Welcome to the PD....

Our hospital days in the paediatrics department (PD) have found a routine, after spending the first week looking rather lost and a bit bedraggled (hadn't quite adjusted to the heat or time zone).

The morning begins with a shower, unusual for me I know, but it is sort of necessary to remove the sweat-dust bio film that appears on the cycle in, its really hard to get rid of sometimes, requires a lot of scrubbing. We are a bit like butterflies, entering the small shower room as dusty brown caterpillars and emerging like spruced up cabbage whites, wth shiny still damp wings.

Next we head up to the second or maybe third floor to find a patient to review, if we manage this we can present them on the ward round. We follow the strict Nepali rules of presenting, speaking in the impenetrable code; DOA, POD, CO I&D etc etc, so it's not really impentetrable, I just had no idea what they were talking about for the first few days. Ward rounds are actually very similar to as in England, yet again the famous Nepali saying 'same same but different' ringing true.

Presentation over, we shuffle on to the next patient, sometimes up to 15 doctors and nurses swamping the bed, so it appears as though the bed is a small island in the middle of a sea of white coats.No one ever seems that phased by this invasion and the words of the senior doctor are clung to by the families and junior doctors alike, as if some sort of mantra. The families make their islands as much like home as possible, food is cooked in the corner, washing is hung on every available surface, and sometime three or four adults squeeze onto the small beds to sleep too.

The ward rounds are also a good place for working out the hierarchy, and where we fit into it; You stand up if you see the Director or Professor (if you were sitting down), you look busy for the consultant, you acknowledge the registrar, you joke with the junior doctors, if in doubt you do what the interns are doing, and you ignore the nurses, unless you want a thermometer, in which case you ask very nicely. That seems to be the way things pan out here. Oh yeah and always remember to give the thermometer back, or you're black listed.

Following the carefully coreographed shuffle of the ward round there are several options and the choice probably depends on energy levels.

1. A low energy option; slope off to the canteen for a tea shaped sugar rush

2. Another energy lacking option; mosey to the library for an hour or so of frustratingly slow internet

3. For moderate energy supplies; temporarily move in to one of the bed islands and chat with some kids and their families. This is definitely a good option, because everyone is always so happy.Even when the subject of conversation is not being able to leave the hospital because the bus fare is too expensive, even when discussing the four hour walk that must be done after the bus journey, even when discussing abusive husbands or other children left behind; optimism oozes from every bed, it's impossible not to get sucked in to the lives of these families, and it is impossible not so come away feeling strangely optimistic too.

4. If we're feeling full of beans, we try and attend deliveries. If it's a caesarean section we first of all climb into a fetching combination of bright pink clogs and grass green scrubs, often still damp from the line on the hospital roof. Louise always has some trouble finding trousers that come below her knees, one of the disadvantages of being about a foot taller than anyone else here. Often we arrive in theatre all kitted out only to find the delivery is all over, this is blamed on poor phone lines etc, but actually I think it is more down to the ongoing war; Paeds Vs. Obs & Gynae. Paeds get in trouble if they do not attend all deliveries, O&G know this and it's no coincidence that paeds either get called 2 hours early or 10 mins late for deliveries. Frustrating for us, and a little too much like dicing with death potentially.

5. For sleepier moments the well baby clinic is the place to go for some baby cuddles. Their intoxicating milky smell is exactly the same in Nepal as it is in England, and the mixture of pride and concern on the mum's and dad's faces when they hand their baby over to be checked by the doctor is no different either.

6. For times when we are feeling brave, we go and watch various 'sterile' minor preocedures. The well worn sterile gloves are pulled from a steel container in a cloud of white talc dust. We watch as gloved hands attend to gathering all the equipment and undressing the patient, before making a fuss about a sterile field and beginning. It's difficult to know what to do when procedures are carried out in such a way that you find yourself holding your breath for a few days until the risk of infection to the patient has passed.

7. Probably our favourite option is sign gathering; enlarged livers, ascites and icterus, tinkly bowel sounds,sluggish bowel sounds, bronchial breathing, sridor and whooping, dull percussion, hyper resonant percussion, fluid thrills and the ever elusive spleen. They are all literally at our finger tips; coming to the hospital is an expensive last resort for most of the population, so many patient's present late and with more signs than in England. It is exciting to finally see, hear and feel all these things that i've only ever read about in books, but it is also a constant reminder of the poverty here and the massive resource deficit. It would be better to find nothing at all.

The six hours between 9 and 3 is easily filled and we often find ourselves leaving late, always sweatier, more tired and with more knowledge than we started out with. I am enjoying it here, this is demonstrated by the fact that I think continuous attendance is at a record high for me - 10 days and counting! Whoop!