Sunday, March 06, 2005

and another...

I seem to have lost a day in here somewhere, but I suspect this is probably for the best as no one wants blow-by-blow rantings (except maybe for my mother…? – still haven’t been shot or fallen off anything mum!)

I’ll try and keep my postings to the interesting happenings now, though my definition and your definition of “interesting” may not necessarily concur!

First day “working” in hospital
Ang Rita received a phone call this morning from the hospital confirming my application has been accepted (woohoo!), so we drove in by taxi and did some more paperwork for a couple of hours. Nothing much seems to happen quickly round here, the pace of life being somewhat slower than standstill most of the time. Even the walking pace is slow, I have to dawdle just so I don’t end up 3 miles in front of everyone, and that’s not just cos they’re all too short.

It occurred to me today (and I appreciate this is a little off topic so I’ll try to keep it brief) why Ang Rita looks so familiar – he looks just like an Umpa Lumpa (?sp)! I realise this isn’t terribly PC, but I also discovered today that he has never been to school and that despite making himself understood more than adequately in English (something I have problems with myself at times), he cannot read or write a word! I am not sure if he is achondroplastic (dwarf), I think probably not because he is not dysmorphic. But I suppose he could be pseudo-achondroplastic (Alex – remember the episode of CSI at the dwarf convention?!). Anyway, I digress…

After the incredibly slow-paced paperwork (rather like this blog – sorry), I am given a whistle-stop tour of the hospital, which is much smaller than my initial impression, and am then dumped with one of the doctors in the OPD (outpatients). I spend several hours listening intently to consultations in foreign and not really being able to tell when the language changed into English in order for an *explanation/question to be *made/asked *to/of me (*delete as appropriate)! Not sure whether this is simply a poor excuse for having forgotten everything I once knew and being totally thick. We shall probably see over the course of the next month – I’ll let you know how it goes!

The clinic is amazing: throngs of people, are seen in no particular order, it seems. The only privacy patients get is a thin curtain separating the examination area from the waiting area, and random other patients are so often poking their heads around this that it may as well not even be there at all! The next patient has come in and sat down before the first has even got dressed again! And the previous patients come back at random to discuss their medications (having just collected from pharmacy)!

The first thing I noticed was the old mercury thermometer sitting in a pot on the desk, with no apparent means of sterilisation… I was relieved to discover (almost instantly as 9 out of ten patients present with fever) that this was used only in the axilla (armpit). Examinations are cursory to say the least: stethoscope (worn back to front) used through 3 layers of clothing (sometimes even fleece-type tops); blood pressure measured in a similar fashion!

Everyone has fever (one chap with a month-long history) and/or APD, which, despite my medical training so far consisting almost exclusively of Gastroenterology, I did not work out was Acute Peptic Discomfort (or something along those lines) for about 20mins. A quick look in my new edition of the Cheese and Onion (Oxford Handbook of Clinical Medicine, essential synopsis of everything medical and some surgery too – coloured yellow and green and about the size of a packet of crisps) when I get home reveals no such acronym, so I feel a little less stupid –but not much!

Only one guy in about 20 or so we saw presented with anything other than fever – and he had multiple poorly localised pains, headache, fever (?!) and stuff. Obviously he was depressed, and I was Impressed with the amount of time and privacy we (obviously not me) were able to afford him compared with everyone else.

I recall at this point, something the Medical Education Centre doctor said to me about the leading causes of death in the country: 1) cancer, 2) Trauma, 3) Heart attack, 4) infective; while in Britain ischaemic heart disease is way out in front. And these guys only eat fried food! Either cancer is way more prevalent here thank in the UK or they know something we don’t about IHD!? She also mentioned IHD was on the increase, however, as is depression (and hence my misguidedly thinking this mind-numbing statistic relevant now!).

I was taken to lunch by the very same doctor I was having difficulty understanding. He is very nice and friendly, and obviously keen to help, but I really can’t tell when he stops speaking Nepali and starts speaking to me. I hope I get better at this pretty quickly!

We walk to the cafeteria (one of the few signs in only English) and I am pleased, because this was not included in my aforementioned tour. This room seems even less clean than the rest of the hospital, which really is saying something (quite why they don’t have superbugs here I don’t know – they seem as free if not more free with their antibiotic prescriptions too! Maybe be the enteric fevers, typhoid and things like that keep the nasties at bay?

But I am encouraged that there are two sinks and a bar of soap at the entrance – having been near (if not directly examining as of yet) some rather dirty/smelly/ill patients for the last 2 hours, and without having seen any sinks ANYWHERE else, I welcome the opportunity to wash my hands before eating!

It seems one has to choose and pay for one’s food before getting it or even seeing what is available – there goes my hope of pointing at a few things and then being given a bill. This method really requires some knowledge both of the Nepali food and language – aaargh. Is all too much, and so when the doc (I really can’t remember his name) asks if I’m not hungry, I agree a little too easily. He orders me a tea anyway, which I am glad for, and when he brings a spare empty plate (pressed, stainless steel with separate compartments for different foods rather like they have in prison – I imagine!) and offers to share his with me I am very pleased. So I manage to have a small amount of soft noodles with some random veggies chucked in and fried with chilli – very nice – and a dollop of what I think is called dhal, which is essentially a curried chickpea/lentil soup. To accompany this I have a ring donut! No seriously – it looks like one: obviously some kind of deep-fried dough, sans the sugar dusting, but quite sweet tasting nonetheless. It may sound revolting, but a little sweetness offset the spicy other dishes quite nicely. Another row of sinks on the way out (though no soap this time) and we were ready to face the rest of the clinic.

The end of the clinic is heralded by the onslaught of (and I am not exaggerating here) 15 drug reps trying to sell their products to the doc. They must have queued up outside for ages. We (again, obviously not me) take their free samples and complimentary tea cups (I kid you not) and refused to use their drugs. Nice.

On finishing the clinic around 15:00 I eagerly take my excuse to escape – well there’s no need to overdo it, right? I mean this is supposed to be a holiday too - most of my friends just bummed around the Caribbean for two months (Rob – yes I do mean you, and I WAS implying you sold your bottom for alcohol…!) So I get into a taxi and headed to Thamel (see previous post).

This time, I have the opportunity to explore and shop, because I am not with Neima (Ang Rita’s daughter – should have mentioned her earlier, I guess). I spend four or five hours in total, wandering around the streets and in and out of shops looking for a couple of things in particular: I want a swanky down-filled sleeping bag. I have made do with my cheapo blacks synthetic-filled bag on alpine club trips nearly every weekend for the past 5 years, sometimes enduring sub-zero temperatures, and I have had enough. I will need something far more substantial for the harsh –20C of base camp. Having looked in the sales in the UK, and found nothing for less than 200GBP (yes I know it’s nice Clare, but will it keep out the draught from the hole it has made in your wallet?!), I was encouraged by friends who have been to Kathmandu before that I would be able to find them far more cheaply over here. (have borrowed one from a friend that will do - thanks Ben! - but my own would be better!) I am also desperate for a power socket adapter so I can use this thing (laptop) for longer than 2 hours having lugged it half way across the world!

Every few metres along most of the shopping roads in Thamel is situated a shop selling mountaineering equipment. Mostly only waterproofs, down jackets, sleeping bags and rucksacks, but the occasional one selling reels of rope (Harriet – does the club need cheap rope by the 200m reel?!), crampons, down suits (I sooo want one!), decent-looking boots, and other such tempting paraphernalia. I am pleased to have the time to wander into most (pretty much all, actually) of them. The first one has a gortex-shelled, down-filled sleeping bag, rated to –20C for about 50quid! And I discover, after several hours of browsing, that this shop was the most expensive in Thamel!

However, largely due to the enormous fluctuations in price, and some obvious differences in quality (not to mention Will’s warnings – thanks!), I am suspicious that at least some of this gear (mostly of The North Face label) may be fake. A few shops stock both locally made stuff (cheaper) and the known brands side-by-side. One shop was selling jackets made of Sherpa-Tex (in the same font as the better-known Gore-Tex!) – they actually look quite good, but I have no idea how well they keep out the water, and doubt there’d be a refund if they didn’t match up to my demanding standards!

I visit every shop and gauge the range of prices, hopefully, when the decision comes to buy, I will be able to remember which shop offered me the best deal for the most genuine stuff! But with sleeping bags, waterproof trousers and some kind of warm jacket all required, I think this is too much for my memory to master – ho hum, will just have to spend another half a day wandering when the time comes.

I do manage to spend a few rupees on a nice top and some Nepal badges I know people want. Also have my eye on some Yak fur jackets with pointy, tasselled hoods, amongst other things…

The taxi ride home from Thamel is difficult – I know the route between the hospital and home well now, and even the route from hospital to Thamel and back, but the route between Thamel and home got me lost – especially because it is dark! The problem is, once you get out of the main streets of Kathmandu/Thamel, there are no street names or numbers, so I couldn’t give the driver an address to take me. I tell him the nearest big thing to the house, and pray I recognise something on the way and can redirect him. Needless to say, I didn’t recognise anything and we arrive at the big landmark in the middle of nowhere! I have a map, but it is next to useless once you are off the main roads. Eventually I persuade the driver to backtrack a little and head north until I finally recognise something and direct him to the door. The journey was meant to cost about 200NPR, but I had nothing smaller than 500 and he didn’t want to give me change… L

When I finally walk through the door, I discover the new student (listen to me – I’ve only been here 2 days!) has arrived and been given the room next door – a double! Grr. He seems nice enough though, despite being the enemy.

Dinner with the Sherpas
Tonight, because Nish (new student) hasn’t had time to buy food, we eat with the family. Turns out not to be quite the cultural experience I was expecting – we have spaghetti Bolognese! It was very good actually, but it felt quite odd to be in Nepal and eating Italian food. I suppose it’s not that odd actually, a little disappointing perhaps?


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Wednesday, February 28, 2007 3:34:00 pm  

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