Going Up - The Trek to Phoksundo

Day 1

The light was very bright coming in the windows of the little airplane, so when we landed and I applauded the Swiss pilot on his landing, asking how he could possibly see the strip, he told me he couldn't really...proof once more that God and some luck were the only things keeping us alive and moving forward. When our team landed in Juphal, we walked out onto the dirt landing strip and picked up our bags. We were asked to show our passports and permits (at least we got to use the damn things, after all the trouble they caused!). We met Matthew, a British missionary living in the region, for tea at a local hotel while we waited for Balber to arrive. Balber is a Dolpa native and would be guiding us to the lake. Our plan was simple - Two and a half days up, and two days back to the lake, then the rest of our team would cross over the two mountain passes to Do to manage the yaks while I turned back to make it back to a plane in time to leave for America. Quickly, we had to adjust as we learned that recent snow had closed the treacherous pass (two mountains above 15,000 feet), so the only way to Do was to come back to Juphal and go back around the other way - 4 days up, 3 days back (too long for the time I had). Ishak and Rochelle would go with me to Phoksundo first, then come back with me and loop around to finish the rest of the trek to Do. We headed out.

We took a truck, one of the only in the area (they were proud to say it had been airlifted by helicopter to the region for $35,000 - a steal, if you ask me) that fortunately had gasoline, down the mountain to the entrance of the Shey Phoksundo National Park. We sat in the truck bed where metal barred benches had been placed. Packed like sardines, we bounced and leaned with the truck as it 4-wheeled itself down the mountain, breathing in the clouds of dust it was kicking up as it went. We were stopped along the way and asked to provide proof of our permits, which were in our bags on the roof. The truck emptied at the bottom of the mountain and we followed a glorious turquoise river for a relatively painless hike to the first stop, where we had to pay the entrance fee of $30 and once again provide our permits. We hadn't eaten in hours, so we had noodles with egg sitting in the family's home. We sat on a bench watching a very dramatic Nepali TV series with a lot of crying. I watched the fancy multicolored ducks eat with significant efficiency the many MANY flies. Rochelle and I went through the first of what would become routine water filtering, and we were on our way.

We stopped a few times along the way, sitting at the river to eat an apple that Balber had brought us from his home where he grows them. Rochelle and I used her knife to peel it (safety fanatics we were, but don't judge - we couldn't afford to get sick this early on). She took some pictures of the pretty horses we saw, with colored ribbons tied in their tail hair and colorful woven saddles. Each was loaded down with 50kg bags of sugar or rice. One thing that became clear early on was the number of animals that take this trail. Huge groups of goats, cows, yaks, or zos (mix between a cow and a yak) would be seen in the distance, kicking up dust. We'd pull to the mountain side to let them pass, watching in awe as their shepherd's various whistle tones would drive them one way or another. I got familiar with the droppings that each left behind and was an expert at not stepping in it, until I didn't care anymore. Poop and dust were the most common make up of the trail, with some dirt and rocks rounding out the list - this was no Annapurna or Everest trail, clearly marked and cleanly laid for high paying foreigners. This was used, a lot, by locals who brought their families and livestock along the trail, which narrowed in some places to just a foot across, and was unbelievably steep in places. I daydreamed of falling off, and what options I'd have if I did - let's just say it was a short daydream.

Dolpo is described as a truly isolated corner of Nepal, and it's even more isolated than usual for trekkers in November, since trekking season ends in October. This year, thanks to the April earthquake, tourism was down around 30% of its usual levels, so we were also exotic, rare animals in this area. Most people who come to this region to trek take porters (which run about $16 a day) who carry their things and cook for them in addition to guiding them. For the most part (except for two desperate moments when I took advantage of my friends to get myself physically up certain parts), we were on our own. We found a very cool abandoned flat-roofed village, overgrown and which had plants growing purposefully on the roof. We were told this is a winter village where animals from the northern region are kept, but without them there, it was eerie and quiet. 

We stopped once to survey a village that Balber works with for his ministry, observing them drying large amounts of bright red chili peppers on the roof. We also found marijuana plants growing freely - the people use the leaves to feed the animals, mix it in their own food sometimes, and use it for medicine.

We stopped on this night at a hotel where we were split up by gender - Rochelle and I in one clay room, and Matthew, Balber and Ishak in the other. The rooms had been built right into the boulder and were wired for electricity. After dinner of Dahl Baht (rice with lentils), we rolled out our sleeping bags on the beds. I slipped on the "stairs" (more of that fantastically structured trail) going to the bathroom and scraped up my hand - injury #2 in the books. The bathroom is a little shack right next to the river with a squatty potty. We brush our teeth and spit into the dirt, using our bottled water to rinse. We can't shower, so we wipe our dusty selves down with wet wipes.

Rochelle hangs out her wet clothes and teaches me how to prepare for the cold night and the next morning, explaining each of the layers, and what to wear to bed, and how to pack the bag most efficiently. We're tired, but feeling pretty good - not that sore, not that discouraged. This is totally do-able, right?

Day 2

After breakfast of an omlete (egg between two pieces of chapati), we ready ourselves to leave. All of our stuff is out everywhere, and in the morning we heard too many groans from the men as we re-packed. We learned then to set the expectation in advance to know what time we'll leave to prevent that moving forward. I take some cold meds to prevent myself from being stuffy, and we're off.

This is SLOW, and so painful. We start right off the bat crossing a wooden fork of a bridge, created after the other bridge collapsed and before they came up with a good alternative, and then straight into switchbacks. My breakfast hasn't processed into usable energy yet, and I'm sucking wind. I take a puff of my inhaler and realize that I have to blow my nose every five minutes to keep it from water-falling down my face. Also, I'm on altitude sickness preventative meds, day three, and the side affects include losing nerve feeling in my hands, dehydration, and sensitivity to the sun, all of which I'm experiencing. I'm freezing and sweating as we go from shade to direct sun, stopping to take off clothing every few minutes. I suddenly realize, only an hour into day 2 of 6 that this was an incredibly stupid thing for an out of shape girl who runs a bake club and who hasn't even been camping in years. What's worse is that everyone stops when I stop, making me feel like I'm holding everyone up (which I am), and when they don't stop, I genuinely worry that I'll fall far behind and just quit. I finally sat down one too many times, and Balber starts pulling things out of my bag, loading them into his. I was horrified - I will NOT be a burden. But I was a burden, and there wasn't anything else I could do. With some of the weight lifted, I finally hit my stride, and by the end of the day, took back all my things to proudly carry myself. I even wanted to keep going when we stopped for the night, which was a bright feeling in an otherwise very difficult trip.

Ishak, Matthew, Rochelle and Balber

We stopped to eat walnuts that had fallen from the trees. Balber taught us how to crack them from their shells with a rock, so we all sat there, trying to keep the nut in one piece while we smacked it repeatedly. Another pitstop to let some children and their mother carrying wood on their backs, supported by straps over their foreheads, pass us. We had another Nepali apple while we waited. The sun was out, and this river we're following is really breathtaking. This is also the day we went along a ledge in the cliff that I was sort of amazed we could traverse at all, let alone these huge animals.

Our lunch stop was more dahl baht at a family's "restaurant"/home. I sat on a log which was burning on one end and enjoyed not having to move my legs for a minute. The family asked if we had medicines with us, and when asked why, presented their son, who had a black growth on the back of his head. Rochelle is an EMT, and I married a doctor, so together our experience means that we have ZERO ability to diagnose or treat this poor kid. We advised they see a doctor, which we knew they likely wouldn't. This is apparently something that happens a lot - trekkers are asked to leave their medicines with families who are going to self-diagnose and take the meds to solve much larger problems then those meds can fix.

We stopped at another hotel for the night and sat around as it grew dark and cold waiting for someone to go to the next town to get the key to let us in. While we waited, we watched the women weave scarves between breast-feeding their many children. There was no shame about the process (as there shouldn't be) - just shirt down, baby in, and wait. Rochelle and I were once again in our own room, this time on the second story up the most interesting staircase I've ever been on - like it was built externally as a ladder and added later (I'll bet that's actually what they did). They took our light bulb, which was turned on by attaching the actual wires to the metal on the battery. They borrowed the same bulb to give us a light at dinner, then brought it back and reattached it afterward. What's for dinner? Dahl baht. Best value for your money. Matthew abhors any and all spice, so they make the foreigner dish without any spice, and the Nepali dish with plenty. This means the dish gets more boring every time I eat it even faster than dishes with flavor :-)

I stayed up this night, even though I felt like crap from the cold, to help Rochelle get some night shots of the little homes and stars - it was really lovely. We really felt like we were in one of the most remote parts of the world...probably because we were.

Day 3

The next morning, we left very early - we skipped breakfast and did an hour of hiking to the next hotel where we got "brunch." We'd go down now to two meals a day since preparation took a long time. While we waited for them to prepare the dahl baht (with potatoes and cabbage this time!), we discussed where in the world we would each go if money weren't a hindrance. It was freezing cold so near to the river, so we squeezed ourselves inside the kitchen area to keep warm by the stove.

After our meal, we began again, passing a boarding school with beautiful wood carvings and then, we hit the first of the switchbacks. We had been warned that this would be our hardest day, but I had no idea how difficult it would be. The trail was barely visible, crowded by spiky bushes. We climbed painfully until we reached what I initially thought was the top. It wasn't.

While we rested there, seated on a boulder, my friends pointed out the next stage of our journey - a tiny speck of something near the skyline almost directly above us. It was a shack, situated high above us, that we needed to reach. My nose is cracking and bleeding by now from all the wiping I'm doing for my cold, and the altitude is choking. My inhaler gives no relief from the lack of oxygen this far up, above the tree line, and I gape like a fish out of water, desperate for air. I can feel hot spots forming on both feet as I move them slowly, locking my knees like Ro taught me to keep my exhausted muscles from feeling the brunt of the effort. The trail is so steep, and mostly comprised of sandy dirt. It was like running vertically in sand. I stop to let a group of yaks pass me. Throughout the whole trek, everyone we meet who isn't a shepherd asks us where we're going. Our guide stops and talks with each of them, and I trudge ahead because I can't speak Nepali and will shortly be behind again. Balber was built for this place - he can get to the lake in just a day from Juphal. He's patient with us, but he's much more able than I, even at his age, which I assume is close to 60.

Matthew is my companion, distracting me with stories. He lent me his trekking poles for this part, which I leaned on heavily. My bag was heavy, even though we had left some non-essentials behind at the last hotel. I drank water to lighten my load. It was disconcerting to me that in three days of trekking, I never needed to use the bathroom on the trail. It was as if the water was evaporating the minute it hit my system. My lips were dried, shriveled lines and my nose was flaking skin. I ran out of the "good" toilet paper yesterday using so much of it on my faucet of a nose, and I was down to the crappy stuff. This difficult part took only an hour to do - to reach the shack - but it felt like five. The sun beat down, and my legs refused to lift. Then, with some added help from Balber who took my bag for me the last 5 minutes of my climb, I finally reached the shack.

I collapsed, unable to speak to anyone. Ishak asked me his favorite line - "Kendra, you doing good?!" His response to the question was "I'm always good," even when you knew he wasn't. My answer to this question was directly impacted by my mood and ability at the moment. In this moment, I had no answer.

I ate a bag of cookies and took my shoes off to mend the blisters forming. Two Tibetan boys were there with us, giggling over who would marry Rochelle, since I was taken. When we began again, we climbed even higher still, to a height around 12,300 feet. I turned around and looked at how high we were - it didn't register. I walked without thinking for the last leg, watching the boys run ahead of us, climbing trees and wrestling one another on the cliff, flying up and down the trail with their thin shoes. I was so jealous of them, and they were likely amazed at how difficult I clearly found this. I will say, I was not the only one who was hurting or glazed over - you can be assured that I was in good company (except for Balber, who was never really affected by any of it).

We finally began to descend, back to 12,100 feet, where we ran into the Tibetan families coming down from upper Dolpo. The kids belonged to their family group, who had brought all they had in woven sacks from the north, including all of their livestock which were grazing nearby.

Then, we reached it - Phoksundo. The town was eerily quiet - arguably empty - but many animals that looked very well cared for milled around. When we crashed near the lake at a table, my body shut down. I didn't notice the things around me, I couldn't feel my legs, or think. I had worked so hard to get here and I barely noticed anything. Ishak came over and told me they wanted to introduce me to a local celebrity - an old man with a log white beard - a Tibetan lama - who had starred in a French film twenty years back called Caravan. I turned it down. I sat next to a rock covered in yak blood from the "meat preparation" the day before, and its drying pelt beside it and just stared into space. It was getting dark and cold, but we needed to find people to let us in to the hotel, so I walked down to the lake to see the ponies there.

There was a shelter there where the Caravan man sat, so I joined them sitting on the ground around the fire his wife had prepared. He was pulling meat from what used to be a goat's head and eating it as he talked. When he learned I was sick (that much was very obvious), he blamed the dust, saying that must be the cause, and offered me some yak soup. I declined, wanting them to keep their food for themselves, and wanting to keep my germs to myself, but I was mesmerized watching his wife prepare it. She propped the soup pan up on three rocks, balancing it over the fire. She added barley and snapped something that sounded and looked like little bones in - yak cheese. Then, she brought out a blood red yak bone and cut the meat from it using the bone as her cutting board. Other Tibetans slowly trickled in, joining us on the floor or standing outside. I leaned myself against something covered in the corner, hoping to just blend into the background until we were let into our hotel - then I needed to go straight to bed. When you can't understand anything being spoken around you, that is a strange but also wonderful thing - you realize how much listening you really do in a day. The hum of Tibetan and Nepali around me was soothing. Nothing was translated for us.

Then, my friends left to check out the hotel. I was too broken to walk, or move, unless it was a for sure thing, so I sat amongst the Tibetans around their yak soup all on my own. I couldn't talk with them, but I could smile, and they did too. I suddenly snapped myself out of the fog I had been in. KENDRA, LOOK AROUND YOU. DO YOU REALIZE WHERE YOU ARE?! I did, finally, for just a moment, and I soaked it in deeply, which we do so seldom in life with our experiences. My friends came back, announced the hotel's availability, and I shook all their hands as I left the covered area, glad that I had woken up in time not to regret my lack of attention.

I rolled out my bag in the freezing concrete room on my bed. A window above me wouldn't close fully, but it didn't matter much since it was colder inside than it was out. I dropped off to sleep and awoke just in time for dinner to STILL not be ready. I sat in the kitchen with Rochelle under her sleeping bag as a blanket and drank yak butter tea. It was like warm chicken broth, salty and fatty, but really good. During dinner (you guessed it! dahl baht), we realized we had cell service and reached the travel agents about my flight. Bad news - 80% of flights had been canceled since we left. I only had two possible days to get home, and one of them was slipping away due to our pace as a group taking longer than expected. We talked about when to leave in the morning, and I begged, even at the possible loss of my flight home, to be able to sleep as long as I needed to. They agreed. We all needed a break, and turning around so quickly after arriving would have been tragic. I don't remember falling asleep, or the food I ate - I do remember watching the family all fall asleep while waiting for the food to cook on the floor. They always have rugs and animal skins on the floor to sit on. But that night I slept hard, a completely dreamless sleep.

Prepping for Trekking

Nepal is a HARD place to get things done. I won't drag this out, because it's a little painful to recount (as my new friend Rochelle can attest, I had a sobbing breakdown at one point - if you want to see me fall apart, keep reading!), but it's important to know how dedicated my friends and I were to making this insane trip happen, and how much s#*^ we went through to pull it off.

So, let's start with my plan to do an 8 day overland trip on my own into Tibet. I had this plan well before we got to Nepal, but upon landing, found that the gas crisis + 8 days of driving wouldn't gel, so I dropped my plan (and my head in sorrow) at missing my crazy adventure. But no fear! While interviewing one of the mission leaders at YWAM, they mentioned a trip they would take with Rochelle, a Hawaiian YWAM-er who was coming the following week, to deliver yaks in the Himalayan area of Lower Dolpa, and to visit Lake Phoksundo. Did I want to go too? Ummmm - is it rude to say ABSOLUTELY OH MAH GOSH WHEN CAN WE LEAVE? Probably. So I said I'd think about it. Derek went for the idea even more than I did, wishing it were him instead, so I signed up. I had no idea what I was getting into.

I had no gear, so as you read in my cooking class post, I bought all my stuff and wrote them to say I was ready to go. We were supposed to leave Thursday or Friday, the week of the Diwali festival (which you've also read about in past posts). Rochelle would land Wednesday, and we'd fly out Thursday. I sat with bated breath. By Wednesday, American Kendra was starting to panic - no news of the flight, and Rochelle had barely stepped foot in the country. So, Thursday, with offices closed for the festival, I hopped on YWAM leader Ishak's motorbike and headed to the YWAM center to meet Rochelle and talk about our trip. This discussion was one of the most tense, crazy talks I've ever been in - scribbling all over notebook pages, talking about how neither of us had the funds to do it, me citing time constraints, etc. But, we felt we should do this, so we got on the bike - all three of us - and headed out to get the last of Rochelle's gear (and to get me a proper trekking bag - apparently, school backpacks don't work that well...). The only thing worth mentioning from this crazed afternoon was that when we were weaving in and out of crazy people traffic - I wish I had a video from my perspective - my knee rammed into a wooden cart. Injury one in the books.

We decide two critical things - first, that we don't need a trekking permit for the restricted area we're going to enter (and they're expensive and impossible to get during holidays like this anyway, so good for us!), AND since flights are being canceled left and right domestically, to save time, we took a night bus (12 hours give or take) to Nepalgunj, the only place from which you can fly to this region, to hopefully at least make the second leg to Dolpa on the next one out. By now, it's Saturday.

So, we get into a neighboring city of Kohalpur and park ourselves at a ministry center for Frontier Missions, where they train people to go out and plant churches. Classes are going on when we arrive, and we were welcomed and fed and took our time sleeping off the heinous bus ride (I really need a separate post for overnight buses in developing countries - just use your imagination). Here we met Rajendra and his lovely wife, and we got on so well...until Sunday. We find out Sunday that there WILL in fact be a flight the next morning to Dolpa - the first in days! There is fuel for the flight, and enough people (two things that caused flights before it to be canceled - we even seriously considered getting on a cargo plane for a bit...I shudder to think how willing I was to do that, with only one engine on the dang thing). But, now we learn from a contact in that region that we WILL be turned around at the airport upon landing if we don't have that permit. Well, s#*^.

We spent SIX HOURS running around Nepalgunj on the advice of someone I spoke to in the Kathmandu Immigration Office which issues the permits - any travel agency in that area can issue you this permit. Turns out even immigration officers will tell you what you want to hear, even if that is in no way true. What's worse, we lose hours and hours from people who don't know how to help but spend loads of time trying to instead of pointing us to the next place. I was so defeated. We realize the only way this trip happens is if we skip the flight Monday and instead fly BACK to Kathmandu to get this permit. So we do - spend hundreds of dollars flying back to the place we just left, and on arrival, have only 3 hours to get a permit that typically takes 2 days to issue. But hey, we know a guy. Rochelle and I fight through the traffic caused by the petrol crisis - at an all time high - to meet our contact, only to be told that they need the $150 per person fee in $USD. But...we don't have USD, we have Rupees, loads of them (you pay for everything everywhere in cash, including plane tickets) and the ONLY way to get US Dollars is at the airport (where we just came from) WITH an outgoing boarding pass. So, it's impossible. Well, s#*^ again.

My blood sugar hits an all time low as we sit with knotted stomachs at the travel agency, Apple Pie, waiting for a miracle. And it happens - my guy Dilliram shows up with $300USD with 2 hours to go until the office closes. Chiring, our travel rep, flies on the keyboard entering our info. We head home to wait and get our night bus lined up (we're hoping to make it in time for the next flight out to Dolpa at 8:30 the following morning so we can't wait to fly), and are able to pick up the permits (yay!) and then our passports (which Chiring forgot to give me - small wrinkle).

We pay a small fortune for a car to take us back to the horrible bus, and we're off. On these bus nights, we sustain ourselves with cookies to avoid getting sick from the food served around midnight at the restaurants. We did not sleep at all, placed in the back of the bus right over the wheels - I was actually airborne, fully out of my seat, multiple times. Rochelle and I chatted about life, knowing we were tempting fate with our hope of making the morning plane, and immediately hit traffic (petrol crisis again). We realize this likely won't work - frankly, I can't believe it took us that long to realize that all of it might not work. But we kept pushing - we were determined. At many points, we wondered whether God was really trying to tell us not to go, or whether we were really supposed to but it was supposed to be really painful getting there...I'm still not positive which it was.

We learn that the flight the next morning has been moved up - by two hours - to arrive at 6:30, and our bus is delayed 2 hours from traffic (even with a bribe offered to the driver if he could get us there in time), arriving at 8:30. We show up, walk ourselves to the center in Kohalpur (it's incredible how quickly you can get accustomed to a foreign place when you're seeped in it - it's like home somehow), and sat on the veranda, contemplating the missed flight. That was my last chance. My flight for the US would leave the following Wednesday, and the trek would take at least 6 days, barring no issues (of which, we clearly had nothing BUT), I was out, and I told them so.

Then, while trying to maintain my feigned "I'm totally fine with getting to miss this opportunity with all the work and money and time that's gone into it" attitude, I have a complete breakdown. I'm hyper-ventilating and sobbing and trying so hard to stop but I'm way past that. I'm horrified that I'm showing these emotions in front of my friends, and especially in front of the Nepali men we're with. They kindly step off the veranda and let me cry it out. Then, Rochelle, who sat quietly next to me the whole time, first tried to explain why it was probably better that I wouldn't be going, and then switched gears and offered that she could read something to me - something that was important in prompting her own visit to Nepal. She read Isaiah 43 aloud. I've never read verses that meant so much to me as those did - it was like they were alive. It didn't hurt that I hadn't slept in two days, was out of money, patience and any sense of pride, completely humbled by the circumstances around me that, despite giving it everything I had, failed to be controlled. I could walk through fire and not be burned, I wouldn't be drowned by the rivers. I was summoned by name.

It took me five minutes - I did the math, and realized that I could pull this off...BARELY, and likely I'd face some serious repercussions when it didn't work out, which I believed, based on the last week, it wouldn't. But I had to try. We booked our flights for the next morning, Wednesday, spent one more night in Kohalpur (at the same hotel as some big deal politician, none the less, who had guards with AK-47s outside the door), and flew out the next day in the tiniest plane I've ever seen (8 seater, Pac 750) to an incredible adventure. I had no idea the new challenges I'd face next, but they were certainly new challenges to me that I'll never forget.

Happy Diwali at Monkey Temple

"The residents at the hospital said this would be romantic... do you feel romanced?" I asked Kendra, as we gazed out over all of Kathmandu while the sun quietly set over the city; buzzard hawks, floating lazily on thermals, seemed to equally enjoy the solitude of the moment and the comfort of so much empty space.

"No. Not at all," Kendra replied, and I laughed at her rejection, while we both kept gazing contentedly out into the void despite the raucous monkey fights all around us. We were at Swayambunath, the Monkey Temple, and had been loitering since mid-afternoon to watch the sun set over Kathmandu. We were waiting in anticipation of seeing the city alight for the festival of Diwali.

This shop is ready to get the party started 

Diwali is a major Hindu holiday also known as the Festival of Lights. It's celebrated in autumn, and we had the good luck to be here while the celebrations were happening. To quote the ever-eloquent Wikipedia, "The festival spiritually signifies the victory of light over darkness, knowledge over ignorance, good over evil, and hope over despair... On Diwali night, Hindus dress up in new clothes or their best outfit, light up diyas (lamps and candles) inside and outside their home, participate in family puja (prayers) typically to Lakshmi – the goddess of wealth and prosperity" Nepal is the only country to have Hinduism as its official religion (even though I believe India is basically de facto Hindi as well), and Diwali is an official holiday. In the days preceding Diwali night, Crows were first honored as "the messengers of Death" with treats. The next day, Dogs were honored as the guides to the afterlife. All of the stray dogs were dressed in wreaths and even adorned with Hindi red dots on their forehead. The poor condition of the stray dogs had been bothering me unsurprisingly, and seeing the dogs in their at-best lean condition trotting around wearing a wreath was comical if not actually sad. At the very least, they all seemed to be given a biscuit or bowl of rice, so they had a meal for the day. Then the most sacred animal, Cows, were honored, and finally it was time to attract the attention of lakshmi with lights, candles, and decorative sand mandalas. 

Seru, our landlord's dog, looking festive

Selling wreaths and decorative chains of flowers 

To attract the goddess of wealth to your home, you would light up the house with festive lights, adorn candles, and make a sand mandala at your doorstep with a path leading inside (or, for businesses, a very non-subtle path to your cash register). This made for a really wonderful aesthetic a out the city, as virtually every door had a mandala, candles were lit all about, and lights adorned most buildings. Having Wednesday off, the residents had advised me to head up to Swayambunath, a hilltop temple over-looking Kathmandu, to watch sunset fall over the city. It was an excellent suggestion, particularly since this temple is one of the main culture sights of Kathmandu and we were going to have to see it anyway. 

The challenge of getting around Kathmandu is that there was literally no city planning, making for a chaotic maze of streets, and the petrol crisis makes taxis untenable for Kendra and I. Even though the dollar is so strong that a rupees is equivalent to 1 cent, the fuel crisis had taxi prices inflated. Kendra could easily afford this, of course, but she made the unfortunate decision of marrying me and I can essentially afford nothing. In a stroke of luck, however, I was here with Travel Kendra, and Travel Kendra will not be denied a cultural sight. She'd figured out how to take the government bus up north to the commercial district of Thamel (ie the over-touristed 'Chang Mai' of Kathmandu), then we could walk the remainder, about an hour. The green government bus departed just as we arrived at the relatively nondescript bus stop, but another one followed in short order and we had the incredible luck to have tons of space and seats! Unheard of in Nepali public transit. After catching our stop and paying our 15 cent fares, we set about walking west to Swayambunath. Seeing a taxi, though, we asked about the price and learned it was $7. We decided $7 was just about worth it and hopped in, glad to for once be on the giving end of all of the honking that takes place here. The road turned upward and we were glad to have taken the trip. 

We reached a bustling market at the base of a long stairway and hopped out of the taxi. True to form, a large band of +20 monkeys, several with baby monkeys, walked across the road ahead and started fishing around for food in a dump. Kendra then became quite the monkey paparazzi as she took photos among the brightly lit garbage. Now, it's to be said that I love all animals. I joke (it's not really a joke) that I became a human doctor rather than a veterinarian because I had too much sympathy for animals. Sympathy, that is, except for monkeys (specifically Macaques), who are furry fanged hellspawn demons that don't even deserve the garbage they were rooting around in.

 [Explanation:  Kendra and I were on monkey beach in Phi Phi Don, Thailand, and a troop of monkeys took it upon themselves to try to relieve me of my tuna sandwich. The sandwich actually was quite terrible, so the selfish monkeys would've deserved it, but I fought them on principle. The whole affair ended up with me backed up into the surf while several dog-sized macaques bared their 1.5in long fangs at me and made rushes at my feet trying to scare me into giving them my sandwich. Safe in the water from their savage monkey bites, I made them watch me eat my sandwich and took my time slowly chewing big bites. They lost interest when a tourist bus arrived loaded with bread. Meanwhile, in a beautiful demonstration of the different genders' approaches to conflict resolution, Kendra had been sitting peacefully holding her sandwich among monkeys playing at our picnic site and was video taping the whole affair.]

After the monkey dump photo shoot, we turned our attention toward the ~400 stairs leading up to the hilltop monkey temple. Kendra stopped to take a picture of two more picturesquely posed monkeys until I mentioned they were, uh, mating, and laughing in surprise/disgust we kept on walking (if you were traveling with us, you'd frequently observe that I'm quite the buffoon and Kendra is the consummate reserved world traveller, but Kendra's not writing this blog so I can say whatever I want). We had our first experience with someone begging at the base of the stairs, a young woman holding her baby. She was surprisingly persistent, but we've long held to the principle of supporting charities but not giving people money directly (eg in Rochester we give money to the homeless shelter, not the few panhandlers at the roadside, who we've incidentally learned- through Kendra's work at the shelter - make more money per hour than I do). 

Climbing up the steps was a fun chore, and they actually became strikingly steep towards the top. We paid our couple dollar entry fee, which the ticket promised was to put toward maintenance of the site, which is hilarious, and crested the steps to the top. On the drive to the stairs, and then during the climb up, we caught glimpses of Kathmandu well below us, and it was beautiful to see the entire city spread out to the horizon, the omnipresent honking of cars and motorbikes intermittently wafting up from below. Monkeys were practically everywhere, and were I not engaged in a one-sided grudge war of resentment, would be entertaining, while the aforementioned hawks floated all around. We walked around the temple, clockwise to be respectful, and Kendra set about photo documenting all the unique sights, vistas, and textures with her camera. The photos can paint the scene much better than I can describe. 

We ended up spending several hours at the hilltop as we waited for darkness to descend. Slowly but surely the sun fell behind the mountains that frame Kathmandu Valley, and then darkness quickly descended over Kathmandu. The city delivered and made the impression it had promised, with lights popping up all over the city as the light faded. 

Having accomplished our mission, we headed back down the steps. It was fun to hear the monkeys making surprisingly loud and violent calls in the darkness as it gave the staircase a very primitive feel. We caught a taxi at the base (for which Kendra expertly kept the price to $7. "Ten dollars?! No, seven dollars. Yes it is night time but there are many taxis. You don't want $7 price? Fine, we walk to him and offer it" <turns back to walk away> Okay, okay, $7. Thank you very much." So brutal. I love her). 

The taxi through the Thamel area was actually one of the coolest parts of the excursion. We looked out from the cramped cabin into narrow streets and alleyways awash with people, motorbikes, colors, candles, lights, and sand mandalas. 

Reaching Thamel, we set about finding our bus stop. After a circuitous walk and a half hour or so wait, the government bus arrived and we hopped on. They were a bit over-eager in their departure from the bus stop (in fact, I'm not entirely sure they even stopped the micro-bus completely), and Kendra took a spill on-entry bumping her shin. She was a champion though and brushed it off, and we headed back home. 

Or so we thought. This bus turned out to be going in the wrong direction, but a nice man on the bus took it upon himself to be our guide (the Nepali people, basically to a person, are extremely helpful, polite, and self-sacrificing. In fact, Kendra has only once, this entire trip, been "ogled," when someone told her "You are cute." Compared to her experience in India - with throngs of men following her around, many blatantly video taping her with their camera phones - it's quite charming). We hopped off the bus with our new friend and waited at an unmarked bus stop. A micro bus arrived but it was literally overflowing with people and we couldn't make it on. Our Nepali friend was able to ask a taxi for the price, 500 rupees ($5, Kendra had been quoted $20-30 for the same length trip a couple days prior), and I took them up on it ( a bit preemptively, it seems, but it worked out). In exchange for our guides' help, and another guy who I offered a ride to after he confirmed our trip for $5 with the driver, we took off down the road and reached our neighborhood. Then Kendra and I, having not had any water or food for the past 7 hours or so, went to a western style restaurant and had water, banana lassis, a pizza and schwarma in a shameless feast. It was a great day in Kathmandu. 

Social Tours - Cook Like a Local

Sunday morning, I woke up questioning whether or not I had what it would take to get me to my cooking class. At the advice of a good friend who had lived here before me, I signed up online to take a cooking class - to learn to cook like a local - but hadn't realized how far away the class was until the night before. Normally, that's not a problem. You have taxis - a 20 minute drive is nothing! But these aren't typical times. The gas crisis meant that the one-way trip north to Thamel, where the class would take place, would cost $30-40 USD, which is ABSURD, especially in Asia where meals are only about a dollar. I pondered my options. Derek, who was working that day, didn't love the idea of me venturing out on my own with so many obstacles. But, eff those obstacles. I'm going anyway.

So, I wandered down the street in search of the taxi and instead found a gathering of people. I assumed it was some sort of bus stop - there was no sign indicating that it was, but that didn't surprise me. I asked a girl if there was a bus to Thamel. She told me to wait. I saw a taxi pass and contemplated calling him over when a gigantic green bus came around the corner. The girl pointed at it. I assumed I should get on, so I did.

I jammed myself into the crowd of people, squeezed into every available crevice the bus had inside to avoid hanging out the door. Buses in front of us had people also packed on the roof. Due to the gas crisis, people are taking public transportation much more frequently than before, and at dangerous levels as was evidenced last week when a bus went off a cliff killing 30 people inside and on the roof. A short girl next to me replied in English when I excused myself for bumping into her (who am I kidding? Everyone is touching everyone else - there's no avoiding it). I asked her if she had any idea how far it was to the area I wanted to go, and she offered to tell the driver to kick me out at the right place. I didn't recognize the area she decided I should get out on - she told me I'd have to walk the rest of the way - but I didn't have a better plan, so I agreed. We chatted about her job until her stop, then I was on my own. At one point, I leaned forward and looked at the driver, who had forgotten about me. He kicked me out right away, probably realizing he should have dropped me off earlier, given the walk I saw I had ahead of me. The ride cost me only 15 cents. Winning!

I found the center, breathless for walking quickly. I expected the class started at 9:30, so when I came in at 9:45 and apologized for being late, they told me I was early and had me wait with milk tea for the others. A gent named Phil from the Lake District in England was there. He had asked to learn how to make Dahl Baaht, and as I didn't have a preference, that was our focus. The lovely chef, Sakuntala, lead us to the market, a small shop where we picked out vegetables. The orange and green lentils are the basis for Dahl, a bean soup that is at the center of Nepali cuisine. Baaht is rice, another staple. We chose to make a cauliflower curry with it. Want to cook with them when you're in Nepal? You can sign up here.

 

We cleaned all of the vegetables with sink water and then with "jar water" as our western stomachs required additional scrubbing with purified water if we wanted to avoid being ill (eh, I think if you're eating regularly in the city, they're likely skipping the jar water wash - just being realistic). For the record, I've not gotten sick yet, and I LOVE street food. If they eat it, I eat it. If there's a line or a crowd, make Anthony Bordain proud and get in line. We followed her instructions and came out with a terrific lunch.

After we ate, they shuttled me to a terrific shop run by Uday called Snow Land. Social Tours refers people to his shop, and he gives them quality products and a fair price. I bought some things there (had to hit the ATM, as no one ever takes a credit card), and when I found a Euro in the pocket of a fleece jacket, they knocked the equivalent off of my final bill. Classy guy :-)

I liked the first class so much, I decided to stay on for the afternoon class to learn how to make Aloo Paratha (aloo are potatos, and paratha is the bread that they're stuffed inside). Phil and I skipped the market visit and let our new additions go on their own - a German and a Canadian who live in Hong Kong. We looked at pictures from Phil's 27 day trek in Bhutan while we waited.

With this class, we got to do our own rolling, prepping the bread skin to be filled, tied, flattened and fried on a tava, a flat pan without sides. Traditionally, this dish came from India and was made in a tandoor (clay oven). Add ghee (clarified butter) and homemade tomato/mint and chili sauces, and we had quite the meal! We even did a few stuffed with sugar - gotta love that they cater to the western palette! It tasted like toffee.

 

Then, I hauled my giant bags from my Snow Land purchases to the bus stop (yes, this does have to do with my mystery plan, which hasn't been revealed yet for a reason - hang in there!), and ran to grab the government bus just leaving. This time, I was precariously hanging near the door, with my bags swinging unprotected. A kind girl who spoke excellent English (she blushed when I told her so) offered to hold my bags up on the dash near the driver so I could get further in. We chatted about her job, America, etc. This time, locating my stop was easier, now that I'm more familiar with my surroundings.

Derek wasn't home when I arrived, so I popped next door to collect a local phone that my neighbors were holding for him. The husband talked at length, telling me about his visits to the states in the 80's to Kentucky and Kansas (so random). He invited Derek and I to his daughter's wedding, starting on the 23rd (they are many days long) in order to introduce us to that important aspect of their culture. I couldn't believe it!

A truly incredible day. What an amazing culture and people with whom to spend our time!

The Golden Temple, Durbar Square, and Dr. Strange

Our Saturday was pretty exciting - we started it by binge watching six episodes of The Blacklist since we finally had internet that was allowing videos through. Around noon, we decided to venture out to see what incredible cultural places were near enough to walk to. We stopped at Samir's noodle shop just a block away and watched little boys breaking pop gun strips with rocks, squealing with delight when they saw the shock on our faces from the loud noises.

Reacting to the boys across the street - they loved my shocked look the most

We headed out looking for Patan's Durbar Square, an amazing cluster of tall temples, some of which were devastated by the earthquake last April. We took a cursory look at our map, and started walking - the geniuses who had used the book before us had ripped out two pages, one containing the local map, so we guessed. We guessed wrong. After walking all the way to the bridge where Patan crosses into Kathmandu proper (2 km, a 20 min walk in the hot sun), we asked a guard if we were close, and he sent us back where we came from. Luckily, we discovered that Google Maps maintains your current location even when you don't have access to wifi, so we used it to work our way back and take the turn we had missed five minutes into the walk.

Of course, we took the back way there, stumbling onto a blockade where we were told that filming was taking place. At least, I hoped it was filming - people kept saying "shooting! shooting!" They meant shooting a film, but combined with blockades and hoards of onlookers, you never know. We turned left, not bothering to try and look through the hoards of people who were trying to catch a glimpse of the film activity, and stumbled quite accidentally on a court yard. There were other westerners there, which we don't see often, so we figured we'd follow a few of them who went through what looked like a house. It wasn't a house at all, but a passageway leading to the Golden Temple.

The Golden Temple was beautiful - a Buddhist monastery known locally as Hiraṇyavarṇa Mahāvihāra originally built in the 12th Century. The temple is famous for feeding rats, apparently, though we saw none inside, and got its name from the guilded metal plates that cover most of its front (though we came in the back door and didn't see this either). A temple priest offered that I could sit on the steps of the inner Swoyambhu Stupa in the center, the most ancient part of the temple. While sitting on a flat pillow, there is a burning alter in front of me, and just beyond that, the barred entrance to the Shakya Muni Buddha's shrine. A 12 year old boy acts as the main priest for one month before passing the responsibility on to another of his same age and gender.

I asked the priest about an older man nearby with a traditional Nepal hat. I've noticed them throughout the city, only ever worn by elderly Nepali men. He mentioned in broken English that the gentleman was deaf - I could see him signing to another child. I don't think he understood my question.

I did my own research on the hat later - it's called a Dhaka topi (topi = hat, dhaka = material). They are popular with the elderly men here as part of the national dress and have intricate patterns in a light colored weave. Their counterpart, the all-black topi (called a Bhaad-gaaule topi) is also seen. The hats are critical to be worn when in a government office or during festivals where traditional dress is expected. You can get one in the markets for around $1 USD.

 

As we wandered out of the temple through the entrance, we hit a wall of smoke, and were quickly ushered to the left side under a plastic ribbon blocking that street. Once we go our bearings, we realized we had stepped from the temple right onto the set of "Check Mate," the Blockbuster American film that they were shooting there. Ironic, avoiding it earlier only to land right on the edge of the set just before filming. We had no idea. I was much more interested in taking pictures of the extras, set in their specific spot, waiting for their queue. Smoke "machines" created loads of thick smoke, so heavy that you couldn't make out the pale figures in the center one block away. Check Mate? Wasn't that a complete failure of a movie launched earlier this year? Or is it that new one I think Chris Hemsworth was just in a trailer for? Derek and I discussed the marital rules we'd BOTH quickly break, with the permission of the other, should we meet Hemsworth. What if he needs more American extras?! (Kendra and Derek are smart, I assure you, but apparently are more hopeful than logical thinking that more pale people are needed if the company flew its cast and crew to Asia specifically to use locals in the filming). Maybe we should stand here all day just in case, and get lung cancer from the smoke - small price to pay. We contemplated our star lust and how easily it seems to take hold of our attention as we wandered towards Durbar Square.

Finally! Durbar Square. Patan is home to one of three in the Kathmandu Valley, and all are considered UNESCO Heritage sites. We took pictures of the square, climbing up on one of the ruined temple bases (what used to be Hari Shankar - picture below of it before and after the quake) to better see the center. The ruins from the earthquake are piled and stacked around the area - mostly red brick. One of the pillars is missing the icon that used to top it. This place would have been even more amazing before April - damn natural disasters.

Hari Shankar before April 2015 Earthquake

The base of Hari Shankar where we stood to take pictures

Derek wanted to go into the Patan Museum, but the incredible crowds trying to force themselves inside the police-guarded door didn't seem worth the wait, or the possible physical danger of being shoved into a rock. Why is the museum that big of a deal? Later we found out - Benedict Cumberbatch was inside shooting for the movie. The cover-name, "Check Mate," on the staff's badges and vehicles outside of the shooting site was a false front for Dr. Strange, the new Marvel film expected to release in November 2016!

I can't blame the shove-fest, knowing it now, but neither of us realized it at the time. We found out days later from others who had seen the photos leaked on twitter. Both of us agreed, now knowing the actor, that we'd both have thrown ourselves at him, in a very un-cool way, if given the chance. What is WITH that part of us? What about stardom and British accents turns us into drooling stalker types? We're really quite normal. Benedict, if you're reading this and you're still in town, we'd be happy to show you around, learn from your sage acting advise, listen to your voice...all in a very normal way, of course. We're the epitome of normal. Kind of.

Not my picture, tragically. Borrowed it from a luckier gent.

Needless to say, we didn't get to see the museum. It closes for Greatness, apparently. Maybe another day.

We found a few more temples and stupas (Sanskrit word for "heap," associated with Buddhist religious purposes) on our way walking home. We ducked into one courtyard to escape the terrible traffic and smoke and found children playing, women working, and dogs - always dogs. We had one of those moments when you think of what it would look out to zoom out slowly from where you were standing to look at the world, and swing back over to America and zoom in on your empty house and your abandoned responsibilities. It was peaceful. We're glad we're here.

Living in Kathmandu - A Day in the Life

Some of our American friends and family are probably curious what our daily lives look like here. I thought I'd do a quick review of our standard day so you can know how it differs from the one we typically live in Minnesota :-)

Waking up prematurely is something that we have to work against - when the sun begins to rise after 5:30, the city around us starts to wake up - dogs barking, babies crying, pounding, music, etc. If we didn't fall asleep with earplugs in, we get them when this starts to happen. The most common noise we hear is spitting. Spitting is practically a cultural practice here. Perhaps due to the smog, the pollution, the dust, etc, everyone is constantly spitting. And not politely. Projectile spitting is both very loud and comes without warning from men and women. For whatever reason, early in the morning, it is an almost constant noise we hear as we get ready for the day.

We have a shower without a tub or curtain, so the bathroom is equipped to send water everywhere. You have to make sure the toilet seat is down so you don't completely soak the seat. The water is warm, and is connected to a gas heater, where the gas is turned on and water is pumped through a box where a fire warms the water. This is pretty hard to maintain consistently for the heat - I almost scalded myself even at the lowest setting the first time I ran it - so we generally keep the heater off and make our showers quick, using the reserved warm water in the tank. When we're done, we have a giant squeegee that we use to push all the water in the bathroom towards the corner drain. There is no outlet in the bathroom (due to water going everywhere), so I plug in my hairdryer in the bedroom and use my compact mirror bent against the wall to watch what I'm doing.

We brush our teeth with "jar water" - we keep a bottle of it on the sink. The water here isn't treated to drink, so the entire teeth cleansing process happens with the bottled water. There is liquid soap that is popular in Asia called Dettol - it's strong smelling stuff. We have a "western style" toilet - the kind you can sit down on - but when we are at work, there are eastern style toilets, affectionately known as "squatty potties." It's a hole in the ground with two foot pads on either side. When you're done, you use a spigot and water bucket to wash water down to "flush." If you're lucky, there's toilet paper. If you're not, that same bucket of water is meant for other purposes, too. Bring hand sanitizer :-)

Our laundry is done each Friday by the cleaning person - she washes our towels, sheets and clothes in a bucket that is kept in the bathroom. Powdered cleaning soap sits on the window ledge in there for her to use, and when she's done, she hangs everything out on the clothesline behind the house to dry. Cleaning in a bucket is very common - directions for doing so are right next to the washing machine directions on the back of the soap packet. When I was in India, I did my laundry in the tub, but no tub here, so bucket it is!

For breakfast, as a previous post mentioned, we boil water for oatmeal and mix in some jam to sweeten it, or add bananas. We recently bought yogurt, after we mentally got past the fact that they aren't sealed and the lids are hardly on sometimes. Around this time, we may or may not experience an electricity outtage. If we do, we have eggs on the gas stove instead (the eggs are not refrigerated). We purchased most of our groceries at a little store down the street, but fresh items like bananas have to be purchased from a fruit vendor. Usually they carry the huge load of bananas on their bikes. Derek makes coffee - Nepal just recently figured out how to successfully manufacture its coffee, our landlord told us - in a press.

We wash our dishes by hand and dry them in a plastic basket on the counter.

Derek leaves around 7:30 to walk 20 minutes down the road to the hospital. I leave shortly after him to walk the 40 minutes to the YWAM center. We work until lunch, when each of us takes a short break - Derek goes to the hospital cafeteria, and I go 10 minutes down the road to a little restaurant where they blare music and have newspapers under the glass on the tables that I try to read. They know my order - vegetarian momos, every day. My friend Anne told me to eat as many as I can, and she's never steered me wrong yet! After work, we each walk home. We both leave by 4, so I usually come back to find Derek under the covers in his workout clothes.

It's cold in our place - the windows are anything but sealed (making morning sounds even clearer in the morning), and the bathroom window has to be left open to prevent moisture from forming mold. Our bedroom door doesn't close - for some reason, there is a piece of cardboard jammed in the door, which I found and removed, only to realize just before closing the door that the door handle doesn't work, and if I had closed it, we'd have been locked in our room. We do a lot of our work under our covers or in our coats.

Then, we head to the gym, which we've already described in a previous post. Usually around now, when it gets dark, the city has another power outtage, or it may not. No real consistency these days. On our way back we stop at a local shop for dinner - usually fried rice or noodles or momos. Then, we might stop at an ATM, since we have to pay cash almost everywhere. Some nights we cook, but the food is so inexpensive, and so well made, that it seems a poor waste of our resources to try and do much ourselves. We have had spaghetti twice, when we didn't feel like venturing out again.

When we return, we're followed by the homeless dogs that stay in our area - there are two black and white ones and one blonde one that are sometimes nice, and sometimes not. There is a gate outside of our property that we open with a Cinderella-looking key, and once inside, we pet the resident dog, Seru, who belongs to our neighbor. The neighbor claims Seru is 20 years old....I'm not so sure about that ;-)

Derek gets very tired around 8, but we both try to spend evening time writing or editing pictures or catching up on work we never get done in the states. I try to keep him awake until 10, as he's still struggling to get on a proper schedule. We take out the garbage, which we hang on the gate in a bag for someone to pick up (not sure of the point of this, since most people burn their garbage right in front of their shops, or you'll find huge piles dumped on the sides of the road, also possibly on fire, or not. If the power is still on, we use regular lights, and if not, we use the generator lights, identified by red tape on the switch. Good night!

Doctor Without Borders

I am here in Kathmandu on an elective rotation at Patan Hospital through the Mayo International Health Program. Mayo has a collective trust from which a committee provides scholarships to visit under-served areas internationally and work alongside foreign physicians to experience care in a resource-limited environment and incite interest in future work abroad. I was very fortunate to receive a scholarship to go to Patan, and now we find ourselves here in Kathmandu.

Each day I walk about 15 min down the road to the hospital. Patan is a 450 bed hospital that was originally founded by Christian missionaries, and only recently in about 2008 was it turned over to the Nepali Government. They have a 60-bed pediatric wing, which includes a children’s ward, PICU, and NICU, as well as a two nurseries, an outpatient clinic, a high-risk patient clinic, and a pediatric research unit. The hospital itself offers lab services, blood banking, x-ray, and ultrasound, while CT/MRI can be obtained at another hospital in the city.

After arriving at the hospital, I head over to the library in the pediatric wing for the morning conference. My first day, the conference was a comprehensive audit of the PICU and NICU, where they reviewed patient cases and discussed their management. Multi-drug resistant klebsiella sepsis in newborn infants caused quite a bit of discussion, as klebsiella is a bacteria that can acquire antibiotic resistance fairly rapidly and cause something of an outbreak within a hospital. After conference, we head to the ward to review the patients prior to rounds. I joke that, in being excited about the different patient cases, I sound like a jerk since I’m enthusiastic about, well, sick children, but it’s really quite fascinating. While Nepal hasn’t escaped the omnipresence of bronchiolitis – it’s so common in the US, we call the winter ‘Bronchiolitis Season’ – their most common disease seems to be bacterial pneumonia. It seems the smog in the city, along with the high density of people here, causes a perfect storm of lung infections, and we have several babies on the service right now recovering from pneumonia. One delightfully precocious ~3-year old girl has been in the hospital for several weeks now after a chest tube was needed when her pneumonia turned into a lung abscess.

Beyond the common cases, though, you have the weird/cool cases. There’s a classic phrase in medicine, “when you’re in Texas and you hear hoof beats, think horses not zebras.” It means, basically, that common things are common, so don’t go chasing House-MD style after the strange diagnosis. Well, I specifically flew halfway around the world to see the strange diagnoses, and they’ve been happy to oblige! For example, Diphtheria is the D in the DTaP vaccine that you’ve had and given your children (unless, well, you’re an idiot. Sorry, that’s a little hostile. I mean, unless you’re exercising your parental freedom… to be an idiot). Back in the 1920's, there’d be more than 120,000 cases annually in the US and 10,000 deaths. But after we introduced the diphtheria toxoid vaccine, there’s now about five cases annually. I’ve never seen a case, until now that is. Another disease we rarely see in the States is Epiglottitis, where you have a very serious infection of your upper airway. Even though we rarely see it, everyone learns about it in detail and remembers it because of what can happen if you don’t. In Epiglottitis, children present leaning forward, drooling, and having difficulty breathing while speaking with a muffled ‘hot potato voice.’ If you go to look in the back of their throat with your tongue blade, though, the child may die (the irritation from the tongue blade can cause their airway to lock down). So you don’t mess around with the Epiglottitis, but it’s most commonly caused by a vaccine preventable bacteria, Haemophilus. Well, turns out they get 2-4 cases here a month!

It’s not only vaccine-related diseases, though. A 10 year old boy presented from a rural village with facial swelling and difficulty breathing, as well as a swollen belly. An x-ray showed a pericardial effusion (fluid in the sac around the heart), which began to squeeze his heart and compress it from beating. They had to insert a needle under his rib cage into the space just around his heart to pull the fluid out. He had fluid in his face, his lungs, his heart, his belly… what could’ve caused this? Well, turns out, he comes from the same rural area where children often catch and eat under cooked freshwater crabs, and they get a parasite that causes this massive inflammatory reaction leading to all of the fluid buildup (it’s called Paragonamiasis). Crazy!

I’ve been able to joke around with the interns and medical students here, and we’ve had lunch together in the cafeteria, grabbed milk tea before rounds, and just hung out in the afternoon. Just yesterday they asked me what my thoughts were, about how different our two hospitals are, and I actually had to say my main impression was how similar everything is. It’s really quite striking to be in such a different environment, but rounding with a team where they go to the bedside, have the intern present the patient, then have a teaching session in almost the exact same way we do Stateside. What are we worried about regarding fluid management in the setting of pulmonary disease? SIADH. How many grams per day should an infant gain in the first two months of life? 20 to 30. What’s the differential diagnosis for diffuse swelling? Think liver, kidneys, and the heart… the list goes on. It’s great.

Plus the milk tea is like ten cents. Which is awesome.

                 55 cents total for lunch

At the end of the workday then I walk back home to hang out with The Hotness. We go to our local gym, which I’ll more diplomatically describe as ‘rustic,’ get food for $1 at a local vendor’s shop, and then watch TV shows or wander around. Well, I’ll hang out with The Hotness for now, that is, until her big adventure…

YWAM Kathmandu

Yesterday, after Derek arrived back home, we managed (after some very frustrating pitfalls) to procure a phone and a SIM card so that I can keep in touch with others at the organization I will be working with. They had given me a "map," in pen, to find their office the next day, and I was concerned (for good reason) that going past Derek's hospital for an unknown amount of time or distance, along unmarked roads, to find a red brick building with a black gate, behind a construction building, somewhere on one of four roads...well, you get the picture. When I arrived, the man there said I was very early (they start work at 10 - it was 8:30) and also that I was a magician with orienteering if I actually managed to find the place alone without help the first time. Bonus points for Travel Kendra.

Do you know Travel Kendra? Only a few do. Frankly, she's much more likable and laid back than American Kendra. She has no schedule, no time restrictions, low expectations. She rolls with the punches. Doesn't sound like someone you know? Thankfully, if you know and put up with American Kendra, odds are pretty good that you'd get along well with Travel Kendra.

Also, we got a gym membership and ran on the two working treadmills and lifted weights in a gym that I can only describe as falling short of DAHLC standards (people in Rochester would shutter to find that there is only one tattered yoga mat and NOTHING to wipe the machines down with - a complete shock to us, of course). When we left, I wondered how long it would take for the ring worm to show up. Thankfully, I'm still waiting.

We went to a Japanese restaurant (we were disgusting, but when we tried to ask if we were dressed well enough to dine, they answered us by graciously accepting our patronage and put us in the back of the outdoor garden), had an epic meal of grilled vegetables, and then realized that we were 100 rupees short (the equivalent of a dollar) thanks to their VAT and service charges, so Derek left me while he ran home for the money. I must say for myself, I'm a pretty good ransom assurance.

So today, I made my way through the labyrinth of this city's roads to the YWAM Kathmandu office to start on a project for them. I will be interviewing the leaders of 26 different mission groups to learn more about them, and so that they can have their missions shared to receive prayer and support. Let me tell you about the five I reviewed today:

1. Church Planting Team - Spreads the Good News through discipleship and holistic transformation by building independent, sustainable churches (helps communities with hygiene lessons, Bible distribution, English language assistance, music, sports, etc.)
2. Driving DTS (Brand New) - Still in an ideation phase, this mission caters to drivers, who have a poor reputation in Asia, to minister to them in order to revive their reputations, give them hope, and allow them to share that hope with other drivers and passengers.
3. Jiri Team - A multi-faceted organization that helps through a Children's home, pop up medical clinics (they served 500 people this year in only 2 days), educational scholarships, discipleship training, social work, physical rebuilding efforts, etc.
4. New Life House - For homeless or needy women and their children, this group gives women vocational training (like sewing and basket-making) and sends their children to school during a 5 month training program that helps them get back on their feet and reintegrated with their families.
5. Frontier Missions - Church planting teams that focus on specific people groups in the high Himalayan areas of Nepal.

Want to give to any of these deserving groups? Click here and enter in for the ministry YWAM Kathmandu center, the contact's name is Ishak Tamang (he is the Valley Leader), and indicate which organization you'd like to support in the instructions box. ALL of these groups have incredible projects that need monetary support - they'll use it well.

There's one other thing you should know about Travel Kendra - she has a trigger finger for making crazy, last-minute, life-altering decisions. Today, she was offered an opportunity to work with YWAM in a very unique way - a way that will probably make her mothers in America ill, once again. But, Travel Kendra discussed it with Travel Derek and he's on board! So little time to prepare...