Monday, February 25, 2013

We Are The Snowy Infirm

February 26, 2013

We've spent the better part of the last week in Pokhara, recovering from a 2-week foray into the Manaslu Himal.  So far, I would not describe our adventure as smooth.  

Our original plan, as thought up from the other side of the world and based on extensive internet research of highly unreliable websites, was to start at one end of the country and hike across to the opposite side.  Pretty simple, really.  We traced our fingers along the map I printed off at work, following it from one side to the other so many times we smudged the ink along our planned route.  We wanted to start in the west and hike east, timing our travel to avoid the highest passes in the early, snowy season, and tackling the higher, more technical passes in late spring.  This seemed reasonable, and would certainly mean walking through some snow, but not too much.  The traditional trekking seasons only really last 2 months in the fall and 2 months in the spring, so we had to deal with a month out of season regardless of when we started.  We chose (limited) snow (hint, hint) over monsoon. 

Upon our arrival to Nepal we were informed that the Simikot airport, our intended destination near the Indian border, had just been buried in 4 feet of snow and was in the process of being dug out.  Uhh...scratch that plan.  Our next idea, to start in the east and hike west, meant going over passes of 6000+ meters during the snowiest portion of the season, much closer to the start of our trip with much less acclimatization. thanks.  After talking to some local guides and poring over maps, we came up with a compromise - start in an area that typically gets less snow and hopscotch around a little to find the most snow-free areas until more passes melted out and we could fill in the blanks in a more straightforward fashion.  

Great!  Let's go!  What's that?  It's been a much snowier winter than normal?  That shouldn't be a problem, should it?  Before I go on, a short meteorological tutorial: Nepal is a long skinny country that is low along one long edge (bordering the plains of India) and really, really high on the other (bordering Tibet).  Storms come from the west, over India, and start dropping rain as they hit first the foothills at the lower elevations, then turn to snow as they get pushed up and over the Himalaya.  In Kathmandu (one of the few places with reliable meteorological data), February normally sees 18.7 mm of rain.  Actual rainfall, as of this past Sunday, was 45.9 mm, with a few days still left in the month. All of that rain down low means much more snow up high.  This year, it means much much more snow up high, which is really starting to get on our nerves.

If healthy, the snow might not be a deal breaker.  Sure, post-holing through 3 feet of unconsolidated snow is no one's idea of good fun, but it's possible.  We expected some hard times.  However, to add insult to injury, we've been a traveling infirmary.  Little did Abby and Mary know that once the volunteer nursing stint ended, the real nursing work would begin.  Our little band of 4 has been spiraling through an assortment of gastrointestinal and respiratory illnesses, and it's been a mix and match ball of fun for everyone, with no man or woman spared.  In less than a month, we've had (in no particular order):
  • 2 cases of severe constipation (who the hell comes to Nepal and gets constipated?!);
  • 4 cases of diarrhea, some recurring;
  • 3 cases of vomitus;
  • 3 persistent chest colds, one of which involved expectorating "crayon-like" sputum; and
  • 1 near-case of head lice (discovered in a purchased toque).
That's a long list.  The attempted cures have been:
  • 2 courses azithromycin;
  • 3 courses cipro;
  • 1 bottle lactulose;
  • 1 attempt at the B.R.A.T. diet (banana, rice, apple sauce, toast); and 
  • 1 visit to the doctor (currently underway).
We've certainly been sick on our previous travels.  Last time we came to Nepal, both Abby and I had some viral illnesses on separate occasions that each lasted a couple of miserable days, and we did come down with giardia.  But those were discrete problems that we solved rather quickly and moved on from.  This is just downright strange, especially in light of the fact that it's within a group, all at the same time, and all different problems.  If it was a case of the flu passing from one person to the next, that's pretty understandable.  But it's not.

Before our readers start despairing too much, none of these illnesses are serious, and we were aware that we were taking a bit of a gamble by arriving early.  Morale is a little low right now, but we're optimistic that some good health and a little time should cure all that ails us.  We're going to spend another day or two in Pokhara, and then head up to the Annapurna Sanctuary to see some big mountains and let the high passes melt out some.  We're off to check on the results of the visit to the doctor, then hopefully off for some mountain therapy!

Sidha Sadabahar Clinic

February 26, 2013

Every time I've traveled overseas, I've felt a desire to volunteer or give back to the amazing people that I meet. It's one of the reasons I became a nurse. Therefore, it was a priority for travel this time around. Luckily, my friend Mary was interested as well, so we did (a little) research before we left, found an organization called Hands For Help Nepal based on a friend's recommendation, and signed up.

We arrived in Kathmandu, and instead of bargaining for a taxi outside of the airport, we were met by a guy holding a sign that said "Abby Koszarek", and, like royalty, were whisked to our hotel. We spent two days in Kathmandu, learning Nepali, walking the streets of Thamel, and visiting temples as part of our "cultural orientation". Badri, a large Nepali man who has been the head of the organization for over fifteen years, briefly described the hospital we'd be spending our time at, and assured us that our home-stay and everything was all set up. We'd be the first volunteers at this particular sire, but he assured us that he had spoken with the hospital commissioner many times, and were "so excited" to have us.

Khadijaur, the village that we were placed, lies about 60 km northeast of Kathmandu, but takes about three hours to reach. We pulled into the hospital courtyard, and were met by a gaggle of wide-eyed villagers, patients, and clinic staff. Mary and I stood awkwardly in the sun, trying to appear calm and confident. After several minutes, we had a quick meeting with the head doctor, who appeared surprised that two foreign nurses had appeared at his hospital. Turns out the hospital commissioner was out of town, and hadn't told anyone of our arrival. Badri did a quick introduction, then wished us luck, and sped away. The doctor gave us a 30-second tour of the facilities, and then excused himself to get back to work. Mary and I looked at each other with mixed confusion, amusement, and dismay. Here we were, in a random village, without a place to stay, a place to eat, and major confusion as to what we were supposed to do as volunteers. We did a micro-lap around the courtyard, smiled and nodded to some people, and then bolted. We walked up the road, took a little path through some terraced fields, and found a place to sit and observe our surroundings. Not knowing when our next meal would be, we devoured the cookies we had brought as a home-stay gift, and giggled about our circumstances.  We eventually made out way back to the hospital, and after much scrambling around, were given a big room and shown to the hospital cantina for dinner.  Regardless of what came next, we would be well-fed and have beds to sleep in.

The next day we wandered to the hospital in the morning, met the doctor and tried to formulate a plan. I would shadow him for the day, and Mary would hang with the nurses in the ward. I sat in the doctor's office while he saw a couple patients, and then the morning rush was over. Turns out it's the "slow time" for the hospital; the dry season minimizes GI illness, and fewer people travel so accidents and traumas are less common. I tried to make small talk, and he politely answered all of my questions. But, when he suggested I  go outside and enjoy the sunshine, my chattering teeth and numb extremities won, and off I went to the courtyard. I spent the morning talking mixed Nepali/English to the bored hospital staff and some children, and when I met up with Mary at the canteena for dal bhat later that day, she had a similar story to tell.

What were we going to do there for two whole weeks? What could we possibly accomplish? It certainly seemed like there was potential for them to benefit from volunteers, but how? I couldn't help but be a bit angry with Badri, our volunteer coordinator, for failing to prepare us, or the hospital, for our stay. I had assumed we'd be busy with day-to-day tasks, like triaging patients, or giving immunizations, or assisting with vital signs - mostly providing an extra set of skilled hands for what I thought would be a busy, understaffed rural hospital. But, they weren't busy. We talked about creating and implementing a public health campaign, but Mary, a community health nurse guru, reminded me that we needed a comprehensive community needs assessment before we just assumed that we knew all about what would improve health for rural Nepal. We went to bed that night feeling a bit demoralized, but decided to spend at least one more day at the hospital, awkwardly milling around in hopes of inspiring a purpose for our volunteer stint. 

Happily, the following day was better, much better. We participated in morning rounds, showering the patients with our smiles and "namaste!" while they conversed with the staff in Nepali. We learned that in Nepal, and other developing countries, the WHO has developed diagnosis standards for common diseases like pneumonia and tuberculosis that are symptoms-based (like respiratory rate, fever, etc) instead of results-based (like sputum cultures, etc). So if an infant comes in, hasn't been able to feed, has a fever and a respiratory rate above a certain number, the doctor diagnoses pneumonia and can prescribe antibiotics in a rural area without access to a complex lab or x-ray. These are all standardized, and have been tested with great results worldwide. It's quite fascinating, and I made a mental note to research it further later. We watched as a man who had nearly sliced his hand in two on a woodsaw walked into the Emergency Department, was shuffled back to the "procedures area" and after being given a shot of pain medicine and some topical lidocaine, endured a full-on repair of his tendon, placement of a steel rod through his finger and into his palm to set the tendon, and extensive suturing. It was unreal. 

We also got to know the staff a bit better: the gaggle of nursing interns, there to learn for three months before returning to their smaller villages to work; Raju, the lab technician; Sangita, the pharmacist who sold us antibiotics to round out our traveling pharmacy; Urmila, a nurse with moderate English who delivers babies by herself (!!); and Ram, the medical assistant (like a PA) who can start an IV in about 14 seconds. We talked with all of them about their jobs, shared stories about our nursing jobs at home, and actually felt like we were maybe getting somewhere. 

The next few days we busied ourselves with visits to local schools to talk about the health issues they face. We decided to forego the community needs-based assessment, and do an on-the-fly survey while talking with them. We named our presentation "Take Pride in Your Health!" and had a lot of fun brainstorming and then teaching them about basic things like handwashing, nutrition, covering your cough to reduce disease transmission, and other things along those lines.  It wasn't rocket science, but they seemed to enjoy it, and it gave them a chance to practice English and us to practice Nepali. And, for the rest of our time in Khadichaur, kids in town recognized us as the health workers, and would run up to us and say hi. One afternoon, we were playing and talking with a group of kids, and when we said goodbye and turned to leave, we were serenaded by an impromptu chorus of "Please Come Back! Please Come Back!".  It felt good. We also provided some education in the form of lectures for the nursing staff at the hospital, especially targeting the nurse intern gaggle. Again, we stuck to simple things like the Glascow Coma Scale, head to toe nursing assessments, and signs and symptoms of basic diseases. We found health posters on the internet, in Nepali, and hung them on the bare concrete walls of the hospital, adding some color and hopefully generating some conversation and awareness.

We also did lots more "hanging out" at the hospital courtyard, learning Nepali from staff and patients, eating amazing dal bhaat made fresh from Vupindra , the cantina cook*, and escaping for afternoon walks up to smaller communities nestled in the mountains. One afternoon we were cajoled into having tea and biscuits with a man and his mother, father, and grandmother. When we found out we were working at the hospital as nurses, he ran into his house and came back with a blood pressure cuff and stethoscope. Why he had it, I have no idea, but we took blood pressures of him and his family, and wrote them on a torn piece of paper that he carefully tucked into his shirt pocket. They are all subsistence farmers, and run up and down terraced fields all day, so not surprisingly, their blood pressures were perfect (even his 90-year-old grandmother!). Another afternoon we stumbled upon an entire family hand-carving a wooden plow and preparing their oxen in anticipation of the planting season. They also insisted we sit down, eat some roasted popcorn and nuts, and drink enormous bubbly glasses of fresh mohi (watered-down buffalo milk - not the easiest thing to swallow without gagging). Everyone was friendly, welcoming, and wonderful.   

When we came to the end of our stay, everyone seemed genuinely sad that we were leaving, and Facebook addresses were traded frantically. Badri returned to pick us up for the return trip to Kathmandu, and we spoke briefly with the hospital doctor and at-length on the ride home about what went well, and what would be important for future volunteers to aid in their success. I had no illusions of changing the world in two weeks, and although I had hoped to do more, it was a good "first experience" of what it is like to volunteer and share knowledge in a rural, developing nation. I'm excited to do more!

*Funny aside: We called Vupindra "Popendra" for the entire time we were there, and he graciously never corrected us once.  On the last day, we presented him with a thank you card that was filled with our meager attempt at Nepali writing that had his name spelled wrong, and one of the other workers read it and told us it wasn't his name.  Vupindra just smiled and shrugged, then tucked it into his pocket for safe-keeping.

Saturday, February 23, 2013

The Travelers's Anonymous (TA) Support Group

Travel is an addiction which you don't cure, you simply learn to live with.  I've recently found some great moral support from others who are in the same boat.

"When I was young and the urge to be someplace else was on me, I was assured by mature people that maturity would cure this itch.  When years described me as mature, the remedy prescribed was middle age.  In middle age I was assured that greater age would calm my fever and now that I am 58 perhaps senility will do the job.  Nothing has worked.  Four blasts of a ship's whistle still raise the hair on my neck and my feet to tapping.  The sound of a jet, an engine warming up, even the clapping of shod hooves on pavement brings on the ancient shudder, the dry mouth and vacant eye, the hot palms and the churn of stomach high up under the rib cage.  In other words, I don't improve; in further words, once a bum, always a bum I fear the disease is incurable." (Italics mine)
     ~John Steinbeck, Travels with Charley.

"Perhaps the balance here, between order and disorder, suits me.  What I find here probably helps me understand my own mind, my own life."
     ~French photographer Frederic Lecloux, on why he keeps coming back to Nepal.

Escape From Arkhet Bazaar

I walked into our coffin of a room at the Arkhet View Guesthouse, one of only 2 in town, neither one good, to find Abby wide awake, cocooned in her 0 degree F mummy bag and perched on the edge of the bed as far from any of the walls as physically possible.  She looked terrified and miserable.

"I'm not going to sleep a wink", she announced quietly.  Her discomfort was palpable, and well-earned.  The room was not clean.  Less than 10 feet square, it had no window and barely enough room to stand up, with a 10 inch gap between the top of the door and the bottom of the door frame.  The carpet was sad and worn, and filthy.  A used band-aid had been discarded by a previous occupant very conspicuously near the door.  The sheets were old, stained, and tattered, and the mattress was more of a suggestion than an actual pad.  In addition to the challenging sleeping arrangement, we hadn't had a shower, nor anything more than a cursory splash for that matter, in almost 2 weeks.  Our clothes hadn't been laundered in even longer, and we'd spent the last fortnight walking up and then back down a trail littered with donkey scat landmines and pockmarked by pools of donkey urine.  It was humid and sticky, and we felt disgusting. 

"What can I do to make you more comfortable," I asked. Maybe I could help.

"You can start by getting rid of the giant spider waiting to attack me from the corner of the room," she replied.  "It's bigger than my hand."  She struggled to free an arm from her sleeping bag, and pointed up behind me.  I followed her finger, and discovered that her hyperbole barely fit the definition - the spider was only as big as the palm of her hand.  Ever the chivalrous husband, I sprang into action.  Grabbing a wad of toilet paper and a plastic bag shield, I hopped onto the bed and lunged after the giant arachnid.  I made a few stabs, but it was too quick and I missed every time.

"No!  Stop!" Abby cried.  "I've been watching it scrabble back and forth for the past hour and it's too fast for you."

Unfazed by her pessimism, I lunged again.  Again I missed, and the spider scampered through a large void between where the top of the wall stopped and the makeshift roof started, disappeared and out of reach.  There was no way that gaping hole was going to be filled by anything less than a large-scale renovation project, but I stuffed the toilet paper-plastic bag assembly into the space in a futile attempt to keep the now-angry spider from coming back.  I turned triumphantly to face my wife.

"Anything else I can do to make you more comfortable?"  I got a sad laugh of acknowledgement then crawled into bed.  It was a long night.

We passed the night dozing off and on, just waiting for our watches to formally signal an end to our misery.  When the alarm went off at 5:30 am, we sprang out of bed and were packed within 2 minutes.  We'd set our alarms bright and early in order to avoid a repeat of our experience getting to the trailhead.  Two weeks prior, in Gorkha, we'd arrived at 6:30 for the 7:00 am bus to Arkhet, only to discover that all of the seats were taken and it was standing-room only.  No problem - we'd hopped eagerly aboard, experienced chicken bus travellers all, and endured the most agonizing 5 hours of our lives.  It was a tortuous hell ride along a muddy, bumpy, treacherous road through the mountains, all to travel a measly 42 kilometers.  Standing-room-only meant stuffed-to-the-gills, and for any non-Nepalis it also meant hunched-over-room only.  I was a full head too tall for the bus.  At one point I found myself sitting on the dirty, garbage-strewn floor next to a local woman who was getting car-sick into a small plastic bag.  None of us were willing to repeat it, hence the 5:30 am wake up.

We shuffled down the stairs, exhausted but eager to get out of Arkhet, and walked into the dining room.  Instead of the empty room we expected to find at that time, we were greeted by a room full of Nepali men crowded around a small radio on the counter, a conspicuously empty bus ticket booklet lying between them all. Trying to assess the situation, I sidled up to a familiar face from a dinnertime conversation the night before.  "What's going on," I asked.  "We see if today more strike," he replied.  "Yesterday Maoist convention, no bus.  Maybe no bus today."  Apparently, the Maoist party, nominally in control of the inherently and famously dysfunctional Nepali political system, had announced a country-wide strike the day before.  No business ventures of any sort were permitted, and those defying the decree had been harassed, vandalized, and even beat up by the activist cadre branches of the party, we were later to find out.

We waited apprehensively on the margins of the group, trying in vain to understand the news stories crackling through the cheap little speaker.  As the stories went on, each separated by the unmistakable musical interlude that separates radio news stories the world over, conversation amongst the Nepalis slowly picked up, their attention wandered, and no outcries were made.  Bus tickets started being sold, and we left the hotel with precious seating arrangements in hand.  Our escape was imminent.  Gorkha, watch out!

Great Himalaya Trail

We have finally arrived at the largest part of our sabbatical year: The Great Himalaya Trail. After 8 fantastic months spread throughout the US and Canada, we're in Nepal making our final preparations for an attempt to thru-hike the entire trail in 3 months.  The Nepal portion of this trail cuts across the entire country through the heart of the Himalaya, passing in the shadows of all of the country's 8000 meter peaks: Kanchenjunga, Makalu, Everest, Cho Oyu, Manaslu, Annapurna, and Dhaulaghiri.  It's more than 1,700 kilometers long, and crosses over passes higher than 6,200 meters tall.  In short, she's a doozy. The trail is a concept thought up by Robin Boustead, a long-time trekker in Nepal who wants to increase tourism revenue in the more remote portions of the Himalaya.  We just think it's an awesome idea.

Nepal’s Great Himalaya Trail
One trail to rule them all?  I don't know about that, but it DOES look pretty awesome on a map.
Abby and I initially started planning the trip solo, but we soon found two friends interested in joining us.  Andy and Mary are friends from Anchorage who have been with us on most of our big recent adventures, including our thru-hike of the Sierra High Route, our spring fly-in ski trips, and our rafting trip on the Grand Canyon.  We're excited to have them along, especially for the more remote sections where there is definitely strength to be had in numbers!  The company will be nice, too.  We've done short sections of it on our last trip to Nepal, 5 years ago, through Annapurna and Everest.  This time, we want to tackle the entire thing.

There is very little information on large parts of the trail, since it's a pretty new thing, and relatively few people have done it, so we're hoping to fill in the rest of the blanks here in Nepal, and let the chips fall where they may.  We'll have a SPOT with us (a small emergency GPS device), which will allow us to send out periodic updates of where we are on the trail.  The link to our site can be found here, and you can check in regularly to see where we're at.

Right now we're in Kathmandu, sorting out the last of the logistics and figuring out where to start.  It's been pretty rainy here in Kathmandu, which means snow up high.  This is a little concerning, but we're here, and we're motivated, so here we go.  Wish us luck!