So if it's not already clear, the local diet is primarily vegetarian. Every few days the dining hall staff will walk round during lunch or dinner and offer single servings of either chicken (one day) or fish (the next), and just about every meal they'll do the same with single-serving plates with yogurt and sliced mango. I suspect that the single-serving business is for the same reason ice cream was served in my high school by a cafeteria worker handing out single portions to individuals - a few of the groups that have been here for various training programs have consisted of, basically, high school students, and my guess is that the custom was established a while back after some knucklehead served himself the chicken meant to serve 40 people. Dredging up the last lecture or three of biochemistry a few weeks back, I know that folks are probably getting enough protein from the lentils in the daal, the beans and peas in other dishes, and the yogurt & occasional bit of chicken, and with the rice, potatoes, and vegetable oil are rounding out well-balanced meals, but it is a little different from what westerners are used to in the meat/protein department.
Breakfast is of similar origins, but of the three squares it it certainly the "What's in store for us today?" meal. I had been told before arriving that westerners generally balk at the idea of curried vegetables three times a day, and can request (and receive) white bread and jam instead. As someone raised on whole wheat bread, often bread also overloaded with other grains, nuts, and forest foliage, I heard "white bread" and thought "that inflatable/styrofoam stuff you serve baloney and yellow mustard on," and thus was pleasantly surprised by what showed up instead: a large, fresh loaf of something more like soda bread, very substantial and tasty. Accompanied by a pot of jam, all without me having placed any requests. Now, a few weeks into the trip, I'm not sure if that was meant to be breakfast or not - the routine seems to be to provide us about once a week with a loaf of such bread or a cake, in addition to the breakfasts described below, so I suspect that for the first week or so, I was on the weekly-cake-delivery list but hadn't yet made it onto the daily-breakfast-delivery list.
Having made it onto that latter delivery list, my breakfasts now generally consist of a single serving of vegetable curry, almost always accompanied by the round fried bread seen in the photo above (that particular breakfast, for some reason they were puffed up more than they usually are). The third item changes from day to day, and if it's on a schedule I haven't yet figured it out: one day it will be the sweet confection seen above, rasbari, milk balls served in a rose water syrup, another day it will be a small onion omlette, yet another day it will be rice pudding. And if it's not any of those, it's some form of julebi, a deep-fried translucent sweet. The first time we were served that, it came as single confection four inches or so in diameter, formed (so far as I can tell) by carefully pouring the dough/batter to form a pretty spiral shape. The second time it was served as a small bowl (like the one pictured above) filled with pea-sized beads, or, well, peas formed from the same confection but in different colors. The third time it was in similar form, but in beads/peas half or a third the size of those served the previous day (sized somewhere between BBs and caviar). We joked that the next day the size would go down another notch and we'd be served a small bowl of deep-fried sugar, but no such luck. We've had the other varieties several times since, though.
Nepali tea, sweet and with milk, is served midmorning and midafternoon, and also pretty much any time you're a guest in someone's office or home. As someone who's resided south of the sweet-tea line in the U.S. much of his life, I've thoroughly enjoyed the tea (and the hospitality it's a part of), but while I'm OK with the milk in it and even the hot part, I'm not sure what this little-tiny-glass business is - sweet tea is meant to be consumed from 32-ounce jugs. (The full-nearly-to-the-rim and usually-handleless small glasses also make for entertainment for the host, observing the expatriate trying to be a gracious guest and pick up the glass without burning his fingers.)
Where does the food come from? Well, the closest thing to a supermarket I've seen was the small convenience store next door to my hotel in Kathmandu (there may have been larger western-style supermarkets in the city, but I was there only a few hours and didn't see much, period). Such supermarkets certainly don't exist out here in rural Nepal. While I imagine a large portion of the food for preparation at the dining hall is delivered or purchased in institutional quantities, the hospital staff residing in the apartments around me purchase some things at the street market in Bardibas, the nearest town, about 4km from here, or other such street markets visited en route to/from field work. There are some fruits and vegetables grown on the grounds, both in small private gardens and in a larger hospital garden, and I often see staff drying corn, rice, or other grains in the sun in baskets on porches or on sheets in front of the residences around me. Thinking about the milk balls and yogurt, I'm now wondering how much of the milk for those comes from the couple of water buffalo that are permanent residents (and lawnmowers) here on the campus.
(And while I'm thinking of it, many thanks to Badri, Ram Chandra, Bishnu, Ramji, and anyone else even vaguely connected to the dining here at LLSC - it's been excellent.)
Someone's going to ask the inevitable question, and the answer is "very little trouble so far." I've tried to be smart about drinking only bottled or filtered water, and I suspect my one bout with intestinal disturbance resulted from off-campus snacking a week or two into my time here. During the motorcycle trip mentioned earlier, we stopped for a plate of momos, dumplings filled with either meat or vegetables. As I learned later from more experienced visitors, the vegetable ones are generally OK if prepared in decent conditions, but the meat ones are almost always deadly for weak-stomached new arrivals, and that snack was probably 0 for 2 in the safety department. That goes on the list of "things learned the hard way."
Gustation aside, posting here has been kinda light mostly because I imagine few are all that interested in day-to-day details of Microsoft Access database development or LLSC internal politics. Class attendance can be spotty at times, but I've been fortunate in the computer-medic area so far, in that both of the hardware failures I've run into have been of the "reseat all the connections and now everything works" variety. Grounding issues continue to be a challenge: I now carry around a USB pen drive with a plastic outer case, after having been zapped a couple of times by cases/shielding that's got more current running through it than it should. Despite my facebook update of a few days ago, I think gecko mating season must have actually been a while back, as I've noticed an uptick in the number of very small (1") lizards around the house, including one little guy sitting on the showerhead this morning. I go on the weekly ward rounds and sit in on other procedures and the like as they come up. And either it's actually been a little cooler recently, or I'm just getting used to it...
]]>Which doesn't mean I've been able to avoid breaking things. A few minutes after sitting down at and powering up that PC of uncertain vintage for the first time, I got one of those "You're making a huge security mistake" popup messages - apparently the firewall wasn't turned on. So, being both security-conscious and Windows-ignorant, I turned it on. I didn't realize until later that the PC of uncertain vintage was the official mail server, and I'd clobbered mail traffic by activating the firewall. Yeah, the firewall can probably be configured to be active and allow necessary mail connections, but for the moment at least, I'm leaving it alone, rather than wreaking further havoc.
But, as Molly would put it, it's all good. Suman, who's overseeing my work, may still consider it up in the air as to whether I'm making any kind of net contribution around here (he was the one who asked, "Hey, you didn't by any chance change the security settings on that computer, did you?"), but I've got a couple of weeks to convince him. Meanwhile, I seem to get a person or two a day who comes to my door thinking I'm the person to talk to regarding employment at the hospital. I've considered reviewing CVs and looking a little gruff while hiring everyone on the spot, but figure that's going to be a pain to sort out in the long run, so I redirect them to Suman's office.
Actual teaching began this week, with staff figuring out when and if they can come to classes. I'm supposed to have a different group each day of the week except Saturday, for an hour or so in the early evening. I'm starting to hit my stride with the beginners, but I'm still figuring out what to teach the more advanced folks, some of whom have certainly spent more time with MS Word, Excel, etc. than I have.
Connectivity, continued, or things we already knew about internet communication but forgot until recently:
Weather can affect satellite connectivity: I'm guessing that whatever satellite is used for providing the internet connection here is a geosynchronous satellite, and thus isn't wandering around the sky relative to the fixed satellite dish on the roof of the admin building, but from my vantage point in the telephone closet, I can watch the connection lights on the satellite modem blink on and off (they should remain lit when the connection is strong), and they looked like the starting lights at a drag racing event yesterday morning as heavy cloud cover (followed by a thunderstorm) rolled in. And here I was blaming the chicken. This contributes to...
The simpler the web page, the faster and more reliably it loads for users with slow connections. And the converse: the more stylesheet, javascript, AJAX, etc. heavy the page, the less accessible the site. Yeah, I know you're sitting there with your DSL line or your cable modem or what have you, and you don't care, but after you've had gmail time out 12 or 15 times just while trying to refresh the inbox (and yes, I'm using the HTML version for slow connections), these things become important. At the moment, gmail is the most twitchy, with Facebook a close second ("Damn you, static.ak.fbcdn.net! Deliver my packets unto me!"), and the New York Times site coming in third. A couple of days ago I was trying to view some random NYT article that was taking its sweet time loading (that's you, graphics8.nytimes.com), and while waiting I took a peek at what had already arrived: 27 external CSS and JS files requested by the page. I'm too lazy to have done straight page-weight comparison, but so far, between a JS- and AJAX-heavy page and a simple page twice or three times the filesize, give me the latter every time. Low-overhead sites load pages every time. And don't get me started on multimedia ad banners.
You don't have to boil your laptop battery to use it. I hear our ancestors used to have to do that to get them to work, but I haven't seen it done myself.
My school's not the only institution blocking YouTube. Laid hands on my first local iPhone today, and no, not one of the just-announced ones with the engraving of Steve Jobs' new liver on the back, either. The owner was asking why the video (YouTube) button didn't work, I was giving it a try, and the search button was "Suchen" instead. Further examination revealed that the phone was language-localized for German. Wondering by what path it made its way here...
SPAM is indeed everywhere. More of a housekeeping note than anything else: I've got commenting here on the blog set such that I have to review comments before they show up on the public site. That's cause the ratio of SPAM comments to actual user comments is currently running about 20:1. I try to check in, review new comments, and post them at least once every 24 hours. Just in case you were wondering whether comments disappeared into a black hole.
The income derived from river rock works out to about $0.50/day/person, and just in case that wasn't tough enough, a heavy thunderstorm on May 13 destroyed several houses. There's already some reconstruction and/or construction of new stronger houses with concrete supports, etc. under way, thanks to some particular donations from overseas. The donations go toward materials and any specialty skilled labor needed, and go through what is basically a town council; the general labor required is provided by the residents.
Also pictured is the new well, dug (by hand) in the last few months. 90 meters deep, it will eventually have a pump, but at the moment, to get water, you lower a bucket by rope and haul that bucket back up by hand. Or you talk the kids into grabbing the rope and running for 90 meters. And as much of a pain as either of those are, they're much easier than the long walk retrieving water previously required.
We also poked our head into the one-room schoolhouse, and just in case there was any doubt as to how much learning is going on there, Dr. Grahame's wife brought a new sari for an elderly blind (and leprous) woman living just outside the village. The newspaper wrapping the new sari was immediately grabbed and pored over by several of the children. And they didn't seem all that interested in the "New Miss Deutschland chosen" article, either.
The Swiss students finished their stay and left early this morning; I've had a flatmate for a couple of days in the form of Kat, a student from the UK who finished her university degree late last week (she'll be taking over the Swiss students' former digs later today). While her freshly-minted degree is in embryology (and yes, I've already tried talking her into teaching at a certain Norfolk institution), she's applied to graduate programs in public health, and is going to be working with the community outreach programs here.
]]>Wednesday was a completely different experience. Instead of spending an eight-hour day entirely in one room (except for a few minutes in a small side room for the aforementioned teas and lunch), I accompanied Dr. Paudel as he left the hospital grounds at 5:30 a.m. to visit small medical clinics/pharmacies between here and the town of Sindhuli, 30KM or so away.
I am a complete wuss (and no, that's not a medical term) when it comes to motorcycles, so while Dr. Paudel is an excellent driver, it did take me an hour or two to unclench my knees and hands after riding on the back of the motorcycle most of the day. The first half of the route to Sindhuli is paved, but the second half is narrow and unpaved, covered with a mix of gravel of various sizes and the occasional patch of sand. The route winds through beautiful hill and river valley country, and given the width of the road and the lack of a center line, standard procedure is to lean on the horn when approaching any kind of blind curve or hilltop, just in case there's a huge Tata truck or bus coming around the corner from the other direction. The motorcyclist is also keeping his eyes peeled for pedestrians, livestock, and recently-felled trees in the roadway. So I'm hanging onto the back of the bike, with the bicyclist part of my brain that never did like gravel roads or sandpits trying to ignore the fishtailing sensation that occurs every hundred yards or so, trying not to lose my grip every time we hit a good-sized bump in the road, all the while thinking, "If I get bounced off of here at 50KM/Hr, I'd better do it in such a way that the driver and the motorbike are left otherwise undisturbed, because the driver's the best person within a couple hundred kilometers to reassemble me after I land."
My wussitude aside, Dr. Paudel's goal for the day was to drop in at several small combination clinic/pharmacy establishments and at the hospital in Sindhuli to network, press the flesh, and generally direct some orthopedic surgery business his direction. At every stop that involved some impromptu examining and consulting, whether orthopedics-related or not, regarding patients who turned up at the establishment we were visiting at the time.
(The first stop also involved some impromptu zipper-replacement surgery, pictured above, on the surgeon's pants.)
Shortly after we wrapped up the visits in Sindhuli proper, Dr. Paudel's cell phone started ringing every couple of minutes, as new cases requiring his attention had arrived back at his clinics near the hospital. That urgency increased the KM/hr of the bike and with it, the terror on the back of the bike, on the return trip. Four children had broken arms in unrelated falls; three of those were treated with casts and slings, but the fourth, a girl of about 4, had a fracture and displacement that needed surgery to fix. The usual rate for that surgery was 15,000 rupees (about $215), but because it was clear the family couldn't afford the fee, and because the girl had been brought to the cooperative clinic (where Dr. Paudel could set his own fees), he offered to perform the surgery for half the usual rate, and possibly would have reduced the fee significantly beyond that. But the family apparently misunderstood the offer of the reduced rate, and left without making arrangements for the surgery. It's possible that they'll make arrangements elsewhere, but the most likely result will be that the little girl doesn't get surgery at all and is left permanently disfigured.
14 hours after we started out for Sindhuli, Dr. Paudel had seen patients at six different sites. A reader asks, "Have they figured out what you are going to do yet?" and the short answer is "sort of," but the best idea yet came from a member of the staff at the last stop of the day, who suggested that I park myself out in front of the clinic, as an advertisement to the effect of, "foreign doctors practice here." My advanced age probably makes pulling that off easier for me than for most first-year students, and frankly, work as signage is less hazardous to patients than most other uses for first-year students.
]]>A quick tallying from my notes for the day shows 33 patients, ranging in age from a couple of months to 80s or so, seen between about 9:30 AM and 4 PM by the physician I was shadowing, but I know I missed several, so that's an undercount. My conversational and history-taking Nepali is nonexistent, so Dr. L tried to slip a few words of history/condition to me in English during examinations and as he took the paperwork for the next patient; cases I did manage to note included several possible cases of leprosy (referred to the official leprosy part of the hospital for further testing and treatment), postherpetic neuralgia, fungal skin infections, vitiligo, gynocomastia, acne vulgaris, impetigo with staph infection, scabies, orchitis, giardia, tinea corporis, tinea versicolor, dizziness with vomiting, cough with fever, possible rheumatic fever, and a huge ankle abscess immediately referred to the wound care clinic. Oh, and one case of hypertension.
A couple of things brought up by readers/emailers ("Hi, Mom."). Altitude: I'm not sure what the exact altitude is here at the hospital, but it ain't Everest Base Camp (5360 meters/17600 ft). Janakpur, the last airport flown into en route, averages about 70 meters (about 69 meters higher than Norfolk) and I'm guesstimating the hospital grounds at another 10-20 meters above that. So (a) it's not high enough to be cool in any temperature sense, and (b) it's not high enough to be above mosquito range. I don't have a thermometer at hand, but so far it strikes me as similar to summer Norfolk: hot and humid. It's just within bearable for this AC-spoiled westerner when the fans are working or there's a light breeze. When the power cycles off (and it's done so a couple of times while writing this), the fans die, the wireless signal indicator goes to zero, and I start to melt. And yes, all three of those make FB/gmail chatting on-again, off-again.
Close calls in traffic: a couple of current patients here, originally seen/operated on before I arrived, are two gentlemen who had their arms hanging out right-side bus windows when another vehicle got a little too close (traffic is on the left here a la the UK), so while my vehicle travel has been minimal so far, my arms are gonna be inside the vehicle at all times when such travel does happen.
Church service Saturday morning: involved a great deal of singing and the introduction of an out-of-towner who apparently said more in the way of brief self-introduction than the speaker was interested in translating; was not an SDA congregation so far as I could tell (but I'm still working on getting some of the church history/theology/etc); and I am pleased to report that some things are indeed universal: small boys the world over while away the service drawing and coloring, lying on their bellies on the sanctuary floor.
]]>I'll admit that the last flight and the first portion of the drive to the hospital had me thinking, "I've come to a country best known for its mountains and I've managed to find the absolute flattest part in which to spend the next eight weeks," but low hills appeared as we approached the hospital, and the grounds themselves are at the top of a small hill. Rumor has it that on a clear day, I'll be able to see Everest from the top of the water tower, but I haven't yet made the ascent.
I'm still learning my way around the grounds, and I'm just getting started on learning everyone's names and the etiquette for various interactions, but I've been assigned residence in the Annapurna cabin, where, at the moment, my housemates are two lizards, a smaller one who seems to patrol from the roofline down, and a larger one who patrols the ceiling. I was supposed to be joined in a couple of days by another medical student, but he's a no-show, and apparently that's not all that uncommon - folks make arrangements months in advance to come, then drop out of contact and never show up. The cabin has everything I need: running water, filtered (drinkable) water, electricity (as much as anywhere on the grounds - apparently a good share of Nepal's electricity generation is hydroelectric, so the supply is dependent on the meltwater runoff and the rainy season, so we're headed into the 16-20 hrs/day of power part of the year), and I'll be damned, wireless internet. I've got a good strong connection to the hub from my front room, but the available bandwidth seems to be in the 36-56k ballpark, so videoconferencing is probably out. And I'm learning the finer points of mosquito netting use ("Mosquitoes: outside netting. Mosquito-eating lizards: also outside netting. Self: inside netting."). It's hot and humid, and it's going to take a few days to adapt to that, but frankly, so far it's about as hot and humid as Norfolk in July or August, so I don't have anything to complain about.
Saturday is the day off here, with most folks attending a church service mid-morning, and Sunday is apparently the busiest day of the week, with the staff seeing 300 or so patients on average. I'm not sure whether that's because most other folk have Sunday off, or for some other reason, but I'll report back when I find out.
Other wildlife of note, mostly not inside the cabin or the netting: 1 semi-feral white cat who patrols the grounds with a yowl that sounds Siamese in origin. Semi-feral as in one of the physicians pointing to bite marks on the ankle of another member of the staff and demonstrating the water-toss employed as a deterrent towards any future bites. 1 monkey being chased off the domestic terminal building at Kathmandu airport. (I don't know why, but the latter made my day.)
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