Nepal

Hello folks! Well I have officially been out of the country for 2 weeks now! Its pretty crazy....I dont have much time to write a full post, so I will instead put an email down that I sent out from my first week....its been INTENSE, but good....missing everyone!!

Namaste! and subha sandhya! (good evening!)

this is to be the longest email ever! so please...grab a cup of coffee, beer, a glass of panni (water), and then come back to read this!!

Firstly I would like to thank everyone who has written me an email---you know you who you are. They mean a lot---I feel like I am actually having a conversation sometimes. :) and it has been great talking to some of you over phone! So I start this email there---I may sound sad and upset and possibly cry over phone. but please know---i am doing good....really good. I just get a bit sad over the phone because I dont have "normal" conversations here and so it comes out over phone. SO know that I am good--unless i say so, of course---and that I can't wait to hear about you! even if i make the phone call all about me, because to be honest, i dont speak that much around here. :) (EXCEPT FOR MY JOURNAL---court---i write in that at least twice a day!!)

ok about nepal. I am living in Kathmandu---in the Thamel area---a very touristy area very busy, someone is always trying to sell me tiger balm, or a shirt orm out from 8am til about 9pm (tonight is the exception but you will see why below) because there is little power (sometimes none) and so that is that. Today marks my one week experience here and I have to say at the end of th week--i am so glad i have come.

My first 24 hours i desparately missed my cellphone---i longed to make a quick phone call to say hello, chat about whatever, etc etc. I also realized how dependent on my ipod i was---when i didn't have power to charge it and it was completely dead. Luckily i am able to charge it from 6pm -8pm so i can listen to my music before bed (you know how i am). it took a good 48 hours for me to let go of these, now seemingly silly, necessities. i have gotten over that, although finding a place that only charges 5 cents per minute to call, means i can call more frequently (although this has come to an end---keep reading) and proabably have this week. (Thanks to those who have answered!!!)

I'll start with my daily life this week (And please know this comes mostly from my journal): I wake up around 645 or 7am...i wake up to crows or dogs barking usually. or the luggeee (sp?) man who lives somewhere near by---it wasn't long before I became the luggee woman---the dust and pollution help create some good ones!!! SO i get out of bed and begin doing my "workout" this consists of wall sits, push ups, situps, pike ups, etc etc etc. i cannot run here due to smoke, dust, pollution so my work out is inside...without a gym. I then sometimes take a shower (nicola and court--you should be proud---its been 3 days!!!) but the hot water is solar power so really it would be better for me to do it in the afternoon but i just dont. then i will write, read, or pack up my stuff, etc. I head to breakfast usually around 845 even though they ask me to come later everday. I drink milk coffee which costs about 70 cents for a small point--and this is possibly the best coffee i've had in my entire life. in addition i have french toast, or toast (depending on the belly). Ratna, the man who drives me to work everyday, is always punctuional (i am constantly suprised when he is there) and takes me the scariest 25 minute drive to Chabahill---the name of the area of where the helpnig hands hospital is. I have gotten used to the roads, although the first few days were awful. The pot holes are as big as I am, there are people walking every where, motorbikes, other cars, somehow we have not hit anything (knock on wood). I honestly don't know how he does it, but I love him for it.
I arrive usually around 10am but the doc arrives around 1030 or so. I work in the outpatient clinic in the mornings---I have seen typhoid, hepatitis (type unknown--they dont bother figuring it out unless it lasts for a long time), many many many pnas and chronic coughs. Which brings me to the TB situation. The people here pretty much have TB. Young, old, etc it doesn't matter. And the people refused to take the medication---even when it was basically given to them. SO the gov't (more on that below) has instituted DOTS---a system that requires people to come to the hospital everyday---they sit, take their medications under a person's supervision and then they can leave. in return they get something reduced (rent or something). its crazy to see the line of people everyday. to see the outpatient doc--it costs 60 ruppees or about 85 cents. to see the OB/GYn--its a bit more expenisive---150 rupeees or about $1.75. crazy eh? to get a CBC its about a dollar. it is costly to the people, but not just low enough that they will pay. they come from all over teh country---one family took 10 hours trip to get there. the clinic has been open 4 months and they ahve seen already 20thousand patients. pretty good i think.
there is no ICU, but they have an inpatient of about 12 beds. there is one OR and one post op room that holds about 8 beds. I have lunch in a office---i eat dumplings basically everyday. i now HATE dumplings. :) In the afternoon I finally get to do OB/GYN.
I love the OB docs. I also love the OB nurses...well one is a sorta nurse, and the rest are just training. but they are super friendly and have taught me most of the nepali I know (I can now ask if the pt has a fever, a cough, pain anywhere, and for how long...the ob stuff is much more complicated to learn, but i'll get it!). The OB stuff is great---they definitely estimate fetal age based on physical exam---how big the uterus is, etc etc. We listen to the fetal heart tones by stethoscope!! I have never seen this in the US, but it works well. I have also seen so many prolapsed bladders, and many many many cystoceles, rectoceles, etc etc. Menopause is late here---woman start around age 54 or so. So it is common to see a woman on her 7th pregnancy at age 45 and still baring a child. abortion is completely legal here, and surprisingly it has become more of a birth control method than anything else---i bet the prolifers would love to hear that. Woman refuse to use OCPs so they get pregnant, and the docs take care of it. pretty crazy. They dont run many tests here----so if they see discharge---they decide what kind it is (yeast, bacterial, etc) based on appearance and then they treat for it. No wet prep test, etc. today my last patient---had suspected choriocarcinoma. I actually felt her uterus enlarged and another mass. They'll take it out next week.

So after work, i get home and read. I read by head lamp when the power is out. The power goes out random hours. I never know when it will be there or not. But it sucks when it is out and i'm in the middle of something---the joke is my room probably looks like watergate from my head lamp. I fall asleep around 9pm and then I get up and repeat. I have finished two books so far---first one was a bunch of short stories about nepal called royal ghosts (about when the royal prince killed his entire family and then himself---pretty intersting) and a jodi piccoult book. I tried reading about the history of tibet, but the book was SO dry that I sold it. I am now on book two of the twilight series.

so my big news. last night i met with the founder of the helping hands organiztion. i went to a dinner at his friends house. it was a very nice house---even by US standards--of course I couldn't see much of it because the power was out when we first got there, and i felt ridiculous getting my head lamp out, so we pretty much sat in the dark for the first 30 min. then the lights came on at 8pm and I saw we were sitting in a large living room that had four couches. I was on one of them and then there were about 8 nepali men on the rest, and the woman sat on the floor. i almost jumped up then to sit with them. I was given a homemade alcoholic drink--to which i took one or two sips of---(i was so worried about offending people) and then a large bowl of hot water with a lemon in it was brought to me and the founder. i was told to wash my hands. I copied the founder. Then a large plate was brought to me---one side had hard seeds, sausage on another and fried meat on the other. I first tried the seeds but they were so HARD that I couldn't even chew. I left those alone. So I tried the sausage, but it had the weirdest spice that I gave up on that. I was about to try the fried meat when the founder told me it was goat intestine. My stomach flipped. So I said I would try it. Lets just say I did and there was no second bite. then other things were brought---a doughy type thing, a couple of chips sorta things, carrots ( I ate all of those) cold vggies in a strange sauce. and then another fried meat. I was ready to eat it although my stomach WAS NOT HAPPY at this point. they told me it was fried goat lung. a fine nepali delicatesee. SICK. I took one bite and knew I was done for. I tried to figure out where the bathroom was , just in case. This whole process was but 1.5 hours. During this time I was told my trip out east was canceled, and instead I was leaving in 3 or 4 days (no one knew) for the west where I will remain until my mom comes. I was shocked and a bit pissed no one told me before hand. So I started saying that I was Full---no more fried meats for me. And this entire time the people kept speaking Nepali to each other--so to busy myself I acted like JD from scrubs (something I now do regularly) and drift into my own head...this time i pretended they were plotting ways to kill me---i envisioned how i would escape everytime---from posioning to beating me up===I would dodge it all with my trusty 25 spray pepper spray that is always in my pocket. I was finally brought fried potatoes and asked repeatively if iw as on a diet. I was then told this was just the start---the real dinner was to come. My stomach flipped. again. So I ate the potatoes and hope I misunderstood.
I didn't.
the real dinner was bout 30 minutes later---in the dining room---rice, goat meat, curry, lentilss and truthfully it wasn't bad. but my stomach not being happy already could only eat a bit---more jokes about dieting ensued.

SO I leave monday or tuesday for the west. i am promised to have internet and phone booths but i am guessing they are mucn more expensive so I will not be writing or calling as much. I am told I will be the only OB doc...for which I replied that I was not qualified for that. and I am told I may be living in teh hospital...for which I hope is a joke, but guess it is probably not. I am told the Maoists are at peace here (although a year ago it was not the case) I go there with the founder and so if any problems arise, I come back with the founder. I am excited to leave kathmandu---this is a busy polluted city...i would love fresh air!! But I feel very safe here--probably because I go to bed early and dont go looking for trouble, but also---the people here are SO friendly. The nurses==who live on less than a dollar a day---bought me tea today to say goodbye. I was so moved I almost cried.

And if you felt the earth move this morning---i had my first dance party in my room tonight. picture this: me listening to Counting Crows hanging around here and dancing like no-one-could-see-me in my room. I am happy here. BUT I MISS ALL OF YOU!!!