Saturday, 23 July 2011

Rural Nepal

This past week has been full of adventure for us. On Thursday, a few more UBC students arrived who were just finished a Global Health Project in India. It gave us a good excuse to take a break and explore Nepal (or at least Patan).
We went to the Patan Durbar Square, Thamel and Asan for souvenir shopping one day and then made the 1 hour trek (by bus) to Bhaktupur Durbar Square. Bhaktupur was my favourite - it was quiet with a lot of old Nepali culture still preserved. I could have spent days wandering down the ally ways, bartering with the locals for souvenirs but we had reservations at The Hotel at the End of the Universe in Nagarkot. Nagarkot is a very small village on a hill that is famous for viewing the sunrise over the Himalyan moutains, that is, if the skies are clear. We were up at 4:30am ready to see spectacular views and drink coffee as the sun rose over Mt. Everest. Instead, we were greeted with fog so thick that you could barely see the trees growing 5ft away. I guess that is to be expected during monsoon season.

Wednesday that week we were scheduled for a tour of rural Nepal and an introduction to rural medicine, Nepal style. We went with a tour guide, a PAHS student and our flatmate, Aaron from New Zealand. It was a long day (we were picked up at 6am and dropped off at the Shalom Guesthouse at 7:30pm) and completely worth every minute of car sickness. It was about a four hour drive zig-zagging tightly up the mountains, dodging pot holes and transversing new rivers that threatened to wash out the dirt roads. We were so impressed with how Nepal is dealing with rural medicine. Like Canada, there are a shortage of doctors that want to practice in rural parts of the country and it is dificult for many people to make the trek into urban areas to seek health care. As a solution to this problem, Nepal has established a tiered system of health care starting with community volunteers. These individuals are usually woman who have basic medical training and are well equipped to deal with maternity issues. They are active participants in trying to decrease mortality due to childbirth in Nepal and they are aware of newly married couples and pregnant woman in the area so that they can ensure they are getting appropriate education and medical care. The next tier is a sub health post that is run by the community health volunteers within a certain geographical area and then a healthpost that serves larger communities. The health posts are run by nurses that run immunization programs and infectious disease awareness. They also have a small lab where cultures can be taken and blood samples tested. In this community we were also introduced to the Women Collectives, which are organizations (started by women) that lends out money to other women for medical expenses or small business loans. I really like the idea of these small communities banding together to give everyone a chance to succeed.
The next place we visited was a primary health care centre, which is large enough to accomodate inpatients. It has one full time doctor as well as nurses and is able to provide imaging and lab tests to the patients. After the primary health center comes district hospitals and then large Urban hospitals (like the one in Patan) that are equipped to deal with almost any medical concern.
This was such a great experience for us to learn how Nepal has identified a problem and how they have come up with a solution that works. I feel like Canada could learn a few things in this area of health care.
Our guide and the PAHS student were amazing - they have such an overt passion for rural medicine and a huge heart for the Nepali people. This experience has definitely been a highlight for me during my stay in Nepal.

Thursday we held another Study Skills Workshop, which was received very well by the second group of students and then Friday was the Mero Mutu Mero Kala (My Heart, My Art) contest. For those of you who do not know, this is a contest where students submit their artful interpretations of the cardiovascular system. There were many drawings, poems, painting, 3D art, photographs and even a music video. All of the submissions were amazing and it was so hard to pick a favouite. One short story left me in tears, others left me nostalgic and some made me laugh. Again, I am so impressed with the Nepali students and how they include their entire person in everything they do, nothing done lightly.

Sunday, 17 July 2011

Butter Naan Anyone?

The past few days have been a blur as time seems to be flying by so fast. I wish there was a way to press a pause button on life to give me time to reflect on the events each day.

One thing I know for sure is that we have eaten a lot of butter naan and a lot of butter paneer. That equals A LOT of butter. But all diet rules are off when you are in a foreign country, right? To even things out, we have been having an lively 80's workout session on the rooftop in the mornings, so hopefully we don't pack out more than souvenirs when we leave.

Over the past week we have held two very successful workshops for the Nepali students. One was about time management and how to schedule your life while in medicine and the other was a study skills workshop. The time management workshop foucsed on tools to help with organization, such as To-Do lists, prioritization and goal setting and then eventually showing the students how we schedule our time and how much of our day is actually dedicated to studying. We recieved good feedback from them and more than anything, I think they like to hear about how Canadians function.

The study skills workshop went even better than the Time Management workshop. We demonstrated how we tackle making notes for exams. We call them our ConEx notes, or our condensed exam notes where we take notes from textbooks, lectures and PBL and organize them into one concise document. The students raved about it so much that those who could not attend the workshop the first time, asked if we would do it again.

This past week we were also allowed to attend PBL. All the students were very conscientious of our presence and inability to understand Nepalese so they spoke English, despite their natural tendencies to debate in their native language. We appreciated this and it gave us a very good understanding of how they communicate to each other throughout the problem solving process. One thing that stood out to me is that after each session every student will give feedback to the rest of the group. And it is honest feedback. They take out the "fluffy" general comments and they tell it like they see it.

Besides schoolwork, we have been able to visit some sites around Kathmandu. We visited a giant Stupa called Boudda Naf as well as the Kapan monastery that overlooks the Kathmandu valley and we visited the Hindu cremation site Pashupati. All of which were beautiful and culturally educational.
Out next stop (if time permits) is Nagarkot where the sun rises over Mt. Everest.

Saturday, 9 July 2011

Namaste Nepal!

It has been one week since Katelyn, Keira and I flew into the Kathmandu airport. We came directly from backpacking around Thailand, which was a good cultural stepping stone for what lay ahead in Nepal. By this point in our travels, we were airport savy so we encountered no problems at the airport, it was what lay beyond the airport that would challenge us. The streets are bustling - there are cars, motocycles and pedestrians dodging traffic everywhere and often vehicles would drive on the opposite side of the road to get through traffic. This was so foreign to me, a country bumkin from Westbank BC, used to intersections with lights, stop signs and very little traffic.

We arrived at the Shalom Guesthouse with a very warm welcome from Kylie, Mike, Renee and Hasan who did everything they could to make us feel at home. Over the next few days we tried to pick their brains of everything they knew about Patan, PAHS and the students. We has several "hand-over" meetings where they intorduced us to the projects that they started and helped guide us as to what our next steps should be. We are sad that we only had a few days with them and we wish our overlap time was longer.

Tuesday was our first day without them. Our first thought was, can we even find our way to the hospital? Luckily we did and it turned out to be a very fulfilling day of lectures and getting to know the students. Today we learned about how to interpret ECGs, which is a difficult topic even for me having already learned how a few months ago. However, I think all the students did really well and asked very good questions. Their dedication and passion for their studies is very inspirational.

Thursday we held a Time Management workshop for the students to help them get organized. We all know how busy life can be and sometimes knowing how to write a To-Do list and make a schedule can make all the difference. It was a successful workshop and next week we will check in to see if the new techniques that we introduced are helpful.

Friday was probably the most fun that we have had in Patan so far. This was Katelyns birthday so Keira, myself and some of the students planned a surprise birthday for her. A couple of the students kept Katelyn late after school because they needed some "extra tutoring" while keira and I went home to decorate. There were probably 20 students who showed up to celebrate with us and it was a great time to get to know the students in a more casual atmosphere.

As much as we love the students, we also love the faculty - both PAHS and UBC faculty.
Earlier that day (Friday) we attended a meeting with the PAHS faculty to discus the writng process of Block Objectives. It was held by Dr. Waechter to introduce a few helpful hints that he has learned throughout his experience of being a cardiovascular Week Captain at UBC. He asked us to come along so that we could share our opinions as students about what we think a good objective and which objectives are not helpful. It seemed like the PAHS faculty took our opinions to heart and they were quite receptive to what Dr. Waechter presented.

Despite trying to cross the street, our stay in Nepal has been very positive and we look forward to the adventures that lie ahead.

Thank you Kylie, Mike, Renee, Eda, Marion and Hasan for laying such a solid ground work for us! Our transition has been very smooth.

Monday, 4 July 2011

A warm welcome and a sad send-off

Well, here I am in the PAHS computer lab, nearly four weeks after touching down in Nepal and coming to the end of my part in Health Trek Nepal (on the ground, that is). Renee left after a touching thank you and donation ceremony yesterday. Hasan, Kiley, and I will be flying to India tomorrow. Although there are more great adventures ahead - and let's not forget the delicious food - this is going to be a heartrending handover, a difficult departure, a sad send-off. Okay, I'll stop with the alliterations! I have a lot of blogging work ahead of me to describe some of our recent adventures (sorry for the delay, it's been a pretty action-packed week and I'll attempt to get some writing in tonight), but my time here can be summarized in one word: unforgettable. Renee and I were trying to list our top three's yesterday and I think we made our way down to number 34 after creating sub-categories (location, people, moments, food, etc.).

Despite falling in love with the Nepal and having a fantastic time at PAHS, it's refreshing to see the project continue with Candace, Keira, and Kaitlynn. Refreshing because they're energetic, eager, and excited. Oops, another alliteration slipped in. I was pretty much comatose after our flight from Canada so I'm impressed that they arrived on Friday evening from Thailand and have been game for the rigourous schedule over the last three days.

Our time together started out with a project debrief at Masala, our local Indian hangout on Friday night - Cardiologists, avert your eyes: paneer butter masala is inching out poutine as my new guilty pleasure - We were up early on Saturday morning for some hard labour at Sunrisa orphanage and then two dinner meetings, first one that we prepared for the PAHS students which culminated in a bhangra dance-off and second with CA didi and Dr. Karki at a Nepali restaurant in the Kingsway area of Kathmandu. Yesterday (Sunday) was a full day of lectures, meetings, and presentations, and another send-off dinner chez CA didi and Bibiana. It's a bit cheesy, but I'm really happy to have had some face-to-face time together during our handover; most of our interactions in the past have been through email and video-conferencing.

The adventures aren't over yet. We're having an electrifying lecture on ECGs this afternoon and then heading into Thamel for good eats and a fun, less formal handover about places to go and things to see in the Kathmandu Valley. And then there's adventure of a very different type!


Monday, 27 June 2011

Sari Shopping

After school was finished on Friday, some of the Nepali medical students (Nihaar, Kailash, and Anjit) offered to take Kiley, Hasan and I sari shopping. Nihaar knew the exact place she wanted to take us, so we hopped in a public transportation vehicle and off we went.
Before we get to the good stuff, first a word on public transportation.  Other than taxis, the options seem to be tuk tuks, rickshaws, or buses. We opted for the latter because there were a lot of us. It wouldn’t be feasible to have a bus in the North American sense on the streets of Kathmandu – those massive giants would never be able to weave in and out of the dense array of pedestrians, cyclists, motorcyclists and cars. (Mind you, there are big air conditioned tourist buses that come through from time to time, but they are few and far between.) The buses in Kathmandu are what we would consider large passenger vans, sort of like a 12 person Ford Econoline if you will, but with smaller seats so as to fit more passengers. They shuttle passengers all over the tri-cities (Kathmandu, Patan, Bhaktapur) and perhaps beyond.  It is close quarters to say the least (I counted 20 people in our vehicle!) but they get you from Point A to Point B for a fraction of the cost of a taxi.

When we arrived in the heart of Kathmandu, our eyes immediately caught sight of a giant white tower. This, our Nepali friends informed us, was Dharahara. 9 stories tall, it was originally used as a military lookout tower, but now serves the same purpose for Nepalis and tourists who want a better view of the city, or perhaps want to visit the Shiva temple at the top. We opted not to that day (we were on a mission!) but will make a point of doing it next time we’re in the neighborhood.

Our Nepali friends expertly led us in and out of the streets and alleyways of Kathmandu, dodging traffic and chatting with us the whole time. We arrived at one particular alley, about as narrow as you could imagine. Here we were guided through kiosks of sparkling bangles to some stairs. When we climbed up to the 3rd floor and we knew we were in the right place.
Everywhere you looked was vivid with color! The PAHS students guided us to a row of stools in the periphery of the room and invited us to sit. As we watched in awe, staff members of the sari shop would unfurl the exquisite fabrics and float them in front of us to the white mattresses covering most of the floor. As soon as one would hit the ground, the staff would open up another sari and parachute it in front of us. We were dazzled! All over the place were sunny yellows, deep indigos, ravishing reds, and icy blues, each with its own intricate, sparkly beading. Our senses were overwhelmed.

We began looking through the piles of unfolded saris to find one that would work for each of us. The PAHS students were wonderful – Nihaar told us which colors would looks best on us, and the gentleman of the group, Kailash and Anjit, were incredibly patient and happy to photodocument the whole experience for us.

Kiley and Hasan each tried on variations of blue, while I tried a magenta one as well as a rich aubergine. If you’ve ever worn a sari, you’ll know that getting into one is no easy feat, especially your first time. You stand, shoes off, on the mattresses amidst the multicolored piles. Your friends and the other patrons of the store look on as a staff member makes a skirt of the fabric around your waist, forms pleats of the material to tuck in to your newly fashioned skirt, wraps you all up and loops the excess around your shoulder. Those who know me will laugh when I say this, but I felt like a princess!

In time we had explored the options and ended up going to a lower level of the store to look at suits. If you’re imagining us trying on grey and black power suits, think again! Suits in the Nepali culture are long draping shirts of gorgeous material and are worn by women. They are less formal than saris and meant to be worn either daily or on semi-dressy occasions. I found a gorgeous purple one with black and gold embroidery that fit absolutely perfectly. Kiley decided that a royal blue sari she had tried on upstairs was something she couldn’t leave Nepal without, and Hasan ended up with the most striking turquoise material that she’ll have tailored to her when she visits India in July.

I think I mentioned in a previous post that it is the custom in Nepal to haggle over the price of something you’re about to buy. The PAHS students took over for us and had an animated discussion in Nepali about how much we should pay. Meanwhile, I played with a baby of one of the staff members, who when I said “Namaste!” would put her hands together and beam the cutest smile at me. In the end, the PAHS students were successful in securing us probably the greatest discounts ever!

Afterwords, Anjit had to depart to go visit his family, while Nihaar and Kailash took us around to buy bangles and bindis (aka “tikas” in Nepal). We taxied home, satisfied with our purchases but even more happy to have made such great new friends!

Friday, 24 June 2011

HealthTrek Presents Canada

The first day we met the students at PAHS they expressed a keen interest in learning more about Canada, our customs, cuisine, extracurricular activities, healthcare system and UBC. A few days ago some of the HealthTrek members and I completed our first presentation with the PAHS students. Although a bit long, I hope all of the students and faculty enjoyed it. Admittedly, I learned a lot that I didn’t know myself.

The students have generously agreed to present a similar presentation of their own. I am really looking forward to learning more about Nepal. Everyday here has been a wonderful learning experience and as our trip comes to an end I feel like I have only scraped the surface of what makes Nepal and PAHS so wonderful…that said, I don’t think there is any amount of time that is enough. I think I finally understand why Dr. CA Didi’s eyes light up anytime she refers to Nepal or PAHS…


I am grateful to the PAHS students and faculty who have opened their school and their hearts to us over the past few weeks. I have been inspired by their hospitality and their kind spirits. Each day, I get to know at least one student just a little bit better, and my gratitude grows. Though we UBC students came with the hopes of tutoring PAHS students in the cardiology we had learned the year before, it is clearly we who are learning from them.

A few years my junior, the students are many years advanced in wisdom and spirit. They are incredibly generous, insightful, and certainly hard-working. It is this spirit, combined with their work ethic, which leaves me learning from them; they are great role models who demonstrate this impeccable work ethic but also the most positive of attitudes towards their work. Each day I observe their keen interest and enthusiasm towards school and their coursework.

When a faculty member is lecturing, it is evident that the students appreciate each moment that the professor is sharing with them. The students focus, attend, and hang on every word, showing that the professors are the most important person in the room. The students know that the professors are a wealth of knowledge to be attended to, and to be respected. They are grateful to be learning, and eager to be doing great work for the people of Nepal. The students are sponges, soaking in every last bit of information shared. I want to bring this enthusiasm, work ethic, and ultimately this spirit, all the way back home with me.