Off to Pokhara!

Greetings! I want to let all of you loyal blog-readers to know that we are leaving for Pokhara tomorrow and the likelihood of further blog posts before returning to the states is low. Please google Pohkara and Poon Hill so you know what we'll be experiencing! We're taking a 7 hour bus ride to Pokhara on Sunday and then begins our four day trek to Poon Hill- where the views of the Annapurna mountains are touted to be the best! The first two days of the trek, according to Aarti, consist of a very steep uphill climb so we'll be feeling the burn! Then we're flying back to Kathmandu on Friday afternoon before our departure for the states Saturday at 8pm local time...scheduled arrival is 1pm on Sunday, March 4th in Chicago.

I want to thank you all for reading my blog. I have had a wonderful time here in Nepal and it has been even more enjoyable because I was able to share my experiences with you. If I happen to have more posts before we leave Nepal I will announce it on facebook. Hugs and kisses to you, I will see you soon! xoxo

Oh the views!

We took our sweet time waking up on Saturday, after having beers and playing American drinking games with our Nepali friends- they thoroughly enjoyed the games! We had some tea, instant coffee, granola bars, oatmeal and hobnobs (our favorite imported oatmeal cookie). At 11am we then took off for Nagargot, a town known for it’s spectacular views of the Himalayas- especially at sunrise. We ended up taking the trail with steep terrain and 1000+ steps that were up to my knees. To make the trek even more difficult, there were no villages for 4 hours straight during the most intense part of our hike, thus, no water. We stopped a couple of times along the way to chug what water we had and eat more hobnobs. We had, by far, the best weather during our trip so far. The skies were clear and the view of the mountains even clearer! The valleys were sprinkled with mustard fields and terrace farming was visible in every direction.

By the time we reached Nagarkot it was 4:30pm and we were parched and starving. We stopped at a fantastic restaurant and treated ourselves with anything our hearts desired- from ginger tea to egg chowmein to mo mo’s(steamed dumplings filled with veggies and/or meat) to pancakes with honey. We stayed at a hotel that Aarti had visited years ago called “Hotel at the end of the Universe.” What a spot! We woke up at 5:50am the next morning, put on a few layers and walked up 20 stairs to the hotel’s look-out. Stunning. Fantastic. Wonderful. Phenomenal. Worth-every-ache-and-sore-muscle-from-those-1000+-steps!

After drooling over the sunrise for about an hour, we headed to the guest house’s restaurant where we inhaled drip coffee, banana porridge (amazing!), eggs, potatoes and chapatti, the popular flat bread, with honey and jam. After giving our tastebuds the time of their lives, we packed up and trekked 3 more hours (with much easier, but still uphill, terrain) to Changu Narayan, a Unesco World Heritage site, where one of Nepal’s only Vishnu temples exists. Vishnu is one of the main Hindu gods commonly depicted in Nepali art and architecture. The temple (built/created from the 4^th-9^th centuries) depicts Vishnu in 10 of his reincarnations mostly via intricate woodcarvings. After taking in all of the temple’s glory, we decided our legs had had enough so we bused it back to Dhulikhel. It was such an awesome weekend trek. Even though I busted my butt and I was in pain, it was so enjoyable! It was good practice for our 4-day trek in Pokhara, beginning this Monday. According to Aarti, we’re attempting to complete this trek in less days than suggested by travel guides…we’ll see how that turns out! A few more days at Dhulikhel hospital before we’re off to KTM to bus to Pokhara for our trek (thankfully we were able to move our schedule around to fit in this much anticipated Annapurna trek to Poon Hill). Until then, xoxo.

Take from the rich, give to the poor!

February 20, 2012

Our action packed weekends unfortunately delay new blog postings…please accept my sincerest apology!

To wrap up the end of our academic week, we had general surgery and dermatology. The general surgeon that led our lectures was Dr. Malla- 5 feet tall, bald head, thick rimmed glasses, great sense of humor and adored by the patients…as Ryan would say, this guy was “money.” Nepal’s unique perspective on surgery centers around typhoid fever (a common illness in third world countries caused by a salmonella strain that is common in unsanitary conditions/contaminated drinking water). A late complication of this infection is a perforated ilium (inflammation around a section of small bowel that punctures through the gut, spilling intestinal contents into the abdominal cavity) which leads to “free air” in the abdominal cavity. This causes intense pain, sepsis and can quickly lead to death if not operated on immediately. We actually got to see 3 patients on rounds with this exact complication! As you can imagine, a common complication (of the perforation) is infection of the surgical wound and abscess formation, which almost all of the patients we saw had. We didn’t see the inside of the OR, but according to Katherine there is 1 OR light per room, electricity went off during a case and they had to bring in a light that was battery powered, no disposable drapes, otherwise very modern with up to date anesthesia machines.

Dermatology was great too! Dhulikhel hospital is the first hospital site to have a laser…making them the only hospital in Nepal to provide cosmetic services. Dermatology is the “money-maker” for the hospital and the head of the department said frankly, “we take from the rich and give to the poor!” implying they are able to provide basic services to many people who cannot afford care because their department makes so much money. We joined him in clinic and he did a great job teaching us on the spot about different skin diseases in Nepal and how they might present differently than in the U.S. All of the diseases we saw in clinic were actually diseases seen in America- psoriasis, lupus (I actually have never seen a real case of this in person- she had many of the classic findings!) & eczema. To top it off, we took an “organic coffee break” and had real drip coffee at around 11a.m! It was so delicious and quite the change from the instant coffee we have been having.

That’s all for now but stay tuned for details about our awesome weekend trek! Miss and love you all, xoxo.

An eclectic week so far...

I hope you all had a heart-fluttering Valentine’s Day…I know I did! We treated ourselves to hot chocolate, grilled cheese and soup at one of the fancier restaurants in town (not quite as good as Momma Evans’s grilled cheese though). Prior to our romantic group meal, we babysat Lizzy, Ben & Sarah’s 2 year old daughter so the two of them could have some alone time- we watched Beauty and the Beast, thanks to Elisabeth! Lizzy was very well behaved (as usual) and on a daily basis is having lots of fun memorizing all of our names and saying “wow!”. She’s a little trooper…prior to Ben and his family joining us in Dhulikhel, the three of them (or make that four- Sarah’s 26weeks pregnant!) went trekking in the mountains for 2 weeks!! Brave souls, I tell you.

This week has been a really nice balance of different specialties: 1 day of orthopedics, 2 days of pediatrics, & 1 day of OB/GYN - mostly consisting of rounds-seeing patients in the morning with the team with some teaching here and there and lectures (with lots of tea breaks in between). Here are some interesting tidbits:

Ortho: By far and away one of the busiest services at the hospital- 70-80% of cases due to trauma. The most common traumas are related to RTAs- road traffic accidents. RTAs are also Nepal’s #1 cause of death (in America, it’s heart disease). For more details on ortho, please visit Katherine’s blog as she is our future “haad” (bone) doctor.

Pediatrics: Also a very busy service and very popular among the students. Many of the children in Nepal are faced with similar diseases as American children, the biggest difference is that children here are malnourished and have difficulty fighting off infections, etc. In stark contrast is the prevalence of infectious disease (in both adults and children). An interesting aspect of infectious disease is the presentation of seizures in Nepal. In America, pediatric seizures are usually febrile (high fever causing seizures) or epilepsy (seizure disorder, usually runs in families). In Nepal, infectious causes are always high on the differential diagnosis list. Tuberculosis can present with seizures caused by a tuberculoma in the brain or by way of tuberculosis meningitis/encephalitis. Another infection, by the tinea solium helminth, or worm, can present with seizures. Patients are infected with this worm by ingesting undercooked/infected pork or other meats or by the fecal-oral route (an infected human sheds the worm or larvae in their stool and passes it to another human, possibly by preparing food without washing his/her hands). These little worms work their way up into the brain and can cause seizures, once a patient has proven neurologic disease, the diagnosis of Neurocysticercosis is made. Worldwide, it has been shown that Neurocysticercosis is the #1 cause of new-onset seizures. Crazy!

OB/GYN: The lectures given were fantastic, but the patient-rounding was less than desirable. There are so many OBGYN patients that the team has to do rounds with lightening speed to see them all. Not surprisingly, with the language barrier and less time for teaching, it was not so fruitful for us. On the other hand, the lectures were fantastic! We got to learn all about childbearing and maternal mortality (death in childbirth- before, during, after) in Nepal. As of today, 82% of Nepalese women still deliver their babies at home! Several factors determine this rate: access to care, cultural beliefs. The OBGYN doc lecturing us said that most women would prefer to deliver in the hospital but don't have the means to get there. The government in Nepal has even begun providing substantial monetary compensation for delivering in the hospital to mothers. More training is becoming available so that smaller communities can have “skilled birth attendants,” like a midwife, available for safer deliveries at home.

General surgery is next...then a fun weekend of travel and trekking! Miss and love you all, xoxo.

Happy Valentine's Day!

Much love to the best husband on the planet, Ryan (and cheers to all you lovebirds out there)! Our crew will be celebrating by drinking Everest beers and eating chocolate. xoxo

Lighting a candle at the Namobuddha temple

The girls of the group: Katherine, Katie, Aarti, Elisabeth and myself, surrounded more beautiful scenery!

There’s a chance you may be curious about certain aspects of my experience thus far in Nepal, such as:

1. Food: Most meals consist of a combination of white rice, a lentil soup called daal, and veggies cooked in Nepali spices, together called daal bhaat. The hospital, where we have most our meals, serves this for lunch and dinner. The daal, veggies and spice level vary (Ryan would be so proud of me eating spicy foods!) but overall, the dishes are fairly similar. Breakfast (also served at the hospital) tends to be chia (tea) with one or several of the following: yogurt, eggs (prepared in various ways), dough nuts or French toast (no syrup, just sugar)- overall, pretty close to home. I tend to eat a big breakfast and try to eat smaller portions at lunch and dinner because the daal bhaat can gets a little predictable (and seriously spicy!!!). The meals at the hospital cost us 40NRS~ 50 cents!

2. Weather: It was a bit warmer in Kathmandu, but in Dhulikhel(at a higher elevation than KTM) it has been roughly 60-70 degrees during the day. It’s usually sunny, but fog and clouds roll in from time to time and cool down the temp and obscure our view of the Himalayas. At night, it gets cold. It may only be in the 30’s or so but there’s no heat, so it’s difficult to feel cozy in the evening- thank God for Ryan’s arctic-ready Northface (thanks Loren!) sleeping bag. It has rained once or twice and afterward the environment appears cleaner because it washes the chronic “dustiness” of the mountainside away.

3. Accommodations: We are staying at KUIC guest house (can’t remember what exactly that stands for) and it is affiliated with Dhulikhel hospital. It is a cement building (like most buildings here) and stays cold indoors even when it is warm outside. We have hot water- and is the majority of the reason we are staying here because it is a bit more expensive that other guest houses (~$10 USD/night/room- sharing with Katherine). There is a nice common room where we can all hang out and play card games, read, etc. As mentioned previously, Aarti put a lot of effort into getting the KUIC managers to fix the internet, so that’s a bonus as well. There is a guard that collects our keys every time we leave and always greets us with a giant smile, “Namaste!”