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.
