Leeches and Lions and Squat Toilets... oh my!

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.