Kathmandu, September 22, 2013

Wake up call at 7 a.m.  Wonderful buffet breakfast; kind omelet man made me an egg-free pancake.  Table full of monks from the Boudha Stupa across the street, dressed in marigold and burgundy robes.  I was reminiscing with Joe about the smells and sounds of these places we visit that feel so very far away from everything we are familiar with.  A kind of loamy, smokey, spicy smell, with traffic, honking, dogs barking and chickens calling.

Looking out over Kathmandu gives one a sense of this special place.  Clearly still a developing nation, it manages to carry its own beauty.  Temples, monasteries, bright colors, prayer flags, and foothills all around.  Then when the clouds part in the right place, one gets a glimpse of the massive mountains that dominate the horizon in the north.

I love this concept many hotels have around the world.  You must put your room key/card into the slot for the room to power it up.  To leave the room, when you take your key, everything will be turned off.  A way to save energy, why not?

Changing hotels – now at Hotel Tibet.  We dropped our bags off at the new hotel.  The hotel we have moved to did not have enough rooms for us the first night, so that was why the switch.

Also a beautiful hotel; everything seems to have ornate hand-carved trim, as is the style everywhere.  The colors are bright and beautiful in this town, and the color marigold seems to dominate as it is considered a holy color.  This is true in the hotel as well; although it is a bright color, it works.

Shankar picked us all up at the hotel, and we made the short drive to the original hospital at which he works, the Model Hospital.  This was our first chance to really view the city as we drove.  Motor bikes, buses, trucks, small cars by companies we know but models we don’t get in the U.S., pedestrians carrying loads, and potholes fill the roads.  Most of the roads seem unpaved and dusty, which adds to the heat.  Rows of small shops - specializing in any variety of items - where the families live in the back and work in the front.  Electrical wiring that boggles the mind how it is maintained or even functions.  Every now and then a bicycle appears with a cute face we can enjoy.  Crowded and chaotic.  The short drive takes us a long time to make.

Model Hospital has 100 beds and services all kinds of patients, surgical and medical.  It has an emergency room, maternity ward, intensive care, and pediatrics.  Does it all.  Shankar started his work here, which has now grown enough that he managed to raise interest in another hospital in Kirtipur, which is being built as we speak.  He did mention at one ward that the patients pay for their care – they  must register and pay what they can up front.  It is important to know the magnitude of the prices however; an overnight stay in a room is about US $5 for example.

Dr. Shankar Rai is one of those amazing visionaries who partners with Resurge, and often with their help – whether just financial or also with teams – manages to bring needed care to the poor.  As he is a plastic surgeon, trained in his home country of Nepal but also at the University of Utah, he mostly takes care of facial and extremity deformities and burns.  He understands his people and the limits of their medical system, but also understands the technology and ideas offered by our medical system, and he brings those ideas when he can.  We have a lot to learn from this man who sees the need for care and will let no obstacle stop his determination to help the poorest people in his country.

Shankar has set up a network of hospitals and clinics.  There are about seven or so, and if he needs to he brings his workers from one place to the other to be sure to staff and provide care in each location.  The largest area covered by a clinic is the west, which is the poorest and least populated, as well as a breeding ground for the Maoist insurgents who recruit from the poor and disenfranchised.  The scope of his work and the reach of his effort is awe-inspiring.  There are many NGOs and donors involved from all over the world, as well as assistance from the government in his efforts.  I am still trying to wrap my mind around all that he does.

After our brief tour, we pile back in the van and make the long drive to Kirtipur to tour the hospital Shankar is having built.  It is another bouncy ride through new parts of town, evasive maneuvering by the driver, and attempts by the team to stay hydrated.  We finally arrive and see  where we will do most of our educating and work while we are here.

The hospital is mostly under construction, with piles of bricks, rebar, and construction debris in various areas.  There is enough finished however, to give one a sense of what an amazing place this will be.  There is a beautiful library with medical books of all kinds, which could use some updating to new editions, but it is a start.  There is a cafeteria underway, which will provide food for the various patients and families, many of whom must wait at the hospital for weeks while their child is nourished to a safer level in preparation for surgery.  They are hoping to grow all the food needed on the grounds with the help of the community and the local university.  Bio waste material is gathered and funneled into an underground dome where it ferments and provides biofuel that will power the hospital and nourish the garden.  Everywhere we walk, we hear of a new dream and a great idea – housing for families and volunteers, lecture hall for providers and visiting medical professionals, occupational therapy for ongoing rehabilitation, and an area for the other children of families to play and be safe.  There are so many devoted people and dreams here that I am weak in the knees.

Finally I get to watch a surgery underway.  Dr. Dev, the anesthesiologist who works here, is an inspiration in his own way.  He gets about $5 a day, and works here 3 days a week – Sunday, Tuesday, and Friday, which are the surgery days here.  They hope to get up to six ORs and fill the schedule, but things are just starting up.  Dr. Dev has another job at the Model hospital, and he and another anesthesiologist share the work alternating a week at a time.  Dr. Dev has two anesthesia assistants, and there are some surgery residents and plastic surgery fellows who watch and learn from Dr. Shankar.  Add another hat to his list.

The ORs are very well equipped, but as often happens with well-intended donations, most of the anesthesia machines and monitors have small but crippling issues that need to be fixed.  Without the knowledge or parts, they must do as best as they can with what they have and avoid questionable functions such as the ventilator because of possible patient injury.  There are six anesthesia machines that each have some kind of failure – ventilator will not work, vaporizers do not deliver gas – and they will need to be fixed if the six ORs are to one day materialize.  A good Datex-Omeda technician would go a long way to help them with this problem.  An HP monitor person could come as well to keep him company…

We meet a child with a cleft palate and her family.  She has had pneumonia and her surgery must be postponed for some time on antibiotics and some time to heal, six weeks in total.  They will go home and return at that time to see if she can be cleared for surgery at that time.  Shankar spends a lot of time explaining to the family – they bring their child to be helped, not to be harmed.  He also walks a fine balance of needing the best outcomes he can get, although he does not have this discussion with the family.  The local people do not like it when one of their own is harmed, and have come out to stone this new hospital before.  Not trusting the system to deliver justice, they take matters into their own hands.  As a new entity, this hospital must come to be viewed as a benefit and a haven for those who live in this area.  With a cleft palate which impairs swallowing and probably a smoke-filled home, the obstacles for getting this child readied are great and the risks are high if she is not strong and well.

Another child is shown to us who is being nourished for necessary weight gain and general well-being before having her cleft repaired.  Malnourishment is a problem in any poor country, and the added struggle of a child who may not be accepted into a community is a stressful burden for these families to bear.  A special cereal/gruel, sourced from Unicef, is mixed and given by the families to the children.  Weight, blood count, and other parameters are followed to guide the care.  This is pre-operative preparation like I have never seen before, yet somehow each child’s needs are met and the difficulties are remedied.  It is never if, but how.

Finally we watch Shankar have a small clinic and see patients for Tuesday.  He shares with us what he would plan to prepare for each procedure.  The room is filled with much apprehension from the families, but much hope from us all.

Long, bouncy ride home.  We are all jet-lagged, hungry, thirsty, and fatigued, and restore ourselves with a meal and a few shared beers at the hotel.  We discuss and plan for our lectures and time here.  There is much we can do to help the wheels keep turning on this project, and we ready ourselves to dive in.