At the Last Minute

So just as I was starting to think (ok worry) that the guys at work were gonna let me go with completely no fanfare at all, Mohan busted in on me and Khem during a meeting this morning and told him to make sure he was free at 6pm tonight for a party for Rob.

I said, "what's happening at 6?".

Mohan took a step back, and goes, "you understood me?"

"Yeah, my Nepali's not that bad. Come on, I've been here for a year. What's going on?"

"We are organising a program for you tonight."

He actually had to idea where were were going. But it seemed that more and more people knew about it. But no one was talking. I wasn't sure whether it was because they didn't want me to know or because nobody actually knew. I left work early because I have been ffeeleing a little sick and wanted to get better before leaving for Hong Kong, but I made sure that Mohan or Nhukesh would call me to let me know where I was supposed to go.

I passed out pretty soon after getting home and woke up at 5.45 with no missed calls and no clue where to go. I called Nhukesh, but mobile phone in Nepal make it impossible to understand even English speakers, let alone English speakers with broad Nepali accents. I eventually found the Marco Polo Hotel, which was the only thing I understood from out conversation. I called again and he told me to go tot he Windmill Restaurant, its well known and very close.

I spent the next half hour searching to the south and east and not a single person knew what I was talking about. Its amazing how when you really need people to understand you that you can't construct an intelligible sentence in Nepali nor can they speak any English at all.

Finally I did a loop back and found Mohan and Krishna standing almost outside the Marco Polo, and they led me out the back to the Wind BELL Restaurant. I mean, what the hell is a WINDBELL anyway?

Inside Dr Reeta, Dr Govinda, Nabin-daai and Khem-daai were already waiting. More of the guys slowly joined us until altogether there were about 20 of my TIlganga friends there. It wasn't long before KHem-daai was pouring me whiskeys and demanding that I have more. In true Nepali style the snacks kept coming and coming and coming. I knew I had to pace myself as a big meal of Daal Bhaat was just around the corner waiting for me to have one momo too many before making its appearance.

Bikram, who we discovered yesterday is 2 years my elder (much to his surprise), found out that I am partial to the occaisional beer. I have always found him to be so professional and curt, very strict in his conversations and not very likely to laugh, or smile. He apologised. "Rob, I am so sorry, if I knew that you liked to drink I would have had you over to my house. I didn't think you drinked." So there you go. 12 months, in almost the same office and bad communication had led us to believe that one may not want to be friiends with the other.

We got some great photos and they presented me with the most amazing present. A map of the disctricts of Nepal, in a beautiful model Nepali window (they have some of the most amazing wooden architecture adourning windows in Nepal). It is obnoxiously heavy, and I hope I can get it home OK, but I really do love it.

Nhukesh also gave me a special present, a rather smaller version of the above with a photo of us during the Festival Jatra in his village.

I had the most amazing impromptu night and I really hope my colleagues and friends realise how much I have appreciated them this year. They are such a great group of people.

Tapaailaaiharu dheri dhanyabaad!

The Question

I ask why a lot. You know this. It’s a bad question in Nepal. Cos no one knows the answer.

Load shedding fun fact #2: They don't seem to need a schedule anymore, they just give it to you when it suits them, which was not for 36 hours the other day.

OMG @ the OMEC

The first time I saw surgery I was almost physically ill. The skin peeled back, a chisel pulled out and some bone chipped away. I’ve seen videos of cataract and other eye surgeries being performed as part of my assignment that I would liken to a game of billiards. But in Banepa, a small trading town on the road to Tibet, in a makeshift operating theatre inside a school classroom, Dr Ruit made cataract surgery look like an art form – 67 times.

Last weekend, I departed at 7am Saturday morning for my very first surgical camp (Outreach Microsurgical Eye Camp). We didn't actually travel far for this one. At an OMEC there are a lot of activities, all of which I sort of helped out with, sort of interfered with, all the while trying to keep my jaw from dragging along the ground. I could go on for hours about all the different parts of it. Most of that I am going to save for an article I am writing for our magazine, but I'll give you the main ingredients:

Departure and unloading - leaving Tilganga at 7 sharp we travelled the relatively short distance (as far as OMECs go) to the town of Banepa (somewhere Mike and I passed through on our Tibetan adventure), we unloaded all the makings for an anaesthetic room and an operating theatre and ate breakfast...mmmmmmm curried soybeans and oily deep fried bread! Sorry, I accidentally deleted the photos!
Screening camp - much like the trip I have already written about, I travelled on with a few of the boys to Dolalghat,



a nice little getaway another 40-50km or so on from Banepa. Many Kathmandu families go here for picnics and the area is famous for its fresh water fish (yuck). Here we screened more than 300 patients, 22 of whom needed cataract surgery.


I was in the counselling room "explaining" about their surgery and what was going to happen. In all honesty, I was writing down their details, while Ripon's brother (with no training qualifications or understanding of what, in fact, a cataract is) told the patients that we would be taking them to Banepa to "clean" their eyes.

[one of my favourite photos]

Apparently, mentioning the word surgery causes a kind of mass exodus that doesn't look good on our statistics.

Or to our donors.

I took a photo of one lady before stupidly trying to show it to her. She politely pointed out that she was effectively blind, and couldn't see the photo I was showing her.


I am constantly amazed at the ability of 80 and 90 year old Nepalis to wait patiently in this position for hours.



We returned on Saturday evening to finish preparing the "operating room", which was actually a classroom, and do final tests on the 22 cataract patients we identified and the other 30 or 40 the other screening camp group found.

Surgery Day 1 - Sunday was the start of surgery. From 8am Suha-daai started anaesthetising patients. Dr Ruit and two American doctors, Matt and Paul showed up and got straight into it!

One of the most amazing stories was an elderly mute man with bilateral "hand motion" visual acuity. Meaning, he could effectively only see you waving a hand in his face and not much more. Constantly frustrated in waiting around for he knew not what he often yelled out angrily, banging his stick on the ground.

[waiting for anaesthetic for surgery 1]

The surgeons got through about 60 patients on the day and we didn't get back for dinner until about 8pm.

[surgery 1]

I popped over to the hall where the patients were staying. That was it, a hall. With blankets and pillows.

[post surgery 1, not a happy camper]

Food, Cards and Good Company - As last time I found the field trip to be a great friend building experience. People I had previously only seen around the hospital were now joking around and making fun of my lack of Nepali. The girls would say stuff to me and then giggle hysterically. Pemba-daai gave me a new nickname. "Aloo Rob". Apparently "rob" also means "plant" in Nepali, I asked "what? like a potato (aloo)?" This caused a huge burst of laughter from the girls and solidified my new name. Pemba still thinks its funny a week later.

Surgery Day 2 - The second day of surgery, all the bilaterally blind patients (first eye operated on the day before) went back for their other eye to be done, following a post-op inspection. The eye-patch put on following surgery the day before is lifted and the ophthalmic assistants check the position of their new lens. It was a very special moment when my special guy's patch was lifted. His son stood at the top of the stairs and held up two fingers. He held up two in response and yelled excited nothings. I don’t know that there are many points in life where you feel the way I did in that single moment. I could not help but giggle as a wave of welcome happiness rushed through my entire body.

[post-op from surgery 1, yelling and pointing at his son]

Surgeries continued as did the screening downstairs. The patients had to wait calmly as each of them had their turn 'inside the room'.

Last Day - It was the last day, we had to finish up our post-ops, pack up and get back to Kathmandu. The patients needed instructions for any problems they might experience and we checked their visual acuity so we can analyse the camp for its level of success later.

[post-op surgery 2, laughing while everyone pointed at me and said "white man"]

The camp was such an amazing experience. I'll have to do another post to tell more of the special stories.

[the man in the beanie was a gorgeous gentleman that always gave me the thumbs up when he caught my eye, he was so happy to be able to see again {massive understatement}]

I was quite amazed to see people the DAY AFTER SURGERY with unaided visual acuity better than mine! Lucky buggers.

[one cool cat]

In total, we did 110 eyes and screened more than 700 patients. Less than 4 days work. That still amazes me. I'll put some links up soon for those of you that want to be able to contribute to this amazing phenomenon. For as little as $25 you can give one of these people their sight back. ;)

Screening

The second thing that I needed to talk about was the field trip I went on Saturday.  As it goes with these things, I was invited late on Thursday afternoon.  So, cancelling all my very important engagements, including a relay marathon run, a nice lunch with a colleague and yet another Hash I committed myself immediately.

Travelling to the small village of Sankhu, 45 minutes north of "the Du" in 2 taxis filled with equipment, two drivers and 8 people was a hair raising experience.  Remind me to post a photo of a taxi. At one stage I was rather concerned that we weren't going to make it up a particular hill, a concern made all the more worse by the taxi driver checking 3 or 4 times that the handbrake was not actually on.

As no one on this trip really knew who I was or what I was there for, I was treated with a kind sort of mild neglect.  In fact my purpose was to simply observe and understand the process of an eye screening camp with a view to reviewing their data collection processes at some stage in the future.

On our arrival, everyone split up and started setting up with equipment in various inexplicable places around the school we were based at.  Not entirely sure what to do with myself I watched on as all this was happening, pretending to busy myself by looking at a pretty run-of-the-mill piece of paper with nothing written on it.  There was a tap on my shoulder and a suggestion to "please come".  Thoroughly uncomfortable, I managed to ask (in Nepali) where it was were were going.  This small effort seemed to be enough to prove to the crew that I was an alright sort of chap, and not there to spy on them, for this broke the ice for the rest of the day.  If fact, that singular moment was more of an opening for hand-holding, belly-rubbing, and other inappropriate man touching than ever there was - at least in my experience. 

We were in fact off to "breakfast" (by which I mean morning tea) usually taken by the staff at Tilganga anywhere between 9 & 10 - with lunch to follow closely at 12).  I do love the breakfasts I get when I am with Nepali's.  For some reason the management at restaurants open in the mornings speak little English and are generally unhelpful when it comes to pointing at an item and the vain hope that you might get to eat it.  Some weird fried beans, a spicy kind of soup and some oil with a touch of flour and water dropped in it and we were back at the school.  

Before we even arrived in the gate, my colleagues had disappeared to their various stations and had started seeing patients that had been registered and were waiting for us to return from breakfast.  Before I had my wits about me, 5 people had already had their visual acuity measured and they were knocking them off at a rate of about 2 per minute.  There seemed to be a lot of shouting and a lot of confusion and a general excitment in the air.  

From the Visual Acuity station they were sent accross a field into the Exam room, where all the lights were off and there was no shouting or excitement but plenty of confusion.  In fact, it was eerily quiet.  Eventually the patients managed to work out (probably through some kind of devining method) that they were meant to walk to the other end of the room and sit down.  There a silent man shone a light in their eyes (to check for disease) and either gave them some cream and packed them off to the Refraction station or gave them some drops and told them to sit on the bench.  For those patiently waiting on the bench, perhaps 10 minutes later, the strange silent mnan would walk up, shine a light in their eyes and direct them to Counselling.  [I should point out here that 'strange silent man' is a very nice bloke who has been very friendly to me all week, and even called me over to see a cataract close up, it was really cool].

At Counselling, by torch light, a young ophthalmic assistant would schedule the patient a pre-op and operation date (within the next week), take their medical record off them, give them a referral slip and briefly (and I mean in 30-40 seconds) explain what happens during a cataract surgery).  

From there, they would go to refraction, and have their refraction measured.  I'm not entirely sure of the point of this, as usually a cataract makes you partially or totally blind in that eye, so having measurements taken for glasses seems a litte redundant.

Expecting to see 200-250 patients, and only getting to 115, we promptly packed up, hired a local bus and made the return trip inside 20 minutes.  We didn't have the hill that almost killed the taxi to thank for this but the insane lunatic maniac bus driver whose muscles were so massive the seams on his singlet were busted.  He drove that bus like we were in a 4x4 race to get onto Noah's Ark with the flood waters lapping at our ankles.  I believe he is probably part of the facebook group "if you can drive through it, do it".

My role, ultimately in all of this is to determine (through data collection and medical records) why some people don't show up at hospital following these screening camps.  And from my minute observations and highly accurate interpretation of the Nepali language, here is my assessment:

- cataract patients tend to be older than 65

- the regions we are visiting often have people living in them with no education

- the whole problem is that no body has any money (our taxi cost 550R), not exactly monopoly money to some people

- many people have been living with blindness for many years

How on earth are you going to handle someone telling them to show up at hospital tomorrow for some other stranger to stick lights, fluids and fingers into your eyes?  Why would I go all that way to have someone cut into my eye with a scalpel, in a procedure I don't understand.  "I was blind yesterday and got through the day, maybe I'll chance tomorrow too".  With all that yelling and confusion, I'm surprised some people knew which way to go to get home.

I'm not saying that the screening camp was not an amazing thing.  It truly was.  I understand that they need to be quick to get through 250 patients with only 7 staff and a few hours.  But I think just a little empathy, a little consideration could go a long way into making sure patients come along when you are telling them they have a disease that is easily curable, provided you allow hem to CUT A HOLE IN THEIR EYE!