Greetings from Nepal!!

I know it has been awhile (ok so only two weeks--but time feels differently here) but I hope you have not forgotten me and my Nepal stories--because here come more to jostle your mind! (read: its a long one---again grab a beer, panni (water), coffee, chiya (tea) and be prepared!) I was in a little town called Ghorahi in the county of Dang which is western Nepal. :)

I am back in Kathmandu--after a crazy 19 hour trip yesterday...it was only supposed to take 12 hours--but there was a road strike (of course--just my luck) so we had to go the extra 6 hours around to get to Kathmandu. I got in around midnight---slightly freaked out if I was going to be able to grab a taxi and get me to the hotel. Plus i had no idea if the hotel was expecting me. So I befriended the only slightly english speaking Nepali and won him over---he lent me his cell phone to call the hotel---they were lights on and waiting for me once I got home! (wow i just called it home here in kathmandu---pretty crazy)

My experience in Dang was absolutely crazy. I lived in the hospital which added to the craziness---the Dog gang outside of the hotel was worse than in Kathmandu--one night I finally got a peak and saw the dogs running happily down the street while happily barking away --free from passing tractors, cars, motorbikes, bikes, cows, goats, etc etc etc. It is definitely their turf at night. :)

I ate dhal bhat and sag every day, two times a day. It is rice, and lentil curry and bitter BITTER boiled cabbage. It got old. REAL fast. But what was I to do? It was free and all Nepalis would be grateful to get that much food everyday---so with a happy smile I scarfed it down like it was the best food I'd ever tasted. Every day. Twice a day. for two weeks. you get my drift. BUT the morning coffee was still the best I've ever had---starbucks has something to learn! I have also eaten cooked fish---the whole fish with the eye staring at me---they are lightly fried....its pretty awful actually. the bones are nasty and I spend the rest of the evening worrying I am going to perforate my intestines (yes i am paranoid at times). Sadly my peanut butter jar is finally finished---it has lasted me a month (I"VE BEEN HERE A MONTH!?!?) so it did its part. So that is the update on the food....My mom is getting in this evening (WHOHOO!!!) so I am ready to eat some good stuff with her---some of the curries are amazing so I am hoping to stick to that for a few nights....

The cases. Not much OB. Mainly gyn stuff so that was good. But I also worked a ton in the general clinic and emergency. I saw two cases of Miliary TB----the chest xray was text book---it was so sad though---the prognosis can be bad. Luckily for that DOTS program I was telling you all about (gov't requires ppl to come in daily for the meds) people actually live good lives through TB. I saw many cases of typhoid---high fevers, headaches, and usually constipation although diarrhea can be there....it can be quite serious because they can perforate as well. I saw a lot of PID---pelvic inflammatory disease---but surprisingly it is not usually from sexually transmitted diseases---hygiene is just so poor that B. Facillis is usually the case (although it was never cultured so who knows...)

I debrided a burn wound that took up half a 72 year olds man's thigh---it happened 15 days before he came to the hospital and was VERY infected. He smelled awful---I am pretty sure it was pseudomonas. The burn was from a candle---since he lived in a village and had no power. I had a 7 year old with a type three supracondylar fracture (its basically an elbow fracture for the non medical readers) with vascular compromise---her hand was cold, without a pulse and decreased sensation to her hand. She needed surgery. I tried to reduce it....it was actually a really good reduction but still no pulse---so we sent her to nearest surgical hospital. It was a three hour drive.

I helped with a bad case of COPD and cor pulmonale (right heart failure) of an amazing 60 year old lady---she had pitting edema (swelling) up to her sacrum. All the woman get COPD here---not because of smoking, but because they cook with a wood fire. She was the hospital first charity case. She didn't have money for even food. (the hospital does not provide to the inpatients!) I bought her a pair of shoes---she couldn't afford any and wouldn't walk because her feet were so swollen. I loved her and was sad to see her leave---no money left and was O2 dependent. So she went to her village and will probably die in a couple of weeks.

And I had two TERRIBLE awful sad hearbreaking deaths. They were one day after another of less than one year old baby boys. It was awful. The situation in both cases was just so sad--i dont think i can comment any further right now.

Every day we rounded twice in our 10 bed inpatient hospital-once in the morning, once at night. The labs we were able to do: HIV, malaria, TB, urea, creatine, CBC, ESR, and urine. THAT WAS IT. So for the severely dehydrated patients we had no idea what their electrolytes were. We just just look for renal failure. We had no culture capabilities. So we treated empirically for everything. Luckily resistance for like pneumonia isn't bad, so we could use basic antibiotics--which is good since we didn't have anything else anyway. The only IV pain killer we had was something like pethidine ? I have no idea what it was truthfully, but I dont think it worked so well. Dr. Sanjeev was the only doctor (does it sound familiar Pancho??) so he worked 24 hours 7 days a week. Overnight the paramedics (think of an 8month training after tenth grade---they really knew nothing) would see the patients and then call him if anything happened so he could come in. But there was a brittish doc there as well---Dr. Jessica (no one goes by their last name) and she was just great!! We immediately became great friends and she taught me a lot. She would work with Kumar--one of the paramedics--at night because he had the best english, so that gave Sanjeev a break.

I had to get used to people staring at me. I guess seeing a white girl is pretty rare---I am thinking most people out there have never seen one in person. I had people (random people) ask me if they could take my picture with them. It was so bizarre. I would be just walking to buy some bananas or something, and someone would walk up to me holding a mobile phone and ask to take a picture (in broken English). Better watch out---I am famous now! Hahahaha


I ran a few times in Dang---it was goregous scenery with rolling hills and a river. It was amazing. This really surprised the people---to see a white girl running by. It even surprised them more when I would pant “Namaste!” to each of them or “Good morning” their eyes would jump out of their sockets and then they would smile and yell “Hello!” or “Namaste” back---it was awesome. The security guard was named Shreedhar (Shre-dar) but I called him Shredder--like the Rat from the Ninja Turtles—because I felt like he was my personal protector and I am pretty sure he could do some Ninja moves if necessary (I might have just imagined him doing these…). I loved him--he didn't speak any english so we spoke with my 30 word nepali vocab and lots of hand motions...he was an ex police man so was into running and exercising with me--it was just great.

My main contribution to the hospital was putting together the emergency bag. After their first code (i missed that one--it was a week before I got there) Jessica said it went so poorly that something was to be done. So we bought a computer case type bag and I put it together. It consisted of two ambu bags---one pediatric and one adult (we only had two fask masks---so we cleaned them with spirit which is ethanol drenched cotton---definitely not US standards) and two laryngoscopes--one peds one adult, but we didn't have batteries for the adult and we didn't have pediatric ET tubes (the tube that goes down the trachea to help people breath when we intubate) so we really couldn't intubate anyone....I also put IV cannulas, NG tubes, fluids, and then made a drug box of adrenaline, atropine, dextrose, diazepam, etc (all meds necessary for a code arrest or seizure). I also made saline flushes since those don't exist here. Hopefully it will be a big help the next time a true emergency comes in. Because the way it worked before---we would need to put an IV in a patient, but first the family would need to buy one, so they would go to the pharmacy (which is attached to the hospital) and buy an IV cannula and then come back with it---this could take up to 5 minutes and really delayed the treatment of the emergency. This also goes for medications, fluids, oxygen, etc etc etc. At least some of the real saving stuff is ready available and then the family can just pay to replace it in the bag. Does that make sense???

well that is the best update i can give right now--more after my travels!!