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.