30.3.10

Tansen, Palpa

Arrived safe and sound after a crazy adventure of 13hrs on a Nepali bus. (For any amount of time it's an adventure, but when you're on for so long you really get to knwo the ppl around you quite well)
 
I've journalled this and hopefully will post sometime, but just a quick note so that you know that we've arrived safely. Meeting @ 0745 tomorrow. so hitting the sack early.
 
all the best to ppl back in Canada!

29.3.10

update

So it's been exactly 3wks since my departure and so far things at the hospital remain somewhat the same. Progress seems unfortunately slow in this country, but also can be quick at times.
 
Update on IFCH hospital
- donations made
- still waiting on an infusion pump and then the Dental room will be ready for usage. The pulse oximeter came in handy.
- still waiting on an air compressor. Despite multiple offers, vendors have still not shown up with anything physical. So we wait... soemthing I am finding it harder and harder to do..
 
Other:
- I was given the opportunity to talk at the Nepal Paediatric Society conference this year. My aunt was also able to attend this interesting conference that illuminated many of the challenges/frustrations that physicians faced in this country. I particularly was saddened by some of the comments made during an engaging panel discussion on whether or not neonates should be resuscitated. Eg. physicians try to their best to save a newborn and finally the child is stabilized and the parents need to discharge in order to get home. Their child is stable but still in critical condition. Their rationale for leaving - a child they can always have another; but their cow, if they loose it, it's over for them and the rest of their family.... It was fitting that the conference theme was "social determinants of neonatal health". Medicine is a very different ballgame here. I was able to share a bit about BABU's initiative to launch an infant flow CPAP program. It was well received, but now to follow through
- My aunt is here with me and we'll be travelling to the United Mission Hospital tomorrow for an intense teaching 7-8day teaching schedule. It'll be fun though cause I actually know what I'll be doing vs. trying to figure out how to be best utilized. The way mission hospitals are run here are so effecient. It's quite encouraging in a country of shear chaos.
- I've had the opportunity to meet with a lot of ex-pats in the area and sharing time/thoughts with them. It's nice to have a fall back community to speak to that I know understands me.
- Just dropped off 2 of my Canadian friends who came and successfully volunteered in the hospital and also at ENPHO (www.enpho.org)
- Will have a lot of contact to follow up with on return from Tansen. There are a lot of people interested in seeing how an RT can be useful. I'll be investigating this cause apparently my chances of getting into the country and contributing clinically are slim. The best way would probably be to come as an educator which seems to be in high demand.
- going through the Mark Series with the Mens group has been great.
- found a good ex-pat church to attend on sunday's at KICC school in Patan.
- load shedding continues - waking up at strange hours of the night to use internet
- petrol shortages seem to be more often now seeing longer lines.
- water shortages are as per normal. We are really fortunate to now have a well. Just finished last week. Now we have water, but the quality unsure. So far nothing funky from dish washing and my 1 shower that I've had in 6days. We'll try tooth brushing with the water soon. Someone came over today to visually sample the water... No one seemed quite concerned. Was tempted to get the ENPHO guys to run their full gamit of tests on the water, but havent' had a chance to get a sample out to them.
 
I pray that things are well with ppl back in Canada. Miss it a lot these days especially since I'm trying to fight an upper respiratory tract infection from all the pollution I've been inhaling. But I'll be out of the valley for a good week, so looking forward to that awesome contrast.
 
Well, gotta get packing, up tomorrow by 0400.
 
peace,
e

21.3.10

start of a new day

So, up this morning by 0630 by the daily contemporary music of performance of chaos by dogs, roosters, chicken, construction and anyone else who wants to contribute. I usually do contribute with a toot or two.

Breakfast consists of bread and deep fried shrimp chips. Very basic foods here lacking nutritional value.

Walk out and find my safa tempo (electric three wheeled vehicle with a small front cab that fits 3 then 2 benches that fit a snug 10. The thing is, vehicles here look SO banged up rust everywhere. I realized that regardless of how well ppl dress, they are bound to get dirty. So everything looks dusty. Anyway, things are as per normal rubbing up against the damp bodies around me. Then the tempo suddenly stops, the driver was taking a call on her cell. This is quite interesting cause we just implemented a law in Canada banning cell phoens and driving. I should have congratulated her. But yesterday I saw some guy dialing and talking on a motorbike, mad skills that i'd like to master some day...

Finally get off and pay the driver for my trip up, only to receive some very damp change. i don't even want to know what that paper is soaked in. Sweat? urine? i wouldn't be surprised by any of it. holding it by the corners i'm not sure whether to just throw it out (and for me to throw out change it's gotta really bad) or not. I get to the pharmacy to buy some more metronidazole and to my surpirse is it's exactly 10NPRs, my change for 10 tablets. The trees have just been trimmed and in the process half the electrical wires have also come down with it. ke garne? what to do...

a day in a life.... and for some the last....

Here at the hospital, the PICU continues to be constantly overflowing.
 
The doc's day started here at 0630 (after leaving the hospital well after 2100 last night) with a surgery then a constant flow of patients streaming in through the doors. Everyone from the underprivileged pt who only has the shirt on their back and hope that this thing called a 'hospital' can make things better for their child to the carefree diplomat.
 
everythign is a lack.
 
Power outages: Are a dime a dozen in this place. It's as if this place is gets a shot of adenosine at random intervals. Lights, computers and all electrical equipment gets momentarily suspended... the generator kicks in but ppl don't know to reset all the electrical things like the AC.
 
A child comes in reporting that a surgical consultation at the only Internationally recognized hospital in Nepal was 12,000NPRs. They were promptly turned off and checked in at another hospital that charged only 50,000NPRs for the consultation, surgery, recovery and entire hospital stay. It's brutal times for healthcare in this country.
 
Note: a good salary in this country is 5,000NPRs/month.
 
Mechancial ventilation 3,000NPR per day at the government hospital
mech. venitlation 10,000NPR per day at private hospital
Congenital Heart defect sx free.  up to 14yrs, but the problem is qualifying them for Sx. recurrent infect'ns prevent them from being candidates.
 
another ER case turns into a disaster as i learn of what standard protocol in a country where wppl dn't know better is. due to the lack of resources and knowledge certain procedures are left not even sure what i'm to write. you'll just have to come and see for yourself. i'm just appalled at the situation. doesn't make sense at all the things you see here.. today was quite depressing, see that body.
 
but i guess situation was bound to come since a diagnosis was made in utero already, but due to non-compliance with medications, lack of knowledge, lack of facilities, this child dies. perhaps death isn't as bad as the process of death...
 
should i be telling their entire stories or are these stories best left untold? perhaps i liiked things better not knowing what can be done or what's going on
 
don'tknow what to think/do... but it guess that's wat keeps you going...
 
somewhat depressed tryign to find hope.
 
i have a presentation to make at the Nepal Pediatric Conference in 4days. . You can pray for good content and clarity. Theme is social determinants of neonatal health. please feel free to fire me any thoughts.
 
it's hard to think after trying to digest what happened today. this country needs help.
 

19.3.10

update

Hey crew, sorry it's been a whil since updating, I'm goign to need some
approval for some expenses incurred. At the current moment I've spent
15000NRps for duty fees in getting all the donated supplies across the
boarder. The boarder rep was originally asking for 25000, but I arbitrarily
asked for 15000. When the final bill came out, I realized that only 1700 was
required by the government our boarder rep pocketted the rest...

other potential requests are
- air hose y-connector,
- screening for windows to prevent flies from entering the hospital wards
-

still trying to setup a bank account

So a typical day. Woke up at 0530 and saw off 2 friends at a bus station.
Went into the hospital early to get a head start only to be greeted by the
most ridiculous time waster exercises. E.g. physically cleaning ethernet
connection in the back of the computer to connect to hospital network. So
frustrating spendingso much time on things you know should take a fraction
of the time. It definitely teaches patience though. So finally finish a
draft for donation list for the charity and a coupon draft for free
pediatric consultations at the hospital. There's still a ton to do for the
conference which is in a week and the CPAP machine has yet to be setup due
to some connectors that still have to be obtained.. Things are slow in this
country.

Anyway, rounds today are a bit less depressing as most of the patients are
decently managed. But it's overkill for the director who rounds twice on
every pt in the hospital while doing outpatient services from 0800-2000
everyday. I remember the first day tha we rounded, there was pneumonia case
in the NICU intubated and ventilated on PC 25/5 FiO2=1.0, RR=60bpm. Modelled
and let's just leave it at that. Goign through charts, it seems there are
enough cases of kids who come to the hospital a bit too late. Perhaps
reflective of the fact that only ~19% of Nepal's births are attended by a
skilled birth attendant.

17.3.10

Integration

@515
twelveth month and 4th day of year 2066 in Nepal. (Mar 17, 2010)
So the plan was to come and integrate into the Nepali way of life here. I believe I'm living quite differently but trying my best to figure out how to be as organic as possible.
 
Up @ 0430 by phone call now, it's still pitch black... and someone is over by 0445 asking if we need more water. It's pitch black now cause of load shedding. we were lucky enought o have some electricity last night (hence able to charge laptop and download emails - way to go offline gmail!)
 
couldn't get back to sleep cause of crazy dogs barking their heads off.. now the roosters are going....
 
But yes, this is Kathmandu and what I'm hoping to integrate into so that the time here can be enjoyed and productive. I'd say my body is still adjusting to dry dusty air, but not as bad as anticipated. More on integration to Nepal life later. I need to investigate the area under the curve of my blanket.
 
just as i say that the birds are now rhythmically chirping away and the dog on the roof running circles..... as the Nepalis' say, "Ke Garne?" meaning ' What to do?'
 
 

13.3.10

Kathmandu update

2215 march ten, two-thousand ten.
Landed uneventfully in Nepal and collected all 12 checkin boxes. Boxes slightly bruised, but nothing spectacular. Somehow loaded onto 2 carts by a zealous porter looking for a good tip. Tried to push past in the express line and stopped by customs people. The papers that I provided didn't seem to satisfy the customes person so had to keep all the check ins in holding. So I was taken to a customs holding area where the stuff was being held until the customs officer could come deal with it in the morning. It was a good thing, I've been here before otherwise, I'd have a lot of trouble accepting the fact that the only colateral I'd get was a ghetto sheet of recycled grade paper that had my name on it. My name which they thought was Canadian/Canadienne as per my passport. 
 
So I exit the terminal and greeted by Dr. Shakya, Nat, Justina, Sandip. Although previously warned by my mother, not to worry, I was diappointed that all this stuff was held up. After meeting a Nepali person we walk right back into the terminal and start asking everyone around what can be done to reclaim the equipment now. I think part of this tactic is to ensure as much ppl know about the equipment that has been heldup as possible so that the ppl that seized the equipment would not be able to secretly make off with the equipment which has occured in the past on countless occassions. It turns out that nothing can be done til the next day. Go back to hospital and hang out catch up for a bit til 0100. By this time, I don't think i've slept over 10hrs in the last 3days.
 
Back at the hospital in the AM 0830 to figure out our tactic for getting equipment back. Return to customs cargo area to reclaim baggage with hospital administrator. Enter into a dicey, dusty warehouse were TONS of suitcases, cargo is kept in holding. we are first greated by a bargaining representative who makes us wait for about 30min and then asks for 600NRps. Apparently this is standard procedure.  I'm ushered in 2ft past the restricted access gates by our bargaining rep to take a look if I cansee my baggage. not able to see much, i reply no. so the next step is to locat luggage, the photos i took and the room where they were held is shown to them and they collect them. another 1.5hr later, the luggage enters the restricted access zone. i'm asked to sign papers and then the boxes are pushed out ofthe restricted zone by eager porters. all the while boxes, andskidsof other held up materials are beingpushedand carted out of this area - everything from treking equipment, coputers, animal anitbiotics, clothing from china are found inthis area. I am now told that half theprocess iscomplete. Here I was thinking that it would all be over. But the bargaining has just begun. I am told that they want us to pay 25000NRps for the goods. Talking with the administrator we decide ona bargaining goal of 15000NRps. We're told to wait.
 
Meanwhil the floors are slowly becoming cleaned with the plethora of boxes being pushed along the floors. It is also important to note that fragile although spelt correctly on boxes is clearly not comprehended. "Breekbaar - Fragile" with the universal glass symbol can be seen on some items that look like they just came out of war. My boxes are in decent shape with minimal holes and scratches; but have definitely been tossed around. In order to increase unloading efficiency, porters load skids to approximately 10 feet with whateer they can take out on the pump cart. a trail of the product they are shipping follows like a crumtrail of a young child enjoying a cookie. In this case, the crums are flat screen monitors. They are kicked along to their unlaoding destination where the 10ft stack is promptly toppled over to create a big pile flat screen monitor rumble. the pump cart is returned while a group of eager porters reorganize the product in their own personal way. stacks of 5, 3,1exist in whatseem to be a formation to create steps. Not sure if they were just bored. As the stack gets taller with subsequent skids that come out, the formation of hte steps start to make sense as these are actually used as steps to get product tothe uppermost part of their piles unreachable on ground.
 
About 2hrs later the bargaining has completed with the bargaining repfinally agreeing to 15000NRps. Theequpiment like every other box inthe cargo area is ripped open exposing it's contents for the scavenging of local authorities for approval. Since we clearly made know our donations were for charities, there wasn't toomuch trouble caused in the search.
 
We finally made it back to the hospital 6hrs after with all the goods in hand with  15600Rps in damage. We find out after the transaction that customs duty only charged us 1695NRps. But this is the way this country works.
 
today we opened all the equipment and had the Capitol Enterprises rep come to help out as well.
 
really ipressed by the International Friendship Childrens Hospital with many clients lining the doors for good consultations. many depressing things to report, but ppl are trying hard here to make things work. It was also nice to see my buddy's donated head lamp still in use for oral exams.
 
Anyway, it for now. next week will be imprementing all the equipment and donating the rest of the stuff to ENPHO and UMH. Been a long week with never more than 6hrs sleep but so much to do.
 
Dogs are awake @ 0530 so better get some shuteye. more later...

Hong Kong

Arrived in HKG 50minutes early just before 0500. The deplaning process was just as quick as the planing process. Quite impressed by the little things dones to optimize the flow of passengers. E.g. separating the boarding pass checkin process to 2 steps, thereby allowing the passenger to walk straight through without stopping until they get to their seat.
 
So I roamed the airport a bit until I found a quiet spot and then tried their WiFi. And it worked! The entire airport is WiFi accessible even the airport express train (but not free there). Caught up on emails and then boarded the Airport Express train. This has got to be the smoothest, and quietest ride I've ever been on. There's just no way of describing a ride on the clouds.
 
As I deboarded at the Hong Kong train terminal, I got into an equally modern looking terminal and proceeded to explore it all before figuring out to get out of this convoluded place. For some reason after about 16hrs of the plane, I totally lost all ability to navigate properly. When I did get out. I started roaming the streets to hopeully hit a couple of sites I saw on a map of the place.
 
ended up at this biological park in the middle of the city with crazy monkeys. Then proceeded up step streets to hopefully hit some type of peak.
 
Met these Philippino house helpers and talked to a bunch of them in the park as they were walking all the dogs of owners. It's very interesting and humbling the type of lives that they lead. More thoughts on this later perhaps. Then met this well-traveled retired highschool physics teacher. I ended up hanging out with him for about 3hrs as we walked to the peak of the city to see the tourist sites. He ended up treating me to a McDonald's breakfast (I had to break my McDonald's boycot; but I think the time that we spent together was well worth it) There is lots to learn from lives of the people that have gone before you. Oh yeah, also met a Nepali security gaurd in HK as well. It's interesting to hear of all the adventures and life lessons from people that have so much life experience.
 
I finally got back to the IFC mall where the train station is and roamed around the harbour trying street food. The craziest system for ordering food.
 
- walking down street full of chinese dried goods, including octopus on street
- go down dark alley where ppl cooking food.
- see somthing i want to eat and order it. told to order with someone different and 2mins later some person who i haven't talked to at all has all my food prepped. had no idea how their system worked, but the food was fantastic. lubriacated esophagus very well with all the oil used.
- crashed at airport
- flight very itneresting meeting a German textiles expert on route to Bangledesh for work.
-fight to KTM uneventful

9.3.10

On a jet plane

So finally after years of conviction, months of planning, weeks of soliciting, days of packing, hours of security clearance, minutes to walk through the gate to the plane, I'm finally off to Hong Kong. The moment is here and now flying over Chita now.
 
In the last couple days rushing to get things together. I realized that this moment now is no more important than any other moment in life. And my time is no more important than any other little child. Each moment is a privilege and to be used optimally. Life is shorter than we all know and I challenge you to treasure each moment doing what you desire. Just watched (more listened) Revolutionary Road while responding to emails where people challenged me to consider what I'm doing. Whether I've slotted myself into a mold or truly doing what is fulfilling.
 
And to be honest, after investing so much time/money into my education, it would seem almost irresponsible not to pursue something related. But is that truly what I'm to do? I've come to conclude that seeking God is first and foremost of importance for from there life convictions originate and true joy and peace occur when those convictions are lived out. Signing off from ~31,000ft. Over and out.

8.3.10

Just about ready

It's the eve of departure day. To say that I'm excited is an understatement, but to say that I'm apprehensive is also an understatement. 

It seems as if the weight of the world is on my shoulders. I feel as if I'm lining up at the marathon startline. Part of me is excited and another part trying to comprehend what ever possessed me to take jepardize my job, take a pay cut, all to go out into the unknown....  But then I come back to the root motivation - realizing that this is a burden that has been placed on my heart. Something I probably can't live with if I just walked on by after seeing first hand the pain and suffering of those in such a beautiful country.

Confirmation came today from my church pastor praying for me in the congregation. I knew then that the church was behind me. It meant a lot; and when he extended open arms to hug me, I think I was still overwhelmed by the privilege it was to represent the finger reaching out to scratch an itch in a hard to get at place. I'll need the help of the other parts (ie. arms, forearm, etc) to get me there and it was nice to see everyone come on board. Additional confirmation came from a friend who came out from Waterloo to send me off. It was nice to also see my uncle and aunt come by to send me off and pray for the trip. Reflecting on all the support, I'm reminded of the immeasureably more than we can ask of imagine that lies ahead...

For a long time it felt like a long uphill battle with countless rejection letters or no responses from vendors/hospitals unable to donate equipment due to legal issues. It has now culminated in almost 10 packages waiting final sealing (ran out of tape). With the help of an ex-beer store worker to help teach the finer details of shrink wrapping packages to be secure, I'm sure that they'll be safe to travel... A special thanks to those that have offered up their vehicles to transport all the goods as well.

So, with less than 22hrs to go and still a bit more to pick up. I'm excited and hopeful.

Wish you were all coming with me to see this awesome country.

Thanks for all your support!


5.3.10

exactly 4 days left...

It almost seems surreal, that I'll be returning to a place where my heart burned to return; yet I feel a bit lost still trying to hack together presentations for people there.
 
But I'm reminded, that I'm there not to impose ideas or things on people but to journey with them. I just pray that all this preparation is going to the reconciliation of man back to peace.
 
With all the donations coming in. I'm feeling the pressure of delivering and making good with the support I've been given. It would be a horrible shame to see this flop. But a reminder that God judges the heart. I just pray that my motivation is pure and work is driven by God.
 
Yeah can't think too much now but figured I should be updating. More later when reality strikes...