Week 8 Dhulikhel – Nearly the last week at work!

Our students have been on placement for 4 weeks and this is their last week which has come around so fast.  The world is also supposed to end this week, which frankly would have been a bit annoying as I’m looking forward to our Christmas dinner next Monday!

This week has been spent planning and informing everyone about the new clinics and Pulmonary Rehab services that commence next week.  I have also been finishing off other reports and projects so that next week that will be mainly taken up with Christmas won’t be too stressful.

Tuesday afternoon Gill and I took our Saris and material to the local ladies tailor to order the blouse and underskirts to be made.  It is really hard deciding how long you want the sleeves, or how low you want the front to be, we are so used to just picking it off the shelf.  They should be ready next week in time for Sachit’s wedding.

Our tree

Wednesday afternoon we went into Banepa top buy some Christmas decorations and Christmas presents for Min.  When we got back we went to the “Department Store” as called by the locals, known as the local shop to us and bought a 1m high Christmas tree and some Santa hats that Raj and his father has got especially for us from the wholesaler.  After dinner we decorated the guest house with all our purchases and put up the lights and decorations left over from Tihar, whilst listening to Cheesy Christmas music – Perfect.

Thursday evening Charlotte, Lisa and I went to a local restaurant with the Interns.  It was the same place we had been to before Niv left for China.  It serves fantastic momos and sequoia (deep fried buffalo), it also serves the local home brew called Rucksi which is lethal, or so I hear as I have successfully avoided it so far!  Isabelle, who is the other Luxembourger in town, and a couple of her friends joined us as well.  The Nepali Interns are getting used to the fact that western girls drink and stay out late, I think we have been a bit of an education for them.  The evening was spent with Isabelle impressing the Interns with her Nepalese which is excellent as she has been here for 3 years, and talking about football (which I obviously had a lot to say about-not!). The conversation always turns to talking about life in the UK, they are really interested in how our lives are different.  These guys really want to travel to the west, but the value of the Nepalese rupee is so small that it really feels impossible to them.  It was a really fun evening, and we were all home by 11pm – which is a really late night here! There are no rules about smoking indoors in Nepal so sitting for the evening in the smoke fog probably contributed to the sore throat and blocked nose I woke up with on Friday.  I did go into work, and selfishly ate the advent Chocolate as I needed the pick me up, but headed home a little early to bed. I have promised Michel he can have to chocolate on Monday.

Saturday morning was an early start as the Physiotherapy students had organised a picnic in Dolalghat.  This is about 2 hours from Dhulikhel towards the China Border and is a popular spot by the river for picnics Nepali style.  This means the bus was loaded up with enormous sound systems and generators, benches and mats, half the catering staff from the hospital, large gas cylinders and burners, lecturers, and students from all 3 years.  We stopped at various points to pick up food supplies, bags of tomatoes, meat, and veg.  The bus was pumping all the way there – Gangman style and the like blaring out at top volume while the students stood in the gangway and danced – even though it was only 8am and not a drop of alcohol had been consumed. 

Buses and speakers on the beach

When we arrived the bus made its way down the dusty narrow and in some places not bus friendly road and parked up down by the river.  There were already 4 other buses here all kitted out with the same sound systems etc – I could see this was not going to be a quiet day by the river.

Food on the beach

Boating

Whilst the kitchen staff were preparing breakfast we went out in a dugout boat which took us up stream against the strong current - no mean feat, and then allowed us to drift back to the bank.  These boats are pretty unstable and it was a slightly scary ride not helped by Michel standing up and unbalancing the boat half way through!!

3rd year students

The only time my brolly has been used for sun!

Drying soggy bottoms

Back on the bank we lounged and waited for breakfast.  After breakfast we took a rafting ride which was nothing like the Trisuli trip Sarah and I took in October as it was very sedate, and no amount of jumping up and down and screaming by us really improved this although we probably helped the rafting guys get some good trade with our efforts to make it look exciting!  The sun was out by this time and so we lay in the sun drying our now soggy bottoms (and we all know this is not a good thing Mary Berry).  All this time the students had the music on which was a mix of Gangnam Style and Hindi music.  Hindi music is very deceptive.  It often starts off sounding like a western song I think I know and then dives off into a Hindi track.  Gill and I spent some time learning some essential Hindi and Nepali moves ready for Sachit’s wedding reception next week.  Then lunch which was beaten rice, chicken chilli, curried veg, poppadum’s, prawn crackers and tomato pickle.  All prepared from scratch and all delicious.

Sumana won!

Or was it designed just to make us look silly?!

Missed!

The afternoon was spent playing games such as spoon and marble (like egg and spoon but held in the mouth and using marbles), bash the pot (being blindfolded, spun and then given a minute to find the pot and hit it with the stick – much harder than it sounds), dancing and singing, oh and with more eating as the snacks appeared mid-afternoon.

Dancing

More dancing and dinner arrived which was delicious again.  3 helpings of curd and fruit later and we all piled back onto the bus to head back as the sun had gone and it was colder and dark.  The music and the dancing continued all the way home the students had no lack of energy.

We took loads of photos by the river at the end of the day, trying to get the perfect team shot!

Charlie's Angels?

Sumana, Inosha, Me, Nishchal, Michel, Gill, Shova, Preeti

I got back at about 7.00pm, waited for the electricity to come on at 8pm, boiled some water and recreated a hot shower, dried my hair and tried to look presentable ready for the first Christmas Skype call home to Ian, Mum, Dad, Sister, Godparents, Cousins(ish) and Maisy the dog.  Then to bed as my cold and throat was really kicking off and after such a busy day I was exhausted.

Sunday was spent finishing booking for the next stage of the trip and packing my excess baggage up ready to ship to Delhi.  I am ready to go home, but I am not ready to leave so I feel like I’m a bit in limbo.  I hope that by getting all these bits sorted today, that I will have less things buzzing in my head that are distracting me from just enjoying the last few proper days here in Dhulikhel.  Fingers crossed.

 

Week 7 Dhulikhel

This week at work I focussed on finalising the planning with Sumana for the new respiratory initiatives of a Bronchiectasis Clinic and an Inpatient Pulmonary Rehabilitation programme.  An outpatient PR programme like we have in the UK is impossible here as the patients come here from all over the region and due to logistics and financial constraints they generally only come once so repeated input is impossible.  We completed the staff training and will be working with the medical doctors next week.

On Friday I arrived at the Hospital at 7am to join the Hospital Jeep going to Dahding outreach centre for the day.  Dhulikhel hospital has 17 outreach centres which support communities in isolated places.  They are usually staffed by a local community nurse, and a medical assistant, and have the facilities to hold clinics and perform minor procedures.  Dahding is a 30min off-road drive from the main road to Pokhara, about 2 hours from Kathmandu.  For an outreach visit there is a doctor and a community nurse, and then they include others such as interns, physiotherapists and visitors like me.  The visit usually has a theme such as Women’s health or Internal medicine.  Dahding this time was Women’s health. 

First stop on the journey was breakfast, which was curried bean soup and Puri which is a puffed up round flat bread. Then we settled for the ride.  Most of the way was on the main road which was generally OK by Nepal standards, just the odd bumpy section that was damaged by landslides etc.  Once we turned off the road it was a real 4x4 experience.  One hand on the ceiling to stop me hitting my head and one hand gripping the seat to stop me leaving it! 

The view from Dahding

The terrain opened up and we drove around the edge of a steep valley to the medical centre, which had amazing views across the gorge.  Dahding is a new facility and it has a small operating theatre, a clinic room, a small ward of 4 beds and a pharmacy.

Dahding Centre

Patients turn up and are seen on a first come first served basis.  As this time of the year is colder the numbers that turn up are less.  The first case was a child who had previously had stitches for a finger laceration, and now had an abscess on the finger.  This was drained and cleaned and antibiotics were given.  The child was only 5 or 6 and she came alone.  The Nurses chose to hold her down to perform the procedure and this was distressing to see but no amount of persuasion was going to make her hold still, and without a parent there, treatment was given in the patient’s best interest

Nurse Education Group

The other cases we saw were mainly gynae, and ante-natal check-ups.  I didn’t understand the assessments as they were all spoken in Nepali, but the notes were written in English so by looking over the shoulder of the doctor I could keep up with what was going on.  One young woman was in early labour, and she was going to stay at the Centre until her baby was born.  Unfortunately this did not happen while we were there.  The community nurse held an education session for the local women about breast and cervical cancer and the attendance for this was good.  After lunch and a few more patients we left and headed back to Kathmandu.  Outreach was a good experience and working with the doctors and the interns for the day was really interesting.

In Kathmandu I met up with Gill and Michel for dinner at La Dolce Vita, an Italian restaurant opposite Kathmandu Guest House.  This is a bizarre place as it is really Italian and I didn’t feel that I was still in Nepal!  Lasagne apparently made with Beef (although not sure how this is possible in a country where that is not allowed) more likely to be Buff (Buffalo).  Still very tasty and no bad after effects!

NEPTA

Saturday morning Michel and I took a cab to Chuchepati near Bodnath to meet with the Nepal Physiotherapy Association (NEPTA).  We were running a workshop for them to look at how they could develop the organisation for the benefit of members and the profession.  They are a fairly new committee, and I hope we were able to give them some ideas and direction.

A quick trip on the back of Nischal’s bike in Convoy with Bimika on the back of another bike, and we headed to New Road for Sari shopping.

View from roof top over Durbur Sq

Communist March in Durbur Sq

Bimika and I met with Gill and bumped into Charlotte, and went to the rooftop café in Durbur Square for lunch, before heading into deepest New Road for shopping.  New Road is the local place to shop.  It is busy and needs stamina – a bit like Oxford Street at Christmas!  Bimika, with her local knowledge took us to the right shops.  In the first Gill found the perfect Sari in navy blue chiffon with gold, red and white bling around the edge.  We tried on various other Sari’s as the trick with bargaining is not to look too keen.  We decided to go to a couple of other shops to try as there were so many varieties and we didn’t really know what we were looking for.  A trip to Bimika’s cousin’s shop found a potential Sari for me in red and gold, but by this time we were reaching saturation and needed to step away for a while.  We stopped off at Bimika’s aunt’s house for a drink, and whilst there she showed us some sari’s that were bought but not used for a wedding.  Amongst them was a bottle green one with gold and brown decoration.  It suited me well so I bought it, having been wrapped up in it and paraded around the living room!

Gill

Inosha another Dhulikhel physio joined us here, so we hopped into her car and drove back to Thamel to visit another of Bimika’s relative’s shops to buy Sachit a Jumper and a scarf as a leaving present.  Michel, who had successfully avoided Sari shopping by visiting Bodnath, re-joined us and we drove to Bhumi restaurant for Sachit’s leaving dinner.  Sachit was one of the lecturers at Dhulikhel and he is leaving to move to Canada in January.  He has been at Dhulikhel for many years and will be missed.  Dinner was lovely and there was lots of talk about saris and all the accessories, and visits to the tailors for blouses and petticoats that we would now need.

Sachit (flanked by Michel and Gill

After dinner, Michel, Gill and I walked back to Thamel and came across the “Mandala Street Festival 2012”.  One of the pedestrian side streets had been taken over by food stalls and a stage where a band called Kumbala were playing.  The band had drums, wooden flutes, and were creating a good sound, and the Nepali (mainly boys) were having a good dance and sing to the music.  The atmosphere was really buzzing and it was great to be there.

 

Sunday morning I had a lie in.  Gill and I then met up to go back to the first sari shop (isn’t it always the way) to buy Gill’s navy sari.  We bargained a reasonable price (although I am sure Bimika would be disappointed with us) of 5,500 (about 38 quid) and then went to bangle alley to try and find the accessories.  Neither of us are people that usually wear much bling, but with a sari, this is compulsory.  We tried various combinations, but we didn’t manage to find what we wanted.  We walked back to the cashmere shop from yesterday, and bought various jumpers etc. for ourselves and as presents for home, before meeting up with Michel for lunch.

From here we parted company and I tool a cab back to Bimika’s cousin’s shop to buy the red and gold sari I had seen the day before.  I know I didn’t really need 2 saris but I couldn’t get it out of my head……….

The rest of the afternoon was spent buying souvenirs and things to take home.  Now I have decided to ship a bag to Delhi instead of carrying everything around India I do not need to be so restrained with my purchases, also as I only had this weekend clear before Elizabeth arrives I thought I should crack on! (since when did I ever need an excuse to shop?)

At 5.30pm I met Deepa, another physio from Dhulikhel.  She took me shopping for the material that Gill and I would need for the blouses and petticoats that go with the saris.  This was followed by bangle and Tikka (the spot you stick on your forehead) shopping.  Deepa and was able to bargain and get good local prices for me.  The bangles we bought were red and gold and so very bling.  An attempt at shoe shopping was not fruitful as the electricity cut out at this time and we couldn’t really see what we were buying!

Back at the guesthouse I met with Rajesh from Himalayan Encounters as he was putting me in touch with a guy to help me with my Indian visa application.  Indian visas are notoriously difficult to get sorted.  They only open Monday to Friday and you need 3 visits that can take the whole day.  I made the decision to pay someone to have the hassle on my behalf.  I met with the guy who took my passport, application form, and photos, and who was going to get the visa for me for a fee.  A fee which I decided was well worth paying.

Monday morning I met with him again and we completed the first stage of the visa process.  I now do not need to go back to the embassy.  He will call me when it is complete.  It is a bit scary not having my passport in my sights, but I completely trust the guys at Himalayan Encounters so I can rest easy.

Monday afternoon was spent shopping for shoes, nail varnish, and a necklace to wear with the sari. I took the local bus back to Dhulikhel, and sat next to a boy carrying 2 very cute black and white puppies, and arrived in time for dinner totally shopped out and in need of an early night.

Deepa playing tug-of-war

Week 6 Dhulikhel.

This week has been fairly hectic.  I spent Monday, Wednesday and Thursday filming a documentary about Physiotherapy in Nepal with Nepal TV.  The team here have been working on scripts and ideas for months and we only had the 3 days to film it all.

Deepa and the cutest baby ever

Monday I was at the Paediatric Cerebral Palsy Centre in Kathmandu.  A really well set up centre with some great staff and amazing kids.  I am still amazed at how well the kids adapt to their situation even after working in paeds in the UK.  They are happy and as active as they can be.  The highlight if this visit was playing tug-of-war with one boy who thought the whole experience was hilarious, and spending time with another boy who was working at putting rings on a stick – small activity, but big achievement for him.  The cameraman came alone, so I was sound assistant for the day – I got really good at holding the microphone for interviews!

The afternoon was spent at the National football training ground with 6 members of a local team.  This section was for sports therapy.  So was mainly shots of players training.  We had a fake injury scene played out – surprisingly the player acted this out extremely well – typical footballer!

Tuesday was a rest day from filming, purposely planned in case the first day had gone disastrously wrong. 

Students in the library

Wheelchair basketball at SIRC

Wednesday we were filming again.  This time we were at the Spinal Injury Centre in Banepa.  Again a really well equipped centre.  WE filmed so gym based therapy and then a wheelchair basketball game played on the roof.  On the way back to Dhulikhel, we filmed my chocolate shop owner and his son walking with the mountains in the background and then the afternoon was spent back at Dhulikhel hospital filming the education section with the existing students acting out various scenes.

Thursday we filmed orthopaedics in the morning and the very important respiratory section in the afternoon – tricky to do where there were no ventilated patients on ICU that day – typical. 


Gautam and guru doing yoga

Filming on ICU with Sumana and Sachit

NICU

Filming in the hospital was a bit of a nightmare as the patient parties (visitors and family) are too inquisitive and nothing is private so trying to do crowd control was a nightmare.  We also squeezed in the owner of the restaurant here above the guesthouse, and his buddy doing Yoga on the hospital roof for the fitness section, and a few final shots in Neonatal intensive care.  A really packed schedule and literally finished with seconds to spare before the final bus for the cameraman back to Kathmandu!  The editing now begins and I really hope it is ready for me to see before I leave.  We are planning to do a big screening for everyone involved.

Min our caretaker arrived back from China on this day as well.  He had a fabulous trip and was so excited about all his new experiences, first time in  a plane, first time out of Nepal, first time seeing his brother in 3 years – not a trip he will forget in a hurry.

CAKE

Friday was a day to celebrate finishing the filming – any excuse for cake, just like any physio department in the UK.  We also celebrated winning a grant of $15,000 from Elsevier the publishers to improve the computer facilities in the library and also the access to journals.  Michele did the majority of the work on this and he successfully won 1 of 4 grants from a competition of 600 applications.  Friday night was film night in the guesthouse aka, it’s warmer if we all sit in one room together! 

Saturday was a lazy start and then into Kathmandu for a lunch and a catch up with Jim before he heads back to the UK for Christmas, and then shopping for souvenirs to take home (sorry Ian all bigger than a 10p piece!)  I met up with Noga, Adam, Alon Doudi (the medical clown) and friends for a wander and tea before they went home to celebrate Chanukah.  Incidentally this sounds like a great festival as it involves lovely candle light and lots of Doughnuts…..mmmmm cake…….

Alon and I then met up with Jonas and Charlotte for dinner in the White House Kitchen.  This was Jonas’s last supper as he flies to India for 12 days tomorrow before heading back to Germany.  The food was fabulous as expected this is becoming a regular haunt.

The not very thrilliing immigration office!

Sunday was a quick breakfast with Jonas, sad goodbyes and then straight to the Immigration office as today was to be spent extending my Nepal visa.  Actually not as painful a process as I had been dreading.  I bumped into a lovely Australian girl called Annie who was the only person ahead of me in the queue at 9am (only 18 bless her, and first big trip away from home!) After submitting our applications and paying the cash, we shared a cab back into durbar square to kill the 3 hours it took for them to be processed.  Here I bought a small stool (small but how do I get in home??) this is so traditional here and I paid 300nrs (2.10p) I then carried it around strapped to my backpack all afternoon.  We also headed to bangle alley (boys switch off now) shop upon shop of sparkly colourful bangles accessory heaven.  12 glass bangles for 40nrs (25p) top! A quick banana lassi for lunch and then back to the immigration office for collection. 

Here is the surprise of the day.  We could collect any time after 2pm which in Nepali time usually means 3 or 4.  However we got there at 1.30pm and we had our passports complete with new visas in our hands by 1.45!!! Amazing!!

A quick cuppa and piece of cake in a very local café 35nrs (20p) and I took the bus back to Dhulikhel in time to catch the hot water for a shower (just need to wait 4 hours so I can dry my hair now).  Min is cooking Pizza tonight which he steams to cook as there is no oven – strange but ingenious.

Can still see my breath in my room roll on electricity.

Another great week will they never end………………….

 

Week 5 Dhulikhel

This week we had a new caretaker in the guest house.  Min our regular guy has gone to china with Niv to see his brother.  To stand in we have Aashish, who also works in the hospital canteen.  His food has been fantastic.  Highlights so far – Thukpa (noodle soup), Dal Bhaat and momos – min has competition.  Really looking forward to seeing what else her cooks and I plan to learn some recipes from him next week.

Time at the hospital was spent finishing off the curriculum and planning for the filming that we are doing next week with Nepal TV to promote Physiotherapy.  We had a food festival on Wednesday lunchtime.  All the nursing students set up food stalls with traditional Nepal food such as Pakodas, Sekuda and Dal Bhaat.  The food was cheap and fantastic.  Unfortunately Jonas and myself were ill overnight, and charlotte was stricken for 3 days with vomiting and upset stomach.  The consolation was that some of the Nepal physios were ill too probably because the food was seriously spicy.

The Elephant Band

Jonas and my first ever empty
bottle of Nepal Ice beer

Friday evening we took the hospital bus into Kathmandu, the original plan had been to see “Skyfall” at the cinema, but unfortunately it has now gone.  Instead we went to the Himalayan Blues festival being held at 1905 restaurant.  800rs (£5.50) got us an evening of bands from USA (Amy Hart, Sean Carney, Nepal (the midnight riders), Norway (oh no! Blue Elephant With No Hat or Straw is Flying On Air!), and Finland (Wentus Blues Band).  The bands listed were fantastic, the elephant band had a Saxophonist and the Finnish band really got the place moving.  Tonight was the first night I have had beer in Nepal and I even managed to drink the whole oversized bottle which those of you that know me will know that is quite an achievement.  Unfortunately Charlotte made it to Kathmandu with us but was too ill to come to the concert.  Here we also met Doodi who was here from Israel to run a medical clowning course at Dhulikhel Hospital next week.

Christmas Baubles

Saturday morning we returned to 1905 restaurant for the organic farmers market, where we met up with Noga (from Nagarkot trip), and bumped into Alon, who is from Israel and is working for Nepal Telecom – he has been here for 3 years.  Together we then headed to the Regency Hyatt hotel for a charity Christmas Fayre.  Shopping here was mainly for food – the best oatmeal, white chocolate and cranberry cookies, and I also bought my Christmas Baubles to hang up in the guest house.  The highlight of this day was the motorbike ride back into Thamel with Alon.  This is the one form of transport that I hadn’t been on and the long ride back from the Fayre did it for me.  Loved it!  No helmets is the norm it is only recently that drivers have been allowed to wear helmets they were banned during the maoist conflicts.

Motorbike riding with Alon (no helmet!)

Kathmandu Guesthouse

Monkey clutchin phallus
(just for Georgie and Sarah!)

After a quick drink on the bar of Kathmandu guest house, sat alongside the monkey clasping the penis (of course!), we took the bus back to Kathmandu, stopping on the way to the bus park to pick up a new shawl for the cold and Jonas bought a great North Face jacket for 3500rs about 25 pounds.

The bus ride back was crowded.  I spent most of the time wedged between Jonas and a Nepali ladies ample bosom!  Kept me warm though so can’t complain.  Dinner at the restaurant above the guest house, and then we all congregated in one room under duvets to watch a dodgy copy of Skyfall that we had picked up in Kathmandu. Perfect day.

Namobouddah

Prayer Flags

Sunday Charlotte was feeling better and so she joined us taking a cab up to Namo Bouddah.  This time the main shrine room was not open which was a shame.  We walked along the ridge under all the prayer flags, and sat in the sun on the outcrop admiring the peace and the view.  We walked back to Dhulikhel which took about 2 and a half hours and was a really pleasant walk.  Locals along the way gave us directions and we made good time.  I have never considered that the people would dare to give wrong directions I trust them too much – let’s hope I don’t come a cropper one day!

Views walking back to Dhulikhel

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The days remain hot during the day when the sun is out, but the evenings and nights are really cold now, and the lack of heating is really hard to get used to.  I am now sleeping with a t-shirt, a fleece, a neck fleece, thermal leggings, pJ bottoms, thick socks, a hot water bottle, yak blanket to lie on and 2 think duvets on top.  My nose is still cold! The only concern is that it is actually going to get colder. 

No wonder the electricity system is in trouble!

The electricity load shedding (ie time without electricity) is going to get longer.  I am typing this now at 7pm and we have 30mins more before it goes off until 11.30pm tonight.  Luckily the hospital has electricity from solar panels and generators all day so I can generally charge everything up there.



My new dress

I have had requests to put a picture of the dress I had made on the blog so here it is.  The material cost about 10 pounds and it cost 3.50 to have made! The time is really flying by now, with only 3 more weeks at the hospital and less than a month until my sister arrives.  Cant’ sit here typing all evening need to go and learn how to make momos!......