Monday, 27 June 2011
Friday, 24 June 2011
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
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.
Wednesday, 22 June 2011
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
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
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
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
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
Tuesday, 7 June 2011
I had more flashbacks to Peru when we stepped into the taxi at the airport. As I was reaching for my seat belt and coming up empty, I remembered that most of my taxi transit in Peru was sans seatbelt too. Renee, our policy of "safety first" is slow to catch on. The other thing that took me back to last summer was the drive itself. Somehow, pedestrians, cyclists, motorcyclists, cars, and buses shared two lanes of the road - and often lanes for oncoming traffic - without major catastrophe, as lane markers and pedestrian walkways seemed to be more suggestions than law. We were taken to our accommodation, a guesthouse about 10-15 minutes away from Patan Hospital where we were greeted by our didi.
The Coles Notes version: Okay, if you've skipped over everything else, here's the important stuff: we've arrived in Kathmandu. We're settled at our Guesthouse and, after a good night of sleep, we'll be ready to start tackling our to-do list and meet the rest of friends/team tonight.
More stories to come...
Monday, 6 June 2011
We'll keep you in the loop during our travels, but for now, here is a little bit about our project:
But the Nepali people have shown a remarkable resilience and have undertaken innovative political, social, educational, and health-related endeavours that serve as beacons of hope to other beleaguered nations. One such homegrown initiative is the Patan Academy of Health Sciences (PAHS), a university designed from the ground up on the principles of social accountability, admitted its first cohort of medical students in June 2010. PAHS aims to improve the health of Nepalese by producing doctors who are willing and able to provide health care to disadvantaged people living in remote or rural areas. (Learn more about PAHS here: http://www.pahs.edu.np/ )
With the help of our advisors (especially Dr. Carol-Ann Courneya, Dr. Robert Woollard, and Dr. Jane Gair), our group is conducting a pilot project this summer, where we will collaborate with PAHS students to identify opportunities for learning exchange in Kathmandu, Nepal. Along with our Nepalese counterparts, we hope to better understand health care in each country, share knowledge on medical subjects, improve language and communication stills, and participate in research initiatives.
So far we have:
1. ...raised money (with the help of our incredibly generous friends and family members!) to buy these students textbooks and equipment they need,
2. ...planned several basic sciences, blood & lymphatics, and cardiology tutorial sessions,
3. ...written problem-based learning modules to help students in their cardiology block,
4. ... and become incredibly excited about meeting and working with the PAHS students!