Primary Health Care and Resource Center

Unfortunately we've had limited internet access over the past few weeks making it difficult to update the blog (as you've probably noticed). We are hopeful that we will have more consistent access over the remainder of our trip, so the plan is to give you all bits and pieces of what we've been up to since the last post and eventually get you all caught up to the present. Hope you all enjoy!

While in Nepal, we are working at the Primary Health Care and Resource Center in Chapagaun (a smaller village south of Kathmandu). The Health Center is completely community run and funded (no governmental funds) and provides a variety of wonderful resources for the community of Chapaguan. On site, they have a one room emergency department, a one room outpatient department, a maternal-child health clinic, a pharmacy, a lab, an x-ray machine, and an inpatient ward (with 6 general medicine beds and 4 postpartum beds). Additionally, the Health Center also has one operating theater but currently is without a surgeon so at this time patients who require surgery are referred to the large government hospital in Patan.  Health education and advocacy is also a big part of the center and they have community health workers that go to patient's homes to provide education about nutrition, hygiene, clean water, vaccinations, etc. There is one full time physician and many medical assistants and nurses who are able to function in any part of the Health Center. Luckily for us, all of the staff speak English (and Nepali). Communication with patients is a little more difficult as most speak only Nepali or a Newari dialect that even the staff have a difficult time understanding. Due to the language barrier, we get to work more using our hands (practicing our physical examination skills and procedures) and as supportive staff. I'm really excited to get more involved in the clinic and to have the opportunity to learn about the Nepali health care system. From what I can tell so far, it seems as though the Primary Health Care and Resource Center is a rare commodity in Nepal and much different from the government run hospitals.

Erin, Pavani, and I posing in front of the sign at the entrance of the Health Center.

Many patients waiting to be seen outside the outpatient department and emergency room.

One of the nursing students weighing a baby at the Maternal-Child Health Clinic.

Pavani and Erin in front of the Pharmacy (Pav's favorite place to work at the health center).

The inpatient facility at the health center.

Pav, Erin, and I will some of the health center staff.

Journey to Bhaktapur

On our first day off from the health center (we work 6 days per week with Saturday's off), we decided to travel to a nearby district known as Bhaktapur.  Kathmandu Valley is made up of three districts - Kathmandu, Bhaktapur and Lalitpur (our village of Chapagaon is in Lalitpur district).  We woke up early Saturday morning, ate our dhal bhaat and drank our chiya (tea) and set off on our journey.  However, our first obstacle started on our front porch.  We walked outside and tried to put on our shoes but we weren't able to track down Morgan or my shoes.  At first we thought the dogs had hid them somewhere but after minutes (which seemed like hours) of searching, they were nowhere to be found.  Morgan ended up borrowing Erin's extra pair of shoes while I jumped into Samyak's (the older son) shoes (old school converses ;) ).  We finally started our journey and headed to the bus stop to catch a mini bus to Lagan Khel and change buses to Bhaktapur. Just a quick summary of our bus ride --these so called mini buses are small old minivans which you hop on and pray for a seat and once you think the van is full, they pile on 15 more people until there is no space left to breathe.  If Morgan, Erin and I did not know each other before, we do now.  =)

 

Morgan and Erin just being Morgan and Erin. ;)

Pottery corner at Bhaktapur.  Here, Morgan and Erin were able to buy small Buddha figures made of clay.  I bought a couple elephants carved in Yak bone.

Bhaktapur is also known as a very well preserved and traditional city.  The architecture is very traditional and Matrika (who is from Bhaktapur originally) told us that the government gives subsidies to the people of Bhaktapur if they construct their houses in a traditional way in order to create an incentive to preserve their history.

Running out of precious internet time so we're going to enjoy this picture from a new technique I like to call "horizontal." =)

Some traditional architecture in Bhaktapur's Durbar Square.

Native Nepali woman crafting on her porch.

Just another day in Chapagaun

Our Nepali home is in Chapagaun, a small village in the district of Lalitpur in the Kathmandu Valley, where we are staying with the Prajapati family.  Ram, the father, is the director of the Primary Health Care and Resource Center (PRHRC), where we are working 6 days a week.  Rupa, the mother, is a scrub nurse in Patan, the closest city.  Both Ram and Rupa work long hours, so it is nice that Ram's mother and father also live in the house to help take care of Samyak (14 yo) and Swoyam (8 yo). We call them Grandma and Grandpa, on our first day Samyak informed me that we didn't need to know their names, as he didn't even know their names.

Our Nepali family

Our Nepali home

Lucky for us, the family has two extra bedrooms, which we have happily inhabited. Morgan and I share a room on the first floor, and Pav is living in luxury upstairs with a room to herself. The house has two bathrooms, which is good when there are 9 people waiting in line to pee in the morning.

Our Nepali brothers, Swoyam and Samyak

A typical day starts with the sounds of the boys wrestling around the house, and dogs barking.  We emerge from the cocoons of our sleeping bags (the temperature gets down in the 30s and 40s at night with no central heat!) and get dressed and ready for the day.  We are greeted each morning by either Grandma or Rupa bearing chiyaa (Nepali tea, which is kind of like Indian Chai--black tea with milk, sugar, and spices).  Morgan and I have taken a particular liking to chiyaa which is good because it's a major part of the Nepali day.  After chiyaa it's time for the national meal of Nepal, dahl bhaat-- curry and rice.  Nepalis eat dahl bhaat for their two major meals of the day, morning and night. It took us Americans, used to coffee and cereal, some time to get used to such a heavy meal in the morning, but we learned to love it. (We also quickly learned how to say in Nepali "a little bit"-- ali ali--, and "full"-- pukhyo!)

After breakfast, we walk to the clinic, which takes about 10 minutes, and if it's a clear day offers an amazing view of the Himalayas.

View on the walk to clinic

Clinic starts with a 9am conference, which is basically check out rounds from the night team, going over any admissions and ER visits overnight. Then we round with the clinic staff and doctor on any inpatients, then it's off to whatever duty we're on that day.  Clinic is usually slowish in the morning and we all stop for a daily chiyaa break around 11:00am.  After tea, the clinic usually picks up a bit, and business is pretty steady until our 2:00pm lunch break. There is a canteen at the clinic where we can buy tea and lunch, but full from our morning daal bhaat, we've taken to each enjoying one of the many granola bars we brought with us from the US.

Chiyaa break!

After lunch, the clinic is pretty dead. A few patients here or there, or some follow up labs, but mostly we just hang around and chat until 4pm when we're set free for the rest of the day.  In an attempt to get in shape for the mighty Bridge Run 10k in March, I decided that we should do daily hikes after clinic. So for most of the week Morgan and I, soon joined by our new Spanish friend Diego, and eventually Pav, made it a daily routine to hike to this temple on top of a huge hill every day after clinic. The hike is pretty chill, until you get to the stairs to the clinic. We'll just blame the altitude for the dyspnea that ensues as we climb to the top. We've been told that it is a fertility temple, and those who visit will become pregnant....I don't know about the other two, but I've got my fingers crossed that this prophecy is not fulfilled because I've walked to that temple damn near everyday...

Taking a break as we climb the temple stairs.
(I'm not sure you can tell from the picture, but I'm extremely out of breath)

After our hike, we are greeted at home by Grandma with...more chiyaa! Then it's time to sit and chat with the boys, read, or, if the power is on, watch Indian television.  Daal bhaat is served around 8pm, afterwards we're usually tired and cold enough to hop back into our sleeping bags, and hit the sack.

Grandma, the chiyaa master

And that's a typical day in Chapagaun

The Living Goddess

After spending Tuesday touring three of the temples of Kathmandu with our knowledgeable guide and teacher Urmila, she decided we were ready to go out and tackle the city on our own. Because of time constraints, Urmila instructed us to head out early Wednesday morning to our fourth and final destination in Kathmandu, Hanumandhoka Durbar Square. With some vague directions and a map, we headed out in the morning, hoping that the lack of street signs would not deter us. By some miracle, we made it to the square without getting lost, and it was definitely worth the trek!

Hanumandhoka Durbar Square

One of the most interesting sites in the square was Kumari ghar, or the home of Kumari. Kumari is a living Hindu goddess. She is believed to be an incarnation of the goddess Taleju. The name Kumari, means "virgin." She is chosen in a similar way to the Dalai Lama, in that when it is time to choose a new Kumari, the Hindu priests go out in search of a young girl who fits certain criteria. She must be from a Buddhist family, born under a full moon, and possess 32 specific physical characteristics. They gather all the girls who fit these criteria and bring them to a dark room where they are left overnight. The girl who does not cry is the next Kumari. She is taken to live with a priest family in Kumari ghar, where she is only allowed to leave 13 times a year for various ceremonies and celebrations. She is fiercely protected, as she only remains Kumari until she loses blood, whether that is from a cut or scrape, or more likely menstruation. Once she's had her period, she is no longer Kumari, and she goes back to live a "normal life" with her family, and the next Kumari is chosen.

Shrine in the middle of the courtyard in Kumari Ghar. If you are lucky you may catch a glimpse of Kumari looking out the window.

Mo and Pavani in Durbar Square

Marigolds

 

After visiting the square, we headed back to our hotel. Of course we stopped at our favorite Nepali coffee shop, Himalayan Java for a cafe au lait and croissant!

The rest of the afternoon was spent in Nepali language lessons with our patient teacher Urmila.  In three hours, she gave us, what I can only believe, was the best crash course in Nepali ever taught. We have a lot of studying to do, but hopefully we will make her proud. For now, all I can remember is malaai bhok laagyo, which means I am hungry!

Now we're off to meet our host family. Until next time.

Namaste.

Pashupatinath

Tuesday Feb 14 was not only Valentine's day but also the day we visited 3 very famous temples/stupas in Kathmandu.  I will be sharing my experience at the one Hindu temple we visited, Pashupatinath. Pashupatinath is one of the most famous Shiva temples in the world.  It is the richest temple in Nepal and biggest in area as well.  

Within the temple area, there are a total of 108 shrines devoted to Shiva, with the one main temple in the center.  Only Hindus were allowed inside the main temple but non-Hindus were allowed to take a separate path that went around the temple.  

The temple with the two golden roofs is the main temple here at Pashupatinath.  Entrance fees were also collected, but only for non-Hindus.  What made us feel a little bit better about the steep entrance fee was that some of the money also went to the old age home situated right on the temple grounds.  This home was for the elderly who could no longer care for themselves but who also had no one to care for them.  Once inside the main temple, I was trying to keep up with our tour guide, Urmila, as she weaved through the temple making stops at certain places to bow or pray.  The weaving was secondary to the crowd but also due to the number of animals that were wandering about, including pigeons, cows, and monkeys.  One of the places inside the main temple that we visited was a maze that was lined with Shiva lingams (a lingam is the figure of Shiva that we worship) and they were supposed to represent the number of lives we have lived as animals before becoming a human.  The human form is thought to be the last reincarnation before ascenting to heaven.  

Once outside the main temple, the Bagmati River courses through the middle of the temple grounds.  This river is thought to be sacred because it joins the Ganga River in India.

 On the banks of the Bagmati River, you can see multiple cremations, as it is thought to be a sacred place for a deceased person's body.  Regarding cremations, our tour guide Urmila explained some of the traditions related to this practice.  For example, the eldest son sets fire to the deceased person, and in particular, the son must set fire first to the mouth as it is believed that doing so will open the gates to heaven.  Urmila also pointed out the changes that have occurred through time including that women were not allowed to set fire, even in the case of only having daughters and no sons. However, more recently, daughters have been performing this important task if necessary.

Multiple Shrines of Shiva within Pashupatinath. (Total of 108)

Hope you enjoyed this mini-tour into Pashupatinath.  We are now off to the town of Chapaguan to meet our host family and tour the health center that we will be working in for the next couple of weeks.

Boudhanath and Swayambunath

Sorry it has taken me so long to post! Between our busy schedules of site seeing and cultural/language training in Kathmandu and the variable 14 hours of power outages per day it been hard to coordinate a time to post! We arrived midday on Monday and have been having an amazing time since. We met our program coordinator, Matrika, on the first day and got settled in our hotel (The Millennium Guest House) in Kathmandu. Tuesday we met our cultural and language teacher, Urmila, and went site seeing. We visited two Buddhist temples and one Hindu temple. I'll write more about the Buddhist temples below and Pav will be sharing her thoughts on the Hindu temple in her post. Wednesday we went to a large Hindu square, which Erin will be writing more about. After visiting the square, we had language classes with Urmila in the afternoon. Today (Thursday), Matrika will take us to our host family in Chapaguan (south of Kathmandu). Erin, Pavani and I will all be staying with the same host family. While we have loved exploring Kathmandu, we are very excited to meet our host family and start our work in the health center. Below I've included some pictures from the trip so far. Hope you all enjoy!
--
Morgan

Pav and Erin with Gloria (a nurse from Spain who is also in our volunteer program) at a curry restaurant called Zaika.

Me at the Garden Cafe in Thamel of Kathmandu.

The Buddhist temple Boudhanath in Kathmandu. The is the largest stuppa in Nepal. The eyes located on all four sides (one set facing each of the cardinal directions) represent the eyes of Buddha. These eyes are considered eyes of peace and eyes of love and are always watching no matter where you are. 

Pavani spinning the Buddhist prayer wheels. Each wheel has the Buddhist mantra, om mani padme hun, written on it 10,000 times. When you spin the wheel it represents saying the mantra 10,000 times. Buddhists walk clockwise around the stuppa three times and spin the prayer wheels as they make their walk. 

A giant prayer wheel at Boudhanath.

Gloria, Pav, and Erin with Urmila (second from the left), our Nepali tour guide and cultural language teacher while in Kathmandu. In addition to teaching these classes for VSSN volunteers she's finishing up her masters degree in Environmental Science.

Wheel of Life at Boudhanath. This is very popular in Nepali Buddhism. In the center you can see a pig, snake, and bird. The pig represents ignorance, the snake represents anger, and the bird represents greed. According to Buddhist tradition in order to reach enlightenment you must rid your life of these three things. Surrounding the animals in center are people doing good deeds and bad deeds. The next level represents Nirvana in the top half and hell in the bottom half. The people doing good deeds make their way to Nirvana while those who do bad deeds don't. The outer most level shows humans engaging in everyday activity. Surrounding the entire circle is Buddha who is believe to control all of the levels.

Swayambunath in Kathmandu. Another Buddhist stuppa at the highest point in Kathmandu. It's name means self-build God because it is unknown when the temple was built and it has exists longer than the city of Kathmandu.

At Hindu style temple at Swayambunath to represent mutual respect for other religions in Nepal.

Me, Pav, Erin and Gloria in front of the Swayambunath stuppa.

Overlooking Kathmandu valley from Swayambunath. Prayer flags can be seen flying all over the stuppas as well as all over Kathmandu. The Buddhist mantra is written on each flag and according to Buddhist tradition as the wind blows through each flag, peace will be sent all over the world.

Erin and Pav at a coffee shop called Himalayan Java in Kathmandu.

Erin, Pav, Gloria and me with Bikash a Pashmina shopowner in Kathmandu. We were the first Americans he had met in Nepal and he was thrilled to have us. We sat for quite some time and shared Nepali tea with him.

Finally!

36 hours later...we finally arrived in Kathmandu, Nepal to be greeted by our program coordinator, Mr. Matrika Rijal.  We unloaded our belongings in our hotel room, had a short orientation and then hit the streets of Thamel.  This local tourist district has so many shops and restaurants that we will have to explore in the upcoming days but so far, we visited a quaint coffee shop, Himalayan Java. I'm looking forward to tomorrow's sight seeing, including Pashupatinath and other famous temples!

This is the final countdown.

T minus 4 hours until we board our first plane outta here! Just sittin' around waiting for Mo, Wes, and Pavani to pick me up. Hope I didn't forget anything...

Take Off

Just finished packing 1 hour before leaving for the airport, in true procrastinating fashion.  But hopefully I remembered to bring all the essentials, and as my parents keep telling me, "you can find anything else in Kathmandu."  Let's hope this is true.  Note to self, and for future reference, you can't buy traveler's checks at the bank anymore. Only at AAA.  Good to know. Anyway, not so sure about the 2 day travel time, but I'm excited to embark on my FIRST, and hopefully not last, global health trip!!

Today's the Day

Today our adventure begins. We leave through Charlotte this afternoon, then after nearly 2 days and over 9000 miles of travel we will make our way to Kathmandu, Nepal.

Me with the biggest piece of luggage I've ever strapped to my back.

T minus 4 days

As I finish up the last few days on my PICU rotation, I can't help but think about our upcoming Nepal trip.  However, I am far from thinking about the clinics we will work in, the places we will stay, the sights we will see, or the amazing people we will meet.  I'm too busy trying to remember the small but not so insignificant details like shampoo, socks, voltage converters, pepper spray (per my overprotective mother), and antidiarrheal medicine (fun fact: What country is the world's leading location for traveller's diarrhea? Yep. you guessed right.)  Through all of this packing frenzy, I'm trying to keep my eye on the prize: http://www.volunteer-nepal.org/aboutus.html

I'm also so excited to be going on this trip with two awesome classmates of mine and can't wait to share this experience with them!! =)

 

Comencing countdown, engines on

4 days and counting, and it feels like there's so much to do. My work in the NICU the past week is, I suspect, about as far from the clinic facilities we will be working in as one can get. I think I'm in denial as to how soon we are leaving. A crucial group trip to REI last weekend to obtain some travel necessities brought the reality of our departure a little closer to home. Some of our REI bounty included pants, shirts, travel belts, and a large amount of DEET. 6 IM injections of Japanese encephalitis vaccine, 3 tubes of Ultrathon insect repellent, and one spray bottle of Sawyer's later and the mosquitoes will have nothing on the three of us!

More to come.

Wisman out.

Namaste!

Namaste Family and Friends! Apparently "namaste" means "I honor the spirit in you which is also in me" and is the national greeting in Nepal. Pretty zen, huh? As you can see, I've been diligently reading my Lonely Planet travel guide to Nepal in preparation for the big adventure.

I can't believe we leave for Nepal in less than a week. For those of you who don't know, two of my classmates (Erin and Pavani) and myself will be embarking on a month long journey to Kathmandu, Nepal. There we will be working in a medical clinic, staying with host families, and exploring the rich culture and natural splendor of the Himalayan valley. Erin, Pavani, and I have decided to make an attempt at a blog (despite our combined lack of technological savvy). The three of us will use this as a space to share our experiences with you and we hope you all enjoy!

Anyway, in the meantime I'm finishing up the last week of my current rotation (Cardiac Rehab) and mostly trying not to forget anything important... like my passport or underwear.

Until next time,
Morgan