Thursday morning we had breakfast
in Kathmandu and piled into a jeep headed out of the city towards Kogate.
Another truck in front of us was loaded with our bags and tied down with
a tarp followed in front. We were excited to escape the city and the
pollution just to see a little greenery and of course begin our clinical third
world journey. Though we were not looking forward to the bumpy ride ahead
that we were warned about. It wasn't too long before we were heading up
and down passes witnessing some breathtaking views. There were many close calls with oncoming
traffic, but all and all I was impressed with the roads. They were bad of course, but not horrific.
The terrifying part was the tight turns and the unknown of what car was
around the next curve that we might crash into.
We stopped at the top of a pass
for some tea while we waited for our truck with the bags to catch up. I
caught a glimpse of a peak of a mountain from our view, but still too much haze
and clouds to see it in its full glory. I know that time is coming.
Since we are practicing in a different region, we won’t have the views as
previous practitioners, but for me that works out fine. It will make the upcoming trek worth it even
more as well as my Everest day trip. There
was a sign posted on the side of the restaurant that was translated for us...
"Come see famous white doctors". We were ecstatic... we were
famous!!
About three hours in we were all
becoming a little loopy and yawning, perhaps from elevation gain? Our
driver was getting a kick out of 7 female girls screaming and bopping of heads.
He eventually put on some Nepali music to further set the mood for our
journey to our new clinic. I recognized and appreciated that we were
going to uncharted regions for ARP, setting up entirely new 3 separate clinics,
and as the hours went by we knew we were really going "way the F*** out
there". We came to a standstill when we noticed the truck in front
of us stalled. The drivers poured water over the engine so that it could
cool down. Soon we were on our way again, but it wasn't too long until we
came across it again, but this time we noticed it wasn't going to make it up
the hill. Our driver jumped out to assist, while we stayed in the car.
Suddenly our car slid back suddenly and again we screamed like a bunch of
little girls. Another jolt backwards and I opened the door and jumped out
abandoning ship. Looking back, that was cowardly but quite amusing to us
all now. Not as funny as the driver sticking a rock behind the tire, the
same rocks we were rolling over. Did he really think that would help from
keeping our jeep from sliding back further? They started pushing the
truck and eventually after getting a running start we were all back on the
road.
Soon we started heading into the
clouds and began noticing beautiful foliage and vegetation except for stinging
nettles, though it makes a fine tasty soup. We made it to Bhimphedi and passed
through town quickly and traveled on a one-lane bridge to continue on to Kogate
where we eventually were greeted with a beautiful waterfall, reminiscent of
Avalanche Lake at Glacier Park in Montana or even Multnomah Falls in Oregon.
I didn’t know what to expect, but I was envisioning something similar and
was just in awe. I secretly held back some tears just from being
overwhelmed with the experience and maybe perhaps realizing just how secluded
we really were going to be for the next 7 weeks. After a long 5.5 hours
or so, we arrived and descended into the village and were greeted with children
and the interpreters with a Khata and beautiful marigolds with jasmine.
We walked right into the building
and into the common area where food awaited us. We didn't have lunch so
we were excited to meet our cook, Zhambu and taste our first preparation from
him. It wasn't soon until we were warned that there were leeches crawling
on the ground. Holy shit... leeches. Seriously? Andrew stood
up and shook one out of his shirt, a nice big fat one. We kept looking
around on the floor and checking our legs and sure enough I had one on my knee.
Ugh. I pulled it off with a napkin
and just sat there a bit shocked. Well, it is what it is. At least I got my first one out of the
way. It is the very end of monsoon season and the rain still comes, so we
suspect another 2 weeks of leeches. Let's hope for the best. We
sorted our rooms and I immediately took out the sage stick I made and brought
from Oregon and smudged our rooms, the entire building, even the toilet and
myself. No running water, just a hole in the ground to squat in and two
buckets to wash our hands and face. I knew this was going to be rough,
but man I was hoping for just a tad more comforts. Andrew mentioned that previous practitioners
had indoor plumbing, western toilets, marble floors and perhaps better food.
One can be envious of hearing this or turn it around and feel pretty
invincible for roughing it and being a part of opening brand new clinics in an
entirely new region. This is a raw and completely new experience for us
compared to past practitioners. Needless to say many kinks need to be worked
out and we have to be flexible. There is
something to be said about needing to use the bathroom three times a night,
when you have to watch for spiders and leeches and squat in a smelly pit.
My stream aim has improved since the first night, but still needs work.
I will never ever complain about camping again. Never.
The next day was a busy one,
sorting through all the supplies and organizing what needed to go where.
We sterilized all that we needed to upstairs on the roof with bleach and
dried in the sun. Later in the
afternoon we met our interpreters. Two of which have been with ARP for a
few years, but the rest were completely new and a little terrified as were
we. We paired up and talked so we could
introduce each other. I met with Sumanmager, a 23 year old whose hobbies
include meeting new friends and visiting new places. He wants to be a social worker and is single
and enjoys his freedom! He was born in
Kogate and was very nervous talking to us, saying it was his first time meeting
Westerners. I reassured him saying I was equally, if not more nervous because
it was our first time too. We soon had role-play sessions where one
interpreter would act as a patient, the other an interpreter and then us as the
practitioner. We soon learned just how difficult this was going to be
with the language barrier. Asking more than one question at a time is
useless and difficult. We have to retrain ourselves to go slow, rephrase
questions and hope we have some clarity into what exactly is going on with the
patient. We shared our expectations of
each other which was really eye opening. Later after dinner we talked
about lancing boils and how this will be one of many common cases coming into
the clinics. Andrew graphically told us how to lance, cup and drain the
boil going at least 1 to 1.5 inches deep to make sure we hit it right, or we
will just cause more pain. Have a cup ready for the pus and blood and
glove up. We went over pharmaceuticals and all of us just sat there with
deer in the headlights after realizing that we are going to be prescribing
western meds. We write a prescription for antibiotics and the patients
can go to the local health post. We have herbs and basic first aid supplies;
Tylenol, Benadryl, etc.… but need to think what is best for the patient. We
truly our doctors out here, primary if only care provider to these people. Again overwhelmed, we have to just keep our
wits about us and do the best we can. We also had a class on safety and
realized that all our education about tuberculosis, HIV and hepatitis and
needle sticks came to this point. Trying to stay safe, healthy, watch for
leeches, crazy spiders, lice, beware of hiking or going out after dark for tigers,
not catching contagious diseases or whatever else.... it really is a lot to
process. Other people are on an island or in Europe and I chose to have
my limits pushed in a poverty stricken country prone to communicable diseases
after graduation. The uncommon in the common world.
Breakfast this morning was
enjoyable; corn flakes and crepe-type pancakes with peanut butter and honey.
I decided to splurge and have one of my starbucks instant coffee packs I
packed. There is only so much Nescafé and milk tea one can have, although
the milk tea is simply delicious. During breakfast Andrew treated one of
the interpreters for a leech bite that had become inflamed and caused some
swelling. We ground up some Huang Lian Jie Du Tang for a footbath and
Andrew tried to bleed the area a bit. Some tears of discomfort came, but
she seemed fine afterwards. We sent her home with some Benadryl and hope
she will be better for the next day.
We spend the rest of the afternoon
sorting needles and herbs, deciding what was going to go to Bhimphedi and who
was going to go for the first week of rotation and opening. Patty was
assigned team leader and will be staying there permanently so that there may be
come consistency in patient care and I offered to come out for the first week
and help. We already have 40 on the books. We are certainly
nervous. It will be chaotic, especially with brand new interpreters and
whatever might get lost in translation.
Our evenings will be filled with researching our cases of the day and
preparing our class to teach. I suspect
we will be exhausted. We finally had the
sun shower set up on the roof so I bravely went for it. Not a fan of cold
showers, but I'll be damned if I get a boil. No sun, so no warm water.
It is what it is. I felt myself becoming slightly agitated with the
continuous swatting of flies, the looking for leeches every other minute, the
shrieks of others who find them on their bodies and no electricity or bouts of
it here and there, but I know things will continue to improve and that this is
all building character and a true part of the experience. I am trying to be more in the present and not
worry about my pet sitter and cat at home, or licensing process, or how my
practice will go when I get home. I do wish I had enough money when I
return to go and sit on an island and sip cocktails even for just a few days in
the sun, but this journey will lead right into working when I get home and that
is welcomed and needed. There is beauty in this hard work and intense
conditions. I am fortunate to have this experience to serve people as a
doctor and have such an impact on their lives. The lesson to learn is
endurance, patience, compassion, trust, and so many more that I have yet to
realize.
