Last day of work; goodbyes and dinner out

Last day at work.  Lots of collaboration.  Heard a talk by Tom.


This patient is prone for debridement and flap for a sacral decubitus ulcer.


Shankar, Kiran, resident, and Tom all working together on a burn patient.




Patient with Treacher-Collins.  She has had surgery before, and the scar on the left side of her face contracted severely and has pulled down her left orbit.  She cannot close that eye.  She is only 14 years old.

Dr. Tom evaluating the patient.

Results - her mouth can close, her nose looks better, and she can partially close her left eye.



Evaluation of a patient with a neck contracture.



Connect the dots; drawing on the puzzle pieces.

Dr. Pradeep performing a supraclavicular block.



Dinner out with the crew...

Food as hot as you can stand it ...



And the rest of the crew.  Will miss everyone!

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.