got more tropical. ​
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I loved the beautiful and wild nature and couldn't get enough of watching it slowly passing by in the car. The forests we passed were in most parts still untouched. Once we even saw some golden langurs. This is a rare opportunity as they are very endangered and very shy creatures.

Now I understand why so many parents come to Thimphu for therapy of their children even though they had to leave their families and familiar surroundings behind:  it's the only chance for their children to reach more of their potential.  In the next blogs I will tell you more about my experiences during the field work and about the situation of the children with disabilities there. 

I am very fortunate that my colleagues from Switzerland, from the Vivendra Foundation, have agreed to advise me whenever I have specific questions. This is a great opportunity for me, as it allows me to benefit from their expertise and brainstorm ideas together. It is especially helpful that I can also consult occupational therapists and speech therapists.
During a home visit, the family of one child asked me what they could do because the child often chokes while eating. Swallowing is difficult for the child due to CP (cerebral palsy). I had to tell the family that I unfortunately do not have expertise in this area, but I offered to consult a speech therapist I know in Switzerland, who has extensive experience with such cases. The family agreed, so during one of the visits I took several videos and photos while they were feeding him rice. I then shared these with the speech therapist, who will now analyze the situation. Hopefully, we can arrange a video call next week so she can give me some advice to pass on to the family.
I am very much looking forward to learning new things that can be helpful for the families.

I have spent the past few days in the Nepali capital Kathmandu, planning a visit to a centre for children with disabilities to share experiences and see how they do it. The centre is known for integrating physiotherapy into its work — something worth exploring and learning from. Yet when political unrest swept through Nepal this week, I had to call off the visit. The staff, clearly under pressure, urged me to stay away: “We have a lot of problems. Don’t come.”
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The cancellation of my appointement was of course just a small disappointment compared to the larger picture. For the centre’s staff and families, daily life had suddenly become uncertain and unsafe, as it has for the millions of people living in this normally bustling city that has come to a very violent standstill at the beginning of the week. 

For outsiders, the experience was a stark reminder of how quickly circumstances can change and how fragile routines are in times of unrest. I for my part have been lucky: my guesthouse was in a part of the city where the protesters didn’t loot and burn that much. Now the situation has calmed down considerably (though there is yet no true political solution on the horizon), the airport has reopened and I will fly back to Bhutan on Sunday as planned.

​Such moments also highlight what it means to work outside familiar surroundings. Every cultural nuance, every interaction, requires attention and adaptation. It can be draining, but it is also deeply rewarding: stepping beyond comfort zones brings new perspectives, resilience, and the chance to contribute where support is needed most.

Pema was so kind to invite me to her place and show me how the very typical Bhutanese dish “Kewa datshi” is made. Since then I have tried out a couple of different datshi dishes. “Datshi” means “cheese” in Dzongkha. Like the Swiss people the Bhutanese use a lot of cheese in their dishes : )

​Ingredients: 
3 potatoes
3-4 green chilies
1 tea spoon of salt
Oil 
Fresh Bhutanese cheese

Tips: 
As a substitute for the Bhutanese cheese you can also use young unsalted feta or ricotta.
​For the chilies you can use long green peppers like new Mexico chilies, Turkish “Dolma” peppers or Hungarian wax peppers ->  it’s best if they are medium hot

I’m having a hard time to really picture the daily live of a child with cerebral palsy (CP) here in Bhutan. I have worked with several children with CP and have seen them a couple of times (if they weren’t missing the physio sessions because they are often ill). What is very practical is that their parents or caregivers like the aunt or grandfather are always here in the centre while their child is here. So, I always take this chance to get them on board and involved. The caregivers are also very willing to learn as they feel they don’t really know how to best support their child. Often they can’t speak English and some of them can’t even speak Dzongkha (the national Bhutanese language) as some come from the East of Bhutan where they speak another language called Tshangla. As there is no centre or support for children with diverse abilities in the more rural areas and especially in the East of Bhutan a lot of caregivers leave their families and known surroundings and come to Thimphu, the capital of Bhutan. They do this for their child to give him or her a chance to have some proper care even if it is much more difficult  to have to build up a new life far from home for them  
So, during therapy I often get another caregiver to translate for me. I need to know how the daily life of the child looks like, what activities he or her can do and In which positions the child is most often during the day. Do they already do specific exercises with the child? What would benefit the child and the family the most if it would improve? What goals should we set? What assistive devices does the child already have? 
I need to know those things to be able to help the child more effectively otherwise I might work on something in physio which the child will never do in daily life and therefore won’t profit from it on the long run. 
But when I ask some of the caregivers most said that their child just lies on a mat most of the day. They often don’t really have any assistive devices and if they have a wheelchair then the child only sits about half an hour in it each day as it then starts to cry. My guess is because the wheelchair isn’t really fitted to the child’s needs and therefore gets painful. Then they have 1-2 exercises they do with the child per day and for eating the child often just sits on the caregiver’s lap but the rest of the day it spends lying down. Except when it comes to class for which the caregivers take the bus which is provided by ABS to the centre and then carry the child on their back inside to class if it can’t walk. They are very used to always carrying their child everywhere even if it is already big and heavy as they don’t have any alternatives. 
I can’t really picture a day in the life of such a child. How do the caregivers do the different daily routines with the child, how much can the child be active itself, where could we add more meaningful activities to the daily routine of the child, how does the child move in the house? Is it always carried? Or is there potential that the child could learn to be more mobile itself? 
As long as I can’t really imagine how each step of the daily life looks like it’s so difficult for me to make suggestions for the parents and support them and train those specific things with the child. Therefore, I will want to do some home visits to those families to really get a feeling for it. Their lives are so different from the ones in Switzerland - for example we never carry the children around but they get a wheelchair and spend most of the time in that and not lying down. Another challenge will be to find an assistive device which is applicable for outdoors so that the children don’t have to be carried. If I look at the roads and pavements and door entrances, I see that there is no easy access for wheelchairs. I will have to think hard about what solutions would be helpful in these surroundings. But I just think that having to carry their children on their backs also isn’t healthy for the caregivers. 
Next week I will hopefully be able to do my first home visits if everything works out as planned.

So, this week my main focus was on getting the parents started on the Qigong massage with the children. 
After practicing the massage with a group of parents on each other, I told them that they should practice the massage at home with a partner or another sibling but that they should wait with doing the massage on the child with ASD as that often is challenging and that we would look at it together in the first therapy session. But when we had the first individual session I asked how it went with practicing the massage and nearly all the parents had already started to do it with their child. This just shows me how motivated they are for doing this treatment. Some parents even already told me that this massage helps their child to relax more and sleep better - which is great! 
It’s so interesting how each child reacts differently. Some children can’t even lie down for the massage and just wriggle and scream and scramble to get up again. With those children we start in sitting position or even in standing as their system is too alert to let them relax and lie down. For some of them we had to do the whole massage in sitting. Some of them started in sitting but then got more relaxed with the massage and even ended up lying down for the last part. Others had no problem with lying down and cooperated through the whole massage and you really could tell that they enjoy it. Some start to have eye contact and interact and with others you had the feeling they don’t even notice that you are doing the massage and just are playing with a toy as if you weren’t there. But most of them in some way showed that they like the massage. Be it even if a child who always is very active needs a break to move around and then after a minute lies down on the mat again without being told because it wants to continue with the massage. One child even fell a sleep at the end of the massage because it relaxed her so much!
Next to this therapy for children with ASD I worked with children with cerebral palsy, infantile Beriberi and developmental delay and a girl with Rett syndrome. But more about that next week!

Finally my apartment is ready and I can move in. It was good to stay at the hotel to begin with but now I’m looking forward to moving out. The thing I will miss from the hotel location is the stupa directly next to it and which I visited every day and had a lot of nice encounters. As it is an unfurnished apartment I had to buy the basics for living as there isn’t even a stove or anything to cook.

Pema and Pasang were so kind to help me buy all the stuff I needed even though it was their day off. I was very glad of their help as they knew exactly in which stores to get good things for a good price. For example the blankets where over 6’000 Ngultrum at the one place where I wanted to buy them but Pema told me she knew a better place and in the end I only payed 1300 Ngultrum there! It's so very helpful to have all the local expertise if you yourself haven't got a clue about how things work in this completely new environment. A few things I can even borrow from colleagues or from the work place which is very kind. Thank you all very much! 

Today I went to the Memorial Chorten (Stupa) which is just across the road of my hotel. It is the tradition to circumambulate the stupa three times clockwise so I just joined the crowed in doing so. Then, I took a seat outside the temple where a lot of people were sitting and just enjoyed myself observing the doings. It is a place of peace and coming together. You hear people chanting prayers to themselves or exchanging a few words. Some sitting there working on their bead necklaces and staring into the distance. Some just sitting there in silence. Others chewing betel nuts.  

​After a while an elderly woman sat next to me and I smiled at her and she smiled back. After a minute or so she said something in Dzongkha which I of course didn’t understand. I didn’t know what she said but I thought maybe she asked where I stayed or what I was doing. So I just told her in English that I lived in the hotel just over the road and pointed towards it. She of course didn’t understand the English so we just continued to smile at each other and she continued doing her praying and spinning her mani prayer wheel (a small prayer wheel which you hold in your hand) and her bead necklace. After a while she took out some fruits of her bag. Looked at me, smiled, said something in Dzongkha and handed it to me. I held out my hands in appreciating gesture and thanked her in English and then said “gadinche la” which means thank you and is about the only Dzongkha I know. She smiled and took one more out of her bag and continued chanting and stared off into the distance. While doing this she started to peel a small part of the fruit and now I saw that it was a kind of plum. She took some pieces of the pulp out and flicked it towards the stupa. I guessed that this was a religious offering. Then she gave me a fruit as well, and I copied her with the offering and then ate it. After some bites the lady looked at me again and said something and pulled a face so I immediately understood that she wanted to say that it was sour and then she put the rest on the windowsill behind her. A view minutes later she offered me a small packed muffin which I gladly took, copying her offering and then ate the rest of it. But when she unpacked a fruit juice package and I wasn’t sure if she had drunken out of it yet or not I did a small hand gesture of refusal but smiled and she understood and drank it herself after doing some religious offering. Soon after that I left and smiled at her when I went. It was nice to share this moment with her!

I love landing at Paro international airport and especially flying into the Paro valley. I already knew the experience from the last time I was here in October 2023. Some people are afraid of it because only a few well trained pilots are allowed to land here as it’s very challenging. But I completely trust those pilots and just enjoyed the stunning view.  The plane makes a hard turn around a mountain flank and then flies into the valley with the mountain sides so close it seems as if the wings could almost touch them.

At 15:20 local Bhutanese time I landed safely in Paro. Finally I got to Bhutan! ​When you get out of the plane you see the cutest and most adorable airport - check out the pictures below. My heart was filled with joy and delight! 

As soon as I passed through immigration I was greeted by Pema and Pasang from the Ability Bhutan Society with the traditional white scarf. Every foreigner is greeted with this warm welcome. Then they took me to a cafe near by and we drank some tea. I wanted to have butter tea as it is very typical for the Himalayas - it is a special mixture which is quite uncommon for us: black tea with melted salted butter. It has an unfamiliar slightly earthy taste from the black tea but is surprisingly salty with a rich buttery taste at the same time. It is very nourishing and warming from the inside and special for me because it is connected to a lot of good memories. 
So, I enjoyed the tea and talked with the two of them about our different cultures and ABS and got to know them a bit. After that we drove to my new home town Thimphu, the Capital of Bhutan, and I settled in a hotel, as my apartment has not been vacated yet. I was very very tired but very satisfied and happy. 

A lot of people asked me whether I was nervous about going to Bhutan. I never really worried about going alone as I knew from the last time I visited that that culture is very enticing to me and I don’t tend to wafer and doubt if I have set a goal and have a vision for what my next project should be. I just feel I need to do this and make the best out of it. But the closer the date of departure came the less real it seemed that I was really going so soon and I had so much to do before I went that my mind was very preoccupied with just getting every thing done. I was like in a timeless bubble. 
The first moment I truly realised that I was really going now and that this adventure was truly happening and not just a dream was when I entered the airplane at 4:40 pm on Friday the 25th of July 2025.
Then the long journey to Bhutan began.  The only thing that made me slightly nervous was that I hadn’t been able to declare my extra suitcase of 30 kg for the flight from Delhi in India to Paro in Bhutan. For the flight from Zürich to Delhi via Doha I was able to purchase a second piece of luggage directly while buying the ticket.  On the internet I had read somewhere that it is possible to add an extra suitcase on Drukair (one of two airlines that fly to Bhutan) but with a maximum weight of 20 kg! The thing also was that in Delhi I had less than 4 hours to change flight and I had to first go through immigration into India and get the visa even though I only was there for transition to Paro and get my suitcase and then go to checkin again with all the stuff and finally go back in through  security again. Therefore it wasn’t much time especially for any potential difficulties with sorting out the second suitcase. 
When I finally made it  to the Drukair Check-in at the Delhi Airport I just asked the first staff member I saw what I should do if I had extra luggage. He looked at me a bit sceptical and thought for a while and then said that it would be best to upgrade to business then I would have two free pieces of luggage. When I asked how much that would be said something with some 100 000 which was Rupee or Ngultrum (Indian and Bhutanese currency) I guessed, which I had no Idea how much that was in USD. I was so tired and that man tried to help but had such an accent I really didn’t understand what he said even after asking a couple of times. He finally realised that I was sceptical and that we didn’t really understand each other. So, he took me to the economy checkin desk and referred me to the lady there. When I started checkin I asked that lady how much it would be to do overweight of 30 kg. I was very relieved when she told me that I could add the extra luggage and just had to pay extra for the extra kilos. When I asked her how much that was in USD she tipped it into the calculator and showed me that it was just short of 130 USD. I wouldn’t have known what I would have done if I had to leave one suitcase there or take out more than 10 kg. At that time I was already so tired from the traveling as it was already nearly 2 o’clock in the morning and my brain wasn’t working properly any more. 

​To be honest I didn’t look forward to packing as I knew that this would be very challenging. What do you take for going away for a year? They also have 4 seasons. Do I take clothes and shoes for all weather or do I buy things in Bhutan? What kind of medicine should I take? Is everything available there in the hospital for emergencies? 
How will I fit everything into two suitcases? At least I have bought two times 30 kg allowance for the first two flights. Which is quite a lot but I also have a lot of assistive devices and physiotherapy material which will at least fill one of the suitcases. And I also need to bring a lot of chocolate and small gifts for the people I work with. All those things take up most of the space and then I also need my personal things.  
And how to do it that I don’t forget anything important which I will regret if I don’t pack it? I decided to collect all the items, sort them by theme and lay them out so that afterwards I could  go through everything once again. Only then I could start the packing. I was worried that I would have a hard time to get everything into the suitcases. But I was astonished how well everything just perfectly fitted and was very glad and a bit proud how well I did. 
But then when I weighed them one was 37 kg and the other one 25 kg - a perfect misfit for the flight allowances. I was annoyed as everything had fitted in so well. Now I needed to swap things over. I got the kitchen scale so that I knew about how much weight I took out and added to the other suitcase. As it was getting late in the evening and I got tired I also got impatient and started to just pull out a lot of things in the suitcase which wasn’t handy as I then had to repack them nicely again. It felt like I was at it for at least an extra hour and I was quite exasperated until I finally managed to have about 29.5 kg and 30.5 kg in the two suitcases. I had also taken about 2 kg worth of stuff out which I couldn't fit anymore.  I left it at that for the night as I would have a few more things to add the next morning anyways. 

On the 15th of April 2025 one of my physio colleagues in the foundation Vivendra retired and had a farewell party. He kindly decided that he didn't want any farewell gifts for himself, but would like to collect donations for my project for the children in Bhutan instead. Thank you so much for this generous deed!
For the event in the Vivendra, Nelleke Bos and I had prepared an information stand with two posters about the project in Bhutan. During the evening people passed by the stand and asked a lot of questions. It's wonderful to experience so much interest in my project. At the end of the evening, we had collected 340 Swiss Francs. What a great success for the first fundraising event. Thank you very much! The children in Bhutan will be very grateful indeed for your help. ​