New Year’s Eve

Happy New Year’s everyone. It is not New Year’s here as Nepal uses a different calendar. New Year’s is some time around April (right now, it is the year 2062). Losar, the Tibetan New Year is in February and the Newari New Year was last month...but each and every New Year requires some sort of party...so we're headed off to a party..

We are staying at a very nice hotel called Hotel Barahi—named after the local temple for Barahi, a goddess who accepts sacrifices of goat, chicken and duck. Our hotel is in good company, across the road from Hotel Holy Heaven, down the road from Fewa Lake, and in the shadow of Macchepucchre—a Himalayan peak that stands 2400m higher than the Swiss Matterhorn. It is the only peak in Nepal that is prohibited to climbers. The kids have gradually started to run wild, making friends on the road, finding a litter of puppies (never too difficult), and running a tab for naan and coke at the closest restaurant...

My day starts at the government hospital in the maternity ward and some afternoons teaching newborn resuscitation in the classroom. The first school I taught at has the cumbersome name of Pokara Technical Multipurpose Health Institute. It is a private school which teaches certificate level nurses and heath assistants.

The newborn resuscitation class is divided into a lecture, a CD-ROM session and then a practical session for the students. The lecture gives them an idea about how babies are born, and what you can do if the baby doesn’t breathe right away. The American Pediatric Association has published a programme in textbook and CD-ROM format with straight forward steps on the immediate care of the newborn. In Canada, heath care providers like midwives are required to recertify in this programme each year. Here, there are no regulatory requirements for ongoing practice. I feel like I am spreading the gospel of newborn resuscitation...and I’m trying to not be too preachy...more on that another day.

I taught a few classes of newborn resuscitation at the government school. This school has no resources, and there are triple the number of students per class than at the private schools. The school uniform is the dated sari (try bustling around a Nepali hospital and staying clean in a white sari...) Students are bachelor level—so they have volunteered or worked for at least two years after finishing their certificate level nursing—these students gave me a snap shot into practices in maternity care outside regional centres. One thing I find confusing is my perception of this healthcare dichotomy going on between the acceptance of fate and heroic measures—or any measures for that matter. Howard noticed this as well, working in IUC at the private hospital. Here, the doctors do not talk to the family about not performing CPR on a very sick patient if their heart stops (a do-not-resuscitate order), They go ahead and attempt to resuscitate everyone (heroic measures). On the other hand, there is the pervasive Ke garne? which means ‘What to do?’ accompanied by a shrug and inaction (acceptance of fate or perhaps waiting for orders from higher up). But maybe there is no conflict, maybe the gods’ plan involves heroic measures or inaction on the part of the heath care provider...this is your healthcare provider, this is your fate... Howard’s patient told the staff doctor that he had a dream, and God told him to leave the hospital. The staff doctors said, that’s fine, but until God gives me a dream telling me to discharge you, you’ll need to stay...Then again, not treating a patient because they don’t have the money for further treatment requires inaction on the part of the healthcare provider—healthcare is not provided for free. One student asked, ‘Ma’am, how long do you help the baby?’ I said, ‘After 15 minute of no heart beat, you can stop the resuscitation, the baby has expired. Why? How long do you continue?’ ‘Hours and hours ma’am...’ I’m no closer to an understanding.

But without further delay, to announce the winners of the 2nd Annual Tibetan Carpet Raffle...
2nd prize of the pashmina shaw goes to Bridget, a Toronto midwife...
And 1st prize of the Tibetan carpet goes to Maggie, a Toronto unicyclist, (of the 168 kgs of donated equipment and supplies that I brought with me, a portion of it was made up of 2 donated unicycles for Shree Mangal orphanage. They already had one, and had requested two more).

The Endearing Nature of a Basketcase

Well, due to technical difficulties, the first blog entry has been delayed. We’ve been here almost three weeks, and time has whizzed by...
But first, I feel that I should start with a short update on the political situation here in Nepal.

Justifiably, Nepal has been awarded the “Basketcase of Asia” title from The Economist. And I suspect, if it were not for Swaziland, Nepal could claim that title for the world. The autocratic King suspended the constitution this past February and declared martial law—he placed the government (appointed by HRH) under house arrest. The Maoist rebels in the hills later on declared a cease fire, and joined an alliance of the other six major political parties. Their unified request is for elections. The King has tried to have the audience of foreign governments and the UN—but was snubbed by everyone but Tanzania and Burundi.

In true basketcase form, the Royal Nepali Army receives quiet military aid from the People’s Republic of China (whose present political philosophy is a rendition of Mao’s writings)—and the Maoists, who also claim roots in Mao’s political philosophy, receive money from communists in Northern India and a ‘tax’ they levy on aid projects set up by international non-governmental organizations doing work in their controlled areas.Last week, there was a one-day nationwide strike called by the alliance of political parties due to a military massacre outside of Kathmandu. At a village fair, one soldier became angry with the local boys after they hassled him for bothering the local girls. The soldier returned to the fair later in the evening, and sprayed the crowd with bullets, killing 11 and wounding 19. He was then shot. The leaders of the political parties have questioned whether he acted with or without orders...who killed him...and how could one man acting alone shoot into a crowd from a number of different angles...Since then, there have been demonstrations protesting the shoddy investigation into indiscriminate acts by the military—indiscriminate military acts are usually a little less obvious...

The bandh, or strike, resulted in the delay of a clinic camp at a government school—organized by the SEDIC, The Sherpa Education Development and Information Center. The following alternate date was set and a group of us set out to set up the mobile clinic at the school. Forty children were given treatment for scabies and worms—many more had diarrhea, and a few were identified with developmental delay, infected sores, pneumonia and night blindness due to vitamin A deficiency. The first symptom of vitamin A deficiency is night blindness—then, if left untreated, progressively leads to permanent blindness. It is common for pregnant women to describe severe night blindness as a normal symptom of pregnancy—as the pregnancy exacerbates vitamin A deficiency. All kids tell us that they eat tea, noodles and rice. All of them were stunted in their growth. One nurse’s role was to educate about nutrition—informing the children that a few dehydrated flecks of vegetables in the Japanese instant noodles does not count as a serving of vegetables (just as at home, telling young, pregnant women that the shredded green stuff in their Big Mac does not count as a serving of vegetables).

We’ve since arrived in Pokara, in central Nepal for a one month stint—me at the government hospital and Howard at a private hospital. With the assumption that we are Christian, we’ve been given Sunday off (normally a work day)...Hope everyone is enjoying the holiday season, the snow and the central heat...