shake that cat

Insourced

[This post concerns primarily the nerdly arts, so feel free to skip it if that's not something you're interested in.]

So it's taken a little while to figure out how best to put me to use, and that is going to be in two areas: first, teaching some introductory computer courses for hospital staff: very basic stuff for those who have used computers very little or not at all, and a bit more advanced for those with some experience or who use them day to day but want to learn a bit more about particular applications, etc. Second, being a jack-of-all-computer-trades, assisting with various issues around the hospital. At the moment, the latter means banging away at an existing MS Access database. You database weenies will recognize the symptoms: Access used as a big Excel spreadsheet, without any validation of entered data, and Excel reports for outside organizations generated by running Access queries/filters by hand and copy/pasting the results into Excel. So I'm creating forms to make data entry easier, faster, and more accurate, and reports that make it possible to skip at least one monkey of the current report generation solution.

[In case anyone who's read this far this wasn't at some point in time connected to WGBH Interactive, the monkey scale refers to the number of humans involved in some sort of technical process that really should be completely automated, but for some reason isn't. A three-monkey solution requires three people where ideally there would be none involved, etc.]

Sukhumbasi, June 14

Above: children of Sukumbasi, Nepal. More photos @ flickr

Sunday is usually hectic, but what with the strikes late last week, this Sunday was even busier than usual: 400 patients seen in the outpatient clinic, instead of the 300 or so of an average Sunday. But I wasn't involved, much; they've figured out what to do with me, to make the most of my skills while I'm here, and that's going to involve teaching computer classes for hospital staff - very general introductions for those who have had little exposure or experience with computers, basic Microsoft Office skills for those with some background. Plus, it appears, a smattering of "we've had this problem, can you take a look at it?" type issues. And yes, laugh all you want, but most of the computers here are running Windows XP of some service pack or other, so this 23-year Macintosh veteran is going to have to bone up on his dark-side skills.

So I spent most of Sunday working on course outlines, as I hadn't arrived packing a complete syllabus, but I did manage to tag along as Dr. Grahame, his wife, son, daughter-in-law, the three Swiss students, Suman, and a driver made their way to the small town of Sukumbasi, a few km away from the hospital. The town is composed of about 40 families, has only been in place five or six years, and is sited on a former riverbed - recently-placed dikes redirect the water during the rainy season and make the area possible for habitation.

Two days, seven sites

(Above, Dr. Paudel, orthopedic surgeon (L), and pants surgeon (R))

Today has been a slow day at the hospital, most likely due to the strikes (bandh) taking place in Janakpur and other smaller towns that closed the roads to traffic, keeping patients from getting here (the physician in charge of the hospital, returning from Kathmandu today with family, had to talk his way past several roadblocks). So far my attempts to figure out what the strikes are about are met with vague talk of "politics," as it seems no one wants to delve deep into a discussion of Nepali politics, at least with this foreigner.

The previous two days, however, have been full ones, as I've spent both with Dr. Paudel, the orthopedic surgeon. Tuesday is his scheduled day in the operating room, and I was able to join his team as they were getting started on the day's surgeries. First up was not really surgery, technically speaking - for the gentleman who had forearm fractures set with open reduction and internal fixation last week, Dr. Paudel checked the range of motion and whether the fracture remained properly set, which testing would have been extremely painful for the patient had he not been sedated. A 14-year-old boy had a separated shoulder set with an open reduction, two gentlemen had foot ulcers cleaned (and in one case, skin-flapped and skin-grafted), and the last gentleman had a small piece of glass under the skin of his forehead he wanted removed. He had been warned that it was so small we might not be able to find it, and that turned out to be the case.

No-see-um questions, part 1

• Is that "zzzzzzzzz" I hear (meaning it's inside the netting and circling) or is it "zzzt, zzzt, zzzt" (meaning it's outside the netting and repeatedly banging its head against the insecticide-treated netting trying to get in)?

• If I spin around quickly in the shower, will I soak the entire surface of my body with sufficient water volume frequently enough to keep the little bastards I know are in the room from landing and getting a toe/proboscis hold?

• Is that mote floating in the beam of sunlight across the room innocent household dust or does it have venipuncturous intent?

• What day of the week is it again?

• How many ways can I misspell mefiquinone melfiquone mefliquinine my malaria prophylaxis medication?

• If tomorrow is the day of the week to take my weekly dose of mefloquine, and I get thoroughly bitten today, am I more screwed than at any other time of the week?

• Can I break my personal record (25) for number of bites received on a single 4cm x 8cm patch of appendage skin while said appendage was next to (inside, but next to) the netting for a brief period while sleeping?

To be continued, I'm sure...

In the general clinic

The physicians here have to be some of the most patient people I've ever met. Yesterday (Sunday) was my first full working day at the clinic, and I was shadowing a different physician (Dr. L) as he saw general patients. He and a second physician were each working at a desk in a single room about the size of the exam rooms I'm used to, and at one point during the Sunday rush I counted 12 people in the room not counting the two physicians and myself. That most likely included the two patients actually being seen at the time, an accompanying family member or two apiece, and then several additional patients (and family members) waiting to be seen by one or the other of the physicians. Patients sit on a stool next to the doctor's desk and present him with their paperwork, or at least that's how it's supposed to work, but at any given minute several waiting patients are also trying to present the doctor with their paperwork. And that's not counting patients seen earlier in the day who have their completed lab work in hand and who jump in as well to have their visit finished off. But it's all very polite and orderly - maybe every once in a while someone pushes their paperwork in front of someone else, but that's about it. An American HIPAA enforcement administrator, however, would probably succumb to a case of the vapors almost immediately.

Statler & Waldorf? Beavis & Butthead? Stan & Ollie?

Friday is a half-day at the hospital, with regular business winding up at about noon. As I don't have an official schedule yet, I spent the morning shadowing Dr. Paudel, an orthopedic surgeon who was seeing general patients, 20 or so in the space of a couple of hours, with one patient or family group coming into the room before the previous one left. You future dermatologists, this is the place to be: about half the patients were here for some sort of skin condition. Three Swiss third-year medical students are, at the moment, the only other folks here in a capacity similar to mine, and as this is an official rotation for them, as I'm writing this, they're spending the afternoon working on a report on their time here.

June 4, 2009: Kathmandu

Kathmandu, at least this corner of it (Jawalakhel) is very quiet at night, particularly compared to my corner of Ghent with its roaring impressing-someone mufflers and backing-up beeping of the midnight Starbucks delivery truck. Doing exactly what you're not supposed to do to adapt to a new time zone and sitting down for a brief nap in the early evening, I got several hours of sleep, with the result that I'm up most of the night. Around 3:30 or 4 a.m. the first bird sounds begin, not all that distinguishable from Norfolk bird sounds to this nonbirder, gradually growing with an occasional dog bark until 6:30 or so, when the first human sounds start: growl of a truck or two, voices elsewhere in the hotel, the first taxi honks. Bursts of music: someone's alarm clock, or is that a ring tone?

I arrived in Kathmandu midday yesterday (June 3) on a flight from Singapore, with a planned overnight here before continuing on a domestic flight to Janakpur and ground transportation to Lalgadh. The same gentleman from NLT who picked me up at Tribhuvan Airport and delivered me to the hotel is supposed to pick me up today to return me to the airport, and when he left yesterday neither of us knew when that was supposed to happen. Yesterday's attempts to figure that out failed, and that's now the first task today.

In the interest of keeping things confusing, time-zone wise, Kathmandu is 9 hours and 45 minutes ahead of the East coast of the U.S., and 12 hours 45 minutes ahead of the West coast. So at noon in Norfolk (and 9 a.m. in California), it's 9:45 p.m. in Kathmandu. Why the fractional hour, I'm not sure...