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!

No egrets

When not making lists about planes in my head, I keep busy at the hospital by patrolling the four floors of the paediatrics department, along with Louise and the many Nepali interns and doctors. White coats are compulsory here and we look like a flock of egrets, craning our necks to see what this or that patient is up to, flapping up and down the many stairs in the heat and constantly keeping a beady eye out for a 'learning opportunity'. Without fail we all make it to the fourth and top floor for tea and samosas at 12 o clock on sundays, tuesdays, thursdays and fridays.

Yes the Nepali week is 6 days long, GUTTED!! but I think the Nepalis realised they were getting a bit of a raw deal too, so the working hours at the hospital are only 9-3pm.

We quickly worked out which doctors are lovely and which are to be avoided; we carefully crafted our first 24 hour on call to be with some of the lovely ones, only to be scuppered by a swap late in the day, which meant we got stuck for 24 hours with the doctor we put at the top of our avoid-at-all-costs list. Contingency plans are now in place to make sure this doesn't happen again; there are so many extremely friendly, helpful and knowledgeable doctors, it would be ashame not to go with them.

At 3 or sometimes 4 o clock we change out of our suffocating and sweaty white coats into shorts and t shirts; the swish of my shiny shorts and the cool breeze is such a relief, so I always leave smiling. We say goodbye to the families camped out by their children's beds and spend a good five minutes sturggling with an unpredictable bike lock before riding home through the dusty chaos of afternoon rush hour.

The cycle back is a constant compromise between eyes on the road and eyes to the side. Both options have their advantages; eyes to the road allows you to spot the motorbikes going the wrong way up the street, the cows and dogs parked in the middle and also the large holes that definitely weren't there that morning. Eyes to the side means seeing people, animals and vegetables doing all sorts of interesting things.

I started off in an eyes to the road sort of mentality, arriving home with a heart bursting with adrenaline from constantly swerving things that were bigger than me, now for some reason less stuff seems to head straight for me and I'm swaying towards eyes to the side. I can look for the best tea shops with the stickiest looking sweets, the most colourful cloth shops, the best places for rip-off t shirts, I see the innovative ways people turn rust into bikes, the way parents look to the future as 5 year olds meander to and from school in skirts, shirts and ties that might last them all the way through to 18 and I see how wasteland is cajolled into becoming green and fertile rice fields and vegetable patches.

Most of the time it is possible to see all this, some of the time I can't see anything because my eyes are full of dust, thinking about it, it might be at these times when it feels like all the traffic is coming straight for me....

Crash landing

Today I have achieved something monumentous; I have made a blog. I am fulfilling a lifetime ambition, and for those of you that know me you will understand how much effort I have had to put in to reaching this stage, overcoming my intertia has required a lot of mental and physical stamina. I've wanted to do this for so long, I've even dreamt about it. In my deams, generally I finally finish writing my first entry, then the comuter crashes, I wake up with a start, realise I have achieved nothing and go back to sleep. Which is funny, because I just finished writing my first blog entry, then the computer crashed. So here goes, second time round.

I've been in Nepal just over a week now. Every day we cycle through a maze of backstreets, of variable degrees of smoothness (please see road surface grading system*) from the lovely house of the even lovelier Rhian and Richard where we are staying to Kathmandu Medical College, a funny building with a big grey ramp at the entrance, which looks a bit like they nicked the last 100m of an airplane runway. Sounds unlikely, but actually is entirely possible because the airport is only minutes from the hospital. This is actually very strange, because every day I see, hear and feel the vibrations of planes leaving; I think of you all only a plane ride away and miss you (a little bit)

It also means that when I'm bored at the hospital, I often think about planes as their jumbo jet engines penetrate my thoughts, like the other day I made a list of all of the things I learnt about Air India flights on the way here, might be useful one day.

1. Despite the budget appearance, Air India is actually an upmarket airline that provides touch screens; not realising this I spent a good half an hour pressing every button on the little remote thingy and waving it at the screen, trying to get Mamma Mia to play, finally this old wrinkly woman next to me took pity, or maybe she was fed up of me waving, because she reached out this knarly old finger, prodded the screen, sighed and went back to cackling with the woman over the aisle.

2. Coke cans open differently, its a bit hard to explain exactly how but what I'm saying is be prepared for this. Also on the subject of cans, the coke can were really beautiful, you know how I like cans, so I carefully saved it, and washed it out with a bit of water, but then when I was asleep one of the extremely helpful flight attendants took it away, put your cans in your bag!

3. The food was the best airplane food I have ever had and it keeps you on your toes with an extremely hot chilli disguised as a green bean.

4. The foot rests have been customised, either by accident or design and act as really good foot massagers, don't miss this.

All in all an excellent Air India experience.

*Road Surface Grading System
Grade 1; tarmac, minor potholes and raised manholes only.
Grade 2; used to be tarmac, major potholes, very large speed bumps plus raised manholes
Grade 3; stony dirt path, man made holes and mounds that appear and disappear daily, lined by stalls and cows
Grade 4; dirt path without stones, similar to grade 3, but extremely slippery when wet
Grade 5; not yet experienced, due to use when mountain biking with Rhian