Its been a week since I landed in Kathmandu. The whole satellite phone situation in India caused me to miss all of the Nepali language classes here as well as the intro lectures on topics like dentistry and tropical medicine. Kind of a bummer but in the grand scheme of things really not that big of a deal, at least I got here. I did get here in time for the altitude lecture given by Dr. Buddha Basnyat which was helpful to solidify all the altitude knowledge that I had already regarding prophylaxis and treatment of AMS/HAPE/HACE.
For all my non medical readers AMS/HAPE/HACE are the 3 big disease states associated with high altitude. AMS/HAPE/HACE are thought to occur from low levels of oxygen in our bodies and usually are seen at elevations >2500 meters (>8000 feet) but can occur as low as 2000 meters (6500 feet). In brief AMS stands for Acute Mountain Sickness and is more or less like a hangover with symptoms of headache, nausea, poor appetite, overall just feeling lousy. It’s not life threatening but is a sign your body is saying “Please! Stop! Go back down!”. You don’t necessarily have to descend but really should stay at your current elevation until symptoms improve. HACE (High Altitude Cerebral Edema) on the other hand is life threatening and requires immediate descent to a lower altitude. Symptoms include confusion, altered mental status, being clumsy or what the medical folks call ataxia. The symptoms all result from swelling of the brain, obviously a bad thing right? HACE is considered the end result of AMS if a person ignores their symptoms and continues to ascend. Lastly HAPE (High Altitude Pulmonary Edema) is fluid in the lungs which obviously causes you to feel short of breath with minimal exertion or at rest. It too is life threatening and requires treatment with oxygen, medication, and many times immediate descent. Bottom line, the definitive treatment for all these disease states is decent usually to 1000 meters lower than where you are but it really is recommended you descend to where you feel well again. If you’re interested in this stuff then you can read more details full of medical jargon here: http://www.wemjournal.org/article/S1080-6032(14)00257-9/pdf
Anyway, a lot of this past week has been spent exploring Kathmandu. Our team has been put up in one of the hotels in Thamel which is more or less the tourist hub of the city. The tiny streets are barely big enough to allow a car to travel through them and are lined with endless shops selling trinkets, pashmina and cashmere scarfs, trekking gear, and pretty much anything else you’d need to survive here including delicious kebab stands. The city and greater area contain some really beautiful and incredibly important temples for Hindu’s and Buddhists alike. I’ve had a chance to visit some of them, see pics below. Thamel is really nice and the surrounding temples offer a real sense of peace and calm but the city at large can honestly be hard to endure at times. The air quality here is pretty awful. In fact, Kathmandu is ranked 5th overall in world for poorest air quality. Most people walk around with masks and dust seems to coat everything and everyone. Oh well, city life here is temporary, the mountain air will be a welcome reprieve.
This week has also been great as it allowed time to get to know the other docs in the team. We usually go about our day and then meet for dinner at 7PM. They are all super chill and really interesting people who have traveled all over and have completed many other medical missions across the globe. Liz Scott and Jenny Black are the two docs coming up to Manang with me. Simon & Helen Randfield and Carlo Canepa will be the team going up to Pheriche. Liz is from New Zealand, Jenny’s from Scotland but living in England, Simon & Helen are both from England, and Carlo is from the US and is also a wilderness medicine fellow only he’s from MGH’s program. On one of the nights we went to an Irish bar which was hosting a trivia night. Believe it or not we won first place! I immediately thought: I’ve made Zach Testo so proud. We actually tied for first with another team but Carlo pulled through at the end with the correct answer to the tie-breaking question: “Which year did the Titanic sink?”. (see victory photos below of Carlo showcasing the grand prize)
So if you’ve read this far you might be wondering “Why are you still in Kathmandu if the lectures are all done? Why haven’t you left for the clinics?” Well…….normally, yes, after the lectures have finished the teams go up to their clinics and the season starts. However….you guessed it, another bump in the road. This time it has to do with Nepalese government.
If you remember from my original post back in February I mentioned that there was a string of arrests here in Nepal of foreign docs practicing medicine. Well that really shook things up here at the HRA as the arrests showed that even legitimate physicians with altruistic intentions are not safe here without the proper permissions from the Nepalese government
Getting these official government permissions has caused a delay in going to the clinics and goes something like this:
The HRA many, many weeks ago had asked the Nepalese Medical Council (NMC) for permission on our behalf to go to the Manang and Pheriche clinics. The NMC are on board with this and are very supportive of us. Once I finally arrived in Kathmandu we went and met with the heads of the NMC to speak face-to-face and show them all our paperwork and that we were in fact legitimate doctors in our home countries. (side note, it was kind of surreal meeting with the heads of a branch of the Nepalese government on my first day in Nepal!). So that’s all well and good right? Well the NMC also wants the “ok” from the Minister of Health (MoH) as well. The problem is that there technically isn’t a Minister of Health at the moment. Nepal recently went through government elections in November/December 2017 switching from the social-democratic party led by former prime minister Sher Bahadur Deuba to a Marxist-Leninist communist party led now by current prime minister Khadga Prasad Oli. Oli was just sworn in a little under a month ago, hence the delay in the appointment of the new Minister of Health. So more of less we’ve been in Kathmandu spinning our wheels waiting for the powers that be to grant us permission to go practice in our respective clinics. This may seem like the whole trip is doomed but just today there has been some really good news and progress and it does seem like we will be heading to the clinics later this week or early next week. Fingers crossed!