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Saturday, September 28, 2013

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.

Friday, September 27, 2013

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

Kathmandu 09/27/2013 - from Dr. Hien Nguyen, Resurge anesthesiologist

I met a beautiful 11 year old girl named Sajana in Kirtipur, Nepal. I would like to share this story along with the pictures of her. Her home land is in a village high on a hill.

One day, over 6 months ago, she got a burn accident from a slip on a pan of boiling oil cooking when she went to the market. I could imagine how hard and how painful she has spent since that time but it's not finished yet because her knee has been bent so she can not walk.

She came to PHECT hospital this morning for surgery to release the scar at her knee. I think that she has been waiting for this surgery for a long time because I saw in her eyes the willing to walk normally after surgery.

She was explained for spinal anesthesia if she is ok to be awake during surgery. I think that she must be sedated. But after a little bit of tears because of the needle of spinal she smiled and co-operated very well. She speaks a little bit English so she asked me my name and she said she was ok every time I asked her how did she feel.

I took picture of me and her and she wanted me to take the pictures of her surgery that was happening behind the barrier of anesthesia and surgical area. I did one.

She asked more and she was very brave to come over her frightening to suffer this surgery

She was very happy to see the pictures of her knee straight.

The surgery was done and I was so happy to have the picture of her before leaving the OR with her thumb raising up. I told her "you are number one".

Wednesday, September 25, 2013

Khatmandu 09/26/2013

Another teaching day.

I am amazed at how quickly the nurses have come up with a plan of action and a list of lectures to do for our class of 15 nurses. And they are amazing teachers.

We had also a scenario of a burn victim brought into the hospital from a fall and burn. Sandy, one of our PACU nurses, we covered with smears of charcoal and vaseline with plastic to make fake blisters. She had charcoal on her nose to inspire a discussion on inhalational injuries, a circumferential "burn" on her lower leg to talk about compartment syndrome, and a large burn on her back that might be missed if no one examined her thoroughly. Len did a fantastic job and so many various teaching points came up as the new nurses were guided through the care of this "patient".

I did a lecture about pharmacology with questions that when answered correctly were rewarded with a peanut M&M. By the end they all chimed in at once and everyone got a treat.

Sandy, Vickie, and Anne did a scenario with monitors and the hooking-up of patients as they arrive in the PACU. There were issues about when and where to put the ECG leads, how to properly put on the blood pressure cuff, and alternate sites for both if burns or other issues. Padding, positioning, assessment, and so many other topics. I got to be one of the patients and lay still as these gentle and tentative little hands moved about trying to understand and do each task. Every now and then something would make me smile and they would all laugh. Now and then I would get a little pat or someone would be holding my hand. I kept my eyes closed to be a good post-operative dummy, but when I opened and saw the seven or so faces around me, they would all smile. Such amazing young women with so much interest and promise.

We have decided to end each day early enough to make an excursion in Kathmandu on our way home so that we can get to know the city in which we are working. This weekend we will go to Pokhara, Nepal and make a trek or two there. This was recommended by Shankar.
http://en.wikipedia.org/wiki/Pokhara

Today on our way home we stopped at the Swayanbhu Stupa. At this point my camera battery died, so I have no photos and will have to borrow from the team. But this site gives an explanation and some photos.
http://en.wikipedia.org/wiki/Swayambhunath

We had some of the best views of the valley from here, and the naughty monkeys were everywhere.

We came back to the hotel and had a meal at the Radisson Hotel next door at their Olive Garden. Don't laugh - the menu has been greatly modified and we weren't brought endless bowls of food. It was elegant and most of the items featured Yak cheese and local items. I got potato gnocchi and was quite happy. Very nice end to a day of hard work.

I think we all felt like it was Friday and heaped into bed as quickly as we got home for a long comatose nap.

Our driver after we arrive at the hospital with a young Nepali.

Construction work underway and a very small woman toting a load of stones and debris in a basket with a strap over her forehead to help support the load on her back.