Feb 23 update

Thank you for your prayers. This week, a part for the generator arrived and it began to function again after weeks of being broken. However…it’s temp is running high and they think it will only work for a week or so. The saga continues. Dr. Paul Saunderson of ALM (American Leprosy Mission) visited Anandaban this week to discuss issues regarding the research lab – planned projects, committees, etc. This coming week will be very busy. Anandaban is running its biannual Medical Officers training course on leprosy. I’ll talk on the immunology and pathology of leprosy for one session (if you are not into science – I’ll basically explain what the cells do during the disease). It’s truly an excellent course, as clinicians can see, feel and talk with leprosy patients representing the entire spectrum of leprosy and its related issues. It’s a very hands-on practical course. Dr. Ruth Butlin has flown in from England to teach a lot of the medical side. She lived here at Anandaban for 10 years as the Medical Superintendent, and then other places for years with leprosy patients as well. Also, there will be a partner’s meeting at the same time this week. Essentially, people from TLM supporting countries will visit Nepal to see things. Those will be two days of meetings and presentations in the city. There are also a number of deadlines this week regarding laboratory projects – national and international. Please pray we have the electricity and email to meet those deadlines!! Then there will be an annual meeting with the government authorities on Friday that review the mission’s programs in Nepal. Saturday, we will have our first medical camp of 2009! It will be in Shankhu. We will have to ride about 2hrs out in a jeep to get there (apparently the road is too bad for the bus). They say we can probably fit 14 or so people in the jeep (Nepali style) with the gear on the roof. I’ll take plenty of pictures! J This email method of blogging is a lot easier than the normal route. Loading a number of internet pages is tedious, long and often – frustratingly - just not successful. But at least this seems to be working!

 

This is what happens in countries with gun control

But, I’ve also heard that these are illegal in the UK.

Monkey waiting his turn in front of the outpatient clinic

Maybe he needs the doctors to look at his disabled hand? I do not know the truth behind the old injury, though there are rumor-like stories which say he got it from someone years ago that did not appreciate his raiding activities. I’ve also heard that he has been known to get into the wards.

Generators, leopards and monkeys

Thursday, a 1kv old generator was sent to the routine lab. That was an interesting option, as we had to strategically figure out which of the necessary lab analyses pieces of equipment could actually be supported one or two at a time sequentially in order to properly process patient samples. At last, we worked something out! The senior electrician, Astaman dai, is a man much in demand here! Here are some pics.

 

Friday, the leopard struck. Around 6pm, I was up near the center of the compound on the playground with some of the kids in front of the main hospital. A stray dog had come within the past few weeks and adopted the nearby house. Since he had been fed and some of the children liked him, he was beginning to settle and show how friendly and playful he could be. One of the 5 yr old’s dared to aim and fire a water pistol at me, so of course I had to respond. As I grabbed him a bear hug, the 2 ½ ft tall dog came “somewhat” playfully jumping and barking, thinking that I was attacking the child. J As it was getting dark, we soon left to go to our homes. Minutes later, as dusk fell, the teenager in the nearest home hear a leopard’s growl and a sharp yelp. She looked out the front door to see the leopard disappear around the side of her home. A few minutes later, some of the men sighted the leopard with the dead dog down the path. The leopard left the body, the men left and then the leopard came back and took the dog’s body. Very few attempt pets here, because this is a common end of the story.

 

I think that the leopard should have hunted the monkey instead. Last week, Dr. Indra left for a training workshop in Thailand and left me his slingshot. During the weekend, the monkey visited my home. I turned and saw him sitting at my screen door while I cleaned my kitchen. I shooed him off. He moved to the window sill on the other side to eat seeds for next year’s garden. I yelled at him through the window. He made a mocking wide mouthed face at me. Out the door I went with the sling shot in hand. He darted off around the front of the house and up the stairs as I followed. As he made the top of the first round of steps, he stopped to check himself. I shot a stone, which went no where near him. I hit my own thumb. Then he ambled off to the left out of sight in front of the guest house. At first, I thought he was leaving. Then it dawned on me that my back door was left open from my rapid exit. I ran around back. Sure enough, he was there jumping down to my roof and then peering down to see if I was there. Not wanting him to know how bad a shot I am, I just shook and aimed the slingshot at him. Then I went inside and he left. He’s survived the leopard 10 years. It’s not likely that he’ll fall prey now.

Trisuli and the road to Chitwan

This is one of my favorite pics from the road down to Chitwan. The road curves through the steep foothills along the Trisuli river, which ebbs ands flows from monsoon deadly to tamer during the dry season. Holly saw it post-monsoon and said the churning waters looked “wicked”. To provide some perspective, if you look just below the center, there is a 2 story Nepali home on the hillside. The hills are so steep and high! On the far right is the road up ahead. As that road is a major highway, the people can walk to the nearest tandem crossing (or a metal cord with a box cage that you physically pull across) to have access to selling their produce roadside or catching public transport to a village market. A few weeks ago, small tangerines called “suntallahs” were selling for 35 rupees/kilo (~50 cents). Tis the season.

Wednesday Feb 11

So, there was no power yesterday during work hours. We have a few car batteries for backup on a few key machines; but they are 4yrs old, do not hold much charge anymore and don’t get enough time to recharge on the limited city power schedule (pic in a previous post). We currently have a small 4kv generator that is being packed around the hospital to selectively run the operating theatre, a ward OR a few hospital lab test machines for a bit. With the rotating outage schedule, it now runs that way several days a week. The most we receive is a four hour block of city power during work hours (Mon, tues, Friday, Sat).  Kapil, the lab manager, and two grad students covered the weekly leprosy clinic held at Patan Hospital in town today; while Saraswoti, a research assistant, and I headed to Tribhuvan University to meet with faculty there to discuss academic issues related to microbiology and biotechnology graduate coursework. We currently have two graduate students from the micro dept finishing their thesis and two new ones beginning their work in the hospital lab. Saraswoti then headed to government offices to deal with paperwork processing required for various projects. Never a dull day and never a lack of things to tackle. In the attached pic, Saraswoti and Chhatra, the other research assistant, are processing cells from new patients (back in the days we had more power). We are trying to develop a test with some Dutch collaborators to see if we can predict which patients will have a leprosy reactional episode during their first year of treatment. This would be very useful for the doctors, as no one can now predict which patients may have the damaging and sometimes very painful reactions. Potentially, this could help towards the development of intervention strategies to prevent patients from developing more nerve damage and becoming more disabled (which can still happen during the years after they have technically been “cured”).  

Meeting between lab staff of Lalgadh and Anandaban in South Nepal

We’re working on collaborations between the labs of Anandaban (Kathmandu) and Lalgadh (~10hrs drive south) to strengthen the capacity of leprosy research in Nepal. There are many challenges, but many more patients need us to pursue better tests and treatments. Please pray that the labs can effectively work together to develop better ways to eradicate the causes and consequences of leprosy.

Monkey joining in an outdoor lab meeting

 

 

There are some reasons for the delay in posting...

Dear friends,

 

The power outages are still at 16 hrs/day (4hrs am, 4hrs pm on a rotating schedule). The power lines destroyed earlier this year in monsoon flooding crippled Nepal from buying supplementary electricity from neighboring countries during the corresponding dry season. Therefore, this year’s power outages in this hydroelectric dependent country are unprecedented. I’d experienced limited power outages in Louisiana after hurricanes, but this is months of sustained power outages that significantly affect a developing world economy. At least, no electricity is needed to grow rice and vegetables (mainly done by hand here anyway – it took months before I sighted a tractor). No one I talk to remembers it ever being more than 8-10hr/day outages at this time of year. To make matters worse, the main generator and smaller backup generator for Anandaban have been broken for weeks. Imagine trying to run a hospital with surgery, emergency care, 115 beds, xray, computers and lab tests. It’s been challenging. We’d initially hoped that the electrical authorities would grant the hospital additional hours; however, after weeks of promises and negotiations, the plan fell through. No extra electricity will be forthcoming. We had sent our electrician to India to get an emergency part for the main generator. He could find none; and while trying to return, got delayed for days in southern Nepal due to road blocks and protests. A second man was sent to India by plane. He returned with a part. Everyone sighed with relief. The electrician returned Monday, installed the part and…found out that it did not work. Another person was dispatched to India yesterday in an attempt to get a functional part. The government is saying the power lines will be repaired soon. Everyone wants to believe.

 

Anyway, some friends from my previous workplace, The National Hansen’s Disease Programs Laboratory Research Branch in Baton Rouge, will be coming to visit me soon!! Hopefully, the power will be better when they come. They are packing to leave, and should be here March 5-11^th. I have to plan an appropriate itinerary for them. Let’s see, meal planning is easy. Daal bhaat. Daal bhaat. Daal bhaat. Just joking. Maybe. J

 

By the way, this post is a test. Apparently, it is possible to blog by email. With the current power and internet situation, it is difficult to get online sometimes, much less navigate a series of pages over time and then upload materials. Email would be much simpler and straightforward. If this works, hopefully I will be able to post more often!! It may also take pics – so enjoy this scene out my back door. No zoom was used, and he seems only to respect slingshots. I need to practice!! Thank you (Dhanyabad) for your prayers.