more pictures

these folks are plowing fields hoping that rains will be coming soon. Hope you can catch more of these images in the weeks to come , ask us to share some if you are around for a visit. thanks again for all your support and prayers during our trip, Love mark, laurie and amber

we've been home

day in the hospital

i thought i should make some attempt to describe a day in the hospital, especially to all my medical friends back home who might be following this blog. Typically we start with maternity ward rounds, a long ward , open style, with about 15 beds , mothers and babies share a
standard twin bed, there are some curtains for privacy when necessary, otherwise its an open ward. Family members often sleep on the floor on mats next to their admitted family member.
There is extra cots for the floor for overflow cases. Laboring moms walk about in the ward or just outside the doors. Scarves, nose rings of various types, multiple rings in the ears, and different shades of brown skin , wrinkles or smoothness of youth adorn the faces, most happy and smiling after birth, some sad or just quiet depending on their circumstance. We have had a number of moms come in with deceased babies to deliver, retained placentas following home births, eclampsia and severe preeclampsia, prolapsed arms, breeches of all varieties come in to the hospital, some after quite a few hours on the road. I am always amazed at the strength and resilience of the human body when it is tested to its limits, which occurs almost daily on the maternity ward. There are 3 delivery rooms in the back with old style metal delivery tables and old stirrups with padding , which serves as the delivery area. Each delivery is attended by nurse midwives and other nursing staff, there may be anywhere from 3=6 people in the delivery room shouting encouragement and instructions in Nepali to the women. There is no pain relief in labor, only encouragement and company. Shouts of "boldognos" meaning, PUSH
and lo lo lo lo lo strengthen the about to be mothers to give it their all. There is combinations of touching, encouraging and scolding given out , sort of all in this wonderful noise that preceeds the cry of a newborn. If I help, its been with a few difficult deliveries, breeches, and doing some suturing and helping with decisions about labor managment or taking a decision for a c section. . They call the nepalese docs or myself . There is no fetal monitors, just intermittent auscultation or listening with either bell shaped ear pieces or a few hand held dopplers.
We have oxytocin and misoprostol which is quite useful . The operating room is a concrete ramp and a hallway away, the dash takes about 2 minutes when needed and the operating room staff are pretty quick to get mothers in for c sections when they arrive. We scrub with bar soap and tap water, and put on heavy cloth scrubs and gowns and wear flip flops in the OR. Im usually dripping with sweat by the time a case is over because its so warm in the OR. Babies are swaddled in linens and taken back to maternity to greet their fathers. Babies are in linens every day in bed with moms, there is no diapers or bottles here at all. Only breast feeding, and a daily bath and change of linens for the babies. I wish all the maternity nurses and my physician colleagues and friends from Toppenish could see the sight. Ill have to describe the outpatient clinics another time. We're down to the last 2 weeks here in Tansen, then off to travel a bit , hopefully for some trekking in the Annapurna area out of Pokhara. Will try to get one more blog off before departure. Thanks for reading.

its summer in Tansen

sorry for the delay in our postings. we have had difficulty with internet access for some time. Also won't be able to post any pictures this round. Since I last wrote, we have continued to be busy with work and minsitries. Laurie and Amber are helping teach english to younger children in a program here, as well as helping with therapeutic play sessions with children in the hospital.
This cheers the children and helps with their appetites as well. Laurie is also teaching good food preparation practices and sanitation in the kitchen to several groups, and has given lectures on nutrition to nursing students. This week she will also serve as a registration hostess at a Christian health workers conference scheduled to begin in Tansen tomorrow. Lots of people in health care from Asia will be coming, and some pretty dedicated and incredible people are staying in the Guest House where we live , and have met some of them personally. We have new friends here from UK and from Sweden, a talented pediatric orthopedic surgeon who is doing lots of bone work in the hospital. We have been able to do some local hiking and seen the more typical villages and houses on our walks, and an older ( 150yr) mansion built by a former
nepalese royalty on a river in a beautiful setting . It has been dusty and smoky and warm, so mountain views have been scarce. Water is becoming more scarce, and people are looking forward to the rains. Laurie and I have taken some Nepali language lessons, and know a few words and phrases. Amber keeps happy with reading and visiting with guests that stay in the guest house. She even can find Pringles here! Thanks to all of you who support us with your work at the hospital, at farmworkers clinic, church, and home. Have a good week.
Love from all of us , Mark

Tansen at last

Hello to all.

We arrived in Tansen, Palpa District, Nepal, monday night the 22nd after flying from Katmandu to Baiharawa, and got picked up in the hospital jeep. Climbed about 4000 feet

on a narrow road in the dark and our driver scooted around a stuck Lorrie, ( big truck) in the middle of the road with a 500 foot drop just outside the wheels. The picture you see has nothing to do with that, ( its a shot from Thailand's

Phang Nga bay) with the famous stone karsts that come out of the sea) My buddy back home, Kevin Walsh, would want to cycle up this climb to Tansen probably, but it would be a suicide mission for sure. Don't tell him Im sucking air playing field hockey which I did yesterday. We are at about 4700 feet or so, but it feels higher than that to me. We are settled in a small apt with a small kitchen but I know its much roomier than most Nepali families have. Amber is enjoying some new friends at being out of the craziness of Katmandu. Looks like Im the senior doctor for maternity ward and also working in the outpatient clinic ( women only) . Im sure it will be quite a challenge. Today we saw a hypercalcemia case ( 14.0 Ca) , high output heart failure in a recently pregnant woman with valvular heart disease, and a woman with nephrotic syndrome.

Looks like the surgeons here do all the sections, so while a bit disappointed in that, I hope to make a contribution on the Nepali FMC. ( = family maternity center back home in toppenish. )

I will work on getting pictures to take home to show you all at some point. Guess what? No fetal monitors!! Laurie got introduced to the community health team here today and will see what develops there. Thanks for your prayers and support wherever you are.

Mark

hey all,
we are just wrapping up 2 weeks in Thailand and flying out tomorrow to Katmandu
had a good 2 weeks vacation with visits with 2 friends, time on the beach, snorkeling,
rode 100cc motorbikes, saw some beautiful country and enjoyed friendly Thai hospitality,
elephant ride, famous Wats, famous Buddhas, and many other great memories.
there has been some political unrest in Thailand which has been interesting to observe
in country. Laurie dumped a motorbike but only had a few scrapes. Bangkok is a busy busy place, one of the worlds Mega cities. Get back to you all in a week or two from Nepal.

Mark for all of us

departure minus 4 hours

6 pieces of luggage to check, weighed and measured,
6 items to carry on board
Laurie got a scale in portland for infants thats going with us
Goodbyes will be said to grandparents and then off we go.
Stuart our friend in bangkok, will meet us at the airport there.
many thanks for Toppenish Hospital folks who gathered up suture and other items for the trip.
many thanks for my friends and colleagues at Farmworkers clinic who are standing in the gap of my sabbatical.