Lectures, cases, and exploring Kathmandu

More photos than news...

Beautiful carvings everywhere; this one colored.

Photos are out of order and I am at work, so am not going to fix this.  Yesterday afternoon we walked up to the monastary and the nuns showed us around.  They had a beautifully trimmed and tended cactus garden.

Every day the big blue sky has been filled with threatening clouds, but only some sprinkles at night so far.

The monastary - you can see the damaged stucco on the walls.  These doors would not open so the sanctuary was off limits.  But they reconsidered and took us in the back door.  I did not want to photograph inside; it felt somehow disrespectful.  But there were may cracks and exposed bricks inside; tragic.

Cactus seen as we were leaving the monastary; filled with cobwebs.  Oddly beautiful.

 
Dogs everywhere - and a puppy!

Family outside of Bir Hospital, this kid really wanted his photo taken, and when I showed it to him, he rang out with peals of laughter.  One of those delightful moments that come so frequently here.

We walked to dinner and passed this beautiful old tree with painted box.

Back to the monastary - this is the nuns' dog!  Looks very pampered.

From the monastary - view of Kathmandu from above.

Dogs in the walkway on our way back to the hospital from the monastary.

On the road to the monastary, we passed a young child playing in an old dilapidated bulldozer,

Another view from the monastary.

Prayer flags everywhere.

More flags.

Nuns catch a ride home to the monastary from the hospital with the ambulance drivers (remember in Nepal driver is on the right side).

Tom consulting patient with Kiran.

Pramila at work.

Pramila with team.

More teamwork.

Child sleeping post-op; beautiful face.

Everyone having lunch.

Another case; Tom, Bishal, and Pramila.

Tom caught me in the act!

Team at work; rhinoplasty

Child burn debridement.

Underside.

Cow crossing guard.

Don't hurt the cow - prison time!

Plastic waste everywhere.

Nurses at Bir Hospital.

Progress taking down the old army hospital next to Bir Hospital.

Quiet day; lecture

On the way into Kirtipur, we stopped at Trauma Bir Hospital not far from our hotel.  We went to the ICU to visit the lady who had the tongue operation.  Everyone must take off their shoes to keep the floors as clean as possible.  Just like home!

The ICU is an expansive room with room for about 14 patients.  Nurses' station in the middle.

View of a ward from the stairs; also wide open; even beds in the middle away from the walls.  Just a place to treat illness; not a hotel.

At Kirtipur OR, everyone rapt listening to Tom Davenport lecture about flaps.

Tom at work; wealth of information.

This patient is having decubitus ulcers treated.  He has them on both hips; he was trapped under rubble for an extended period of time.

Back to Bir on the way home to check our lady again.  Noticed this very San Francisco-esque set of buildings.

The old army hospital next to Bir is coming down, bit by bit.  Every day we see some progress.

Came to my room right from work and dived into a set of by-laws as a start for Kirtipur Hospital and 16 more protocols for the nurses to use.  If I don't do it now, I will let it add to my list of things at home and it will probably not get done...

Tuesday, machine day

Tongue lady from Sunday doing great.

It was a beautiful breezy and clear day outside, but I spent most of it in the hospital with machine reps trying to get information about what is available to upgrade the hospital equipment.  You can see the monkey temple to the right, on the knoll.

Biggest case for today did not end up as a flap; they were able to cover it with a skin graft.  Simpler is usually better.

The new doors have been put in downstairs for the ORs there.

We also spent some time today with the nursing supervisors talking about policy and procedure paperwork.  We made headway on many issues and the nurses are very helpful and seem interested in this aspect of organizing their hospital.

After we got back to the hotel, we went to our respective rooms to work on various items - talks, policies, and machine quote emails.  Brief dinner on the rooftop, and back to work.

Day of rest, for some

Today was the day of our lady patient with the cancer of her tongue to have her surgery.

Early this morning Richard and I made a nice walk around the palace compound near our house.  It is a good loop but part of the walk is new construction of the brick path, wall repairs, and street work.  We found they had done new black top yesterday and the brick walk is nearly finished.

All over Kathmandu are these seemingly feral dogs who feed on what they can find in the street.  Many are maimed, some have collars, and most seem either to be intact males or pregnant females.  They are territorial to each other, but very friendly to humans.  Most of them look like dingos, a kind of average mix of dog breeds.  This one had a very cute wookie face but got spooked and began to bark when I pointed my camera at him. 

All along the walk we see not only piles of rubble and signs of the recent devastation, but also very organized efforts to sweep, pick up, and clean up.  This tidy row of reused sandbags were filled with shards of glass and debris, probably left for pick-up by the road.

Some parts of the palace are taped off to avoid pedestrian traffic next to the crumbling walls.  In some places the paint is intact and they still seem standing, but a gentle push shows some movement to the bricks inside the paint layers.

Even some of the road, once laced with nice brick patterns, are roughed up.

Shankar picked us all up after breakfast and we went to the Ministry of Health to register Tom, our new surgeon, and then to the trauma hospital to see our patient for the day.  Saturday is the day of rest, the other 6 - including Sunday - are for work.

On arrival to the hospital, the military hospital next door was being razed by a large bulldozer.

We entered the new hospital via the emergency room, which was a room about 75 feet square filled with registering patients, patients on guerneys, and a central desk.  It was a large and busy place.

We made our way up to the 2nd floor, changed into our scrubs, and were led by some of the local MDs into the operating room.  It was full of people, including the anesthesiologist and his four assistants, who eventually put the patient to sleep.  The surgeons were all discussing various plans and flaps for this patient.  She has a very large tumor on the side of her tongue that will require removal of 1/2 of her tongue and maybe floor of the mouth.  They apparently do not or cannot use frozen sections to guide the surgery.  The ENT doctors will start with removal of the lesion and a neck dissection to remove lymph nodes.

There was so much work to be done first on the patient, and so many people in the room, that we all decided to take a cab home and Dr. Tom could return when they needed him.  We went up to the roof top lounge to visit and read, and Tom's call finally came a couple of hours later.  With some talk of a possible fibula graft and hemimandibulectomy, it appeared that the procedure had become more involved and any possible number of choices for his day could unfold.  The rest of us stayed behind, and now at midnight I have heard no word.

The rest of us napped, shopped, had dinner, and worried.  We will find out tomorrow what happened.