update from Tansen

So been here for just over 24hrs and I think I've been regenerated as I feel as if I'm actually contributing. Today started with a ridiculously good rest (as always indicated by drool)...

 

0700 up and got some reading and praying in.. was actually up earlier too

0745 doctor's group devotions at the hospital followed by doctors rounds with a paediatrician from the states. Helped with inhouse NRP training and running through scenarios was fun and refreshing seeing people gain skills and understand the reason for doing what needs to be done in an effort to save lives best - as we know so far.... Day was done @ 1715 and went out to the city to explore and roam with my aunt. dinner for cheap and good...

 

coolest reading today: Mark 5:21-43: presents a medical case of and lady with idiopathic symptomatic hemorrhaging persisting for 12yrs. The text says that she endured much at the hands of physicians and had spent all she had and was not helped at all, but rather had grown worse. This comes at a fitting time where I am seeing a lot of people with diseases that persist far beyond any reasonable time. Nevertheless, this lady is instanteously cured through her physical act prompted by faith. Make me wonder whether my faith or belief in what I do can help address the hemorrhaging that is going on in the world today. Is that what it means to have faith?

 

The other interesting thing is that this story is encapsulated in a larger story of a 12yr old child who is 'resurrected'. Interesting how the use of 12yrs is used again. For as long as one person was alive, another was hemorrhaging. So while we may seem to be hemorrhaging for a lifetime, there is still hope. 

 

Thank you to all who have written words of encouragement as I try to make sence of all that my senses are trying to process. It's tough, but finding so solice being away from the craziness of Kathmandu in a quieter place where I can breathe and begin to think a bit more. 

 

Hope you are all well... 

 

peace,

e  

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!

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

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.

 

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.

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?'