A collation of emails.
The view of the Himalayas from the back of the Tansen Guest-House on a clear day.
Namaste! It has now been over a week since I left Australia and a great deal has happened over that time. This has become a far greater experience and adventure that I could have envisaged.
As you know, I left Australia on Monday afternoon with an overnight stay in Bangkok. It only occurred to me when the plane had left the ground that, although I had somewhat prepared myself for Nepal, I had barely given Thailand a thought. I arrived after 10:30pm at night and managed to fumble my way through things, find the shuttle bus to the hotel and check in. Staying at the airport Novotel Hotel, I realised the stark disparity it would be to Kathmandu the next day.
Nothing could have prepared me for what awaited me outside. There were Nepali taxi drivers closing in from every direction all vying for my attention and yelling out to come with them. And there it was, a sign with my name floating in a sea of Nepalese faces held by my liberator, Deborah (the UMN medical elective coordinator). I was extremely impressed with the ease with which she dealt with the situation. After some haggling in Nepali, she finally struck a deal with one of the taxi drivers and we were ushered to his nearby car, which was at least 30 years old with no seatbelts (sorry Mum, that's usual), a boot that didn't open and a front passenger's seat with a back rest which got lower with time. We also got a discount since he wasn’t actually registered as a taxi. After finally getting the car started some time later (with some help from his friend), we were off!
The splendid chaos that is Kathmandu
I will never complain about Sydney drivers again! There we were, ducking and weaving through the heavy traffic consisting of motorbikes, cars, trucks, buses, animals and crossing pedestrians (who would meander across at any point without warning), with extraordinary skill and judgement (fine-tuned over time I imagine). Instead of indicators, horns are lavishly used. Pollution is a major issue in Kathmandu and is the result of a combination of impure fuel, poor car exhaust and a lack of exhaust regulation. You will see many people walking around with handkerchiefs or masks over their mouth.
Typical Nepal driving experience (minus cows). No bonuses for hitting something.
NB: There is no need to look when crossing the road, but walk slowly and purposefully.
Kathmandu has a rather disorganized layout. There is a major ring road that runs around its periphery with a labyrinth of roads throughout. I actually stayed just outside Kathmandu city at the Shalom guesthouse, in a suburb called Patan. Walking around by myself that afternoon, two things struck me most: how little the people had and yet how well they survived on that little amount, with such apparent contentment.
Quality isn’t something that is regulated in Nepal. Despite their qualifications or training, people can set up services or sell whatever they like. People would set up their own pharmacy or medical store. People build whatever they like, and I saw plenty of home-made, strung up walls or roofs. Safety isn’t really taken seriously either – one example I saw was people racing around with wheelbarrow loads on scaffolds 30 feet off the ground without any barriers or safety measures. Rubbish is strewn everywhere. It is truly a different way of life over in Nepal.
The Workplace Health and Safety Department would have a field day if it existed in Nepal!
Safety first.
I was invited to dinner at Deborah’s household. I enjoyed the challenge of getting there in the dark, in the heavy rain with the basic directions she gave me (thank goodness for my good hiking boots and poncho). Deborah’s parents were also staying with her for a few weeks. They live on the second floor of a flat and interestingly (or disturbingly, as the case may be) they have a family that lives in their garden shed.
Plenty to choose from and plenty who will try and sell it to you.
Durbar Square was a sight to see with many ancient buildings and temples. Quite a few times Holy Men tried to ‘bless’ me by placing a rice and paint-like substance mixture on my forehead but I adamantly refused (people have been ‘cursed’ unknowingly by this). We enjoyed lunch at a cosy cafe in a place called Thamel – it is an area of Kathmandu that is quite ‘westernised’ and well catered for tourists.
An example of the heritage-listed architecture at Patan Durbar Square.
Since Deborah had some other business to do, I decided to brave the streets of Thamel alone. I was essentially prey for the ensuing shop and business owners. I had barely walked 10 metres before I was accosted by someone trying to sell their services for trekking. This happened several times over the space of 30 minutes, with my only reprieve being to duck into a shop (to be met by a persistent shop owner!). Many more shops, scams and drug offers later I decided that I had had enough for one day and managed to find my way back to hail a taxi for my ride home (for which I was quite proud of and extremely grateful for).
There were many of these material shops in Kathmandu and Tansen.
That night I again enjoyed the company and meal with Deborah’s family. On the way out one of their dogs quickly slipped out of the gate, so it must have provided some amusement watching a bideshi casing after a dog yelling english late at night. It got a bit dangerous when other dogs got involved and I didn’t want to risk being bitten (rabies is quite prevalent). Fortunately, when I later rang from the safety of my guesthouse, it did not pose a major problem.
Let sleeping dogs lie, especially when in Nepal!
As per usual, throughout the night there was the banging of the workshop just down the road, people yelling on the streets and car horns. I was up at 4:45am to pack and lumber down to the bus stop with my packs to wait with some other bideshi for the UMN ‘Buck’ (endearingly entitled so because it’s a cross between a bus and a truck). When it finally arrived, it was quite full of hospital supplies, some Nepalese families and a psychiatric patient.
Buck - what you get when you cross a bus with a truck!
A taste of the beautiful scenery and lack of safety.
The bus ride down into the valley was exhilarating and downright perilous. There was barely a safety barrier between us and a several hundred foot drop. However, I felt quite safe in the capable hands of our bus driver who had an uncanny ability to manoeuvre around the traffic. When I saw people riding on top of the buses and trucks coming from the other direction, I was tempted to ask to do likewise. The bus attendant would climb in and out of the bus windows and clamber around on top of the moving Buck with superb agility. Stopping at one of the towns, I had my first taste of the Nepal national dish, dal baht, which is essentially a dish of rice, lentils and salsa or chutney served on a large, round metal tray.
The higher you go, the bigger the fall!
Dal baht (no goat meat on this occasion).
Since there were a few who left at Butwah, for the last leg of the journey back high into the mountains of the Palpa region, I rode near the front of the Buck. Most of the journey up the 4000 feet mountains was done in low gear. Finally we arrived at the gates of Tansen Mission Hospital after 11 hours of travelling. I don’t think I could have ever imagined how incredible it was to see a town and hospital precariously perched on the side of a mountain. I made my way to the guesthouse with some others who were also staying there to settle in.
Ummm... how much of the road do you want?
We have arrived! We are greeted by a wonderful mix of colours.
Looking into the valley from Tansen's lower road.
The bustling metropolis of Tansen (greater area population ~20,000).
Nike greeting on a house near the hospital.
Tansen is a beautiful mountain town with rich Nepalese culture, being kept from western influences (although, this is beginning to creep in). Situated at the heart of the town is the bazaar, where you really experience what Nepal is all about. The streets are littered with people selling all manner of things from fruits to bright coloured dyes to wonderful materials (something Tansen is famous for). Earlier this year Tansen was attacked by the Maoists, who unfortunately bombed the palace and other unique structures. There are many lovely walks around the mountain-side, and the views are spectacular, which ever direction you look. I’ve quickly discovered that I’m the right height for being in Nepal (in fact, a little above average), as I fit through doorways and passages with ease (I now know why God made me short!).
Tansen Bazaar looking down 'straight street' (as we dubbed it).
Looking down 'steep street'.
Shitalpati, a well recognised structure and place to sell fruit.
"Suntala kati parcha?"
19th century Hindu Temple. Largest in Tansen.
The remains of the recently bombed Palace.
Bright colours typically seen walking around Tansen.
A small village near the hospital.
One of many alleyways to explore.
Chickens running freely as per the norm.
Nepali kids who run after you yelling "Namaste!"
Women with their dokos (woven baskets)
I’m staying at the Tansen Mission Hospital Guest-house, inside the hospital grounds. The Guest-house is cosy and has people in and out all the time, so I’ve met plenty of internationals already over my short stay so far (at one meal-time we had people representing Australia, America, England, Ireland, Nepal, India, Sri Lanka and Sweden). The facilities are basic but have all that one would need. I have now even got the hang of the squat toilet, although I have to hang on to something so I don’t fall over backwards (we’re not designed the same way as Nepalis). The main living/dining room has its walls lined with book shelves with a plethora of books, and nearby comfy seats to complement. There’s even a TV and DVD/VCR player, so often in the evening a few of us will gather to watch a movie (and you thought I would be ‘slumming’ it!). Since the monsoon is over, the sky has been slowly clearing and the awe-inspiring Himalayan Mountains can now be seen in the distance (I tell them here that people would pay a lot of money for a view like that back in Australia!). Meals are provided, so I get my daily intake of Dal Baht (lentils and rice), which I really enjoy.
My room in the Guest-house. Home for the next 6 weeks...
Steadiness and good aim is required to master the squat toilet.
Two of my favourite Nepali friends (Rachel and Reuben) whom I had to chase around the Guest-house (accompanied by disapproving looks from the Didis...) and ate my chocolates!
There have been many surgical cases here that wouldn’t be commonly seen back in Australia. One 40 year old man came in complaining of an ulcer on the base of his foot that had been bothering him for 4 years. He had seen 3 different hospitals and had had many operations and was assured that it would heal with time. When we looked at it, the lesion had all the hallmarks of a malignant melanoma. He has a bleak future considering it had already spread to his inguinal lymph nodes. Possibly his best option would be amputation of his foot at another hospital that offered radiotherapy.
Then there was a 27 year old lady who had been complaining of joint and muscle pain and swelling on and off for about 2 years and had been seeing the village ‘pharmacist’ for treatment. She presented to Tansen MH after having had a gentle massage, with a fractured femur (thigh bone). The x-rays showed that she had a bone marrow cancer (multiple myeloma) that had riddled the bones throughout her body making them very brittle. Again, another poor prognosis.
Mid-shaft pathological fracture of the femur, secondary to multiple myelomaThe ‘bread and butter of surgery’ here seems to be traumatic fractures and skin infections. There are multiple reasons why the Nepali people are always fracturing bones. Firstly, their bones are weaker due to poor nutrition. For example, one 20 year old man had fractured his femur kicking a ball. Secondly, they are always climbing trees (including the elderly), riding atop buses or doing an assortment of many other dangerous acts. One boy came in lucky to be alive after riding on the handle bars of his father’s motorbike and grabbing the accelerator. Last Friday afternoon was busy sorting out the result of a jeep accident that occurred just outside the hospital (failed brakes or a drunk driver was two theories being circulated by the injured). Apart from trauma, there are always abscesses to drain and wounds to debride (often TB is the culprit)!
Fractures, fractures and more fractures.
Me cleaning up a rotten foot. Well, someone has to do it.
I’ve also been privileged to attend the inaugural Nepal Christian Medical and Dental Association (NCMDA) medical student and recent graduate conference here at Tansen in recent days! This has been a wonderful experience and I have made some fantastic friends from India and Nepal. It is reassuring to come to the other side of the world and know that we worship the same God. The majority of sessions were held in English and many doctors shared over the 2 days. Being prime season, I had some good in-depth conversations about cricket. A particularly memorable moment was sharing a time around a camp fire one night whilst having a meal, singing Nepali songs, dancing and telling jokes. And yes, they have a similar sense of humour and instead of blonde jokes they tell their equivalent, Sardar (Indian men with long beards and Turbans) jokes. They appreciated my adapted blonde jokes that I had converted to Sardar jokes! On the second morning of the conference, a group of us got up early to watch the sunrise over the town and surrounding valleys, with the Himalayas in the distance.
Sunrise over the Madi valley
First morning sighting of the Himalayas. Absolutely breath-taking!
Lions building.
'White Lake' formed by the morning fog that collects in the Madi Valley.
Being here, even only for two weeks, has greatly broadened my global perspective, especially regarding world mission. There is much to be gleaned from the remarkable Nepali people. Many of the students have endured great hardship and toil to be where they are now and these people would put the average westerner to shame in comparison. It is not uncommon for them to go to another country (usually China, India or Russia), where they would often have to learn a new language and study medicine in that new language. I found it difficult enough just to finish my medical degree! I find it extremely humbling that most people I meet here can speak 3-4 languages fluently (those who have been fortunate to have had an education).
Riding atop a bus destined for Tansen after a day-trip near Ridi.
A pretty sight along the way.
Everyone decides to cross at once.
There aint room for the two of us.
Beaten copper pot. This bloke's ears must ring for days afterwards.
17/11/2006 - M&Ms (3)
I apologise for the lack of recent communication but this has been the first opportunity in several weeks to be able to write. I will be travelling back to Kathmandu on the ‘Buck’ (bus/truck) this Wednesday, staying the night before flying back to Australia to make it in time for Phil’s wedding in Sydney on Saturday, 25th November. So, it’s a tight schedule with not much room for error (so, I’m praying a lot).
Let me try and update you all with some snap-shots of interesting things that have occurred...
Trekking
After complaining to everyone before I left that I wouldn’t have the time to trek because of my busyness at the hospital, the opportunity to do a short trek in the Himalayas presented itself. My supervisor allowed me to take time away from the hospital to do a short 5 day trek in the Annapurna region, near Pokhora (roughly a 3 hours jeep ride north of Tansen). Besides the wonderful experience of being in the beautiful surroundings, it gave me great insight into the complexity and uncertainty that exists in this country when arranging to do something.
My aim was to fly from Pokhora (~800m) to Jomsom (~2500m), an airport high in the mountains and to then trek up to Muktinath (~4000m) and down. However, organising this proved to be much more difficult that I thought. Before leaving Tansen, I had twice rung the travel agency being used by one of the hospital doctors (who was doing a similar trek with his family), who assured me of a ticket for the flight. When we were on our way to Pokhora, the doctor informed me that he had rung to double check and found out that they still didn’t have a ticket for me. After speaking with them at length, he had possibly obtained a ticket for me for a later flight, which could be problematic if the winds picked up. When I went to collect my ticket in Pokhora, they still didn’t have the correct ticket which was quickly rectified. As it turned out I was able to catch the first flight since I was there early waiting with the other doctor’s family! I’ve learnt to expect nothing but be prepared for anything.
Then there was the angst of arranging a porter. It wasn’t my intention to hire a porter but a new law had become effective mid October stating that due to ‘safety reasons’, all trekking groups required either a guide or a porter. Additionally, there was a fee which paid for the porter and guides to belong to their union, which ironically was the main instigator of the new law! Originally I was of the mind to find a porter once I was up there but eventually found out that I could be stranded in the airport without any documentation. The doctor I was with managed to speak with a trekking agency in Pokhora and kindly put me on to them. Since I would meet the porter in Jomsom, I would have to pay for an extra 3 days for his travel time to be there. This was all outlined to me by the trekking agency manager, a Nepali outfitted in a suit and tie, who I’m sure did quite well sitting behind a desk alone.
Any travel in Nepal is exciting and the jeep journey to Pokhora from Tansen was no exception. Undulating, winding mountain roads always with surprises lurking around corners, such as broken-down cars, on-coming traffic, road works, animals (cows, chickens, goats, monkeys – you name it) and lots of people (including one man peeing in the middle of the road, who looked twice at the rapidly looming jeep before running for safety). People were out in their fields joyfully harvesting crops.
Jeep is the travel mode of choice in Nepal to get places.
The usual road sign that understates the degree of road curvature.
Is there room for one more?
Boating at Lakeside.
Peace Pagoda jutting out along the silhouette of the hills.
This brings a whole new meaning to doing a '1' and a '2'.
I was up at 5am the morning of my flight to Jomsom to do my final pack and be waiting for the doctor’s family to arrive in their hotel vehicle. During this time a total of 9 taxis and 1 bus offered to take me, which I found staggering at this unusual hour. As aforementioned I was upgraded to the first flight at 6:30am, which meant that I had to be rushed through their security check (avoiding their full body frisk). The flight was complete with an attendant with a tray offering cotton balls (ear plugs) and a chewy lolly (to equalise ear pressure). Being early in the morning, we had fantastic clear views of the snow-capped peaks.
Bye bye Pokhora!
Hello Jomsom!
After numerous security checks at the Jomsom airport, I went on to the Majesty Hotel to collect my porter, Ram. The main risk I faced this day was the rapid ascent of altitude from Pokhora to Muktinath, with the possibility of altitude sickness. The scenery was absolutely beautiful with the mountains, buildings, people and ponies (their mainstay of transportation in the area).
If you get this porter, demand a refund (unless you want to go slow...).
Tractor load of women and kids. No, I didn't ask.
One of the beautiful ponies with its Tibetan carpet adornments and distinctive bell.
Just before Eklobhatti I came across the expected Maoist checkpoint, for which I had been forewarned. For some time now the Maoists have stationed themselves in the popular trekking areas to collect ‘taxes’ from tourists to support their cause. Speaking with the doctors from TMH, I was told how they had successfully negotiated discounts from the usual tourist price of 1200 rupees (~$25 AUD) to as low as 100-200Ru. So, I mustered together what Nepali I spoke at this stage and argued with them over the price and mentioned being a volunteer at the UMN hospital and eventually settled for a 50% discount. When the other doctor from Tansen came through, he also had a lot of difficulty with this particular man.
A sneaky photo of the Maoist checkpoint.
We passed through Eklebhatti to Khinga where my porter (who had started to lag behind) had a friend who owned an inn there and locked my meagre 10kg pack in a room to collect on the way down. We reached Muktinath at my goal of lunchtime and enjoyed some Dal Baht and tea. By this stage I had become quite light-headed, so after exploring for a while we started our descent to Kagbeni to stay for the night. There was a plethora of apples sold along the way, so it was always refreshing to buy some (this route is also known as the ‘apple pie trail’). I enjoyed a fresh yak burger for dinner (tastes like marinated steak) after speaking with the man who couldn’t shake my hand because it was covered in fresh yak blood. Sleep was difficult that night with the altitude and my running nose from a respiratory viral illness that had taken grip.
Tibetan lady weaving a scarf.
Mysterious town of Jharkot
Muktinath has been conquered!
Kagbeni
Fresh Yak burger!
Now I've seen it all...
Mm...mm...mm... It's yak-time!
350 year old painting
After this delay the winds had begun to pick up, which we had to work against. We still reached Marpha by lunchtime before a detour through a Tibetan refugee village. The scenery through this area was exquisite and it felt as though we had been transported to an entirely different place. Through Tukuche, many children were asking for sweets or to take their photo at a price. Although I was quite run-down with my virus, we pushed on to reach Larjung by late afternoon.
Marpha
Buddhist temple
Suspension bridge across to a Tibetan refugee village.
Tibetan refugee village.
We had planned to have an early breakfast to do the Dhaulagiri Ice Falls side hike (and to lengthen my trek to 5 days since my porter was complaining that the trip would otherwise be too short). In the morning I was up at 4am feeling absolutely rotten. I was unable to keep my breakfast down and I put it down to some cooked mushrooms that I ate the previous night. My porter seemed rather pleased by this until I firmly decided that we were still going.
It was still dark when we left by torch light and watched the sun creep up over the mountains. Some pony ‘trains’ were already on the move with their driver whistling and urging them on. Gritting my teeth (and packing gastrolyte drink) to do the climb, with many stops along the way, was well worth the effort as the views were unbelievable on this particularly clear day. Over halfway up the mountain we serendipitously came across a yak camp of ~15 yaks. A man was there in his tent milking a yak, so by the time we reached him on the way down he had boiled some for my porter to buy (and for me to taste… let’s say that it is an acquired taste). It was very cold when we reached the summit at 10am and needed to rest for some time considering the high altitude (3900m). The downward journey was much faster and we came past Sekong Lake with a sign about a yak blood drinking ceremony that is held there every year.
Yak camp.
Yakkity-yak
This yak didn't sound too pleased to see me... so I didn't stay long
Dhaulagiri Ice Falls... viewed from 4000m
Magnificent views.
Sekong Lake - Visit at the end of April for yak blood drinking ceremony.
We received a resounding welcome upon returning (a mixture of joy and relief I think). We went on to Katopani, where I immediately proceeded to bed and slept for 12 hours to recover. I met an interesting Nepali politician and owner of the teahouse here who had been living in the area for 50 years, continuing his father’s business. There were many photos on the walls with him posing with international politicians and other famous people. Whilst eating breakfast he received a phone call for which he calmly got up and launched into a long spiel. Afterwards, I was told that he had just been speaking live on a radio broadcast about some recent issues in Nepal.
The next day was a race to Tatopani (literally, ‘hot water’) to secure a hotel room and then to head for a long bathe in the hot springs (since I hadn’t showered the entire trip due to lack of hot water). I had been meeting many interesting travelers from other parts of the world (England, Poland, America, Israel…) along the way, who seemed to end up converging at this rejuvenating point.
Tree relocation service.
The massive pack of supplies distracts you from the fact that he's only wearing thongs.
People dancing off for a ceremony at the Hindu Temple. Looked fun.
The bus ride was incredibly bumpy – I likened it to driving on a dry river bed. As the Nepali music raged in the background, I attempted chatting with the people around me. Most of the initial journey the bus was less than 1m from certain death, with a sheer drop down the side of the poor excuse for a road, with the bus often tilting and tempting fate. The traffic was steady in both directions (taxis, buses, trucks, people, animals… the usual), which made for interesting stand-offs since there was barely room for us! At times we would have to reverse for 20m to allow buses or trucks coming from the other direction to pass. The bus attendants would hop out and bang out a code on the side of the bus to direct the driver. The trip took 4 hours in total as we winded our way back to Pokhora, and I savoured every minute of it. The hot shower and steak for dinner back in Pokhora was also noteworthy.
"Could you tilt the bus a little more over the edge so I can take a photo? Thanks"
I had some time the next day in Pokhora, so Becky (the other medical student) and I walked up to the Peace Pagoda overlooking the lake, before getting boated back across. (Mum, please skip this section…) Then I had the spontaneous desire to hire a motorscooter to ride out to the Tibetan refugee villages on the outskirts of the city. The Tibetan Buddhist temple was very restful and beautiful but ironically amongst the burning incense and offerings was a large, round Christmas tin on the altar (?!?). Being a Saturday the Tibetan carpet weaving demonstration wasn’t taking place.
Peace Pagoda
The lake and mountains in all their glory.
Boating back to Lakeside.
We cautiously rode (the only way to ride in Nepal) to another refugee village in another area to look at their quality Tibetan carpets. Although, we were assured of a full tank of fuel and had barely traveled 8km, we ran out of fuel at this village. One Nepali child, come entrepreneur, wanted to capitalise on the situation and offered to collect 1L of fuel for a small price. After some negotiations Becky, with her diminishing patience, got frustrated with the situation and hired a taxi to collect fuel herself.
Trekking had certainly shed a new perspective on Nepal.
Surgical Ward Round
During my last week spent in the surgical department (before trekking), one morning we witnessed a patient go into respiratory arrest (ie literally having his last gasps of breath) in front of us on ward round. CPR wasn’t attempted due to its futility for this particularly ill patient. The relatives came and mourned and spooned water into his half open mouth. One of the residents explained that it is thought that the water in his mouth would become ‘holy water’ (Ganga Jal) from the River Ganges. They believe that it will enable him to have his last requests granted.
General Medicine
After returning from Pokhora, I jumped ship to the medical department. The ward round was entirely different and on my first day I saw cases of malaria, tetanus, HIV, tuberculosis (TB), meningitis, enteric fever, Japanese B encephalitis, along with a multitude of large spleens. It was disappointing to find out that smoking and alcohol (roksi – home brew made from millet), were the major causes of morbidity and mortality in Nepal. There were many on the ward with self-induced chronic lung and liver disease and the plethora of social problems tied up with alcohol misuse.
TB ravaged lungs... or at least what used to be lungs.
After ward rounds there were always plenty of opportunities to tap fluid from bellies or lungs. Often this was done for diagnostic reasons, mostly to rule out tuberculosis, which is very prevalent. One patient even had 700ml of blood-stained fluid drained from the sac around his heart!
The outpatient department is divided into male, female and child clinics (this makes things a lot simpler for people to know where to go!). The breadth of pathology you see is incredible. One 30 year old male came in complaining of an abdominal mass, which we discovered to be metastases from his enormous testicular cancer (which hadn’t obviously caused him any great discomfort).
Male and Female outpatient clinics - a source of never-ending work.
I never ceased to be surprised by what the Nepali patients would come out with. A lot of the time patients wouldn’t take their medications for one reason or another. They would come back to outpatients having only taken some of the medications and then ask why they haven’t improved. They would then proceed to ask if there was an operation that could be done, which really took me back. Other Nepali patients would be at the other extreme having being forced to come in by family to be seen for their ill health. One such lady, who had pneumonia, was seen to have a dislocated shoulder on her chest x-ray and sure enough, wasn’t able to lift her right arm. When asked whether she would like a surgeon’s opinion she bluntly told us to leave it alone since it had been that way for years and she had learnt to live with it.
Death is an accepted part of life in Nepal for very ill, particularly with being unable to afford the medical treatment or support them at home. I saw many patients die on the wards. One 30 year old lady came in to hospital having seizures and a decreased level of consciousness. The senior doctors diagnosed her with meningoencephalitis (brain infection) and despite good care, she died a few days later. Another 40 year old lady was admitted with a rapid heart rate, who went into shock. Despite all options available, passed away (this most likely could have been prevented if the hospital had a defibrillator).
Sport
It is difficult to play sports in Tansen as there is a distinct lack of flat, grassy areas. The army training camp has taken over the main town sporting oval, so team sports are rarely held there. To counteract this, the foreign hospital staff introduced a game called sahalu, which is essentially land hockey with a plastic ball played on the hospital ‘tennis’ court. Occasionally the interns and residents will gather to play some Nepali ‘backyard’ cricket, which I joined when I could. The other week when I went in to bat I copped a fast bowl to the groin region, which confirmed a universal understanding for males that transcends all cultures and languages. They appreciated the funny side to things as I rolled around on the ground and the bowler didn’t stop apologising for days.
The usual spectators; patients looking down from the hospital balcony.
Final note
The Moaist peace agreement was signed Nov 8th, which means peace for Nepal after many years! A fair had been set up on the Tansen oval in celebration. Pray for my safe and timely arrival home (there are rumours of road blocks on Wednesday growing already).
I'm sure this isn't safe...
29/11/2006 - M&Ms (4)
You will all be pleased to know that I safely arrived back in Australia on Friday November 24, after flying through the night. The Buck ride back to Kathmandu two days earlier was uneventful and I celebrated my last night in Nepal having dinner with friends. My flight was 2pm the next day, so I had some time to walk around city, enjoying my last moments there.
A truck full of buffalos with some men climbing around on top.
Buses and buses of Maoists in Kathmandu, the day after the signed peace agreement was confirmed (Tuesday, Nov 21st). The 22nd is now recognised as a public holiday in Nepal.
I caught a taxi around 11am to ensure I got to the airport early but needless to say a few back routes (more like footpaths) and plenty of driving on the wrong side of the road got me there well ahead of schedule. Then there was the issue of where to line up to check-in for my flight, as the officials couldn’t seem to decide amongst themselves. Ah, the splendid chaos that I dearly enjoy and would miss. Quite a few of the foreigners were getting quite heated about the situation but I didn’t have the heart to tell them to relax and that this is Nepal after all.
Taking a few 'backstreets'. Obviously not the only ones.
We were on the wrong side of the road for far too long this time.
It’s still a blur to me but I’m not sure how I was allowed to check in my baggage, which was 27kg, 7kg over the limit (something which Nepal is renowned for being strict on, usually slugging unsuspecting travellers with a 40USD per excess kilogram fee). Not to mention my bulging ‘hand-luggage’ backpack that I had to struggle with to stay upright. Somehow I think a little Nepali unintentionally aided my situation. Then there was the long wait with hundreds of other people before I was aboard and on my way.
I was able to write the final copy of my wedding speech during the 4 hour stop-over in Bangkok. Despite some delays, I was able to catch my Brisbane flight to Sydney with 10 minutes to spare. Friday night was spent having dinner with Miriam’s and our family.
The wedding the next day was held at St Andrew’s Cathedral in the city. The morning was a relaxed affair for the blokes but it wasn’t long before the girl’s were behind schedule (hair and make-up issues) and late for photos. The ceremony was absolutely wonderful and a little too mushy for my liking at times… I experienced a fair bit of reverse culture shock, being thrown into such as intense environment so soon.
Myself and Phil
For me, the initial shocks were: the Australian accent (man, it sounds terrible!), how clean everything is, mundane driving, people getting upset at trivial things (eg Dad getting upset when someone cut him off while driving… if only he knew), sitting on a western toilet again. Things I miss the most about Nepal: all my newly made Nepali and bideshi friends, being called ‘Peter Uncle’ by all the Nepali children, the community, the hospital, the mountains, the patients watching us from the hospital balconies as we played sport, the relaxed Nepali way of life, Nanglos (our favourite Nepali restaurant) and dal baht. Perhaps the only thing I don’t miss (so far) is the acrid aroma of rubbish that they would burn everyday and allow to waft into the hospital wards. All in all, in a lot of ways I wish I was still there!
"Peter Uncle, Peter Uncle!" (The Nepali Wiggles???)
Now that I’m back and starting to readjust to the Australian way of life, I thought I would write one concluding email to tie off a few loose ends.
Emergency Medicine
Sometimes of an afternoon or evening I would spend some time in the emergency department. This served as both an opportunity for learning and for spending time with the interns and residents. Patients are seen first by a clinical medical assistant (CMA), who would then be seen by an intern to assess their need for admission.
The modest emergency department
One patient of note was a 15 year old boy presented to the emergency department with lower abdominal pain and distension. The story was that he had not passed urine for nearly 3 weeks with a preceding lower spinal injury. Ultimately he was considered to have urinary retention from the spinal injury and almost 3 litres of fluid was drained from his bladder with great relief. This kind of late presentation and lack of awareness is common in Nepal.
On-call
I decided to enter the realm of being on-call with my intern friends one night. I had set up my sleeping bag on the floor of the on-call overnight room with instructions to be roused when they were phoned for any medical or surgical admissions. Sure enough, the calls began. Within what seemed like moments of resting my head the phone rang and it was down to the emergency department to deal with some patients. Around 1:30pm Suryaman, the intern I was with, knowingly led the way to the nursing quarters in the surgical ward where they were in the process of cooking. Here he used his charm to secure a decent bowl of noodles for each of us. Then it was off to the maternity ward to visit the nurses there for another round plus a cup of tea.
Suryaman and myself re-energising after a night on-call.
One night, whilst I was having dinner with some doctors, the surgeon on-call there was rung to attend a lady with ecclampsia (put simply, a horrible situation of a pregnant lady with a condition that causes her to fit). Basically, the only way to rectify the situation was to stabilise her as much as possible and conduct an emergency caesarian section (surgically open up the womb) and get the baby out. Hastily I joined him to provide him with another set of hands for the operation, for which he was grateful. However, before the operation, no foetal heart sounds could be detected by ultrasound with the lady’s life still in the balance. Dead twin(!) boys ended up being removed from the uterus (one was deformed), a horrible twist. Providentially, the lady’s life was spared but would have to shoulder such a terrifying ordeal for years to come.
Maternity
One of the foreign surgeons working here saved a lady’s life one night on call. During labour she sustained a ruptured uterus. By the time she reached the operating theatre there wasn’t much that could be done to save the baby’s life and the mother was dangerously close to death herself. In the process she had to have her uterus removed, which had huge social ramifications for her since this was the only male child she had had to be able to carry on the family name. In this culture, the husband now has the ‘right’ to leave her to take another wife.
Paediatrics
This was mostly filled with children with respiratory tract infections. However, there was all too often many difficult situations to deal with and a distinct lack of options. It wasn’t uncommon for the experienced doctors here to decide that all they could do for some very sick children was to offer the best treatment available, to eventually send them home to die with their family.
One such instance was a fitting newborn baby brought in by his mother. Despite being careful, the mother had used a non-sterile knife to cut the umbilical cord which resulted in the baby contracting tetanus. Regrettably, the potentially life-saving tetanus immunoglobulin (to counteract the tetanus toxin) is not available in Nepal and could only be obtained across the Indian border. Due to the timeframe and the progression of the disease, the mother wouldn’t be able to make it back in time to administer it to save the baby’s life. The baby died the next day as foreseen.
It is reassuring to know that this is becoming a rarer occurrence with the prevalence of neonatal tetanus having declined markedly over the years. This has largely been due to public health measures, such as sterile birth kits, vaccinations and education.
Dental Department
Juicy big needle...
...and a pair of 'pliers'
Cultural Interests & Ironies
I thoroughly enjoyed the cultural differences of Nepal. For one thing, the food was fantastic and I kept adding to my repertoire as time went on. I’ve probably mentioned already that you cannot eat cow products, so instead they have buffalo meat and milk (with which the only problem being the unusually thick, creamy layer that developed on top). Chicken or buffalo momos (pastry dumplings) became a favourite dish of mine. Goat’s meat is a delicacy and I did get to try this on one occasion. The butcher shop in Kathmandu would display its live produce outside, ready for the choosin’ and choppin’.
Cooking up a momo storm.
Kuhurako momos
Fresh goat for the buyin'.
Something that I got quite good at by the end of my stay was drinking from the water jug without allowing the spout to touch my lips. This is considered the norm over there, so I eventually mastered being able to pour and swallow as I went. I’ll show you next time you have me over for dinner with guests ;)
I was amazed at how much is pirated. Of course there’s the usual CD and DVDs at the going rate of a 90% discount but I found out that their TV channels are ‘stolen’ from India, which made for some culturally unacceptable viewing at times (and Nepal doesn’t even like India). Likewise, I would be amused by the women who would be wearing their traditional sari, whilst sporting a Nike beanie (made in China, of course). Even in Tansen, there were people wearing t-shirts emblazoned with Britney Spears or Bob Marley across them. The ‘Beckhem’ jerseys were also laughable.
Frequently I would be walking the streets to see beautiful women stick their heads out of an above window to throatily hock-up and expectorate quite unceremoniously the contents of their lungs. Although I never tried, I wondered whether reciprocating the feat would impress them.
Many a time I would find myself about to walk through a doorway, only to be barged aside by someone else. Other times I would stand for quite a while allowing others to walk through, waiting for a gap that would never come. Finally, I realised that I just needed to ‘politely’ push through like the rest of them.
Making a Difference
In closing, I would like to convey my deepest gratitude to those who freely gave and helped financially and prayerfully support my trip to Tansen, Nepal. Being there has had a deep impact on my life and its future direction. It’s not possible to come back to Australia and not be affected and changed by what I’ve seen and been a part of.
With the financial support I was provided with, I was able to make contributions towards several projects. Firstly, I was able to purchase in Australia several hundred glucometer strips to bring their glucometer (blood sugar level reader) back in use while they await new supplies to arrive. Some of the medical students weren’t able to pay their way for the NCMDA conference, so again I was able to contribute. A significant amount was given to the hospital’s poor patient fund, which is self-explanatory (and makes a huge difference for these people, often life-saving).
Finally, I wanted to share with you the story of P*. P*, at 15 years of age, was introduced to TM Hospital several years ago after sustaining crush injuries to his left arm and leg. His condition deteriorated as osteomyelitis (bone infection) set in, causing a protracted hospital stay. Although he was unable to ambulate properly and was not completely healed, he was discharged after several weeks. He became a suitable patient for the half-way house, a recently established project for convalescing patients not yet ready to reintegrate with society. Through his time there his bone infections finally healed, leaving only shortening of the bones and some deformity as tell-tale signs. More importantly he became a believer. The project was also able to provide support for him to return to finish his education (he is now in grade 9). Recently he has preached at Nepali church and walking with him you’ll find that the crutch doesn’t slow him down much.
Through people’s support, I was able to generously give towards the building of a new ‘Half-way House’, which is to be constructed in coming years. It is an exciting project that will be a great service to the Nepali people for decades to come. On behalf of the Nepali people, I would like to pass on their thanks to my supporters once again for your generosity.
A Final Word
You’ve all played a part in my journey as you’ve carried me in prayer. I hope these emails have provided a little entertainment and a lot of insight into the exciting things happening in Nepal. I’ll be looking forward to catching up with each of you personally in due course and recount the many adventures that were had (and photos to match). Also, to find out what has been happening in your lives.
Until then, Namaste!
Peter
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