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.

Thursday, 23 June 2011

Introducing Anthony Marston

Learning medicine sometimes feels like we’re also learning a new language with hints of Latin, Greek, and even some previously hidden treasures in English. How do you begin to decipher the polysyllable words that health care providers sputter off? Let’s use an example from yesterday’s approach to medical terminology workshop: gastroenteritis. A word that meshes nicely with my previous post on food…

Linguists, eat your hearts out:
Gastro- for “stomach”
Enter/o for “intestine, usually small intestine”
-itis for “inflammation”

When you put it all together, gastroenteritis is inflammation of abdominal viscera, usually involving the stomach and small intestine. Months in advance of touching down in Kathmandu, we were warned that most North American visitors would develop gastroenteritis, a reaction to the food, water, and/or environment in Nepal. After all, the “flora” - the bacteria and other microorganisms that exist in Nepal at this time of the year - are different than the ones that we typically encounter back in Canada. Despite a battery of vaccinations including typhoid and Dukoral (cholera and some E. coli protection), we’re not completely primed to fight off these foreign invaders. [Enter gastroenteritis.]

Hearing that most of us would be affected, we thought that we would draw some experience from Agatha Christie’s work: “And Then There Were None”. In this mystery classic, ten guests are tricked into coming to an island and, one-by-one, they get knocked off the island. Parents, don’t worry, our 2011 guesthouse version doesn’t involve anyone getting bumped off. We were curious to see who would be affected by the wicked gastroenteritis that we were warned about and whose gastrointestinal system would be robust enough to endure the entire time.

I’m sad to say that I’m the first to be affected: the Anthony Marston of our tale. Last Thursday, Renee, Kiley, and I arrived at the domestic terminal of the Kathmandu (Tribhuvan) Airport when I realized that something just wasn’t right. I became very familiar with the facilities at the airport and had a diva moment where I wasn’t sure if I could board the plane (sans washroom by the way) for our quick 25-minute jump to Pokhara. We arrived without any close calls and walked through Pokhara’s calm streets to Fish Tail Lodge (see Renee’s post for more Pokhara details). A touch of vomiting, a dash of fatigue, and a spoonful of GI upset, but I made it through the day relatively unscathed thanks to Renee and Kiley who snatched an antibiotic (Ciprofloxacin) from the local pharmacy, refuelled me with digestives and Pringles, and rehydrated me with WHO-approved electrolyte solution.

With Cipro on board, I thought that I was in the clear. That I had had done my pledging with the dreaded combination of gastroenteritis and travel. I couldn’t be more wrong. I started to experience symptoms again on Monday evening and, unfortunately, wasn’t well enough to attend our first problem-based learning (PBL) session on Tuesday morning. I spent most of the day cycling between being a couch potato, sleeping, and frequenting the guesthouse’s facilities. It was one of my body’s weakest points – there were times when I could barely muster the energy to sit up; moving up and down stairs felt like doing the Grouse Grind. I had an incredible amount of support from the rest of the Health Trek team, CA didi, and even a personalized home visit from one of the administrators of PAHS. I started to recover yesterday morning, only to relapse again in the evening. I was so uncomfortable during the evening that I wasn’t able to sleep and watched the entire Hannibal series on a local movie channel. I don’t know if it was the best thing to settle an already tumultuous stomach, but it kept me entertained in the early hours of the morning. I finally decided to ask for some antibiotic advice when it felt like my abdomen had more pressure than road bike tires! CA didi and the PAHS team have been amazing – they quickly arranged a ride to a clinic at Patan Hospital and a visit with one of the physicians who didn’t seem too concerned about my current condition. A big thank you for all of you who looked out for me.

Fellow travelers, especially to Nepal, a few reminders that I wanted to share from my consultation today:

- Travel shots are a good idea, but don’t provide complete protection
- Be cautious about your food and water quality, but gastroenteritis can still occur with strict precautions
- Cipro is not the miracle drug that I expected it to be and can give you a false sense of security; because of its wide and sometimes inappropriate use, many pathogens have become resistant to it in Nepal
- Your travelling pharmacy should perhaps contain some of the following: dimenhydrinate, metoclopramide, loperamide, and some form of antibiotic coverage
- Worsening symptoms, blood or mucous in stools, and high fevers always need to be investigated further

Now, we wait and hydrate. I can’t wait to put this behind me and get back to work on the project. The next question is: Who will play Ethel Rogers in our tale? I certainly hope the novel comes to a surprising ending before Ethel Rogers plays her part.

And then there were five.

Pokhara: Day 1

We had a few days of downtime last week when the PAHS students were writing their Haemopoetic Block exams so Mike, Kiley and I decided to go to Pokhara for 3 days. We had heard many great things about this sub-metropolis from students who are from Pokhara, from friends of ours who had travelled there, and from Bishnu, a colleague and friend of our HealthTrek Nepal mentor Carol-Ann Didi, so it was a natural choice for our mini-vacation.  

Pokhara is about 90 miles from Kathmandu, as the crow flies, and there are two ways of getting there: a 25 minute flight or a 6 hour bus ride. We opted for the former, and chose Buddha Airlines as our chariot over the breathtaking mountains of Nepal. As we waited to board in Kathmandu, Mike (he’s given me consent to tell you, and will blog about this later!) developed a serious bout of gastroenteritis. Needless to say we were all a bit on edge until we arrived safely at our hotel, the Fishtail Lodge. At that point, the Kiley and I were able to procure some ciprofloxacin and oral rehydration salts, and Mike started feeling better within hours.

The Fishtail Lodge is located on Lake Phewa, the second largest lake in Nepal. To get to the Lodge, you have to cross the lake on the Nepali version of a Seabus. To a Vancouverite, the Seabus is a large, motorized ferry that sails between downtown and the North Shore, across the Burrard Inlet. To a Nepali, the Seabus consists of planks of wood nailed together and secured to large floating former oil barrels, covered by a sheet metal roof for the rainy season. It is powered by a person who physically pulls the boat across the lake, back and forth, for 24 hours a day. Perhaps it wouldn’t be feasible in Vancouver, but I enjoyed the latter because it was more serene and more environmentally friendly.  


I spent the first day walking around Lakeside, a somewhat touristy, somewhat “hippy” part of town, filled with artisan shops and charming cafes, all amidst the thick smell of Nag Champa incense and the snow-peaked Annapurna Mountains. If you know me at all, I bet you could guess that I loved it! I wandered down the street to warm shouts of “Namaste!” (the beautiful Nepali greeting which means “The light in me honours the light in you”) from merchants and other passersby, and sometimes even the endearing but clearly untrue (given my sweaty, post-travelling appearance) “Kumari!” (goddess) from the occasional over-zealous vendor.

Since we got to Nepal, I’ve had my sights on the colourful saris worn by many of the women. So it is no surprise that I was lured into a sari shop when rich reds and dazzling purples caught my eye. I picked out 3 or 4 potentials and asked the seamstress if I could try them on. Though she didn’t speak much English and I speak almost no Nepali (yet!), she motioned to one of her 3 daughters in the shop to take me to the changing room. I followed her through a narrow, cinder-block corridor to a room that turns out wasn’t a changing room at all, but a 12’ x 12’ space outfitted with two beds, a hot plate, some clothing, a TV and some dishes. This was where the family of 6 lived. (I learned later from a Nepali man I met that rent is so high along Lakeside that people opt to live in their stores.) When I entered, a man who must’ve been the seamstress’s husband scooped up their young son and scurried out the back door, as their daughter drew the shades and left me alone. 2 of the saris fit perfectly, as if they were made for me. In Nepal it is common, and expected, to barter when you’re buying something, so the seamstress and I haggled a bit, smiling the whole time. For $5500 Nepalese Rupees (about $75 USD), I became the proud owner of a gold sari with crimson flowers and a blue one with hunter green and silver embroidery.

I carried on down the street, dodging cows and stray dogs, until I got to a grassy field near the lake. There was so much going on around me – teenagers playing soccer, children swimming in the lake, tourists chattering excitedly about the sights, construction workers building houses – but I had the most peaceful sit down as the sun lowered to the horizon…


Wednesday, 22 June 2011

For the love of books....

Hello everyone!

Thought I'd write a few notes about some interesting books we've been reading about Nepal while we're here.

1. Little Princes by Connor Grennan
I was able to read this one a few months ago, and Marion, Eda and Mike are into the story now. It's a fun read. Jist of the story is that an American plans a one year trip in 2004 and hopes to do something helpful during it by volunteering at a small orphanage for two months just outside of Kathmandu. He falls in love with the children and Nepal and embarks on adventures and goals inspired by this.

I love as he comes to terms with what it means to sign up to volunteer (a moment I can remember living myself in the past): pg 16 “I hadn't realized until that moment how much I did not want to walk through that gate. What I wanted was to tell people I had volunteered in an orphanage. Now that I was actually here, the whole idea of my volunteering in this country seemed ludicrous. .... I couldn't recall ever spending time around kids, let alone looking after them.”

There's also his traveller's account of what it was like stepping into Patan Hospital where we are volunteering next door to: pg 36 “..Farad and I took both boys to Patan Hospital in Kathmandu... Inside we navigated the dense crowd. I kept my head up, looking helplessly at the signs in Sanskrit hoping for a clue as to where to go. I found the admissions desk... she called over a colleague who knew a few words of English.. The hospital itself was a terrible place. It felt more like an abandoned bus station than a medical facility. Everywhere, patients sat or lay down with wounds covered in dirty bandages. ... We were directed to yet another room, where we were told to take a number and wait our turn. The number on the screen was six. I looked at the number on my piece of paper. Seventy-nine.”

We've not had the need to be patients ourselves yet. But the faculty we've met have been inspirational.
In general, my perceptions of the hospital have been more positive than this.

2. Red Dawn Rising by Katrina Butterworth
Thanks to our mentor Dr. Bob Wollard at UBC for recommending this one. Katrina has lived in Kathmandu for many years I understand, and wrote this work of fiction which describes the Nepali Maoist insurgence and a family's survival through it in wonderful detail. There's several moving moments in it for those of us in health care-- another account of Patan hospital: pg 3 “A woman sat in the crowded room and tried to look around her without actually catching anybody's eye. She had never been inside such a huge building... In this room the outside clamour of hundreds of voices had settled into a slightly respectful murmur... In front of them were ranged a row of desks.. and beside each desk was a man or a woman in a white coat with a bit of tube strung around their necks – the doctors she supposed.... She had been waiting for hours. From 5 o'clock this morning, she had been standing in first one queue and then another. Impatient men had pointed her from line to line...One of the doctors called out...”Which one is sick?” “All of us”...”Then you should have bought three tickets, not just one.” The doctor looked at the flash of panic in the woman's eyes and sighed in exasperation. These village women were so hopeless.”

There's much more “food for thought” in this book. A must for anyone thinking of coming/volunteering in Kathmandu I think. Just makes you reflect.

3. Lonely Planet Nepal
So glad Renee was able to bring few copies of this one! Renee and Mike have been keeping us up on the history of Nepal with the Forward in this book. It's also been great for helping us create our own walking tours in Nepal, and the maps as always are helpful. For Pokhara, we used it to find our “luxury” hotel that donates its proceeds to a Cardiology fund (kind of fitting for this trip!) and for a few tips on restaurants (I ate at the highly recommended Canadian/Nepali restaurant there... mmm amazing paneer and naan!)

4. The Tipping Point by Malcolm Gladwell
This book has been out for awhile, but just had a chance to read it. My sis Lauren was a bit curious this book was in the “Self Help” section of Chapters online (and kindly loaded it onto my Kobo for me). But the author tries to break down why change can occur, suddenly but not always spontaneously. It made me analyze some of my friendships and connections back home but also loved the health care example on the spread of syphilis and thinking outside of the box on what caused the spread of this STI in Baltimore.

It seems I always get more reading done when I travel.... next on my list: “250 mistakes 3rd year Medical Students Make”. Crossing fingers I learn something in that book too!

Saturday, 18 June 2011

Lessons learned….

We have only been in Nepal for a few days and already I have realized how many things I take for granted both as a medical student and a Canadian. Nepal is an amazing country rich in history, culture, and kind people. It is the differences between Vancouver and Nepal that have helped me gain a better appreciation for my hometown Vancouver, as well as my new home away from home, Nepal.

The following are only of few things that have struck me over the past few days:

1) Water: According to my discussions with our local hosts as well as my travel books, water shortages are a chronic problem in Nepal. Of the water that is available, many of our resources have told us not to drink the tap water, which is a drastic change from Vancouver, where I’m now appreciating that not only do I take the clean running water in my tap for granted, I also use it too liberally.

2) Electricity: Electricity cuts (“load shedding”) are a fact of life here in Nepal, where electricity is rationed from city to city. Again, this is a stark contrast to our lives in Vancouver where on the rare occasion that electricity is cut, perhaps due to a tree that has fallen on a power line, I find myself frantically searching for my flashlight or a candle as well as not knowing what to do with myself without a cell phone, computer or tv. Thankfully, the Nepalis have taught us how to appreciate electricity when we do have it and to not take it for granted. Although I can’t say I’ve experienced the load shedding to a significant degree I have experienced the less than ideal wireless. I wouldn’t say I’m addicted to my wifi but perhaps I am severely dependent and may be experiencing a slight withdrawal…

3) Fortification of food: Today, we attended a lecture regarding the importance of Vitamin A in health. Vitamin A is a critical micronutrient that has a number of functions in maintaining our health, including vision and child development. In developing countries such as Nepal, Vitamin A deficiency is a reality due to malnutrition. What some of us living in Canada may not realize is that this is not a major concern in our country because we have regulations that ensure our food is fortified with important nutrients including Vitamin A. Today, we learned that in Nepal fortification is challenging because many individuals in rural communities are living off their land and do not access processed foods. Luckily, there are a variety of initiatives currently underway to develop sustainable solutions to this public health problem.

4) As a medical student, I have realized that I have been taking the notes packages that are prepared for me, my textbooks, and other resources for granted. Although they may not have the same materialistic resources that a UBC student may have access to, my time here in PAHS has made me realize students here are flooded with what I believe makes a great medical program: supportive faculty, passionate professors, and driven students, just like home.

5) Family and friends: Having been living in a hole studying for exams over the past few months, and then promptly leaving to fly across the globe, I have realized that I take my friends and family for granted. Thankfully, I am travelling with some of the most wonderful friends a girl could ask for, and I have landed in a country where everyone has made me feel like a long time friend, or even family.

Monday, 13 June 2011

Let them eat dal bhat

One week before departing for Nepal, I spent an evening with some of my closest friends at Vikram Vij’s infamous restaurant on Granville and W11th Avenue. Appearances included the usual suspects and a few new players: a round of Punjabi heart attacks, beef and lamb samosas served with coconut, the infamous lamb popsicles, a soul-satisfying paneer and lentil curry, and curried trout. The meal was so satisfying (disclaimer: I’m not endorsed by the restaurant). The dishes could only be outdone by a celebrity chef run-in with Vij himself (see Facebook for photographic evidence).

After a night chez Vij and in limbo between end of exams and our trip to Nepal, I was left wondering what the culinary experience would be like in Nepal. My last adventure to Peru was a very meat-and-potatoes experience, although there were some pleasant veggie surprises along the way. Preparing for Nepal, we had heard so much hype about the traditional Nepali meal of Dal Bhat, a generous bed of rice with a lentil “stew” and vegetable tarkari (curried vegetables). Would we be eating Dal Bhat all day, every day? Would it still be satisfying after four weeks? Would we find other savoury treasures while exploring Kathmandu’s restaurant scene? As a self-confessed foodie, these are the things that were crossing my mind and, on the ground in Nepal, I’m happy to report that fellow foodophiles will be pleased.

Today in an engaging lecture about vitamin deficiencies, one of the instructors used the image of treading carefully over a bamboo bridge. If I can take that out of the vitamin context and apply it here, we’ve been doing much of the same: trying to cross the gap from Canada to Nepal and have an authentic Nepali experience while treading carefully and avoiding the wicked travel-related gastroenteritis. I decided to be go vegetarian during this trip. There are some concerns about meat handling, food preparation, animal treatment, and sustainability, but these concerns aren’t exclusive to Nepal. Vij, don’t worry: I’ll probably be coming back for the lamb popsicles eventually. I thought that it would also make for an interesting challenge. The mission, should you choose to accept it: to find restaurants that offer vegetarian meals while consuming adequate protein intake. Fortunately, every restaurant we’ve visited so far has vegetarian options and some have been exclusively vegetarian.

Making a throwback to the HDI block (Host Defences and Infections), one rule of travel that’s stuck with us is that eating food from street vendors is an at-your-own-risk activity. How many fruit stands have I walked by, tempted by the bright flesh of watermelons and thick golden slices of mangoes? Or the sweet scent of freshly grilled corn? Or the fried doughnuts (sorry CA, I know they’re not heart healthy)? Dommage.

Don’ts aside, our first exposure to Dal Bhat happened on our first official day in Kathmandu. Kiley and I made friends with a Swedish student staying at our guesthouse who showed us around Thamel, the tourist district of the city. Raving about a fabulous combination of hummus with paprika and fried onions and mushrooms, he escorted us into OR2K on a quiet pedestrian-only street in Thamel. Kiley opted for the Dal Bhat and I selected the coconut curried vegetables. As expected, the Dal Bhat was filling – the lentils, warm and satisfying; the vegetable tarkari, spicy and crunchy. I have only glowing things to say about the veggies prepared in coconut milk and a delicate combination of spices. I could really get used to these.

Two days ago, we thought about experimenting with our own lentil curry. Didi at our guesthouse, however, is a bit of an expert in the kitchen and prepared the Dal portion for us. We insisted on preparing the vegetables (eggplant, zucchini, green peppers, onions, garlic, and ginger) with cashews and spices (tumeric, cumin, and coriander). So flavourful and so much fun to prepare in our own kitchen. I think our next target will be the hospital cafeteria – every morning on the way to PAHS, the scents wafting from the kitchen can make even the fullest of stomachs ready to receive more food.

I could drone on and on about food for hours. We’re trying to be safe about our food choices while keeping our taste buds stimulated. We’re discovering so many homecooked and restaurant dishes that will make me miss the Kathmandu food scene when we leave for India in a few weeks. Until then, let them eat Dal Bhat.

Saturday, 11 June 2011

UBC Meets PAHS: The Launch of HealthTrek Nepal

So as you’ve read thus far, we made it to Nepal safely and have been getting acclimatized. I am glad I avoided the math of how long it would take to travel here, because I may have been intimidated and missed out. By the way, it’s 36 hours (…not that I noticed). Mike and Kiley got here one day ahead and led the way once we arrived. We checked out the grocery store, had some fabulous meals and settled in. Now, that sounds very relaxed doesn’t it? Don’t be fooled, if you read about our morning exercise regime you’ll know we don’t just laze about. Thankfully, during our 36 hour journey I didn’t know I was expected to be up early on my first morning in Nepal following a strict “boot camp”.

But the real highlight of our first day here was visiting Patan Hospital and meeting PAHS Faculty and students for the first time. HealthTrek Nepal has officially begun. So we set off.

Five excited UBC medical students began the walk to Patan Hospital, the number 1 hospital in all of Nepal, yet still only has 1 doctor for every 150,000 Nepal residents. Understandably so, we were very eager to meet the people behind the hospital and school that we had heard so much about. The 20-minute walk was an adventure in itself, we got to see some sights and were ready to face the challenge of traversing the roads of Nepal. We had been warned, but certainly didn’t appreciate what the challenge would be. Being a pedestrian in Vancouver does not compare to what pedestrians in Nepal face - the fury of motorbikes, vans, cars dogs, and even cows racing at you in either direction seems similar to the videos I’ve seen of running of the bulls in Spain.

The locals, however, commute with ease and as pedestrians traverse roads seamlessly. Not to worry though, now day 2, I must say we are quicker at crossing streets – one person, usually Mike, takes the lead and decides when it is as reasonable as possible to cross, and as a group, we just go for it.

When we walked through the gates of Patan Hospital we immediately gave a sigh of relief and appreciation that we were there. Our hope was to have a moment or two with Dr Shambhu Upadhya, the Undergraduate Medical Curriculum Coordinator who had been so kind to give us the opportunity to come to PAHS. Dr. Upadhya made space in his incredibly busy schedule for us and received us so warmly that we each felt at home. His energy and enthusiasm for PAHS is contagious. He is at the helm of an intensive selection process of 1800 applicants for the relatively limited space available for the next incoming class – the current class is only 58 students. They are conducting the interview process in just a few days but Dr. Upadhya focused his attention that afternoon to welcoming us and ensuring we were comfortable. Dr. Upadhya took further time made sure to introduce us to Faculty and we had the honour of meeting Dr. Arjun Karki, the Chief of the Department of Medicine at Patan Hospital and Vice Chancellor at PAHS. Again, Dr. Karki made time for us and warmly welcomed us to PAHS and Nepal. Dr. Karki is well-respected and was the trail-blazer who spearheaded PAHS. If you haven’t realized, we were meeting the leaders of Nepal medicine and we were thrilled.

As an added bonus, Dr. Upadhya surprised us by having organized a student meet-and-greet to follow. We were ecstatic – we had thought we would just get to have a few moments with Dr. Upadhya and we were incredibly touched to find out he had planned an entire afternoon for us.

The students were kind and excited to meet us, as we were to meet them. Like their mentors, the students welcomed us warmly, sharing tea and conversation with us, and suddenly, we felt we had friends and family here with us in Nepal. We discussed ideas with the students of how us UBC students could be helpful and how we could work together for a successful summer of projects and activities, including learning and cultural exchanges. Before we knew it, we were making plans to attend the next morning’s Grand Rounds and lectures and left the school more excited than when we arrived, full with tips on local activities to do while we’re here.

We walked confidently back to our guesthouse, dodged the dogs/cars when necessary, and made a list of to dos for the upcoming weeks. We look forward to working more with the students and will let you know what we have in the works. In the famous words of one smiling student ready to participate in the UBC/PAHS exchange, “we’ll make it work.”

Friday, 10 June 2011

Make it work Hospital "Ambulance" and ICU patient transport

Just had a few flashbacks to my days as a Respiratory Therapist today. For about 3 years, I trained and worked at Royal Columbian and Vancouver General -- two of the largest hospitals in British Columbia and both major trauma centres.

One flashback was watching a patient transported from ICU to I'm not sure where at Patan Hospital (Where the Patan Academy of Health Sciences is attached to.) Three people were moving an older metal bed with smaller rickety wheels down a hallway. No IV poles or IV med administration devices, no RT and ventilator (granted this patient was not intubated). Patient had broken his right leg as about three water filled jugs were attached to a pulley system to provide traction. Simple colourful blankets in his lap. No white-dressed porter pushing the bed, but a women in a pink sari at the head of the bed trying to steer, and two gentlemen in khakis and polo shirts at the rear.

Another flashback came as were were leaving the hospital grounds to walk home. I'm used to screaming ambulances, diesel engined ambulance trucks, C-spine precautions, and 911 calls. A man had probably fallen at a construction site. Instead of calling an ambulance, his co-workers brought him to the hospital (maybe faster? maybe affordable than the local ambulances? Not sure.) Unconscious, 1 person held his head, two his arms, and two his legs. Blood dripped from his left temple. Needless to say, it made us all stop in our tracks and reflect.

Maybe these flashbacks will make you reflect a little too?

Hugs and love from Kathmandu

We've arrived!

Eda, Marion, and I landed safely in Kathmandu two nights ago (sorry about the delay, the internet has been a bit sporadic) after a quick stop in… Bangladesh? Yeah, it was a surprise to us, too! We took a taxi (the details of which are not appropriate for the parents in the audience!) to Shalom Guesthouse and had a lovely reunion with Kiley and Mike, who showed us to our rooms and gave us a tour of our home base for the next month.

After an incredibly restful sleep, we woke up to do Kiley and Mike’s grueling version of boot camp, which we are going to try to do every morning. The program consists of a variety of calisthenics, strengthening exercises, and cardio (Hi Dr. Courneya!). It was during this 30 minute routine that Eda, Marion, and I first met our “Didi” (Mike and Kiley had met her the day before). Didi is a Nepali term that translates to “elder sister”, and our Didi is sort of a house mother to us. Five or six days a week, she comes and does all of the housework and even does our dishes. It’s been pretty tough to adjust to, as all of us have the instinct to lend a hand. But she insists on doing all of it herself. In return, we repay her by picking up one extra chocolate croissant or cinnamon tea for her when we go out.

 Anyway, Didi arrived just as all of us were doing our boot camp program and she must have thought we were nuts! She couldn’t have been more pleasant though, and we’re happy to have her.
We then stepped out into town to run a few errands, namely, getting a couple of cell phones for our group to share. Crossing the street was a test of bravery, to say the least! More on that later.

Then the five of us had a lunch meeting at a restaurant across from our guesthouse, where we discussed some of the details of our project.

Then we were off to the Patan Academy of Health Sciences to meet some of the faculty and students we had been emailing prior to commencing our trip. We will write more on this AMAZINGLY warm and wonderful experience later, but we just wanted everyone to know we’ve arrived safe and sound!

Wednesday, 8 June 2011

6 hours to go!

Hi all!

Marion, Eda, and I have arrived safely in Hong Kong after a 13 hour flight from Vancouver. We flew on Cathay Pacific, which is apparently quite a treat. When Marion asked our flight attendant whether we got food and in-flight movies, the reply she got was, “Honey, you’re flying Cathay Pacific”. Needless to say, we ate well, slept better, and were thoroughly entertained on our flight!

Upon our arrival, we took the HK Express train into town and toured around the biggest mall any of us had ever been in. We didn’t want to venture far from it for fear of getting lost and missing our connection, so we literally spent about 3 hours walking around it…and still didn’t see everything! It was also the fanciest mall any of us had ever been in. As we walked through we were serenaded by live classical musicians, and everyone seemed impeccably dressed. This made for a stark contrast between our attire, which featured more conservative, (much!) more casual, lounge-y airplane clothing. You should have seen the looks we got. I haven’t felt like such a social pariah since two weeks ago during finals (see the before-and-after documentary photo on Facebook if you haven’t already). But, we justified it by reminding ourselves how ridiculous we’d look if we showed up to Nepal in haute couture.
We did end up stepping outside into the sun for about a half hour and checked out some of the sights around the perimeter of the mall. Hong Kong is stunning! If you ever get the chance to go, don’t hesitate for a moment. Go there. Picture beautiful mountains surrounding incredibly stylish architecture amidst crisp blue waterways. Gorgeous.  

We had to get back for our 6 hour flight to Kathmandu, after which we’ll be reunited with Mike and Kiley in Patan, but not before we feasted on the most delicious salads you can imagine! We will look forward to stopping back and treating ourselves to leafy greens on the way back to Vancouver in about a month.

For now, the three of us are off to Nepal in about an hour. We’ll try our best to write more ASAP! Stay tuned…!