Week 4 – Dhulikhel

This week was a normal week at the hospital.  Sumana and I worked mainly on the curriculum for the new batch of BPTs, and planned the 4^th year for the CPT converters.  We made good headway and have identified the bits I can help Sumana with while I am here.  This week we tried a session with the students that put the emphasis on the students doing the thinking, and encouraged them to think about the patient as a whole including social and psychological factors.  It was a really interesting session and at first they really didn’t get the relevance until we started looking at the physiotherapy role and then we could really see the light switch turn on and the realisation down – a really good session and a new concept for the students and Sumana.

Evenings this week were filled with walks home from work across the paddy fields with Jonas – we decided to take the scenic route in the hope that it would get us home and much to the amusement of the local farmers we saw.  We found our way back to the guest house, passing cows, goats and the harvested fields – A pleasant change from the dusty road.
On Wednesday we had the Norwegian girls over for dinner and Min did a great Dal Bhaat dinner and more lassi, he really knows how to cook the traditional dishes.  He learned everything he knows from his mother.

Thursday evening was spent at the KUSMS graduation party.  Here graduation is call convocation, and like in the UK it is a formal event, this year attended by the Prime Minister of Nepal.  The party began at 5.10pm and was due to run until 11pm.  We popped in early and found it to be empty so went off to Dhulikhel Lodge Resort for some dinner.  Unlike other parties we had attended at the hospital this one was outside, with a DJ and a full light rig.  The music they played was all dance music and a mixture of western and Nepali.  There were many UK songs that had been “danced up” which was interesting.  The bar was serving large quantities of alcohol, and by 7pm there were many drunk students falling around.  It was a novelty to ask the western girls to dance and it was a relief to have Jonas and Niv around to cut in when they got a bit “enthusiastic”. It was a great night and a chance to catch up with the other westerners from the hospital as most of us were there.

Friday was spent in bed, I don’t know if it was something I ate or the alcohol I drank but for the second time this trip I was ill and did not make it into work.  Thankfully by the end of the day and a few Imodium later I was feeling better.  Charlotte and I had a bit of dinner cooked in Min’s kitchen while he was in Kathmandu and had an early night.

Saturday morning I was up at 6am to meet some of the girls from the physiotherapy department for a trip to The Last Resort, which is an adventure resort set in a gorge close to the Tibetan Border.  The bus picked up Sumana and myself as it passed through Dhulikhel, and took about 3 hours to get to the Resort, including a tea stop and a stop to repair the bus.  The plan for the day was for us all to do Canyoning and for Deepa and Sumana to do the Canyon Swing.  We crossed the bridge over the gorge passing the platform for the bungee and the canyon swing and it was the first view of the 160m drop that Deepa and Sumana were going to experience later on.



Suniti, Sumana, Me, Deepa (in front), Bimika, Inosha

Bimika

This was the first time that any of us had done Canyoning and everyone was a bit nervous. We donned our fleeces, wetsuits, waterproofs, harnesses, helmets and gloves and set off with our 2 guides.  The scenery was amazing.  We took a 15 minute walk up the side of the valley, and were briefed before stepping into the first part of the river.  We walked and slid to the starting point for the abseil down the first of 7 waterfalls.  Each time we abseiled we had a guide at the top teaching us to hook on, and a guide at the bottom holding the safety rope. 


Inosha and Sumana

The first 2 waterfalls were shorter and easier, and each got progressively more difficult.  Unlike dry abseiling which I had done previously in the UK this was much harder because the rock surface was really slippery and the water was hitting you at the same time making it harder to concentrate.  I was never scared but it was really exhilarating particularly as we first lowered ourselves over the edge.  The last waterfall was 45m and to get to the end felt like a real achievement particularly for the girls who had not done anything like this before.  We took a 25minute walk back the resort, which was a steep stepped uphill climb – quite hard going in all the gear.



Deepa

Me

The end!

A lovely hot shower and a change of clothes and we settled down for a quick lunch before going to watch Sumana and Deepa make the jump.  They were nervous, but surprisingly happy before stepping out onto the bridge.  We sat under the bridge and watched them from the safety of the bank.  Deepa went first.  They are harnessed up and the elastic comes from the centre of the chest.  From the bridge they swing down and away from the bridge in a massive 160m arc. 

The view over the edge of the bridge where Sumana and Deepa jumped from.

The gorge is so deep that she actually disappeared from view very quickly.  The descent gives 7 seconds of free-fall.  We heard the screaming all the way.  Most of the screaming came from us it was nerve-racking to watch so I can’t imagine how it felt to do it.  Next was Sumana, she seemed a little more hesitant at the top to begin with, but then obviously decided that it was time, and off she went.  We heard the screams again and saw the rope swing.  After they had both finished we heard screams from the bottom of the gorge and this was the 2 of them having their moment together after the jump.  Whilst waiting for them to do the ascent back up to the top we saw their videos which really showed the distance they dropped and the speed of the fall.  They were totally hyper when they got to the top, both a bit surprised that they had actually managed it!

Sumana and Deepa after the jump - adrenaline still pumping!

We took the bus back, and slept most of the way.  It was a really good day out and I really enjoyed spending time with the girls away from work.  Inosha commented that they had never had so much fun with a fly-in – this is probably because they have all been much older than me, but it really was a lovely compliment.  There are plans for more trips afoot so watch this space…………………..

Week 3 - Dhulikhel 



Momo

Monday was a usual day at work.  In the evening we learned how to make Momos with min.  Momos are a Nepali speciality and “Momo Day” is a big event at the hospital every Friday Lunchtime.  These are steamed dumplings filled with either a sweet cheese, vegetables or spiced meat.  We learned the art of sweet Momos – the standard shapes went to pot while we created Cornish pasties shapes and other variations.  Min was really patient and the resulting feast was delicious.  After dinner we went to visit the local radio station, Grace FM. 

DJ Vijay

Unusually in a Bhuddist country, this is a Christian radio station, but in a country with great religious tolerance it has listeners from all religions.  Vijay who was hosting the show this evening has a real radio voice and it was great seeing him in action.  His show is a request and messages show, and has Nepali music for the first hour and Hindi music for the second.  He told his listeners that we were all sitting in the studio, and we received lots of messages wishing us well and Happy Tihar.  Grace FM is on 107.6FM and is on line if you want to listen between 9 and 11pm Nepal time.

At the hospital, it was an easy week as we had 3 days off for the Tihar celebrations. 

Tihar तिहार is also known as Deepawali is a five day long Hindu and Bhuddist festival celebrated soon after Dashain, all ethnic groups celebrate this festival. The name Tihar means the festival of lights, where many candles are lit both inside and outside the houses to make it bright at night. The five-day festival is considered to be of great importance as it shows reverence to not just the humans and the Gods, but also to the animals like the crow, cow and dog, who maintain an intense relationship with the humans.

Kag Tihar Is the first day of the festival (worship of the crows). The crows are worshiped by offerings of sweets and dishes on the roof of the houses. The cawing of the crows symbolizes sadness and grief in the Hindu mythology, so the devotees offer the crows food to avert grief and deaths in their homes.

Monday was Kukur Tihar or Kukur Puja (worship of the dogs). The Dog, believed to be messenger of Lord Yamaraj, the God of death, is worshiped once a year on this day. People offer garlands, tika and delicious food to the dogs.  Tricky when most of them shy away from contact, particularly the street dogs, so people must have taken a bit of a risk or bribed the dogs with food.

My lights

Tuesday was the start of the Newari New Year so I went into Kathmandu and spent the day wandering around buying flashing lights for Tihar.  In the evening I was aiming to go to Durbar Square as various events were due to take place there however I never made it that far because there was so much going on.  I spent time watching a dancing display by a group of young people, they were doing dances ranging from traditional Nepali and Newari dancing, through to hip hop and street dancing. 


Traditional dress

All the doorways to the shops had mandalas outside which are designs on the floor made from stone sand, coloured Tikka powder and marigolds and they have paths painted into the building to guide the gods into the shop, this is all decorated with lights and candles.  Kathmandu was a real picture – as close as you could get to Christmas lights, but in November.  Later that evening I met up with Niv, Adam (deputy assistant Israeli ambassador), Tony (Norwegian from Australia) and the Norwegian medical students who used to stay at the guesthouse.  We went back to the White House kitchen for dinner, which was a nightmare to find but did the most amazing food, and then onto a bar where a large group of Swiss tourists were dancing like your dad and provided the entertainment for us.

Tuesday was Gai Tihar and Laxmi Puja Houses, offices and commercial complexes are decorated with garlands in the morning of Laxmi Puja. The morning of the third day is Gai Tihar (worship of the cow). In Hinduism, the cow is sign of prosperity and wealth. In ancient times people benefitted a lot from the cow. Its milk, dung even urine was used for different purposes like purification. Thus on this day people show their gratefulness to the cow by garlanding and feeding the cow with the best grass. Houses are cleaned and the doorways and windows are decorated with garlands made of marigolds and chrysanthemums.

In the evening Laxmi, the goddess of wealth is thanked for all the benefits that were bestowed on the families by lighting oil lamps or candles on doorways and windows to welcome prosperity and well being. At night the girls enjoy dancing and visiting all the houses of the village with many musical instruments playing a historical game called Bhailo all night long. They collect money from all the houses by singing and dancing and share the sweets and money amongst themselves.

From the third day onwards Tihar is especially famous for Deusi and Bhailo, light and fireworks. Deusi and Bhailo are the songs which have only been sung on those Tihar days. The Deusi is mostly sung by the boys while the Bhailo is sung by the girls. They visit local homes to sing these songs, and in return the home owners give them money, fruit, rice and Selroti (a special type of Nepali bread made by rice flour and sugar).

Mha Puja is the fourth day of Tihar.  The Newari community on the night of this day do Mha Puja (worship of self). Because this period is also the beginning of Nepal Sambat, or the new year of Nepalese especially commemorated by Newars, it ensures prosperity for the new year.

Cows in the street!



For this day I wandered into Durbar square to sit and watch the world go by, today mainly in motorbike processions and processions of cars and trucks.  New Year is celebrated with noise and music and loudhailers that are carried around the city by the bikes and trucks.  The bikes go in groups and the riders all wear a sash of the same colour so you know where they have come from.  Despite the increased traffic however there are still cows in the middle of the street! (Don’t think I am going to get over this!)  Back in Thamel I found an amazing street party had kicked off.  The street was blocked and the biggest sound system I have seen so far in Nepal was blaring out western dance music.  The people at the party were 99% boys and 50% drunk.  Girls stay at home today to help get ready for the evening celebrations.  Having a female westerner to join in was a novelty and not for the first time this trip I became the local entertainment, luckily Niv was there to spread the load.  As today was also the day to worship cows so as with the dogs there were cows (in the streets) wearing Tikka paste and garlands.



Tika Powder

For the evening of Mah Puja I took at taxi to Satdobato which is just outside Patan to join Sumana one of the physiotherapists from Dhulikhel and her family.  Mha puja is the part of Tihar where you worship yourself and wish wealth and health to yourself because if you have these you can lead a good life and live a good Buddhist way.  Sumana’s house was a 3 storey brick house with a secure wall and gate enclosing a beautiful green and flowery garden.  Her family have lived here for 20 years.  The house was very comfortable and warm and was a lovely change from the guesthouse.

Spending the night with Sumana and her family was a real highlight of the week.  They were so incredibly welcoming and involved me in every element of the celebration.  We started by finishing the decorations around the house and garden.  The decorations were mainly lights and lots of small oil lamp, illuminating the house and the path to the front door.  Mimi, Sumana’s sister had made a beautiful Mandap (a small mandala) outside the house and a path with the cutest little footprints led from here to the door.  The footprints would show the way into the house for Laxmi the goddess of light.  

During these preparations the local kids came by to sing for money and treats.  The song they sing translates as:

Goddess Laxmi

Tihar came with light,

Listen everyone,
Laxmi came to your front yard,
Open your heart,
Laxmi came to your front yard,
Open your heart,
Green cowshit on the floor
Worshipping Laxmi
Hey listen to the day of the half moon
The Tihar cow came.
 
Green cowshit is extremely holy which is why it gets a mention.  I am not sure this has been translated into English before so there may be some inaccuracies. 



Laxmi Shrine

The main celebration began by blessing different parts of the house starting with the front Mandap, the gate, the car, the well, the water tap, the cooking stove and finishing with the store cupboard which also had a shrine to Laxmi.  Each part gets anointed and worshipped and tika is placed.  The store cupboard shrine was worshipped by Subhakar, Sumana’s Father guided by her Mother, Renu, who is the facilitator of the evening, she makes sure that everyone does the right thing at the right time.



Dining Room Mandaps

We then went into the dining room and sat on the floor in age order – needless to say I was close to the head of the table! Then sat Sumana, Mimi and Munni, Sumana’s younger sisters.  Inside the house in the dining room and where we were to sit for the evening, smaller mandaps had been made for each of us and I as I finished off one Sumana’s father Subhakar told me the significance.  The mandap is symbolic of the circle of life.  Each of the rings is significant, each is decorated in a different way with rough rice grains, rice popcorn, rice grains that have had the husks removed by hand and then been picked for their perfect shape, and marigold petals covering the lotus petal outline made by the stone sand.  In the middle was a circle of oil symbolic of the soul and a dot of Tika in the centre coloured yellow and orange.  A circle of Jajanka (holy string) was placed on top.   Around the Mandap there was fruit, dried fruit, candles and an incense stick was lit.

We started with purifying ourselves with water, then we were blessed by Renu who placed dried rice and marigold petals all over us, before giving us tika.  We also lit wicks placed in a cross over the mandap.  These had to burn completely to symbolise the cycle of birth to death.  We had holy string, called Jajanka that was the length of our body that we wore around our necks and knees like a protective zone. 

Food is very significant and we ate and drank various foods such as boiled egg, dried fish as part of the ritual and we drank salted yogurt with spices.  All were symbolic and Subhankar described each part to me.  We also received fruit that couldn’t be dropped - tricky when you are trying to balance a pomelo, apples, oranges walnuts etc. in 2 hands! needless to say I dropped an apple which was a bit embarrassing!  After the final blessing we gave Renu money as a “consulting fee” the family had bought her presents as well.   Then we ate a feast for dinner.  The girls and Sumana’s mother had spent the whole day preparing 10 different dishes for the evening, and they had made them less spicy than normal just because I was there which I was grateful for.  The food was delicious there was mushrooms, fish curry, spinach, potato curries, fried aubergine, bean and bamboo curry, bean curry, fried fish pieces, beaten rice (normal boiled or steamed rice is not allowed to be eaten today), paneer, kidney beans, mutton curry and Nepali desserts made from sweetened milk called rasbari.  We finished off with curd (like sweetened natural yogurt) from Bhaktapur (the best curd there is) followed by fenugreek and pickles to help with the digestion.  After dinner I tried Paan which is a betel nut leaf (not the species that gives a high) filled with crystallised spices that you chew and swallow, and a good shot of Apple brandy from Mustang which was potent but delicious.  I have not eaten so much food in one sitting since I have been in Nepal and the whole meal was delicious.  The food was unusual and extremely tasty and it was obvious the amount of effort that had gone into the meal.  At this point I had to stand as my legs and hips were aching from sitting on the floor for the 2 hours.  When we had finished then Renu came to eat and was served by her daughters.



The Baidya Family

After dinner we took a few photos together and we looked through all the photos that we had been taking all evening.  Before going to bed Sumana produced illegal firecrackers that she had acquired for the occasion (illegal but not unusual!).  We went up onto the roof to light the sparklers and also fireworks that were like Catherine wheels but smaller, that you light on the ground then jump into the sparks as it spins – I think the furry slippers I was wearing survived, this was hilarious and although her parents had gone to bed I can be pretty sure they heard every thump!

I had a comfortable warm night’s sleep in Mimi’s donated bed, and stayed for breakfast the next day.  Sumana and her Dad dropped me at the bus stop where I crammed onto a local bus and stood all the way to Bonepa (about 1.5hours).  My time with the family was so special and they took great care of me and really showed me what this festival was all about.  Sumana’s mother was really worried that the spicy food may have ruined my innards, which it absolutely didn’t (and we all know what an achievement that is with me!), and Sumana was really worried that I had no seat on the bus but actually I was so rammed in that I didn’t have to make any effort to stay upright, and in this country I am tall by local standards so I didn’t have my face in anyone’s armpit like I would have had on the tube in London I had a good ride back.  The whole experience was perfect.

Thursday was Bhai Tika the fifth and last day of Tihar, a day where sisters put tika on foreheads of brothers, to ensure long life, and thank them for the protection they give. When the sisters give the tika, the brothers give gifts or money in return. Brothers sit on the floor while sisters perform their puja. Puja involves following a traditional ritual in which sisters circle brothers three times dripping oil on the floor from a copper pitcher. Afterwards, sisters put oil in the brother's ears and hair, then give Tika. Tika starts with placing a banana leave already cut into a line shape placed on brothers forehead held by one of the sisters hand, then applying tika base (made from rice paste) in the open space. Then sister dabs seven colors on top of the base using her fingers or a cotton bud, the seven colors are applied on top of the base. A special marigold garland is made for the brothers, symbolizing the sister's prayer for her brother's long life, and this is put around brother's neck. Then brothers give tika to sisters in the same fashion. Sisters also receive flower garlands around their necks. Brothers give gifts such as clothes or money to sisters while sisters give a special gift known as Sagun (which is made of dried fruits and nuts, and candies), and a fantastic Tihar feast takes place.  

Jonas recieving Tika

I arrived back In Dhulikhel on this day around lunchtime.  This was just time to shower and change into my Kupta and to join the family that own the restaurant above the guest house for Bhai Tika.  We joined them were worshipped by the boys of the family, receiving blessings, garlands and gifts and then we all had lunch of chicken curry, dhal bhaat and curried vegetables, accompanied by frozen slushy mountain dew drink and curd.

Charlotte and I receiving Tika from Min's sisters

The Bahadur Family and Western Guests

At about 3pm We walked to Min’s house to share the same experience with his family.  This time his sisters did the tika for all of us, and his mother had cooked and prepared fabulous food as well, more than we could manage to eat.  Min’s house was very different to Sumana’s, his family are farmers and live in the hills in houses made of mud and clay.  This makes them smaller and darker inside, but incredibly warm in the evenings and at night.  The family have a 2 floor house with a stable on the ground floor for the 2 goats and the buffalo called Kali.  Again Min’s family were really welcoming and his sisters Muna and Romila,and his brother Sam, all speak excellent English and were great fun to meet.  We stayed over at Min’s house and the girls kindly donated their bed to Charlotte and me, I slept well here too.  In the morning we walked back to Dhulikhel in time to change and head off to work.  I had removed the Tika to sleep but was left with a stain from the coloured powder which was a lovely reminder of Tihar.

Min and Water Buffalo callaed Kali

Min's House

Friday I finished work a little early as Niv, Jonas and myself were going to head up to Nagarkot to meet with Adam and Noga – a new friend from Israel working for an NGO in Kathmandu.  Nagarkot is at 2175m and sits on a ridge in front of the Himalayas.  It gives one of the best uninterrupted views in the area (weather dependant).  In our wisdom we decided to take the bus. 
The first part of the trip was crowded to Banepa, which is fine for me but 6’2 Jonas and 6’ Niv don’t travel well standing up in a bus designed for 5’5’’ people.  We then hopped off to meet Nota and joined a bus To Bhaktapur with the idea of then catching a cab.  The cab prices were ridiculous for the distance we needed to travel, but the drivers were taking advantage of the fact that the last bus to Nagarkot was already bursting at the seams.  After a bit of deliberation, and prompted by the fact the bus was going to leave, we elected to get on the roof of the bus.  We climbed up and joined the other locals on the roof, the best seat at the edge with legs dangling off were taken so we sat in the middle of the roof.  I was wedged in between a monk and a guy heading back to army camp.  I was cosy and warm (and glad of my down jacket) Niv was cramped and Jonas was sat on the ladder holding on for his life for the first part of the journey. 


On top of the Bus with Niv.

Noga had thought better of it and had squeezed into the bus properly.  This should have been a hair raising experience careering through the mountains in the dark up ever ascending winding roads, on a bus that seriously looked like it would fall apart at any moment, and looked like it couldn’t possibly hold all the people squashed inside.  But it was actually comfortable, warm and not scary - maybe because it was in the dark and I couldn’t see over the edge.  A bonus was the guys heading back to army camp shared their peanuts with me.  Once the bus top cleared out a bit we were able to sit on the edge for the last 30 mins of the journey and take in the views and the sheer drops.  We arrived at Nagarkot after about 1 hour and were met by a chap from the hotel.  Adam had already made his way up on his motorbike and was happily settled having a pre-dinner nap in bed.  We turned him out and headed up to the bar to order rum punch and dinner around the big open fire.  Dinner was good, but we were knackered so after a few games of shithead we headed to bed.  The room I shared with Noga was comfortable and warm and really quiet so we were in for a good night’s sleep (can you see a theme here the guesthouse is not warm so warmth is a big bonus!). 

Sunrise at Nagarkot

The next morning we got up before 6am to walk to the top temple to see the sunrise over the Himalayas.  The view was fantastic, and it was worth the effort.  Unfortunately I had spent a few hours of the night up being ill and so probably didn’t fully appreciate the view at this time.  Back to bed with Imodium and a long snooze later and I woke up much refreshed and ready for breakfast.  After breakfast we said goodbye to Adam and started the walk back to Dhulikhel which was going to take us about 7 hours. 

The Himalayas

Noga, Niv and Jonas.

The walk back was relatively gentle with not too much “Nepali Flat” and with good company it was a lovely day.  The sun was hot and conditions were good.  Today was obviously everyone’s day off and there were many groups of children and teenagers having picnics.  We gave some of our apples to a group of kids who swapped it for some radish.  Many of the groups wanted to stop and chat. The conversations here tend to go the same way: “where are you going?” , “where so you live?” – we learned that to say Dhulikhel and not England completely stumped most of them.  “what is your name” etc.  The less fluent in English just stuck to “one chocolate, one pen, one rupee…….”.  We made it back to the guesthouse and were joined by some old guests of the guesthouse, 4 Norwegian medical students.  Dinner was one of the best yet -  chips, fried rice and banana lassi..............

Strange bugs

6

DHULIKHEL

Week 1 

I was collected from Kathmandu Guest House by a Hospital vehicle – a very comfortable 4x4.  The journey to Dhulikhel took about 1 and a half hours. 

Dhulikhel sits approximately 400m above Kathmandu and has amazing views of the Himalayas.  It sits on the main highway and the streets leading off it are wider, smoother and much quieter than Kathmandu.  Away from the main town it becomes more rural very quickly and walking here I will see mainly countryside and farming areas.

The back of the guesthouse my room is 3rd floor up window on the left

my room

Nabil Bank- Entrance to the guest house

I arrived at the guest house which is three floors down from Nabil Bank, and 2 floors and a world away from the rooms I had been taken to with Sarah and George!  There are about 7 rooms each with its own bathroom (complete with western toilet).  Min Bahadur is the manager and he provides breakfast and evening meals from the kitchen managing with nothing more than 2 gas hobs, there is no oven. 

Min

Min cannot do enough to make us happy and his intentions are good.  He has a book that we write in each day to say what we want to eat and what time we want each meal, and this will be the basis of our bill at the end.  He seems to not then refer to it again, so my muesli and yogurt at 7am becomes egg toast after we have woken him up at 10 past 7.  I am sure it will all work out in the end though and he is really a very lovely guy.

Also staying in the guest house is Charlotte a Dietician from Luxembourg who is here until March with the hospital and then stays to play in Nepal until the end of May.  We get on well and I am very pleased to have her around at work and in the guesthouse.  She already speaks 5 languages; French, German. Luxembourgish, Spanish, and English, and with this natural talent she is picking up Nepali really quickly – I however am not!

The temperature here is hot during the day, although not as warm as Kathmandu and cold once the sun has dropped.  Now I am wearing trousers and a long sleeved top for indoors, but lunchtime sat in the sun is baking hot.  The sun drops at about 3pm and then indoors it is very cold – fleeces, scarves, heaters and hot water bottles required.  It does get to a point where outside is warmer than in, particularly as there is no heating.

The hospital is spread over the hillside and occupies a large area.  Over the past few years there have been great developments and where there were paddy fields as far as the eye could see, there are now new buildings and staffing accommodation popping up.  The building is of good quality and looks very smart.  Most of the usual departments are here; Internal Medicine, Paediatrics, ICU, Surgery (upper and lower GI), and orthopaedics.  Most of the support departments are also represented, with laboratories, microbiology, radiology, parasitology (!) and of course physiotherapy.

Library building on left and Teaching block on right

Further down the hill are the university buildings, KUSMS which have classrooms and practical rooms allocated to each subject.  The library is small, and is gradually improving there was even a copy of Physiotherapy (CSP UK edition) on the shelf.

One of the first mornings I attended morning conference which is where representatives from all departments meet to inform everyone else which patients have been admitted and to report on the existing patients.  This meeting is largely in English, and is led by the chief doctors, Dr Koju and Dr Ram.   I was really surprised at how technical the language was that was used – I had expected it to be simplified as the 2^nd language, and I was also surprised at the range of conditions and surgeries that were being conducted.  They exceeded my expectations.  

The wards were as I expected.  They are much more basic than in the UK, and practices are occurring that we have put a stop to, such as nurses coming into contact with blood and not wearing gloves, going from one patient to the next with no antibacterial measures in between, and being bear below the elbows.  Uniform white coats have just been introduced, but they are all long sleeved.  Before entering ICU we have to change our shoes, and wear a full gown and face mask, which is good, although the gowns are shared between staff and between patients, so in some ways it defeats the object.

The physiotherapists visit the medical, surgery and ICU wards every day and see every suitable patient, and their underlying knowledge is excellent.  There are many barriers to care and knowledge here.  Internet access is limited and so collecting evidence based material is difficult.  Resources are tight, so for example getting a post-op patient out of bed day 1 is difficult when all they have to sit in is an uncomfortable plastic chair.  The doctors seem to have a very prescriptive view of physiotherapy and it is not always easy for the physio staff to make their case.  The patients pay for care here and the general education level of the majority is very low.  This means that they do not understand preventative management, they do not see the benefit of getting out of bed and moving around when they are ill, and when things deteriorate then do not understand that medicine cannot work miracles.   I have seen families getting aggressive and blaming the medical teams for the death of their relative (not unlike the UK!).  Indeed when people die the family are brought in immediately so they can see the drains and Lines and oxygen lying around the bed space as this is one way to show them that everything was done to help.  Patients often would rather spend their 200rs on medication rather than physiotherapy which means utilisation of physiotherapy services is lower than I had expected.

The caseload here from a respiratory slant are post-op patients, COPD, Bronchiectasis, Asthma and poisoning which is extremely common, both accidental and purposeful.  Organophosphate (OP) is readily available to the farmers and when life is that tough sometimes they use this as the way out. It causes multi-organ failure.

The main aim of the first week was to establish exactly what I would be planning to do during my time here, there is so much that could be done, but I have time limitations, I am also well aware that change is slow and having only 2 months is likely to mean that some projects may not complete before I leave.

The key people I will be working with are Sumana and Sachit, who the current lecturers on the Bachelor of Physiotherapy course, and also cover the clinical caseload on ICU.  Krishna is a newly qualified physiotherapist who covers the Medical ward, and Jabina covers Surgical.  Ranjeeta is in charge of the course.  The rest of the department is made up of outpatient, orthopaedic, Neuro and Paediatric physiotherapists.  There is currently another fly-in here called Michel, a Dutchman from Austrailia.  He has been here since February and has a more over-arching role to improve the department as a whole – he leaves when I do in December.  The staff team are extremely welcoming and friendly, and are working really hard to produce a quality service and course.

The team from the left: Bimika, Shova, Michel (behind), Deepa, Krishna (behind),  Jabina, Nischal (behind), Inosha, Sumana, Ranjeeta, and the tall one is me! 

There are currently 2 physiotherapy courses running.  There are 13 3^rd year students who have previously completed the certificate course and are now converting to the bachelors – they have all been practicing physios in between courses and have more experience.  The other course is the 1^st year Bachelor course and these are all high school leavers.  All students are Nepali and all teaching is done in English (most of the time).  The learning style is very different here and I can really see the difference between Nepali and UK students.  Here the facts and knowledge base are absolutely sound, so when asked a factual question the entire class will accurately respond.  Challenge them to apply this theory, and to use their clinical reasoning and the response is less solid.  This feels a direct opposite to the UK where clinical reasoning is promoted and well developed, and often knowledge base is the lacking area.

This week as also sports week, where the students play basketball and football against other student teams – I am pleased to report that our boys and girls won both!

The main aims for my time here will therefore be based around development of the curriculum for respiratory.  Encouraging forward planning.  Supporting the staff development, and developing out patient respiratory care.



Garden of Dreams

Dasain swing

Friday night I took the bus into Kathmandu and stayed in KGH.  I pottered around in the morning and then met Sue for lunch in the Garden of Dreams.  Sue lives in Patan with her husband Al and they teach at the international school.  They’ve been here for 3 years and I have got in contact with them through my “cousin” Bex who used to work with them in Reading.  The Garden of Dreams is a haven in the middle of Kathmandu.  It was built in the 1920’s by Field Marshall Kaiser Shamser who modelled the gardens on those he had seen in Edwardian England.  It is manicured and comfortable with ponds and pagodas. Sue and I had a luxurious lunch and cocktails and then played on the Dashain swing set up in the garden which was top!

Early morning views

Namobouddah from afar

 Sunday was spent hiking up to Namobouddah with Michel and Gill his girlfriend, who is an Irish physio who now lives in Australia.  We left at 6am so that we would arrive in time for the morning teaching session and the walk took about 3 hours.  This was a particularly special session as it was being led by Thrangu Rinpoche who is one of the key spiritual leaders in this branch of Buddhism.  We were allowed inside the main temple and we sat on the cushioned floor with all the other monks who really didn’t seem to mind that we were there.  We knew that the session was going to be translated into English, but we didn’t realise you had to take a radio to hear the translation so the upshot was that we sat for over 2 hours listening to Rinpoche read Nepali from a book.  This was pleasant apart from the occasional hack, cough and spit into the microphone!  Despite not knowing what he was talking about, the atmosphere was lovely and the chanting done by all the monks together at the start and the end of the session was quite hypnotising.  I am glad we stuck out the full session.  The session as also available on the website so on return  from the walk I listened to it and it seemed to be a lot about digestion and how to keep it healthy and how this affects you spiritually – maybe a good job we didn’t hear the translation?! 

Preyer flags at Nomobouddah

 

Views from Namobouddah

Sunday was spent loitering around Dhulikhel working out which shops were available and I also put in the order for the dress to be made from the material I had purchased in Kathmandu – to be picked up after Tihar.




Week 2

This week I made some headway with the planning of the clinical placements for the course.  The team is not so good at forward planning, they work more in the moment, and when I presented the 5 year forecast for the number of students they will be taking and the number of placements that will be required against the number of places they currently have there was definitely a sharp intake of breath.  They will be quadrupling their student numbers once the course is full which shows their success.  I feel that I am really settling into the department and I am building a some really lovely relationships.
 

Friday night we took the hospital bus into Kathmandu stayed at KGH.  An Israeli friend of Charlotte’s called Niv joined us from trekking in Lang Tang.  He also volunteers at the hospital as an intern doctor.  Although we were tired we made the effort to meet up with Sarah a student doctor who had volunteered at the hospital previously, before travelling around Nepal.  She was back in Kathmandu to meet her boyfriend who was coming out to join her.  She had called us from Dubur Square where there was an end of festival concert taking place.  Jazzmandu is a week-long festival that showcases Jazz musicians from all around the world in Kathmandu.  The stage set up in the middle of the square, complete with flashing lights and a DJ was incredible.  The Nepali crowd were going mad to a band called No Jazz, a French band dressed in peculiar outfits including a DJ dressing in an all in one foil suit!  The music was excellent- and there was a saxophone as well which pleased me!

Saturday morning was taken over with the best massage I have yet had here.  We took a cab to a Spa  where the beds were heated and the massage was amazing and lasted for more than 1 hour – feeling very chilled, and a little oily we made our way back into Thamel to shop for gifts to take to Min’s family for Tihar.  This turned into a bit of a shopping fest - 2 cashmere jumpers for £14, Niv bought a north face coat for £25 – bargain. After treating ourselves to a good coffee and sandwich at Java coffee, we headed back on the bus to Dhulikhel. 

Sunday was spent pottering around Dhulikhel and catching up on mundane jobs.  In the afternoon I went for a wander in the paddy fields and took a good book to read.  This time of day it is warmer outside so sitting in the sun to read was perfect.  Whilst sitting there I was joined by an old Nepali woman who had come up from the fields.  She sat down gave me her sickle and rested her hand on my leg.  Anywhere else in the world that would be a reason to get up and leave, but here this is quite usual – physical contact like this is to be expected.  She spoke to me in Nepali and I replied in English and we got nowhere, but it didn’t really matter.  The only thing we managed to understand was “Dhulikhel Hospital” which is pretty universal here.  When the sun went down and it got cold outside too, we both went our separate ways.

 

Today Jonas arrived to stay in the guesthouse for the next month, he is a final year medical student from Germany.  With Niv's return, this made our guesthouse group now 4.................