Life is crazy in Nepal

These days, there seems to be no such thing as "business as usual" in Nepal. Maybe that's always the case, but it's crazy right now! May 28 is the deadline for the government to finalize a new constitution for the country. They have been working on it since the middle of the last decade, when Nepal became a republic (democracy) instead of a monarchy. There have been numerous previous deadlines for its finalization, but they have never been met. There have been 6-month extensions, 1-year extensions, and it just seems to keep going. I was actually in Nepal for the previous deadline - Nov 28. At that time they extended it for another 6 months (which, as a side note, means that I have now been in Nepal for 6 months...to the day, today, actually), and said that if it was not completed by that time, a new government would have to be formed.

It was looking promising...sort of. One of the biggest issues had to do with getting former Maoist soldiers rehabilitated, and steps have been made in that direction. But there are SO many parties, with SO many demands, and it's getting more and more ugly as the deadline approaches. Nepal needs a miracle.

What do I mean by ugly? Well, as you've all probably gathered by now, the main method of protest in Nepal is to call a bandh, or strike. Pretty much anyone can call a bandh, and they decide how far-reaching it will be, and how strictly it will be enforced. These days there are bandhs happening everywhere, it seems. In the far west region of Nepal, the poorest, most remote part, they are currently on day 20, I believe, of a very strict one. Everything is shut down - the roads, the schools, the businesses. The situation out there is getting rather desperate for people...increasing food and fuel shortage, and just general misery, probably. Usually when a bandh is declared it is given a time frame. This one is indefinite, and there seems to be no sign of it letting up any time soon.

There have been a couple of nationwide bandhs where everything across the country is shut down, and they have been enforced quite strictly - more strictly than usual. Apparently starting tomorrow there is an indefinite nationwide bandh starting. Who knows what that means? In the Terai (the flat, southern part of Nepal that borders India), there has been one going on for quite some time. For people coming in and out of Tansen, travel through the Terai is usually necessary, though usually you can take a detour around it and go through Pokhara instead (adds an extra 4 hours to the drive). But now there's also a strict bandh in Pokhara. So we actually have some people who are sort of stranded here right now. One of our residents did manage to make it back from Pokhara to Tansen last night - but only because he travelled at night. You can imagine that nighttime travel has its own dangers, when you're driving along these narrow, winding mountain roads with no guardrail!

Our patients are affected. We have discharged some from hospital, but they can't leave because they can't get home. Or they have to stay in a "hotel" here in Tansen. Patients who are already in financial hardship because of their hospitalization...hospital bills, plus they are missing their income because they're not working...now are even more so, because they have to keep paying for lodging and food here, and still can't work.

I wasn't directly involved in any of these cases, but I'm told that yesterday 2 patients who came to the ER were dead on arrival, and another died shortly after arrival. That happens sometimes...but we all wonder if it has to do with the fact that people are waiting longer to come to the hospital because they don't know if they can safely get here. And we're concerned we may see more and more of this over the next few weeks. Yesterday in clinic we didn't know what to tell people about when to come back for follow up or test results. Usually pathology reports (which come from Kathmandu) are available within a month, but who knows when they will be available under these circumstances. Dr Doug, one of the other surgeons here, started telling people to come back for follow-up after the constitution was written. We all laughed at that one...will they EVER come back?

Usually ambulances and hospital vehicles can get through the bandhs okay, but I heard of an ambulance (carrying a patient in it) being vandalized somewhere down in the Terai the other day. Some friends who did manage to make it from Kathmandu to Tansen the other day (but are now stranded here for the time being - they were supposed to leave today) said that there are roadblocks (trees, rocks, stones, and lots of people) all along the way. They did let the hospital vehicle pass through them that day, but it sure took awhile to clear the block so they could even get through. I'm told the hospital vehicle didn't leave for Kathmandu today as it usually does on Wednesdays.

Here at the hospital we see the impact of all this on our patients and their families. And on people trying to get here or get out of here. But we don't (at least at this point) have any concern for our own safety, thankfully. But Nepal is suffering right now, for sure, and whether these demonstrations will accomplish anything or not remains to be seen. At this point they are accomplishing a lot of hardship and difficulty for the people of Nepal. Will they have an impact on the decision-making process? Time will tell. And what will things be like after May 28? If the constitution deadline is NOT met, what will happen? And even if it IS met, there is sure to be ongoing discontent. It may be a rocky ride for awhile.

Please pray for this nation, that God would move the mountains, and establish righteousness and justice as its foundation. Pray for protection and peace for all those who are affected by all that is going on. It all seems impossible, but we also know that God can do the impossible. So we look to Him.

First Day

Finally, I don't feel like I'm lying in my blog header anymore! Today I spent my first day in the hospital, and I now really am a General Surgeon serving in Nepal. Although this first week or so I'm mostly just hanging out with one of the other surgeons working here...they kindly haven't put me on my own QUITE yet.

I apologize in advance if this post is too "medical" for some of you. They won't all be like this!

It was a pretty straight-forward day. Started with team handover and morning report, which happens every morning at 7:45. The interns and residents give a summary of what's happened in the hospital over the last 24 hours, so that we all have an idea of what's going on. Then we made ward rounds. I'm not sure how many patients we saw, but there was certainly a range of problems. There was a baby with burns on the leg but who can't get a skin graft until her diarrhea settles down (risk of infecting the graft). There is a woman with a badly burned right side whose skin graft isn't taking very well. They are the only 2 burn patients in the hospital right now. Apparently there were several more last week, but all the others were getting so sick that their families just took them home to die. Such is life in Nepal.

There was someone recovering from surgery for an upper GI bleed, a man with a chest tube in each side for bilateral pneumothoraces (collapsed lungs) after a fall, another man in a halo because of a C-spine injury (who is actually recovering some of his extremity movement, and has been here for 4 weeks already and hasn't developed a bedsore, thanks to good nursing care and a fancy mattress with air pockets that inflate and deflate at different times to constantly redistribute his weight), a young boy recovering from surgery for a ruptured bladder and urethra after a fall, someone else with a hip fracture in traction, a man with some kind of immunodeficiency with multiple chest wall and back abscesses, a pancreatitis, someone else being monitored for a head injury after a fall, a couple postop patients who had ureteral stones (in the tube connecting the kidney and the bladder) removed, a kid with Henoch-Schonlein Purpura with a possible hydrocele, and a bunch of other things that I can't think of right now

Oh, and there was one post-op appendectomy patient. Fairly routine for a general surgeon, but the sweet part of this story is that the 2nd-year family practice house officer (kind of like a resident) who is hoping to get into a surgical residency, was telling us the story, and beaming from ear to ear because he had done the appendectomy skin-to-skin himself (with the staff orthopedic surgeon, who was the one on call that night, just standing closeby). He had done a great job, and he was thrilled. It was neat to see how visibly excited he was. Makes me excited about the teaching component of my job here.

Before the OR starts, we have our all-important chiya (tea) break in the hospital canteen. Today I had chiya and samosas. The OR started around 10:00 or so. I basically joined another surgeon for his OR day, but we split the cases. For my first day I got a couple of easy things...removing a small mass (looks benign) off the shoulder of a 9-year-old girl, and a straightforward inguinal (groin) hernia repair. For you surgically minded out there, yes, we have prolene mesh here, and I used it and did essentially a lichtenstein repair under spinal anesthesia. For the rest of you, you don't care...sorry! Prolene mesh is pretty cheap (less than $10 for a large piece...you cut a piece out of it to get the size you want, and then the rest gets resterilized and used on the next several patients, too). We also have a good variety of suture materials...all the ones I'm used to working with at home, so that's great. Gloves without holes in them get removed, sterilized, and reused. And, of course, we have cloth drapes. There is one doctor (Nepali) who has some anaesthesia training, and another one in training at the moment, and there are nurse anaesthetic technicians. We can do both general and local/regional anaesthesia here.

The last case of the day I did together with the other surgeon. It was a bit complicated. Looked like some kind of abscess (pocket of infection) inside the abdomen, but we couldn't tell from the ultrasound what it was or where it was coming from (Yes, we have ultrasound here. No CT, of course). Turns out, in the end, we're pretty sure it was his gallbladder. It was HUGE, and full of stones and really (sorry) foul-smelling pus. And it was stuck to everything...the colon, the duodenum, the liver, etc. We worked in there for quite awhile, and eventually opted to just remove a portion of the gallbladder (the part we'd managed to free from everything else), and then stick a few drains in and quit before we did something really bad (like perforate his duodenum) while trying to do something good (like take out his gallbladder). So that one was a bit of a challenge, but at least it was very much within the realm of what I'm used to...i.e. operating inside the abdomen!

I had an intern with me, and she assisted and closed the skin at the end and did a great job. As I mentioned, I am excited about teaching here, though I will still be learning a lot at the same time. I do believe that's what I've been brought up to believe a doctor should be...both a student and a teacher at the same time. So I guess that's okay.

I was happy to discover that I have not forgotten how to operate...nor have I lost my love of surgery and medicine. I had been starting to wonder after almost 6 months of not being in the hospital how I'd feel being back, but I feel very much at home...at the same time as this is all very new and will be for quite some time.

Tansen Home

As promised, here is a tour of my home here in Tansen.

The kitchen is the first room you come to when you walk in. I spent quite a bit of time after I first arrived trying to figure out the stove. I didn't realize that you need a lighter to light it, and I was wondering why I kept turning the knob and no flame came...and why the kitchen was smelling more and more like gas! I eventually figured it out.

Next is the bathroom - my least favourite room of the house. Water shortage is a big issue here, so you do everything you can to conserve water. Thus, there is a bucket under the sink, and the water in the sink drains into it. You also stand in a bucket to shower, so that you can collect the water you use. The final common pathway? The toilet. Yes, it's true that there is no back to the toilet, and that it appears to be smack in the middle of the floor. And there is no flushing mechanism, other than pouring water down it. 

As for the shower, it took me quite awhile to figure it out. There is an electric water heater, which works when there is proper electricity (and not just generator electricity). There hasn't been proper power the last couple days, so yesterday I skipped the shower, and today I opted for a cold one. The first day, there was electricity, so I turned on the heater about 30 minutes before shower time. Then it took me a good 10 minutes to figure out which knob you turn to get the hot water, which one gets you cold water, and which one makes it come out of the shower. And then getting the balance between hot and cold was quite a challenge, so I decided I might be best off just leaving the hot and cold knobs exactly as they were and just turning off the shower. Bad idea, as it turns out. A few minutes later I could hear the sound of running water, but assumed it was the guy next door showering. About 30 minutes later, someone knocked on my door and informed that that water was pouring off my roof. He came in and promptly closed the knobs that I had left open, and that solved the problem. I guess I'll be fighting with hot/cold issues every day.I think I would like the bathroom much more if there was a shower curtain. The problem is that Nepalis don't use them. Few even have indoor showers (most shower outside at a local public tap, or they do bucket baths), and those that do have showers don't seem to mind that the entire bathroom gets wet when they use it. So despite my best efforts to find a shower curtain in the Tansen bazaar yesterday, there was none to be found. Fortunately there is a couple I know coming for a visit next week from Kathmandu, and they have kindly agreed to buy one for me and bring it along.

 I really like the living room, but I really DON'T like the "couch" at the moment. It is a bench with a really old, ratty piece of foam on it, and a ratty piece of cloth covering it. I'll be replacing both the foam and the cover, which will make it more comfortable, and more colour-coordinated.

There are two bedrooms, both quite spacious and with good amounts of storage space. Feel free to come for a visit if you're in the area!

 This is the house from the outside

 If you turn 180 degrees from where I was standing to take the outside house photo, you can see the hospital.  It won't be too far for me to go if I get called in in the middle of the night!

Phul Kumari is my wonderful house helper. Daily life takes a lot more work in a place like Nepal than it does back home. Laundry is done by hand, cooking is always from scratch, groceries are purchased daily at the market or little shops, and there are other things too that make it pretty much impossible to both work full-time and keep house. Phul Kumari works for me two days a week, and is doing a great job so far. She cooks both Nepali and some western dishes, and is lovely to have around. She also is great for practicing Nepali with.

Goodbye Kathmandu - Hello Tansen!

Hi from Tansen! I have waited for several months to be able to say that, and now here I finally am. I arrived on May 1, and have been spending the last couple days unpacking, sorting, and working on getting settled into my new house here on the hospital compound. Once I am fully sorted, I will give a blog-tour of the new place and the compound. But I'm not quite there yet.

The drive from Kathmandu to Tansen is about 10 hours long, on a good day. "Good day" means that the roads are in good condition (no potholes from the monsoons), there is no landslide or road traffic accident blocking the road, and no political demonstrations going on to slow things down. Thankfully, the road was in reasonable condition, and there were no obstacles along the way, so we got here in good time. I'm told the roads get really bad in monsoon season, which will start in another month or so. Then we'll see.

Usually hospital staff take the hospital vehicle, known as "the Buck" because it is a cross between a bus and a truck (seating in the front, storage in the back) to and from Tansen. The Buck goes to Kathmandu from Tansen every Wednesday and comes back to Tansen every Thursday. We didn't take the Buck this time, because it was a Tuesday.

There are 3 stages to the drive. The first, which takes about 2 hours, is just getting out of the Kathmandu valley. It's not that the distance is all that great, but there is usually a lot of traffic and it's slow-going. The roads are quite windy at that stage, but because you're going so slowly you don't notice it too much. Once you finally get out of the valley, you suddenly realize you can breathe again (much less smog and pollution), and the road becomes quite flat and straight for the following several hours. This is because you are driving through the Terai, the flat land that is in the south of Nepal (as opposed to the foothills in the middle, and the mountains in the north). After about 6 hours of driving along that road, you pass under the "Welcome to Palpa" arch (Palpa is the district that Tansen is in), and then begins the uphill climb to Tansen.

That climb takes about 2 hours, and it is really the most hair-raising part of the trip, and the time you're most likely to get sick! Though I have to say that going down is worse than going up. The road is narrow and windy, and there really isn't enough room for 2 directions of traffic, but they sure try. There is a steep drop on one side of the road, and no guardrail. Once or twice a month, there is a major road traffic accident with multiple victims that end up needing treatment at the hospital here, and that can be quite a challenge! I will certainly blog about it when that happens. And ongoing prayer for safety would be much appreciated!

Thankfully our drive was uneventful, and we arrived in good time. Almost all my stuff was already here waiting for me in my house when I arrived, as I had sent it on the big hospital vehicle last week. As I said, stay tuned for more details about the place.

The last couple weeks in Kathmandu were good. I spent a final weekend at the Children's Home, where we had a party, complete with chocolate, cream donuts and Coke/Sprite/Fanta, and said our good-byes. I will still see them when I visit Kathmandu, and Paul and I are planning on having a wedding celebration there, Nepali-style, when we come back to Nepal in December. But I will certainly miss the times I had with them there...my big Nepali family!

I also enjoyed a final dinner with my landlady and her family. They have been hosting bideshis for over 25 years, and I enjoyed spending time with them and getting to know them a little bit during my time in Kathmandu. In case you're wondering, the Nepali custom is NOT to smile when having your photo taken. I don't think I plan to adopt that custom as my own!

I now have my wedding dress all designed and ordered, and it is being made for me in Kathmandu. Obviously I won't share any of the details about the dress, but I did think you might be interested in the name of the shop :)

Happy New Year!

Let me be the first (maybe) to welcome you into the Nepali year 2069! They follow a different calendar here, instituted by some king or other way back when. There are still 12 months in the year, but they have different names, and the months start roughly in the middle of our Gregorian calendar months. Most calendars around here have both the Nepali dates and the Gregorian dates on them.

There isn't too much to report at the moment. I have just over 2 weeks left before I move to Tansen. I am cutting back on my language study classes next week to just 2 hours a day, and then won't have any classes that last week, to give me time to shop, pack, and prepare to move to Tansen. Oh, and continue to plan my wedding! I was thinking I should be able to find a dress here, because at Christian weddings more women are starting to wear white western style dresses. But after a lot of asking around, and visiting several places, I have concluded that there are approximately 5 ready-made western-style wedding dresses in all of Kathmandu, and they are all hideous (in my opinion, of course)! Frills and bows EVERYWHERE! I did find a tailor/designer who does a lot of western-style wedding dresses, and she came recommended by a few people, so I'm having the dress made from scratch - woohoo!

The weather here has transitioned into much warmer temperatures (mid-to-high 20's), especially during the day. But there have been crazy thunderstorms almost daily for the last 2 weeks. Maybe even daily...I'm not sure. It'll be beautiful and sunny one minute, and the next minute it's pouring rain and there is thunder and lightning. The other night I was awakened at about 2 am by a sound. At first I wasn't sure if it was thunder or really strong wind, because it sounded so strange. In the end I decided it was thunder, but it was the craziest thunder I've ever heard. Not super-loud, but absolutely constant rumbling for about 45 minutes straight, and the lightning was also constantly flashing for that same length of time. I've never seen anything like it! Nobody can quite agree whether this is typical weather for this time of year in Nepal or not. Some say it is, and others aren't so sure. At any rate, I've never experienced so many thunderstorms in such a short time.

I'm getting excited about the move to Tansen, though I will confess that I do feel a bit nervous, as well. It'll be another new place, a new job, and the learning curve will be steep at first. But it is why I've come to Nepal, after all, and I know it will be fine. But I do appreciate prayer for the transition over the next few weeks.

Village Stay

I am now back in Kathmandu, after my 2-week village stay. Village stay is part of the Language and Cultural Orientation Program that I have been doing here in Kathmandu. It's meant to be a language and cultural immersion experience - a chance to see what life is like outside the city. Certainly most of the patients I will be caring for in Tansen will come from more rural settings, rather than a big city, so it is good to get some exposure to a context that is a bit more like theirs.

When I heard about the village stay, I was picturing being out in the middle of nowhere, in little mud huts (or something similar) with no running water or electricity, or even toilets. I was picturing bathing outdoors at a public tap, going with the women in the morning to fetch water from the river, that sort of thing. While that would have made for a good story, I'm quite thankful that it WASN'T like that. The village we (there were 3 of us who went) stayed in was about a 45 minute walk from the outskirts of Pokhara, which is a fairly major tourist city about 6-7 hrs from Kathmandu. It was rural, for sure, but we weren't really roughing it. Homes were cement homes (and even the "traditional Nepali home" that my language teacher pointed out had a "traditional Nepali solar panel" on the top of it!). There was electricity...or at least, as much electricity as there is anywhere in Nepal, where "load-shedding" (i.e. no electricity) happens many hours every day, according to a fixed schedule. The home where I was staying also had running water and an indoor toilet and shower area - woohoo! It was a squat toilet, but that's not too big a deal, at least when you're healthy. Thankfully NONE of us got sick while we were there - big thanks to God for that blessing! That would not have been fun.

The home where I was staying had a family of 6 living there...the mother and father, their 3 children (2 daughters, aged 20 and 18), and a son around age 15. The oldest daughter is married and has a 2-year old daughter, who also lives there. Her husband lives elsewhere in Nepal for work. This is a very common situation in Nepal...husbands and wives living apart and maybe only seeing each other a few times a year - IF that! If they live in other countries (which is also very common) they might only see each other once every few years. I can't imagine!! The family was very welcoming and hospitable. They've had other bideshis stay there in the past, so they were kind of used to some of the differences between Nepali and western culture, which was helpful. We communicated almost exclusively in Nepali, though occasionally the younger daughter spoke English with me. It was really good, at this stage of my language learning, to be forced to communicate in Nepali for an extended period of time...really helped my comfort level and fluency with the language that I do have at this point.

The daily schedule went something like this:

7 am (ish) - someone from the family would bring me a cup of tea and sometimes also some biscuits.

7-9 (ish) - I would get dressed, sometimes shower (okay, not shower, really...the water was WAY too cold to shower - I would run the water just enough to get wet and clean and to wash my hair without getting completely under the running water), sometimes do some laundry by hand, sometimes help make the morning daal bhat, sometimes sit around and read or play my guitar, which I had felt silly bringing, but was so glad I brought.

9 or 9:30ish - Time for morning daal bhat (rice and lentil soup with some kind of side dish of curried vegetables). This is the classic meal for Nepalis, and they eat it twice a day (morning and evening). These are usually the only 2 meals Nepalis eat in a day, and the amount of rice they can consume is astonishing! They are always shocked when bideshis don't even eat half the amount that they eat, and it's a bit of a delicate balance between not eating so much that you feel sick, but also not offending them by not eating enough (or making them worry that you're going hungry). The family sits on the kitchen floor to eat and eats with their hands. I did that the first day, and then I think they noticed I was very fidgety and having a hard time on the floor, and so from then on they had me sit on a little stool and put my plate on a chair to use as a table. And when I burned my fingers from trying to eat with my hands, they graciously gave me a spoon! There would also be buffalo milk (freshly obtained from the buffalo they had, and then boiled prior to serving) that they'd give me, and we'd pour it over the daal bhat.

10-1 - Nepali lesson - we had 2 teachers come in from Pokhara. I had lessons together with one of the other people who came for the village stay, since we're at a very similar point in our studies. We did the usual Nepali studying (grammar, vocab, etc), and also did some village-related learning. We took a visit to the local health post one day, and to a mushroom farm another day. A couple times he also took us around to people's homes. For each little "field trip" we had to ask questions we'd prepared and talk with the people there about village life, health issues, mushroom farming, whatever the topic happened to be for the day.

1-3 - Sometimes I napped, sometimes hung out with the family. Somewhere in there there was kajaa (snack, which really was lunch for us) - sometimes roti (flat bread), sometimes popcorn, sometimes biscuits, sometimes instant noodles, or other things.

3-7 - The 3 of us would usually go exploring, either on our own, or with some of the kids from the village. One day a couple of the village boys took us to a bat cave...which was kind of fun. Other times we just wandered around and compared notes about how things were going. Usually sometime around 5 we'd go back to our respective homes and I'd usually help with evening chores and daal bhat making.

7 pm - Evening daal bhat time. Same drill as for the morning meal.

Bedtime came early most nights, because there was almost never electricity in the evenings. That was fine with me. I was asleep before 9:00 most night!

It was a good experience, overall. Even though we weren't really roughing it, it was still a cultural and language immersion time, and it was rural. Most people were farmers, and they had crops and animals, and we learned a little bit about rural life in Nepal and what's involved in it all. The highlight for me, I think, was the fact that there was a 2-year-old in the house. She was scared of me at first, but we became good friends, and she was a real cutie. I do have a soft spot for little ones, I must say!

So now I'm back in Kathmandu, and have one more month of language study before I move to Tansen. Moving date is May 1, which is a couple weeks later than originally planned, but I'm glad for one month of "normal" life before I transition, since the last couple months have been a bit crazy.

On another note, Paul and I are doing our best to stay in touch as much as we can. It's a challenge being apart, especially when phone calls are super-expensive and the connection is unreliable. He's just this week gotten internet up and running, and so theoretically we can talk on Skype, but so far it's been quite hit-and-miss, as well. Please keep praying for us in that regard. We'll sure be glad when we're not oceans apart anymore!

Developments...

I just got back from a week-long visit to Tansen for a work orientation. It was great to finally see the place and to meet the people I'll be working with in a couple months. It's a 10-hour bus ride to get there, which is why I haven't visited until now. The hospital has a vehicle, known as the Buck (half bus, half truck) that travels once a week between Kathmandu and Tansen. We took the Buck there and then flew back (the closest airport is about 1 1/2 hours from Tansen along a very windy mountain road that makes you motion sick pretty quickly). After having been there and seen how beautiful it is (SO much nicer than dirty, noisy, smelly Kathmandu!), and spent a bit of time in the hospital, I'm starting to get excited about moving there and starting work. There will definitely be a steep learning curve at the beginning, but that is to be expected. Burns are very common there and all but the most superficial burns usually require some form of surgical intervention. In Canada this is usually done by plastic surgeons, but there is no plastic surgery department at Tansen. What else did I see during my one day of rounds? There was a baby a few days old with spina bifida and an open spinal cord defect (probably not much that can be done for her, but the surgical team is caring for the wound for the time being). There were a few people with TB-related pleural effusions (fluid around the lungs) requiring chest tube drainage. There was a guy with alcoholic cirrhosis (alcohol abuse is a big problem here) with badly infected fluid in his belly...not too much that can be done for him here. There was the usual mix of gallbladders, hernias, appendixes, and other more "typical" general surgery cases.

I was interested to find out that the hospital does have mesh that they can use to repair hernias with. It's expensive so it's used sparingly, but it's good that they have it. That's the gold standard for most hernia repairs in the west, but I wasn't expecting to have that option here. There is a laparoscopic set-up, as well. It's pretty basic, and the picture quality isn't great...but hey, at least they have something. They do try to do their gallbladders laparoscopically if they can, which is great...both for the patients (when it is successful) and for someone like me who wants to keep up her laparoscopic skills if possible. I helped another surgeon with a gallbladder the other day. We started laparoscopically, but it was a pretty inflamed gallbladder, and we were both visiting surgeons and weren't too familiar with the equipment, etc, so we ended up converting to an open procedure, which was the safest thing to do at that point.

Tansen is right in the Himalayan foothills, and the town itself is built into the side of a fairly steep hill. You are almost never walking on level ground. Water supply is a huge problem, and so people walk quite a distance with buckets to get the water they need for daily life. It's less of a problem on the hospital compound, but you still have to use water sparingly.

In other (more important) news, as many of you already know, I have recently gotten engaged to be married to a guy named Paul!! No, we didn't meet in Nepal - we've actually been friends for 8 years now, but it's taken this long for the relationship to develop into more. He was just here for a visit (during which we got engaged on a little 18-seater plane, right in front of Mount Everest!), and he was able to come and see Tansen with me, which is great, since he will also be living there after we get married. We also had a chance to spend a weekend at the children's home, where all the kids have already started calling him the Nepali word for "Brother-in-law" (older sister's husband, to be precise). They were all very excited to meet him, and we had a wonderful weekend there. He is off to Africa now for 6 months (sigh) to finish up a building project there. We plan to get married in Canada in October, and then come back to Nepal together as a couple in December. We're very happy (obviously), and everyone - both here in Nepal and back home - has been so great and supportive. People here are excited to have us in Tansen as a couple, and he had a chance to meet some people he may end up working with when he comes back. These next 6 months will be challenging for us, especially since a long-distance relationship between Nepal and Africa isn't the most straight-forward. We're just praying for good phone networks and internet connections so that we can stay in touch as best we can. We did manage to plan the majority of our wedding while we were together, so that was a bonus!

I'm off on Friday to Pokhara (a tourist town about 5-6 hours from here) for a weekend of touristy things with a couple other language students. Then on Monday we head to the village for our 2-week village stay. I don't expect to have internet access there...or showers, for that matter!