End of April
Another week, another post. Lots of changes around here. Construction wise the workers have finished all the plumbing, electrical, and major shelving projects and have now moved on to putting in wood floors in the office and clinic rooms. Painters have arrived and have begun sealing and painting the exterior and interior walls of the offices and clinic rooms, finishing with our bedrooms after we have left for the season. As a bonus, the workers constructed a TV stand in the kitchen! We found an old dusty TV and DVD player in the lecture hall that we cleaned off and sure enough it works! Real exciting stuff. There were also two boxes of dust covered DVDs near the TV which we cleaned off. So far we’ve watched 7 years in Tibet, Shawshank Redemption (loooove that movie even though I’ve seen it probably 50 times), and Adaptation. Nice form of nighttime entertainment after dinner. During the day I’ve been reading more than I ever have in terms of leisure reading. I’ve recently finished Into Thin Air by Jon Krakauer as well as the first two Dark Tower series books (Gunslinger and The Drawing of Three) by Stephen King and am now well into the third book, they are soooo good.
Also I’m learning a little Nepali and a little more Hindi. My Nepali is more or less limited to “Malaai naam Ben ho, bhok lhagyo” which means: My name is Ben, I’m hungry. Also I know the word "pugio" which means full. Only the important phrases of course. The construction workers are all Hindi speakers from Bihar India so every morning I greet them with “suba parbat” which means good morning. Hopefully someday I’ll be more fluent in Hindi.
I’m a little sad to report that Grishma, Gobi’s son, left on a helicopter early last week to go back to Kathmandu. I miss him a little as it was fun playing cards and being a goof ball with him. I nicknamed him “dally boy” cause of how much dal he ate which he retorted back with calling me “bhaty boy” for the supposed large amount of rice I ate. Super smart and funny kid. The clinic is a little quieter and a little less fun without him here.
The Metha Archery Festival was celebrated last week at the edge of town and was really interesting and fun to attend. The festival dates back many centuries and on basic level is based on the triumph of good over evil with the objective to wipeout evil spirits and demons so that the people of the valley will live a prosperous, healthy, and happy life. Mainly it seemed like it was like any other festival in the western world with the air surrounding those participating wreaking of booze and tobacco, in this case raksi (local wine) and cigarettes. The bows were intricately carved, many of the men had this traditional dress with fur hats on, and the whole event was doused with drumming and whistling by those on the sidelines. Felt like a regular old 4th of July without the all the fireworks and hot dogs.
Last week I went on a walk through the fields on the other side of the Marshyangdi river which separates the town from the mountains. It was just me, myself, and I out there, no tourists and no insistent drilling/hammering/sawing from the never ending construction from the clinic. The waters of the river are a bright emerald blue which is attributed to the glacier run off from the Gangapurna glacier maybe a mile upstream. This river flows down the entire valley and well into Kathmandu. There is a stark difference though between the river here and the river in Kathmandu. Here the river is beautifully crystal clear, frigid, and fast flowing but arrival in the city turns it into a trash filled, brown, muddy, and low level stream that looks more like an open sewage system than the beautiful blue current of the Marshyangdi in the Annapurna valley. On my walk I also ran into a goat herder which was a really fun experience. I strolled through this heard of like 100 goats with the emerald Marshyangdi waters to my left and the snow capped peaks of Annapurna III, Annapurna, IV, and Gangapurna to my right. Ultimately I had to cross back over the river a few miles down over this incredibly sketchy bridge which is beautiful to photograph but pretty precarious to cross.
Ok, case time. Honestly the clinic was pretty slow this week. No one was super sick but nevertheless we got a few interesting cases to talk about.
First off is a rash. Young healthy local male came in at dinner time with an “allergic reaction”. He lifts his shirt up to reveal grouped vesicles on an erythematous base in a unilateral dermatomal pattern on his left chest in approximately the T7 distribution. He reports mild itchiness with a lot of electric pain in the same area before the onset of the rash. This is classic for shingles. Strange that a young guy got it as its usually a disease of the immunocompromised or elderly. We gave him acyclovir and instructed him to get a full check up in Pokhara or Kathmandu where they can do lab testing like a complete blood count to evaluate for any extremely high or low white blood cells counts. As an aside, it was interesting what he called the rash: Janai Khatira which roughly translates to Sacred Thread Rash. His rash happened in the pattern where many Hindu boys wear a special shash when they have reached a certain age. So in theory, he had a more special version of the shingles rash.
Next up is a local man who got a piece of metal in his eye. The idea of work gloves and safety glasses does’t exist around here. At least we’ve gotten the guys working on our clinic to wear safety glasses when they grind metal or use the table saw, sometimes. Anyway, the guy noticed a foreign body sensation when he was grinding metal last week, now his whole eye was sore which prompted him to come here. We could see a spot at the 12 o’clock position but without any real magnification it was hard to tell if it was a rust ring or a persistent piece of metal. My guess was rust ring based on the timeline. No Sidel’s sign on fluorescein exam which is good as this would mean his actual globe would have been ruptured and slowly leaking, a true eye emergency. Anyway, after attempts to remove the foreign body with a Q-tip failed I didn’t really feel comfortable fishing this thing out with a needle without a slit lamp or some higher level or magnification. Liz on the other hand said “oh I do this all the time”. Alright, have at it. She tried but really couldn’t safely get the thing out. She did manage to scratch his cornea a bunch so once those numbing eye drops wear off I bet his eye was hurting something awful. Plan was for ciprofloxacin ointment and next day travel to Pokhara to see an ophthalmologist.
Liz’s dog bite patient returned early last week for suture removal after about 4 days. Liz snapped a quick pic of me removing the sutures. Kid will have a scar but hopefully with time as he gets older it won’t be that noticeable.
Lastly to round out the cases is a classic Acute Mountain Sickness Case. A young female in her mid 20s took a jeep to Chame at 2600 meters, the lower limit of high altitude. She got a headache shortly after the next day when ascending to 3300 meters in Upper Pisang. The headache continued but she continued to ascend. As she went higher and higher into the Annapurna circuit she got more of a headache, dizziness, low appetite. Eventually she got to Letdar at 4100 meters and felt very ill. Her soup came for dinner and she took one sip and then no more. She went to "get some air" outside and syncopized (fainted) twice. Luckily she had a really good friend who split from the group and brought her back down to Manang about 600 meters lower. She felt slightly better but still not that well once in Manang and had persistent moderate shortness of breath with minimal exertion. Her friend came to our altitude lecture and told me about her case to which I said "get her to our clinic". She got here looking pretty crappy but overall her exam checked out well. She had moderate to severe AMS and when I told her the diagnosis she got up and said "I think I'm gonna be sick" and immediately went out into our courtyard looking for a vomitorium. She grabbed a bucket and I yelled "not there! we do our laundry in that bucket!". She luckily heard me and stepped a little further to spill her guts all over some old wood from the previous building that was torn down last year. She got some Diamox, some Zofran for the nausea, and planned to take a Jeep out to Besisehar the next morning. Pretty bread and butter Acute Mountain Sickness.
Ok, that's all for now! Tune in same time next week for more updates from my life in the Himalayas.