The view just outside my front door

A nice view from just outside my front door, looking down into the village of Tikabhairab and onto more of the foothills of the Himalayas. Some of the terraced fields are just beginning to turn yellow with mustard greens.

New Delhi International Airport

In the newly opened Delhi International Airport, this large sign is posted on the wall above immigration. Something interesting for you to think about as you wait in line to enter the country. There is tremendous preparations activity in Delhi for the upcoming Commonwealth games. Be forewarned, even if you have an Indian multi-entry or work visa: no one is now allowed to “arrive” in India more than once in a two month period without visiting an Indian embassy in-between arrivals and obtaining a special stamp permit. This process takes a day or so; and could be enjoyable if hours of people-watching in an Indian embassy is considered an entertaining tourist attraction for you.  If you do technically arrive to enter India (to leave the airport) more than once in two months without a special stamp encompassing that particular dated arrival, immigration will put you on the next flight back to wherever you last came from. No leniency. This would apply to circumstances such as using the Delhi airport as a hub for South Asia travel or swinging to Nepal (to visit us!) and then going back to India. I’ve heard stories from those who’ve had travel plans suddenly changed mid-path because of it. Luckily for me, I had a prearranged connecting flight in less than 24hrs and was offered the option to sit in the new airport transit zone area for 18hrs. There is supposed to be free wireless internet – but you have to provide a mobile phone number to access it without explanation as to what will be done with your number. Phone spam is an issue in India. No thanks.  

Water is out

This happens every once in awhile – but today I caught a photo for you. The water pipes leading uphill must have broken again. It is nearing the end of monsoon, and there have been some landslides along the road that curves around the mountainside to reach Anandaban. Some hospital guys took a tank and a small pickup truck to go find water. So, in this pic, you see one of them transferring two buckets of water to my house buckets. Sometimes it takes a few days for the pipes to be repaired.

Other china pics

The leprosy science meetings have concluded (one pic below). It was very good to hear everyone’s presentations about what leprosy research is being done in their countries and then to discuss what can and should be done in coordination with each other next. Answers we find in research need to be applicable to many different countries – which means not only different cultural contexts but different genetic backgrounds (which affects immunology). We had representatives from many involved: India, Pakistan, Ethiopia, Columbia, Brazil, Philippines, Korea, Japan, Thailand, USA, China, Nepal, UK, Netherlands. Several represented Leprosy Mission sites. Netherlands Leprosy Relief provided the funding to support the meeting and discussions (formally called IDEAL: the Initiative for Diagnostic and Epidemiologic Assays for Leprosy). Unfortunately, our Bangladeshi colleagues had visa issues at the last were unable to attend. In the evening, we had dinner together at a famous dumpling house, which were something like Nepali momos. There was a crew that could be seen through a glass window preparing the dumplings. They had many varieties, including pumpkin with shrimp (pic). We had three tables of people, but I only have photos from the table where I sat. At the end of the day yesterday, Nora and I walked in a nearby park. Our hosts have planned and organized this meeting very well and we greatly appreciated their warm hospitality.

Riding with kids 2

 

China

Did you know that Facebook cannot be accessed in China? The pages just do not work here. If you ever travel there, Kunming airport is not intuitive and finding someone who speaks English is not a good possibility around 5am. Upon arrival at the hotel in Beijing, however, there were already a group of familiar faces in the lobby from Colombia, Brazil, India, USA, etc. As we awaited the delegates from other countries to arrive, we rode out to the great wall of China (about 1&1/2 hrs away). I will not be posting pics from the days of workshop meetings, discussions and presentations. Somehow, I do not imagine them as interesting for you! 

 

These are some pics from the Great Wall. Many of the bricks have scrawled Chinese graffiti, but I sighted one with “Nepal” written on it. There is a pic with Nora, a leprosy researcher from Columbia and then a group shot with other researchers that also had arrived at the time. Strangely, I also met some people from Louisiana touring the wall. This is only the second time that I have accidentally met Louisianans on this side of the planet. The accent is unmistakable. J Of course, one of the leprosy group said that my accent appeared suddenly stronger when I spoke with the Louisianans. One guy and his wife was from Alexandria, while the other was from Denham Springs (his street name was even familiar). The wife had taught at Central for years.  Imagine that! 

The 54th momo and beyond

Short term medical student interns and volunteers often come from all over the world during the summer to Anandaban. Many have helped to make and then tasted Dr. Indra and Jwala’s momos (steamed dumplings). Last night, a visiting prosthetics student broke the record: 54 momos (when we ran out) and still had room for dessert (cake and homemade icecream). I do not know if he will have room to eat anything today!

Training local students

Our labs also have visiting academic and medical students and staff that come for some exposure. These are some students that came this week and are observing one of our lab techs take slit skin smear samples from a patient for testing.

Cracked laptop screen

When this laptop was purchased, it came with an accident “anything” will be fixed or replaced policy. “Do you know that I’m taking this to Nepal??” Thankfully, when I came to the US for a leprosy meeting in July, IBM sent for it, fixed it and shipped it back before I flew back to Nepal.

Patan Dhurba, public taps & things that sometimes happen to patients on their way to proper diagnosis

Elisa and I took some Aussie and an American guest a few blocks from Patan Hospital to visit Patan Dhurba Square.

 

Very common sight: people line up to get water from the public taps (because they do not have water in their homes).  

 

A new leprosy patient reported to our doctors recently. His right hand was swollen from a leprosy reaction. No one had correctly diagnosed him previously. A well-meaning relative had placed a traditional hot poultice on him – which explains the burns. Another patient came in with 3 severe burns on his elbow. Wanting to test nerve damage by sensation of hot and cold, a doctor from somewhere else had taken a glass test tube of boiling water and held it to the patient’s skin in 3 sites around an elbow lesion. “Do you feel this?” The patient felt nothing because the nerves were damaged from leprosy. However, one is supposed to use warm water – not boiling water!

View from within the burned out forest above Anandaban (hilltop)

To see information about the forest fire, see postings from April 2010.

Mountain hawk-eagles and more nature observations

There is a pair of these that stay in the trees about my house for many hours every day. From these steep hillside treetops, they have a nice view overlooking a rural valley of hand-farmed fields. Whatever they are, they’re a very talkative species with piercing cries as they circle and land, circle-dodge ravens– and land, soar – circle and land, etc, etc.

 

Someone saw one of them in the tree with a serpent in its mouth. In the high hills, we do not see many snakes and most are not poisonous. (Snakes/poisonous ones are more common in the hot Southern flatlands, but here we see maybe 2 slow moving rat snakes a year.) Nevertheless, the mongoose and hawk-eagle yard patrol is much appreciated as well as entertaining.

 

The monsoon rains have not officially begun – but the insect eggs from last year are awakening with the pre-monsoon occasional showers. The cicadas, locally called the “boring bug”, have started their monotonous monotones. They won’t begin to die out until the end of July or August. Sometimes they are so loud in the evening, that even with the windows closed, it is difficult to hear someone trying to speak on the other side of the room! I typically do not see many roaches – but the other day sighted one that probably could take on a mouse. The giant slugs (~5-6” length, 1” diameter) and their arch enemy, the slug-tigers with green glow-in-the-dark spots on their rears, will appear within the next month or so. But, thankfully, the summer leeches have not yet become a common sight. J

Mongoose sightings & Nepalese Orange mosquito hawks

 

Nuwakot Camp Pics: last patient

The last patient of the camp: he walks boldly in, declaring vague stomach symptoms to Dr. Pradeep as Dr. Indra looks on. Dr. Pradeep began to ask the standard questions without receiving the normal answers. “Well, it’s not happening now. Sometimes.” A smile and a another question. “Well, really it’s for my Grandma.” Dr. Pradeep writes a prescription for a one dose chewable dewormer (something essentially everyone, kids to Grandmas, needs here anyway).  J   

Nuwakot camp: Dental room

I did not spend too much time in the dental room this camp. They extracted around 30 teeth with anesthetic. Extraction is essentially what Yam and Karuna can do during these camps – and it is amazing to see some people so happy to have a troublesome tooth removed. Honestly, though, when I went in the room, Yam was removing a tooth. And the cracking sounds weren’t pleasant. The next patient looked on indecisive. The receiving lady calmly declared she felt nothing while Yam yanked, cracked and pulled. So…I did not stay in that room that long this time. J

Nuwakot camp: General, skin, women & children rooms

Sylvia, a Swiss nurse, and Neeru (a translator) talk to a patient. Dr. Ponkaj listens to a mother and daughter. Two Swiss nursing student volunteers weigh and take the blood pressure of women patients for the gyne room. Dr. Min checks a baby’s feet while his mother describes symptoms. Nearly everyone has recurring stomach complaints, so antiparisitics and dewormers are essentially given to everyone.