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Thanks to our readers for following along on our journey.  I'll keep this one short.  Sydney airport to L.A.  Flew all night, watched Star Trek (about time travel) and landed before we took off.  Appropriate.  L.A. to D.C.  Amazing views of the Grand Canyon and (I think) Hoover Dam.  Wow.  Washington to Rochester.  Um, yeah.  Few noteworthy anecdotes to relate...it was just a long day.  So long for now...

The Beach

 

For our last full day in Australia, we decided to take the ferry across Sydney harbor, to the nearby suburb of Manly.  Manly is known for it’s spectacular beaches, where surfing enthusiasts hit the waves starting at dawn (even in the winter).  Yesterday, there was apparently a baby humpback whale seen splashing in the waves with the swimmers (unfortunately it didn’t make a repeat appearance today while we were there). 

 

The ferry was a pleasant 20 minutes through the harbor, where we got some great views of the bridge and opera house, as well as views of the surrounding neighborhoods on either side of the water, with beautiful houses climbing up the hills.  When Chris makes his millions getting a recording deal, I definitely want a house on the water here.

 

We were entertained on our way there by eavesdropping on more obnoxious Americans, whose conversation went something like this:

(looking at the Sydney skyline, with the Sydney Tower – like Seattle’s Space Needle – a prominent feature, impossible to miss, and written about in nearly every tourist brochure)

American lady #1 – “Look at that big tower thing!”

American lady #2 – “It looks just like a needle or something”

Lady #1 – “It’s so big, what do you think it is?”

Lady #2 – (Asking an Australian sitting next to her) – “What is that big thing there, do you see it?”

Lady #1 – “It’s that big tower thing, with the needle on top, do you see it?”

Lady #2 - (now ignoring the Australian who was starting to tell her about the Sydney Tower) – “Oh, I know, it must be a restaurant, like the one at home that turns around?” (Referring to some kind of revolving restaurant in the US)

Lady #1 – “Except I’m sure this one doesn’t turn around.”

 

They went on to talk about the incredible “pointy tower thing” for several more minutes, with the whole conversation occurring while they were trying to keep track of several small children that they were holding on those child “leashes”, and offering to give them pretzels if they would please just sit down.  It’s very embarrassing being an American in a foreign country sometimes (although amusing to listen to others).

 

Manly itself, on first appearance, seems similar to many other beach towns we’ve been too – upscale touristy versions of Charleston or Florida or the Outer Banks.  We crossed through a central public square, with lots of shops, restaurants, fountains, etc.  We came to a beautiful beach – it reminded me of Waikiki, only without the skyscrapers.  Manly has multiple coves and beaches, and there are maps detailing many different walks you can take around the water edge.

 

We started off down one of the many public paths taking us around the coastline to a park in a marine preserve.  This particular bay is known for being home to several endangered species, including the woody sea dragon.  Next time we’ll have to come in the summer, so we can get in some snorkeling.  Even though it’s the middle of the winter here, it was still a sunny beautiful day, and there were a lot of people in the water – all with full wetsuits. 

 

We were going to venture a little further into the “bush” in the nature preserve, but then Chris got “surprised” (I think scared) by a very large spider.  It didn’t really come out in the photo, but he assures everyone that it was both big and scary (and I’ll agree to that, although I think pretty much all spiders are scary).  Given that we’d both recently read Bill Bryson’s book about Australia, which describes the many poisonous spiders to be found here, we both felt it would be safer to stick to the paths along the coast rather than venture inland.

 

Our time at the beach made for a quiet and relaxing day – a great way to end what has otherwise been a busy and eventful trip.  We’ll head out for one last dinner on the town tonight, then tomorrow we head back to the airport for the last round of planes taking us back to New York.

 

Tomorrow, we travel through time…

Sports around the World

When watching TV in Australia, it’s easy to think you’re in the US.  But once you get lulled into that universal Americanism of the couch potato, you’re soon to be reminded that you’re in a strange and different place.  So OK, you can watch Letterman, the Simpsons, and Oprah.  You can watch the world news on the BBC, which is a little weird, but nothing you don’t find on PBS at home.  But if you try to watch sports, you’re bound to see something weird.

 

OK, I know what you’re thinking—Chris is going to blabber more about cricket.  Although that’s been a continued source of entertainment on this trip, I’ll let it lie for the time being.  In Australia, it’s a given that you’ll see cricket, rugby, soccer, and Australian football (a game one can easily mistake for rugby).  I’m also not surprised to see a lot more formula-1 racing—I know it’s much more popular outside of the US.  But I’m not talking about those obvious ones.  I’m talking about really weird stuff.  I’ve seen indoor men’s volleyball.  I’ve seen swimming.  I’ve seen track and field.  Americans don’t even pretend to care about these things on non-Olympic years.  But one race I saw takes the cake.  I see a pretty scrawny, weird-looking kid racing around a track with a pained expression on his face.  I’m thinking, why is he running so awkwardly?  The commentators made a remark about how he’s so far ahead he’s walking to the finish line.  I’m thinking, is he at the very end of a marathon?  Why else would someone run in such a bizarre fashion?  Then the camera panned out and I saw the rest of his body.  He was powerwalking.  Yes, I saw a televised international teenage powerwalking competition. 

 

Mind you, I am not watching the bizarre sports channels on a 1000-channel cable TV.  I have about 15 channels in this hotel.  This is not ESPN-8, “The Ocho,” or anything.  It’s just regular TV.

 

In Nepal, TV basically shows no sports except for cricket.  But I did enjoy reading the sports headlines in the newspaper every day.  In the US, outside of the Olympics, usually  sports headlines don’t deviate from baseball, football, and basketball.  (Though golf is also common.)  A hockey headline is a rare sight, and in the right season, you might get the occasional tennis or NASCAR headline.  But in Nepal, the non-cricket headlines could be about anything!  Formula-1 was in the news since Michael Schumacher is coming out of retirement.  (Never heard of him?  In the 90s, only a few athletes like Michael Jordan and Tiger Woods made more money.)  In Nepal, I also saw headlines about judo, volleyball, cycling, tae-kwon-do, track, and wrestling (not WWE).  In an article about a martial arts championship going on in Thailand, the newspaper commented that all the Nepali competitors were out of medal competition except for in a certain class of judo, because only three countries had entered that particular field.  I thought that the most ridiculous headline I saw was about badminton—something like “Nepalese Shuttlers Flying High”—until I saw a newspaper headline about competitive rock climbing.  You can’t make this stuff up.

 

On a related note, during our 13-hour layover in the Delhi airport transit room, we sat for several hours next to the Afghani martial arts team returning from that Thailand competition.  I didn’t talk to them much, but an annoying hippie girl behind me did.  It was interesting listening to their conversations.  They were excited to meet an American, and talked mostly about cultural differences, like the fact that they don’t drink alcohol because they’re Muslims, and that it’s very difficult to get good jobs in Afghanistan and in America it’s pretty easy (relatively speaking).  They asked her what religion she was and she responded “Child of the Earth.”  Ugh.  Then they started talking about drugs, and she was amazed they were from Afghanistan and didn’t know what opium was.  Great ambassador for America, that one.

 

Walking in Sydney

Put on my brown leather shoes and boarded a plane.  Touched down in the land of the kangaroos just a little bit south of Brisbane. 

Then we went walking in Sydney.  We went walking on our feet for like 10 long miles.  We went walking in Sydney.  And now that’s why Melissa’s full of smiles.

OK, this song is quickly deteriorating into a bad case of rhyme time.  And actually, if you’re in Australia, Brisbane doesn’t even rhyme with plane.

It was not a remarkable day, but quite pleasant.  Yesterday we were completely exhausted and slept all day.  That was because we spent the last two nights in the Delhi airport and in flight, and we didn’t sleep much either night.  It was sad to leave Kathmandu, but I was ready to go, and it’s nice to be able to drink tap water again.  Australia is just so agreeable!

Our walk took us around a few small inlets of the harbor and through the botanical gardens.  I liked that they had a sign that said “Please walk on the grass, smell the roses, and hug the trees.”  There’s a fountain there with freshwater eels that sometimes eat small ducks, and despite draining the fountain several times, the eels keep coming back.  What an interesting mystery.  They think the baby eels wriggle across the lawn from the harbor—weird.  We didn’t see the eels, though. 

We did see bats.  Lots of them!  They were hanging from the trees in the gardens, occasionally flying around.  They made a lot of noise.  I think it’s because they were trying to sleep but it was too bright out.

The walk gave us lots of great views of the opera house as we gradually made our way to its steps.  It really is an amazing building—I could just look at it all day.  We had lunch on the dock nearby, and a mean seagull eyed our plates the whole time from a nearby umbrella.  As soon as Melissa got up, the seagull made its swoop and knocked one of the glasses off onto the cement sidewalk.  Stupid bird.  We had been warned, though, by the sign that said “Birds will try to take food from your plate.”  Australia has great signs of warning.  I also bought a kangaroo tie.

Then we went to the harbor bridge and walked across.  It was a long, beautiful walk with lots of great views.  I was pretty tired, though, and we soon made our way back to the hotel.  I estimate we walked 12 miles, but Melissa thinks it was 8.  I’m a little too tired right now to be witty in this blog entry.

We’re headed to dinner soon.  Last night we had food at a German restaurant, and I ordered weiner schnitzel.  I had no idea what it was.  Turns out its like a big slab of fried beef, I think.  Melissa liked her chicken paprika.

The one complaint about Sydney remains: it’s really expensive.  Australian dollars are worth slightly less than American, so I have to remind myself that it’s about 10% less than it seems, but still.  Two sandwiches and two drinks for lunch was $35.  The hotel charges by the minute (and the megabyte!) for internet usage, we have to pay the hotel extra for a shuttle to the airport, and I still can’t get over that sidewalk cafes charge extra to eat in!  Whatever, nobody wants to read this trivial nonsense.  I think I should put this blog entry out of its misery.  See you in a couple days.

Goodbye, Kathmandu

Yesterday was a lazy day.  We mostly stayed inside and watched movies since it was rainy.  And besides, my impatience with tour guides has extended to impatience with salespeople, rickshaw drivers, taxi drivers, restauranteurs, and those teenagers who continually ask if we smoke weed (we turned down 5 in the space of 2 blocks the other day).  Yeah, it's time to head somewhere a little less in-your-face than Thamel.  So we'll go to Delhi.  

In Delhi we plan on a lovely stay in the transit room of the airport.  That will be the extent of our accommodations for tonight.  Then tomorrow we have a flight to Singapore, and then tomorrow night's accommodations are the lovely seats in coach on the overnight flight to Sydney.  Throw in the fact that we have no hot water in our hotel at the moment, and we're looking at the next 2-1/2 days with no shower or bed.

Ah but then we return to serene Sydney, where the air is clear, the water is safe, and everyone says "no worries" instead of "you're welcome."  (Well, the water isn't safe if you're swimming, and in fact there's plenty to worry about, what with the sharks and crocodiles and jellyfish.)  A three night stay in Sydney will be just enough before I'm ready to get home.

We'd like to return here sometime soon.  I'm not too keen on two more weeks in Kathmandu, but a trip to Pokhara and a trek of some kind would be a great experience.  Melissa's interested in returning for medical work that involves more than just observation--a career in international health may be in her future.  So for now, we're signing off for a couple days as we likely won't have internet until Wednesday.

P.S. Our last activities before leaving for the airport included a shot of the Sabres hats near a buddhist stupa and a typical nepalese marketplace, as requested by Victor.

Rain in Bhaktapur

Chris has apparently decided he is no longer able to write blog entries without digressing into random personal commentaries, so we'll see if I can do any better.

As he was trying to discuss in his previous entry, today we decided to venture to the nearby town of Bhaktapur.  This smaller city is about a 45 minute drive from Kathmandu, through some urban sprawl, with distant views of the hills surrounding Kathmandu valley.  

The city itself, as noted previously, is unique in that the city center is a car-free zone, which meant that we got a pleasant break from the incessant honking that usually fills the background of our trips.  As with Patan and Kathmandu, Bhaktapur has it's own Durbar Square, where the greatest concentration of significant temples surrounds the palace that was home to the formal royal dynasty (again, with each of the three cities originally having it's own king).  

Some of the features which make Bhaktapur's square unique:

Each Durbar square contains one or more museums, usually in part of the former palace.  We wrote previously about the excellent museum in Patan, devoted to explaining some of the basics of Hinduism and Buddhism in Nepal.  The museum that now occupies part of the "55 Window Palace" in Bhaktapur is devoted to art.  We didn't end up having time to explore the museum today, but did note the sculptures in front, which depict two of the more vicious incarnations of Hindu gods, one of which, Bhairab, is shown in the process of disemboweling a demon.  Supposedly the demon could not be killed "by man or beast, by day or night, or by any weapon", so Shiva took the form of a sort of man-beast chimera (Bhairab), attacked at dusk, and used it's own claws rather than a weapon, thus saving the kingdom from the evil demon.  Public disemboweling - nice.  Hindu temples have an interesting way of choosing either the most graphically violent, or graphically erotic scenes to display in public on and around their sites of worship - definitely not PG rated if you take anything more than a cursory glance.  With this particularly display, the artistry was apparently considered so fine, that the king had the artist's hands cut off so that he couldn't make a duplicate copy for anyone else.  You can see the lovely scene in the picture above (the carving is next to a big stone lion).

In front of the palace is the Golden Gate, which, according to our guide book, is generally considered to be the most important piece of art in the whole valley (although, with so many beautiful and intricate structures, I have no idea how or why they came up with this particular distinction).  We were thinking of heading into the courtyard, but it was guarded by several army guys with big automatic weapons - as soon as we brought out the camera they quickly ducked out of view.

We also got to see the tallest temple in all of Nepal, 30 meters in height, with a 5-tiered roof in traditional Newari style.  The stairs are guarded on the lowest level by a pair of mythologic wrestlers, who had the strength of 10 men, and above them are two elephants, then two lions, then two griffins, and finally two goddesses.  Each set of figures is supposed to have a strength that is 10 times that of the figures directly below them, with the weakest of all, man, being represented by the people in the square.  An interesting concept.  

The oldest temple in Bhaktapur is dedicated to Vishnu, and surrounded by statues representing his typical symbols, including a disc and conch shell, and his means of transport, the man-bird Garuda.  The temple and site have been in use since 1080, according to our guide book.  In addition to depicting items that would be associated specifically with Vishnu, there was also a statue of a lingam and yoni (symbolic representations of male and female parts, if you know what I mean), and Chris thought it would be appropriate, given my occupation, to take a picture of them.  The yoni always points north, for reasons I have yet to learn.

There are many other incredible structures all around the city center, and by this point, we had gotten a chance to see, at least briefly, most of the primary temples and structures in Bhaktapur's main square.  We had a longer walking tour laid out in a tour book, and so decided to stop for a quick lunch before delving into some of these more out of the way places.  It turned out to be a good decision, because shortly after entering the restaurant, it started to rain - then to pour.  We were able to get a couple great views of the surrounding valley from the rooftop of the cafe just before the weather turned.  As we were taking some pictures, we could see the grey haze of rain approaching from over the adjacent mountain-top. 

After realizing that the rain wasn't going to stop anytime soon, we decided that a deeper exploration of Bhaktapur's streets just wasn't meant to be on this trip.  We booked it back to where our taxi was waiting (he'd agreed to wait two hours for us - we had a little help with our hotel in arranging transport), and, soaked through, were brought back to our hotel.

Tonight we will hit the town again for dinner - last night we went with a group from the hotel to a place with live music.  The cover bands here are actually really good, and this one played a mix of classic rock, Rolling Stones, Hendrix, and also some blues.  It was a little too loud for good conversation, but fun to check out the local music scene.

Tomorrow is our last full day in Kathmandu.  We've gotten to see quite of bit of the city, and hopefully will get in just a little bit more before we start our two day journey back to Sydney on Monday.

Thoughts about New Jersey and Tour Guides

Since the weather in Pokhara prevented our excursion to the quaint mountain town, we settled for a half-day trip to Bhaktapur, a nearby city with the standard collection of ancient temples and historical curiosities.  Bhaktapur is the third of what were once three kingdoms in the valley (the others being Kathmandu and Patan) and we'd heard that it warrants its own trip.  

We left on a beautiful morning, with clear blue skies.  The cab ride took us along the Kathmandu-Bhaktapur highway (see previous journal entry), which never really leaves the urban setting, though it connects the two cities.  I sort of felt like we were driving through the Nepalese version of New Jersey, a long continuous road of sprawling unattractive development that connects population centers.  (My apologies to any friends or in-laws who may happen to be from New Jersey--I know it doesn't entirely conform to my stereotype, but I'm trying to illustrate an impression here.)  

Bhaktapur has some things going for it.  Notably that no cars are allowed in the main part of town.  It makes for a much more pleasant tourist experience, a quieter pedestrian village that feels more authentic than Kathmandu.  Still, that didn't prevent the tour guides from accosting us.  We had traveled no more than 50 feet from the main gate and we'd already turned down 5 tour guides.  It's like they're all trained in the exact same way; every conversation is the same.

Guide: Where are you from?

Chris and Melissa: (silence, reading their guide book)

Guide: Are you from the US?

Chris: Yes, we're from New York.

Guide: Ah, New York!  How long are you in Nepal?

Chris: We're here for two weeks.  And we're not interested in a tour guide.

Guide: Have you seen much in Nepal?  Nepal has much history!  It is good to know all about it.

Melissa: We're reading the history in our book.  We're not interested in a tour guide.

Guide: The book does not tell you all the history.  I tell you everything.  I give you good price.

Chris: (walking away) We don't need a tour guide, thank you.

Guide: (walking with us) Not expensive!  1 hour, good price!

Melissa: (walking away) We don't need a tour guide, thank you.

Guide: Very cheap!  10 bucks!

Melissa and Chris: (silence, walking faster)

Guide: I stay here.  You change your mind, remember to come back.  I'll be here one hour waiting for you!

Such is the standard interaction.  But I admit I'm losing my patience.  Two weeks of this is enough to try anyone's level of politeness.  The conversations have sort of devolved to the following example, which I recall as closely as possible from Bhaktapur today:

Guide: Where are you from?

Chris and Melissa: (silence, reading the guide book)

Guide: Are you from the US?

Chris: We don't want a tour guide.

Guide: I tell you everything!

Chris: We don't want a tour guide.  That's it.  We don't want one.  We're all set.  Thank you.

Guide: I give you good price.

Chris: (walking away, waving arm dismissively) No!  We don't want a tour guide!  

Guide: (spots fresh meat exiting a taxi)

Chris: (to Melissa) Ooh, watch this.  Let's see how these poor saps handle this guy.

(from a distance, Chris and Melissa observe the poor saps speaking to the tour guide)

Chris: Uh-oh, first mistake, they stopped walking.  Oh, these guys are finished, he's making eye contact.  Oh, now he's nodding!  Big mistake!  Ok, there, he's walking again.  Good for him.  He's still nodding, though.  Ok, I see a dismissive arm wave, he's getting the hang of it.  

(By this time, Chris and Melissa have been approached by and dimissed yet another tour guide.  Just as the poor saps are ridding themselves of the first, the second tour guide is making his way towards them.  Repeat.)

Clearly I have some resentment towards the damn ubiquitous tour guides.  But I do feel for them.  What a way to earn a living, having to approach strangers and attempt to sell yourself and get turned down hour after hour.  I feel bad for having to be rude to them, but their persistence practically requires it!  If one is not very very direct with them, it encourages them.  I've got to think that educated people with decent English skills can find a more productive way to earn a living.

This originated as an entry about Bhaktapur, and I didn't even get to the bulk of the story.  Ah, well.  The photo above shows me right upon entering Bhaktapur.  See those people in the distance?  They're all tour guides.  I'll let Melissa write the official entry about Bhaktapur and tell you about our thorough soaking.

Development Money

So when I think of foreign aid, I have no idea what that actually means.  I always envision trucks distributing bags of rice or pallets of water being airdropped from helicopters.  Governments give massive amounts of foreign aid to developing countries--where does it go?

I've got a few examples.  We did not get to go to Pokhara where there is a museum dedicated to mountaineering that was funded by Germany, if I recall correctly.  This makes sense because the Germans, having conquered the Alps during the 1800s, were the most enthusiastic in first attempting to conquer the high Himalayas in the 1900s.  That Germany would cherish Himalayan history with a museum is very cool.  But we didn't see that one.  We did have the opportunity to see a nearby museum about religion, which you may recall from my blog entry "Patan."  The museum's pamphlet says that it was made possible by money and work from the Austrian government.  Why Austria would put its resources into preserving the culture of Nepal escapes me.  Still, I think it's great, because access to education here is limited, and that single museum can provide a brilliant experience for local people that we take for granted with our huge number of museums in America.  It's particularly nice that it commemorates and educates about the local heritage, so that local people see value in their own culture and it doesn't get entirely taken over by Nike, Coca-Cola, and Apple.  But I digress.  The fact that there is no obvious connection between Austria and eastern religions actually makes me happy, because it seems to be that Austria is preserving culture for culture's sake, without any self-interest.  

At the same time, I find myself wondering if a museum is really the best use of funds in a country that has great need for basic services.  Today we drove to Bhaktapur, a distance of about 20 km, on a road that was in various states of construction.  It almost, at times, resembled a normal highway (though with a center line that still is only a suggestion--it makes for some near misses).  In one place where it is still entirely dirt there was a large sign that said the Kathmandu-Bhaktapur highway was made possible jointly by the governments of Nepal and Japan.  This highway will connect two major population centers along a route of much commerce, so it will benefit the local population a lot.  Though it is a shame to see land paved over at the expense of progress, I can only think that if a road connected Kathmandu and the villages suffering from cholera, medical aid might have reached those people soon enough.  So yeah, go Japan, funding a much-needed road.

The other government-funded project we're aware of is the maternity hospital that Melissa already talked about.  It is funded largely by South Korea.  This project contributes directly to a lower infant mortality rate, a lower maternal mortality rate, and generally promotes well-being in a country without good health care.  Despite Melissa's descriptions of the facility that make it seem backward to us, it's a heck of a lot better than delivering in a rural village with no health care at all.  So yeah, go South Korea.

The absence here of descriptions of US-funded projects is only because we haven't happened to notice any.  I have no doubt the US government contributes lots of money to development projects here and elsewhere.  Melissa noted, however, that due to the global gag order instituted by President Bush (and Reagan before that) the US government would not fund anything like the maternity hospital because it does counsel about contraception and terminations.  (Melissa points out that there are American organizations here that do that kind of work, but they are NGOs that receive no government funding.  Obama did rescind the global gag order in his first week of office.)

As I've made note of these development projects, it's led me to think about how international development and economics work on a larger scale.  I really don't know a lot about it, and I'd like to read more.  It is by no design of my own that the three examples relate to three separate fields: culture, infrastructure, and health care.  It seems appropriate that we should distribute aid in such a way, rather than focusing only on delivering food to the hungry, for example.  As important as such humanitarian work is, foreign aid would be a never-ending sinkhole if it does not go to establish something permanent.  (Which can also, of course, translate into alleviating hunger.  I've read about programs designed to educate farmers or genetically engineer higher-yield crops in Africa.)  Anyway, I hope that the foreign aid is distributed by people who are both compassionate and intelligent, working within systems that lead to sustainable changes.

(The picture for this entry doesn't really have anything to do with the topic.  But it is an example of the odd juxtaposition of a modern building taking shape underneath shaky scaffolding made of bamboo lashed together.)

The Racist Dog and Other Observations

The Hotel Courtyard has one primary entrance in and out.  It goes through, you guessed it, the courtyard.  This is the central location where patrons often sit to have a drink and make conversation.  The owners hang out there and socialize while conducting the day-to-day business of the hotel.  Always present is their little yappy dog, Tibby.  I'm not sure what breed of dog Tibby is--it would be sort of like trying to identify the race of Cousin Itt.  Underneath the ugly hair and yapping is a pretty friendly dog that will sit in your lap and let you pet him.  But Tibby fancies himself the courtyard's guard dog as well and misses no opportunity to defend it from anyone threatening.  As the courtyard is the primary entrance in and out for everyone, it has a regular flow of not just patrons, but drivers, porters, deliverymen, cleaning staff, etc., all of whom are native Nepalese.  Tibby only barks at them.  If I walk in, or an Australian, Brit, Canadian, Greek, German, or Italian, Tibby greets him/her by trotting up and sniffing.  If a Nepali or Indian enters, Tibby greets him/her with ferocious barking and occasional nipping at the knees and calves.  This racial profiling occurs with remarkable consistency.

It is at times amusing, and at times annoying, to watch Tibby go from placid to vicious with the entrance of a dangerous new visitor.  The dog's racism is a joke among everyone here, but it's also pretty curious.  The owner explains it like this: Nepalese people don't typically own pets. Dogs fend for themselves, and the notion of a domesticated pet dog is unusual.  Consequently, dogs are often subject to abuse by Nepali people.  The owner thinks Tibby can somehow sense the different attitude towards dogs.  I don't entirely buy this because some of the hotel employees who are around Tibby every day and like him are still subject to the racist treatment.  The cook, for example, just smiles while Tibby attacks his heels, and I think he feels affectionate towards the dog despite being victimized by him.  Or does the cook just smile because it's the owner's dog, secretly harboring resentment toward the mutt that daily terrorizes his ankles?  

On a related note: a westerner might come to Nepal and think that the Nepalese people are pretty homogenous.  This is far from the case, which one might expect in a mountainous country with weak central government and poor transportation and communication.  Despite its small size, apparently Nepal is quite diverse in its ethnicities and languages.  Most people in Kathmandu speak Nepali (and some English) but I understand that the longer treks will take travelers to parts of Nepal where people don't even speak Nepali.  The ethnic differences between these peoples would be difficult for westerners to distinguish, but I think that for local people, those differences are quite real.  To illustrate, consider the interchange between my hiking companion Bruce and our Nepali guide, Isur:

Isur: I am the only member of my family to come to Kathmandu.  I'm from the mountains near Ganesh Himal, so I know the mountains very well.

Bruce: So what, you're like a Sherpa?

Isur: No, Chhetri.

Bruce: Huh?

Isur: Chhetri.

Bruce: So that's not Sherpa?

Isur: No.

Bruce: What's the difference?

Isur: Um...

Chris: They're different ethnic groups, Bruce.  I think it would be like assuming Puerto Rican and Cuban are the same because they both speak Spanish.

Isur: Yes, that's right.

Bruce: Ok, cool.

Incidentally, Chhetri and Sherpa don't speak the same language, so it's even a bigger difference than Cuban and Puerto Rican.  Still, you get the idea.  In an earlier entry I talked about the Newari meal we had, and I commented that I wasn't sure what Newari was.  Well the Newari are the ethnic group descended from the medieval people that traditionally inhabited the Kathmandu valley, before the country was unified.  "Nepal" is thought to be a poor transliteration of the older word "Newar."  Today, "Nepali" refers to any person from Nepal, cutting across ethnic lines, while "Newari" is reserved for those descendants of the medieval Kathmandu valley, and is only the 6th largest ethnic group in the country (thank you, wikipedia).  

I'm not attuned enough to the language and culture to detect different attitudes about different ethnic groups here.  But in a few conversations with people I've detected condescending attitudes about urban Nepal vs. rural Nepal.  One shop owner who sold me a knock-off North Face shirt commented that in the country they're suffering from cholera because they're not educated.  He said they don't know better about drinking clean water.  I said something like, "Well, aren't they pretty poor? Maybe they just don't have the money to do what they need."  And he said, "Yes, they are poor because they aren't educated.  In Kathmandu at least we are educated so we know about these things."  He continued, showing an awareness of how a westerner (me) might view Kathmandu: "You might look at the streets of Kathmandu, and they are very dirty and dusty, but this is the most modern place in Nepal.  We know we need to make our city better, but out in the country they just don't know.  This is why there is cholera."

I also purchased the board game that is a traditional Nepalese pastime.  Similar to checkers and chess, Tiger-Goat is the official game of Nepal, and we've seen groups of people huddled on street corners to observe an intense game.  Shortly after I bought mine, I asked one local person how to play it, and he responded, "I don't know the rules of that game.  It's for the peasants and farmers."  He was sort of joking, but not really.

Unsuccessful flight, take 2

Chris and I have been excited, getting ready for a short trip to a nearby city in Nepal to end our time here.  

My last day at the hospital was yesterday.  Initially the plan was to do an overnight shift with Reena, but, we were both pleasantly surprised to learn (at the last minute), that instead we would be headed back to the same hotel where the week prior we had gone to a conference.  Yesterday's session was to discuss the results from a pilot study on initiating a medical termination (aka, taking a pill instead of having surgery) access program across Nepal.  Unlike the week prior, where the conference was geared towards Nepalese providers, and thus few of the talks were in English, this workshop was geared towards making new nationwide policies for access, protocols, and monitoring, and in addition to local physicians, there were also members of the World Health Organization, Ipas (a US based organization focusing on international women's health), as well as several other NGOs in attendance.  The presentations were all in English, and there were some great small group sessions to listen in on, as these leaders in gynecology tried to establish some ground rules for incorporating a new process into the existing system of care.  Plus, I got to meet a few Americans who have dedicated their lives to women's health around the world.  Pretty cool.

After Reena and I exchanged contact information and said our goodbyes, I headed back to the hotel.  Chris and I hit the town to do the last of our shopping, and got dinner at a great Thai restaurant, accompanied by a Corinne, a British teacher who is staying at our hotel.  The plan was for an early AM flight to Pokhara, so we tried (not too successfully...) to get to bed a little early.

This morning, with our bags packed for an overnight stay in Pokhara, we headed to the airport.  Pokhara is a smaller city, with a population of around 200,000, that is located about 6 hours away from Kathmandu by bus or car.  It is located on the second largest lake in the country, and on a clear day is reputed to have some incredible views of the Annapurna mountain range.  Many of the long term guests that we have met have been to Pokhara, and all strongly encouraged us to check out this lovely town.  Given that we would have only one, or at best two nights to stay in Pokhara, we decided it would be worth the expense to save time by flying.  Also, the roads will occasionally be blocked due to strikes, and, while we've heard that tourist buses are usually allowed to pass with no issues, we still thought the safer route would be to brave Nepal's air transportation system.

As we set off, the weather in Kathmandu was overcast with a light drizzle.  We arrived in the airport, and there were crowds of people waiting, many for mountain flights that had been delayed.  (Chris and my attempt to see Everest had been on a much clearer morning, and yet the plane had still been forced to turn back because there were too many clouds around the highest peaks).  Despite announcements being in loud, static-filled Nepali, we were able to figure out that our own flight was also being delayed by around an hour, but since we'd brought our sudoku book, were able to keep ourselves occupied.  Once we boarded, the plane was filled with a mix of tourists from around the world, as well as locals either returning home, or headed to Pokhara for business.  

About 20 minutes after take-off (on what was scheduled to be a 26 minute flight), the pilot announced that weather conditions on the ground were too rough to land, and so he turned the plan around and brought us back to Kathmandu.  Chris and I were pretty disappointed that our trip to Pokhara was unsuccessful, but I guess this means we'll just have to return to Nepal one day so we can try again.  Fortunately, it seems that the policy here is that if your plane has to turn around and can't make it's destination, you get a full refund.  

It was still rainy when we got out of the airport, but we decided to at least hit one tourist site today.  We decided to go to the Buddhist stupa at Bodhnath.  This is the largest stupa in Nepal, and if not also the largest in the world, is very close to it.  It is surrounded by a ring of shops and restaurants, as well as a cluster of Tibetan monasteries.  They are pretty incredible structures, with each part representing a different natural element - the base is the earth, the dome is the water, the spire is fire, etc.  as well as representing elements of Buddhist symbolism, with the Eyes of the Buddha, etc.  The stupa is surrounded by prayer wheels and other smaller temples, and prayer flags (which send their prayers with the wind) are stringed up to the top from around the periphery.  The stupas themselves are reputed to contain Buddhist relics, and Bodhnath supposedly contains buried within it a bone from Buddha himself - this plus it's size make it a particularly revered site.

This has otherwise been a pretty lazy afternoon.  We got in a nice nap, and the sun has finally come out, so we will likely enjoy a quiet evening around the hotel.  Now that we have two more unexpected days in Kathmandu before finally setting out on Monday, we may try to get in another day trip with more sightseeing, but it's also tempting to use this time to kick back and relax - after all, it is summer vacation!

Lots of babies

Yesterday I spent the majority of the day at the Maternity Hospital here in Kathmandu.  As I mentioned in my previous entry, the Maternity Hospital does approximately 19,000 deliveries a year.  This has apparently significantly increased in the last year or two, and the number is continuing to grow.  After speaking to some of the other medical officers / residents, I learned that women who come to this hospital not only can get their deliveries paid for, but also are eligible for free care for any gynecologic or obstetric issues they may have (for example, a free hysterectomy).  Afterwards, in addition to having received this free care (including all meals, which is apparently very unusual for Nepali hospitals), they get 1000 rupees (the equivalent of about 15 dollars US) for transport.  Considering that a 30 minute taxi ride usually only comes to about 200 or 300 rupees for gullible overpaying tourists, for locals, this is a pretty good amount of cash.  As a result of this government offer, women come to the hospital from all over Nepal for care.  The hospital does also have some more private facilities for patients who are able to pay, and most of the outpatient services do have small fees.  However, because this is the only area hospital that runs this government sponsored program, they are struggling to keep up with the increasing demand, in terms of space, personnel and other resources.  (Interestingly, I was told that only a few months after starting this program, the government is already running low on funding to cover it, therefore much of the money now comes from foreign interest groups, including a large portion from South Korea).  

Just try to visualize what hospitals would look like at home if we told people not only would they have no bill, but would be given a stack of cash at the end of the day - as you can imagine, the birth center is quite a site to behold.  There are three main areas that comprise the obstetric ward.  There is one large room with about 30 beds, for all of the pregnant ladies who first arrive, where they are triaged.  If it looks like they might be in active labor, they are sent to another room with about 20 beds, where they sit with a loved one, and wait until they are ready to push.  No such thing as an epidural here - there is no pain medication, and in terms of monitoring labor, the typical patient can expect only an occasional auscultation of fetal heart tones with a stethoscope by one of the medical officers rushing through, and periodic checks from the nursing staff.  Because of the many patients, all of whom are in active labor and therefore making all kinds of noises, the few nurses are not always able to tell which ones are progressing quickly, and which ones just don't cope as well with contraction pains.  Therefore it is not unusual for them to walk past a patient only to notice she is midway through delivering, at which point there is a flurry of activity to try to grab gloves and a clean blanket for the little one that is literally falling onto the bed.  This happened twice in the 20 minutes I spent in this part of the unit.

Once a patient is fully dilated (assuming she didn't surprise the staff with a quick delivery), she is whisked down a hallway to another set of three adjoining rooms, each with 3 or 4 beds - there is no privacy here, no curtains or dividers, and so patients are often going through this experience together as a small group, or one who just delivered will look on with sympathy to her still-pushing neighbor.  Most of the deliveries are done by a cluster of nurses, who go from patient to patient, taking turns with who does the delivery, who takes and cleans off the baby, and which few stand by to loudly cheer on the patient.  There are usually a couple doctors on hand to help with more complicated deliveries, if needed, or to do the occasional uncomplicated one, when things get particularly busy.  Following delivery, if the patient does well, she is sent home about 4-5 hours after giving birth.  In less than an hour, I saw around 10 deliveries done in this way.  

I also had the opportunity to see their crowded antepartum wards, gynecologic wards, and operating theater.  (Again, with the ubiquitious communal shoes - if and when I return to Nepal, I'm definitely bringing my own supply of crocs).  

Meeting some of the new doctors who work here, I got a little more insight into the medical training process in Nepal.  After high school, if a student decides they want to go into medicine, they will go to college to receive a "bachelors of medical science", during which they do all of their pre-med courses as well as the courses that we would consider part of the first two years of medical school, when the bulk of our lectures on anatomy, physiology, microbiology, etc., are given.  They then apply for an internship, which seems to be about a year to a year and a half's worth of clinical rotations, similar to our third and fourth year rotations in medical school.  After this time, they take exams, similar to our USMLEs.  Upon graduation, they can then apply for a position as a medical officer.  At this level, they can write prescriptions, do basic procedures, and take care of patients on the wards, sort of like our interns or first year residents.  At this point, they have usually not yet chosen an area of medicine to focus on, but can do hospital practice in internal medicine, emergency medicine, pediatrics, obstetrics or surgery, under the general supervision of a specialty trained physician.  After a couple years as a medical officer, they then apply for a post-graduate posting, similar to our residency programs, in their field of choice.  Ob/gyn is a three year program here, compared to four years in the States.  

At the Maternity hospital, the wards and the birth center are covered by a handful of interns and medical officers, with a doctor on call who has completed their ob/gyn post-graduate training.  They don't actually have a post-graduate, or residency training, program at this hospital, as it is a government site and not affiliated directly with any university.  I think this is a shame, because this would be a gold-mine of opportunities for a young doctor, and hope that at some point in the future they will be able to establish a formal program here.

It is a pretty incredible facility, and despite the staff being overworked and tired, they all had smiles on their faces, and in between catching babies were eager to share their knowledge with this wide-eyed foreigner.   After witnessing this incredible group for only a few hours, I feel I can now attest with certainty that any medical provider who spends more than a couple months at this hospital would be more than capable of walking into any delivery situation, and handling it with a calm reserve and great expertise.  

So for those who have been putting up with my ramblings about Nepali obstetrics, here are some non-medical observations.  Chris may have written previously about the craziness of traffic in Kathmandu.  Imagine hundreds of New York City cab drivers, tackling streets that are more maze-like and irregular in their intersections and alleyways, half paved and covered in dust and potholes.  Then add to that two or three times as many motorcycles as cars, with all of the vehicles in various states of disrepair.  Then imagine that you took away all of the traffic rules - no stop signs or traffic lights, no speed limits, and even the center dividing line is only more of a suggestion, rather than a rule.  Add to this hundreds of roving pedestrians and feral dogs, and a handful of cows and goats, all trying to cross the roads at random.  This will give you a sense of the insanity of the streets in Kathmandu.  

Now, usually, to get a meal, or do a little shopping, we are able to walk, precariously, on the edges of the narrow streets of Thamel, protected by the other throngs of tourists who are also wandering by.  To get to the hospitals or more distant sites, however, it is necessary to take a car (or for intermediate distances, you could compromise and take a rickshaw, which we have yet to do, but want to try at least once before we go).  So yesterday morning, when I arrived at Kathmandu Medical College and was told that one of the medical officers would be taking me over to the Maternity Hospital, it was my assumption that they meant she would serve as my guide as we took a taxi, to make sure that I didn't get lost.  Most taxi drivers speak very little English, so if I need to go to my hotel in Thamel, it is no big deal as they all recognize the names for the popular tourist sites, most of which are within a couple blocks, but to explain how to get to another non-tourist area in the capital is totally beyond our limited communication.  

So as you can now imagine, I was pretty nervous when I learned that instead of hailing a cab, we would be taking her Honda motorbike (kind of a cross between a scooter and motorcycle).  With my other options pretty limited, I hopped on the back, grabbed on tight, and kept my fingers crossed.  After a few initial harrowing minutes, I was actually pleasantly surprised to discover that it was kind of fun to wind our way through the streets, with a cool breeze in our face.  There is a sort of unspoken courtesy of the streets, that, while not apparent as a passenger in the back of a taxi, you discover with the more intimate experience of being in the open on a motorcycle.  While the Nepalis seem to have no order to their traffic, they do expect all travelers to have a respect for others on the road, and honking here is done as more a sort of warning - a "hey, I'm over here, so be careful not to turn too suddenly" - as opposed to the anger and road rage at home.  Nepalis tend to react intensely (and sometimes violently), if any drivers should be irresponsible enough to actually get into an accident, or, god-forbid, hurt someone with careless driving.  What I had previously perceived as lucky near-misses seems in fact to have been a graceful style of carefully navigating roads that were never designed for this many vehicles.  Not that I am eager to tackle the streets again, nor would I even consider ever actually driving one of those things, but after arriving safe and sound at the hospital, I was glad to have gotten this unique experience, to learn and appreciate a little more about this unusual culture.   

On the surface, Kathmandu is seething with activity, crowded, dirty, loud, and generally scary for a Westerner who is unfamiliar with it's ways, but spending more time here, you discover there is a great deal of friendliness, respect and beauty that goes into all of that craziness.

Fair Trade?

Perhaps you recall a few years ago reading about a massacre of a royal family by a deranged crown prince.  Well that was Nepal, and the palace where that took place has since been converted into a museum.  I don't know what the museum contains, because it was inexplicably closed today.  Well I think it was, but I'm not entirely sure I was at the right entrance.  Some guards who didn't speak much English told me that behind the large gate was the museum, but they said "closed"--I think.  The guidebook was published before the palace became a museum, so it had no information on it.  

A few blocks away was a street that has a lot of fair trade stores, which Melissa and I have been interested in finding, so I set off.  (Incidentally, I make no effort not to appear a tourist.  I wear my camera around my neck, and carry the guidebook, often reading the map as I walk.  I mean, I could hide the camera and guidebook and try to blend in, but who would I be fooling.  So I embrace my role as tourist.)  I found the fair trade shops and made some purchases (it's a good thing I bought that extra backpack--I'll need it for all the additional stuff we're carting home).  I was proud of these purchases, glad to patronize shops that proudly help the local community.  

But it's not quite as transparent or simple as that--one of the stores had a cashier who spoke good English and was very talkative.  He said that last night he'd watched The Notebook, and really loved it.  He summarized the whole plot for me.  He said he'd been to the US a couple times for trade conventions, and that made me think he'd be a knowledgeable person to ask about fair trade.  I noticed that the stores had almost the same products as all the (not fair trade) street vendors.  So I asked him what exactly fair trade means, and whether purchasing from street vendors was good or bad for the local producers.  He enthusiastically told me about it, but what he said made me somewhat skeptical of the whole thing.  He said any goods purchased anywhere help the population.  Nepalis are so in need of jobs and so eager to have people buy their products that revenue from any vendor will go to help those local artisans.  The difference is that the prices are controlled in the fair trade stores.  A street vendor might mark up a product 100 or 200%, whereas the organization of stores called "fair trade" have fixed prices that can't exceed 30% above cost markup.  He said it makes for more fair practice with regard to the consumer.  Furthermore, his organizations work hard to market their products abroad and online, so that retailers and wholesalers will be able to sell Nepali-made goods and help the local population.  Again, sounds good.  But he didn't address in any detail where the products come from.  It was this evasiveness on the issue of the products and artisans themselves that makes me skeptical of the whole enterprise.  Clearly, so many different stores hawk goods that are so similar, that there must be a limited number of companies supplying all the tourist shops--including the fair trade ones.  The cashier said that those producers don't allow their vendors direct access to the artisans.  He said the producers provide documentation of the fair practices in production facilities, and vendors must trust that documentation.  Further inquiry about where and by whom these goods are produced would be unwelcome.  

I think the bottom line is that any work, even if it is backbreaking, repetitive production of tourist items (textiles, artwork, metalwork, jewelry, etc.) is welcome among people who otherwise would have no work.  A shop can call itself fair trade, but the degree to which it takes that label seriously seems to vary.  For example, one shop had a brochure that described contributions it makes to clinics and community development programs, whereas another had a brochure, but mentioned no such charitable use of its revenue.  One might say it's fair trade, thinking that some minimal wage qualifies as "helping the local population" but another might say it's fair trade and genuinely take action to improve quality of life.  The industry seems to regulate itself, which makes it difficult to trust.  I'm somewhat disappointed that I can't guarantee the revenue from my gift purchases goes to the right places, but I do the best I can, and at least we're not getting ripped off with a 100% markup at the fair trade stores.  This would be a topic that could make for really interesting investigative reporting.  Perhaps Anderson Cooper or Steve Croft could hire me as a field investigator...

An overdue (and very long) medical update

Time for another post from Melissa (and again, very timely, considering that Chris' blog from today is just a random smattering of highlights from the Kathmandu Post).  

So it's now been a full week that I've been "working" (more like shadowing) at Kathmandu Medical Center, and I've seen quite a bit.  Please forgive this very long entry, but it's been an eye-opening experience, and this only just brushes the surface of all I've seen.... 

After my introductory tour of the hospital, my first full day was pretty much spent chatting with Reena (the one and only ob/gyn resident at the whole hospital), comparing how we do things on opposite sides of the world, and finding that, at least in conversation, most things are quite similar.  A laid back day.

The next day, Reena was supposed to be in "OPD", or clinic.  This turned out to be quite unlike clinic back at home, where every minute of my time is tightly scheduled, and spent running from patient to patient, apologizing profusely for being late, and then spending even more time trying to catch up on writing notes.  Not the case here.  Clinic started at 9am.  We managed to get there around 10:30, after some delayed rounding and reviewing the few hastily scrawled words that sum up an entire day's worth of medical care.  Their clinic is basically a hallway, divided into rooms by curtains strung along every 8-10 feet or so, with each cubicle containing a desk and few chairs, and an examining table with another curtain.  So patients who are to be seen in the last cubicle walk through the others where patients are being interviewed and examined, and occasionally pause to listen in as we discussed details that most people would blush to hear (this in an ob/gyn office, after all).  No such thing as HIPPA here (the at-times militant set of rules that governs privacy of personal medical information in the US).  About an hour into the experience, we were seeing two young women who came in together, one concerned about maybe having an STI, and the other wanting Norplant (which we don't use in the US anymore, so it was pretty cool to see it  actually be inserted, rather than just reading about it in the "items of historical interest" section of our textbooks).  

At around 1pm, we got a call from Dr. Chanda, who is the doc that is organizing my time here.  She asked if we wanted to accompany her to another hospital in the area where she was headed to do a C-section.  So just like that, despite a waiting room full of patients, Reena and I were in a cab, headed across town to the private hospital.  I learned that this hospital was different because patients were expected to pay "a lot" for the privilege of staying in an open room with only 6 beds or so, as opposed to a free stay at the teaching hospital in a room with 20 beds.  Now patients at all of these facilities might get a bill that includes the cost of any procedure that might be performed, or for their bed, particularly at the private hospital, or if they want a bed in a somewhat less crowded room.  However, they are expected to purchase and bring with them any disposable supplies and medicines that might be required during their stay - so they routinely show up with a bag that includes a couple pairs of sterile gloves, bandages, antibiotics and pain medications, and any other supplies that in the US, we usually keep in bulk at every nursing station.

The cesarean section at the private hospital was my first experience of the operating room in Nepal.  There is a room where you take off your shoes, and put on a generic pair of crocs that are only to be worn in and around the operating theater (crocs that many other feet have worn before you, and which you probably don't want to know when were last cleaned... I still haven't figured out, after a week, why they are so fastidious about changing into these OR shoes when little else about the process seems particularly sterile...).  We then changed into scrubs, and move on to the cluster of operating rooms.  There is little used here that is disposable.  All of the drapes are of a thick cotton material, even most of the sponges are rewashed and reused.  Not much gets thrown away at the end of the case except for the gloves, which again, the patient bought and brought with her for use in her surgery.  What probably shocked me the most, was that not only are they doing c-sections in sandal-like versions of crocs (visualize the open-toed "shower shoes" of college days), but they actually took off their shoes and operated barefoot in a procedure that at home, we wear knee-high waterproof boots for (c-sections are probably the messiest of all surgeries).  While I was somewhat frustrated to be restricted to the sidelines to just observe, I was grateful to not be in the splash zone.  

The next day (and after a thorough foot scrubbing after getting back to the hotel), Reena and I were invited to accompany Dr. Chanda to one of the ritzier hotels in Kathmandu for a conference.  Dr. Chanda is one of Nepal's leading doctors in reproductive choice, and was one of the first to start performing terminations when it became legal here a little over 5 years ago.  This conference was set up so that a group of researchers and public health leaders could present the findings from their just completed study about complication rates associated with surgical first trimester abortions.  This is the first study of its kind in Nepal, and the next day there was an article on the front page of the paper about the study, and how well health care providers are doing in terms of making change.  Complications associated with abortion care are a major component of maternal mortality in places where women are forced to go to illicit providers, who are usually not trained in medical or surgical care - this is why making and keeping abortion legal, while at the same time expanding knowledge about and access to better contraceptive methods, is so vital, and saves so many lives.  The conference was a great opportunity to meet some of the women who have helped to make this huge change in Nepal.  I was also pleased to learn that, unlike the situation in the US, where many clinics are surrounded by protesters, and providers are often threatened or worse (like the recent murder of the doc in Kansas), here in Nepal, once the laws were changed, the public, in general, seems to have accepted legalized abortion, and signs for clinics are posted publicly where they can be recognized and therefore the services utilized openly.  Pretty progressive (or, more likely, the people are just too focused on bigger issues like getting safe drinking water, stopping the cholera outbreak, etc).  

The next day, we were back in the operating rooms at Kathmandu Medical Center for a full day of surgery.  While technically the procedures are the same, the differences in the culture of the operating room were pretty profound.  Our OR staff runs a pretty tight ship - schedules which are constantly updated, and detailed computerized systems.  Patient monitoring with name bands and checks at every corner to be sure we know who is where, and that we are doing the right thing to them.  The scrub nurses are like hawks, always keeping an eye on their sterile field, and if you should even approach the margins of that sacred zone, watch out - you will get a stern lecture, and if you should actually violate the sanctity, and (gasp!) contaminate the field, you are in big trouble!  Not at all the case here.  There is a single unmanned desk, with a pile of roster books which the medical students will periodically write down the name and procedure of whoever they just watched have surgery done.  Above this desk are a few printed sheets that list a tentative schedule of the days cases.  This schedule is by no means adhered to.  We changed the order of every single case (including, for reasons I have yet to comprehend, moving the potentially fatal possible ectopic to the end of the day - fortunately she did not have an ectopic, was possibly not even pregnant, as she just had a small ovarian cyst, and a several day old urine pregnancy test result from an outside clinic).  Most of the time, our anesthesiologist and nurses had no idea which case we were doing until we walked the patient into the room, and this was routinely done while the dirty stuff from the last case (I'll spare you details...) was still in the room.  And of course the patients were walking in - you guessed it - barefoot.  In one of the more shocking moments, while under anesthesia and in stirrups, a patient's foot dropped onto the sterile field not just once, but twice.  No one even batted an eye - they just put the patient's leg back into the stirrup, with a single velcro strap, and continued on, using the same instruments from that same table.  

Alright, so I'm probably going a little overboard with the shock value here.  The doctors here seem very good, and I think they are doing the best they can with the limited resources they have available to them.  They are aware of the deficits in sterility, and attempt to make up for them by putting all of their patients on 24 hours of heavy duty antibiotics.  Maybe not way I would attempt a solution, but better than nothing.  I also had the privilege of watching one of the only two female gynecologists in Nepal who is trained in laparoscopy.  Now, coming from an American hospital where we learn from faculty who are national experts in laparoscopic technique, this was far from the mastery of the skill that I've come to expect from my teachers, but still, just the fact that she was one of the first in her country to even attempt to adopt a minimally invasive approach was pretty impressive.  

After an eventful week, I had the day off yesterday to spend with Chris (and our new friend Bruce) exploring the temples and museum in Patan, as I'm sure our avid blog-readers are aware.

Today was back to work, with another morning spent in the OR, followed by spending a couple hours this afternoon at one of the Nepal's largest Comprehensive Abortion Care clinics, where I could see all that I'd heard about at the conference in action.  Again, the sharp differences in both patient privacy and cleanliness were a bit shocking (although I did get to wear another lovely pair of communal crocs).  However, it was great to see that these women at least have a safer option - particularly after my earlier experience in the OR, where I was witness to the result of what a botched procedure looks like when a patient came in after three, that's right three, attempted procedures in a little rural town with no trained medical provider.  It was very scary, and she is lucky to have survived.  

The rest of my week will hopefully include more obstetric experiences - I still have yet to catch a normal delivery, as well as perhaps a tour of another nearby hospital.  Dr. Chanda has offered to take me around the Maternity Hospital.  This is a huge facility, run by the government, which only does obstetric and gynecologic care, with a small pediatric wing for the newborns.  They do 19,000 deliveries there every year!!  Over 50 cesarean sections a day!!  I've been told, that spending a few months in this hospital would teach me everything I ever wanted to know and more about the practice of obstetrics and bringing new life into this world.  Unfortunately, I'll probably only get a couple hours.  But I'm still looking forward to it.  Another interesting note about this hospital - apparently the government will pay for a woman to have her delivery here, which is why they get such a huge volume.  Every women can have up to two deliveries on the government's dime, although since they don't really keep any formal medical records, that means that any woman who shows up, no matter how many kids she has, will get free care.

Ok, that is more than enough for now (Chris is reading over my shoulder, and telling me this entry is way too long--"enough doctor talk").  Hopefully this hasn't been too boring for all those non-medical folks, if any of you have made it with me to the end.

I'm having an awesome time here, and hopefully will continue to have some great experiences in our last week in Nepal, before we head back to a place where it's safe to use the tap water when we brush our teeth, and where I can wear my own shoes to operate in.

A Boring Blog Entry

Not much new to report this morning.  Highlights from today's Kathmandu Times are as follows:

The garbage strike is over.  An agreement has been reached and cleanup has begun (I witnessed some cleanup nearby yesterday).  I'm happy for the people of Kathmandu.

Sri Lanka crushed Pakistan in cricket yesterday.  I watched some of the match--it was never really close.

And one headline reports that High School Musical star Ashley Tisdale doesn't like to watch scary movies.  I'm not sure why anyone would care, especially the Nepalese.

In other news, I've become a huge fan of south asian food.  I am not widely familiar with it, but what I know, I like.  If I were stranded on a desert island with a chef who only knew how to make one meal for the rest of time, I think I'd be pretty content with chicken tikka masala, mattar paneer, and naan.

The beverage situation is a different matter, though.  Bottled water is readily available here, but usually isn't too cold.  I like to order the soft drinks because they use the refillable glass bottles, so there's little environmental impact, but the 250ml bottles contain like 3 swallows.  That's one part of America's super-sized lifestyle that I won't complain about--when I order a beverage, I like a lot of liquid.

Sorry, not much brilliant cultural commentary today.  I'm honing my sudoku skills.

Patan

Our outing for today (Melissa's day off) was to Patan.  Once a separate city, it was one of the three main cities in Kathmandu valley.  As the cities grew, they've merged into one giant metropolis, but Patan is still technically distinct.  We went there to see the Durbar Square of Patan, where the royal palace housed its king centuries ago, before Nepal was unified.  Durbar Square of Patan is known for its remarkable concentration of architecturally significant temples and its royal palace that has been converted into a museum.  Bruce joined us for this day trip.  

Walking into the square one is immediately impressed by the number of temples, each with remarkably intricate carvings.  We read our guide book to learn when each was built and which deity it focuses on.  We went inside one temple, dark and damp inside, up to a second floor shrine where people were lighting candles in worship (no photos were allowed here).  I was struck by a significant difference between Buddhism/Hinduism and Christianity/Judaism/Islam.  In the eastern religions, there are holy shrines and buildings, but nowhere are there rows for gatherings of people to sit and worship together.  They have many festivals, but their worship and prayer are not communally based, nor focused on a specific time of the day/week, as best I can tell.  This is in contrast to western religions where our holy buildings are primarily built for gathering large groups of people at specific times.

Anyway, some highlights: one temple was draped with what Melissa correctly identified as intestines.  We learned from a tour guide that they were water buffalo intestines.  You can see them in the photo above.  Nice.  Also in the photos you see a Hindu ascetic holy man.  These people hang around all the major tourist sites, allowing pictures or giving a blessing for a "donation."  So we paid him for the picture.  Also in the pictures you see me next to one of the mythic snow lion statues.  A close relative of mine recently compared me to a dog in my current hairy state--I prefer comparing myself to a snow lion instead.  I look positively vicious.  

After a bite to eat (which included "chicken lollipops") we went to the museum.  Its reputation as one of the best, if not the best, in Nepal is well deserved.  It was clean, beautiful, informative, and had a remarkable collection of religious items.  Most of the museum was dedicated to explaining the religious iconography of Buddhism and Hinduism.  Since we've been here, we've marveled at the structure and age and intricacy of all the monuments, but there are so many and they're all dedicated to such diverse deities that it's quite overwhelming.  Hinduism as it exists today is a blending of many ancient religious systems, so the number of deities and the mythologies that surround them are vast.  For a westerner (and probably many easterners) it's tough to understand.  The museum explained many of the basics, which was great since we knew so little.  In one of the pictures above, for example, you see a variety of statues of Hindu deities, and the purpose of this display was to explain the symbolism in the different hand positions.  We soon became more familiar with how a given statue or image contains clues to who the deity is and what its intention is.  For example, Vishnu often holds a staff that represents wisdom and a shell that represents creation.  Another image might look similar, but a close inspection will reveal the deity holding a jug of water, representing health, or a string of jewels, representing prosperity.  The other items in the image helps identify as well; each deity has a vehicle, or animal.  Ganesh is accompanied by a rat; Vishnu rides a bird; and so forth.  I particularly liked learning about the different positions in which Buddha is depicted.  A hand extended indicates charity; a hand making an "OK" sign suggests Buddha is teaching; a hand raised represents comfort; a hand touching the ground symbolizes the moment of his enlightenment when he drew upon the power of the Earth.  Walking back home, we were able to stop at the roadside shrines and stupas and make more sense of the diverse symbolism.  I felt a bit like Robert Langdon.  (Melissa says I'm a dork.)  One last note on the iconography.  It is interesting that on many of the Buddhist and Hindu structures one sees the six-pointed star, an ancient symbol from Hinduism.  It is even stranger to see swastikas, an ancient Hindu symbol of balance.  And the swastikas aren't just on ancient religious structures.  One sees them on buildings conducting business.  On the road outside our hotel is a manhole, and the iron cover says something like "swastika sanitation" on it.  I imagine the 20th century meaning that this symbol has taken on is pretty far removed from Nepalese religious associations.  For a westerner, though, it's pretty strange to see.