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.

Visit to Gokarna Resort

Saturday we got out early to go to a talk at a resort in the foothills that was to be given by Shankar, Kiran, and B.  This was to be a burn prevention lecture to the Lions' Club at Gokarna Resort.  It was nice to get out of the fumes of the city.

There was a lush vegetable garden growing on the banks of the river.

Still many tent cities to be seen in all areas of Kathmandu.

Pasang Lhamu was the first Nepali woman to climb Everest.  She was a young woman who had climbed all her life.  On the attempt she made and finally got to the top, she did not survive the descent.  This statue was erected in her honor, and many things in the area are named after her.
https://en.wikipedia.org/wiki/Pasang_Lhamu_Sherpa

So much devastation.  Much work to be done, but the city has come a long way with much debris consolidated and cleaned up.

Gokarna Resort.





Shankar starting the lecture.




Inspirational speaker in traditional dress.  Very entertaining!
http://jeevanvigyan.com/?p=1337


B and K



Team saying thank yous after we were included in lunch.



Beautiful flower arrangement.



On our way home, we stopped at the Boudha Stupa.  Very sweet of Shankar to take us there.

Once we made it back to the hotel, we head out for a walk that would circumnavigate the palace.  We saw another tent city through a stand of bamboo.



Downed houses, up close.



Everyone back at work.



Living in tents just superimposed on the modern technology still standing.



Of course there is much debris to clean up.



Damage to the palace.



Flowers are oblivious to the ruin.



Fruit bats abound in a few trees near our hotel.





Scenic building on our way back.

Re-do day

Friday has come very quickly.  We made our way into work with our trusty assistant, Hemanta.  He drove us a new way today to show us some sights, and made a stop from a bicycle vendor to buy grapes for the OR crew.  He said most of this fruit comes from India, the neighboring country to the south west.

Excited to take in the new equipment I brought to spiff up the machines. All calibrated and ready to go!

Sadly our patient from yesterday did not have good outflow from her free graft.  She had to return to the OR and was given a graft from her radial area (skin and fascia) and after a full day again, it looks beautiful.  A difficult thing to have to do, but a very valuable lesson for the team to see and work through with their expert Dr. Megee while he is here to guide them through the process.  There will be more failed grafts in the future, but they have been through the fire drill and now are armed with the knowledge to deal with this situation.

For those of us who recycle, if you need to feel discouraged, come to Nepal after an earthquake!

Brick fence down around a compound; razor wire goes up.

It has been a long week and I skipped dinner to go supine.  12 hours later, I feel ready for more!

Another day, another free flap

Front of our hotel has some sample views of what can be seen in Nepal, peeking up alleys and around corners.  Beauty and colors!

Carving and details.

Flags and weather.

Driving in, we see many cows in the road - walking, sleeping, grazing.  They are considered sacred, and if anyone injures or kills a cow, it is worth 20 years in prison.  Pretty harsh, but at least it keeps traffic under control. 

Resurge support staff bringing snacks to the OR.

Clever tourniquet looks like a bicycle pump.

Flap number two today - rectus abdominus to anterior tibial vessels and defect.  Luckily did not have to do 7 hours of prone with make-shift padding again.

More beauty just outside the OR window.

Finishing flap; just needs skin graft to seal it over.

Sweet anesthesia assistants and anesthesiologist.

Small free standing machine; just like the Resurge design.

Walk around the corner of the hospital - lillies!

Tent encampment on the way home; one of many.  

Up to code?  This was my first thought when I heard of the earthquakes - all that wiring.

Many tall but tiny free-standing buildings.  Conserving space.

Down time at dinner!

Gecko visitor in my room.