"I need some Nepali phrases like 'How are you feeling?' and 'What's the problem?'" says Kirsten Schwarz, a doctor from Germany over omelette, puris and tea. "All you really need to know is kahan dukchha" replies Humla's district health officer, Roshan Pokhrel. "Just ask them to show it."

Breakfast talk at the Nepal Trust Guest House in Simikot with its staggering view of snowy peaks, the valley, the village and its runway. It was the last day of preparations for the 2004 Humla Health Camp, which ran for the last week of November bringing together doctors, nurses and student volunteers from Nepal, India, Britain, Germany, Austria and the United States.

The aim: to offer medical services to the people of Nepal's most deprived and remote district. The organising charity, the Nepal Trust, says child mortality here is between 30 and 40 percent, child malnutrition is 42 percent and female literacy is only four percent.

The Nepal Trust is based in northern Scotland with directors in the UK and Nepal. It first became involved in Humla a decade ago building clinics in outlying villages. Nurse Janet Griffin, a grandmother of eight from near London and one of the camp leaders, took part in the trek to build the first clinic.

"A 49-year-old woman having her 19th child said 'Of my 19 children, half are dead and half the children from this village are dead.' That made me determined to come back to Humla and see what we could do," says Griffin.

A family tie gave rise to Nepal Trust Austria, which raised 40 percent of the funds for this camp, while Nepalis and Indians came from the Nepalganj Medical School led by surgeon M Kidwai. "It's an absolute condition that the Nepali team lead," said Trust chairman Tony Sharpe, a retired forester who says the Trust's initiatives follow invitations from local leaders.

The Trust hoped for an increase over the 6,000 Humlis treated by the first camp in 2003 but conflict and perhaps winter held numbers to some 4,500. On the first morning, hundreds of people queued from 5AM, crouched up against each other and huddled in blankets, women and men separated, babies everywhere. A puppet show with health messages prompted ripples of laughter among those waiting.

There were stories of tragedy. One elderly man felt paralysis creeping up his side and his power of speech seemed to be disappearing. Doctors were not sure they could treat him. The Maoists, who control the district outside Simikot, had stopped or delayed many wanting to attend. It appears they tried to filter sick people from those they believed were just trying to escape the villages.

They had stopped Hari Bahadur Shahi, his wife and their gravely ill son from moving for a week. Probably as a result, the son died, the third of the Shahis' four children to pass away. A mentally ill woman had just given birth but mother and child, shunned by all, had no shelter.

Major operations were carried out including the removal of an abscess from a breast. A 15-year-old girl was diagnosed with heart disease, enabling the prescription of years' worth of medicine to prevent acute fever. Nonetheless, about half the patients "Were not sick, but think they are" said Kapil Sharma, a doctor from Hetauda who examined 145 patients in one morning.

The Nepal Trust has built seven clinics in Humla and has diversified into local electricity schemes, eco-trekking and monastery restoration. Tony Sharpe admits a health camp could only scratch the surface, perhaps the Trust should have started by strengthening the poorly-equipped district hospital where the camp took place, rather than with clinics.

The priority now is to give the hospital the tools to conduct small operations and to make it a proper referral centre with stronger links to Nepalganj.

(Also see: 'Moving mountains', #116)