Kathmandu 09/29/2013 - Pokhara

Leave it to a Resurge team to put in long days all week and then use the weekend to … put in long days!

Today we got up at 4 a.m. to get on the road up the mountain at Sarankot to see first light on the Annapurna range (http://en.wikipedia.org/wiki/Sarankot).  It was interesting to wind up the winding, dark and potholed road and see the locals already up sweeping in front of their stores, walking up the hill to get exercise, and making food for their families.

We finally made it to the pinnacle and as we waited for Nature’s show to begin, the area filled in with more and more tourists.  Then a few buses arrived, and there was this other human show that was interesting too.  Unfortunately the peaceful quiet one would hope could accompany such a scene was not going to happen.  Quite the contrary; loud voices and clicking cameras on tripods dominated the moment.

Finally small rims of pink appeared on the tallest peaks, and then to oohs and ahhs the sun peaked up over the horizon and made a showing.  Then each peak began to brighten up and show its full height and glory.  No clouds to be seen around the mountains, but there were fingers of fog throughout the valley and the foothills.  Very nice display.

I had to be careful taking pictures because occasionally as I was looking through the camera, I would see a flash of color up close.  Enthusiastic neighbors.

Except of course Hien, but we had an arrangment because I can see over her head!

We made our way back down the mountain, had a wonderful breakfast, and everyone made their way back to bed for a nap.

Vickie serenaded with her ukulele.




















Flight back to Kathmandu, relax and shop, a couple of people not feeling great, and we move hotels in the morning back to Hotel Tibet International.  Trekking season, so all hotels are full.

Old-fashioned scale at the airport.

Did some shopping once back in Kathmandu.  Anne needed a pair of speakers to show a teaching video, and the shop owner and her daughter made a beautiful pair themselves.

No lawyers in Kathmandu!  So much construction; some of the store and home fronts have been bulldozed away to widen the streets.  One has to watch closely lest you trip on steps or fall in a hole in the sidewalk!

Thoughtful store owners will remind everyone to take care.

Kathmandu 09/28/2013 - Pokhara

Early rise to get to the airport and our flight to Pokhara.

Buddha Air to Pokhara (http://en.wikipedia.org/wiki/Pokhara).

 Waiting for our ride to the hotel.

Joe has the weight of the world on his shoulders.  We had a great lunch at the Mountain Museum.

Devi's Falls.  Here's a video (http://www.youtube.com/watch?v=I033fbjhAp4); but it was way more full of water today.  All the rock formations were buried and the sound was deafening.

Then we walked to the World Peace Temple (http://en.wikipedia.org/wiki/Pokhara_Shanti_Stupa).  In the background were whirring beetles and a drumming monk.

The views were amazing.

Sandy and me at the Stupa.

Fishtail Mountain (Machhapuchhre).

Trekking down; a bit trecherous.

Little harbor at the bottom on Phewa Lake.

 Hien and I.

Boat repairs.  Wool stuffed into the cracks, then covered with tar.

Kneading the tar like dough then massaging it in.  Turpentine in bottle.

On the boat to cross the lake to town; a fellow sailor.

Passing a boat and a small home-stead

Super nurse Anne and fearless leader Nancy.

Passing boat with canopy.

Passing boat with 1/2 of team - Sandy, Hien, Vickie, and Joe.

Another passing boat - women hauling wood in the boat...

... and dragging behind.

Dinner at the hotel - tired and hungry.

Vegetable dinner tarkari:  papadum and rice with raita, curry, spinach, potatoes, and dal.

And then ... to bed.

Kathmandu 09/27/2013

An OR day.  We arrive at the hospital to help start cases; picking up Hien and dropping off Joe on our way.  Hien gets everyone to laugh.  Four patients in the day and a chance to see everyone at work and which ideas we have shared that have been of interest.

On my way upstairs I noticed someone bounced out of her shoes and left them behind!

One of the first cases was a young girl who suffered a scalp burn that left her with a skinless piece of skull.  There was no tissue or blood supply left over the defect, so it was not going to be a good place to put a blood-dependent skin graft.  The a flap of skin was raised and slid over it, which also left some skull exposed but at least it had a bed of periosteum for the skin graft to attach to.  Very interesting case.

Nurse Anne, superb circulator and teacher.

Scalp surgery, underway.

 Without a burr, they had to rough up the bare bone with the handle of a scalpel to give the new flap of scalp a surface to attach to.

Flap slid over with its own blood supply still intact, to reattach over the open space.  New space, but with a periostium and good blood supply was covered with a full-thickness skin graft from her groin.

There seems to be much less attention to pre-op mental condition of children, and they cry and carry on in a way that scares anyone in ear-shot.  There are no guerneys to transport a sedated child, no tables to start IVs, and no Sevo for mask induction.  So it is a difficult situation.  This hand procedure was done on one of our favorite little guys, and he was very unhappy with us going into surgery.

One child came to the OR to have her knee released.  Always in a flexed state, her knee does not allow her to walk.  Her procedure of release and skin graft will offer much improvement.  Only 11 years old, she opted for a spinal.  She cried out a couple of times, but mostly kept her sunny disposition.  This is the child in Hien's blog also from today on my list of entries.

Everywhere we get reminders that this is a very poor country, lacking in infrastructure and systems that work to keep the down working.  I have seen several people carrying heavy loads (all women) strapped to their heads   Makes me hurt to watch.  From the hospital grounds to the streets, a person needs only a strap and a sturdy bag to move mountains.

They try hard to recycle and keep everything organized.

One must be flexible and not judgmental, because we all have our faults…

This oxygen attachment is between a high pressure tank and the machine and requires high pressure to run it (pneumatic power).  One has to remove the dial or it will blow off, and there is a step-off of pressure by using this attachment.  But nothing else is compatible and it is a way to get all the connections to attach.

The nursing students are enjoying their day and each other; a lovely group of workers.

Infrastructure.  We take organization, work force, and financial resources for granted.  How to pay for services in an area with many people who do not have an income and live off the grid?

Home, walk and shop a bit, and off to sleep.  Tomorrow we leave for Pokhara.
http://en.wikipedia.org/wiki/Pokhara