Seeing the Sights

Since we've gotten to Kathmandu, we've gone out almost every single afternoon/evening to explore around the sights and get a feel for Nepali culture.

Our first stops were to the Kathmandu Durbar Square and the Patan Durbar Square. Nepal used to consist of many small kingdoms, with the kingdoms of Kathmandu, Patan, and Bhaktapur being the most prominent and each has a grand durbar square, which is located across a palace in that city. They're similar to large open courtyards filled with temples and courtyards. We walked around the squares to look at the beautiful pagoda style temples and the historical artifacts they had in a museum in one of the courtyards.

The pigeons seemed to find Kathmandu durbar square
as pretty as we did

Kal Bhairav statue

Next up is everyone's favorite: monkey temple! Known actually as Swayambunath, it is a temple located at the top of a hill in Kathmandu. A stairway of 365 steps leads you to the top where there is a stupa painted with the buddha eyes looking out onto the city in four directions. True to its name, there are hoards of monkey located around the steps and at the top. As with almost everywhere in Nepal, the monkey temple is also thickly decorated with prayer flags to give the temple an extra element of grandeur.

Buddha eyes looking upon you from the  stupa

Monkey at monkey temple

To make the most of the gorgeous weather in Nepal, the six of us decided to spend our Saturday hiking outside. With a consultation from the travel desk in the hotel, we arbitrarily chose Nagarkot as our destination. Though the travel agent told us the hike was going to be 5 hours long, we severely underestimated what this actually meant and found ourselves exhausted by the end of our 15 mile trek. But views along the way and the little villages we passed through kept our spirits up and helped reach the peak at Nagarkot Tower.

A field of mustard plants on the trek up

View of the himalayas from between a gap in the hill

First Days in the Labor Ward

During our time in Nepal, Kimber and I will be visiting the Paropakar Maternal and Women's Hospital in Kathmandu. For our first couple days we spent time in the low risk labor ward observing nurses perform deliveries, talking to them about how the manage labor and go through their decision making process, and just getting more familiar with the staff.

One of the nice differences we noticed in the labor ward at PMWH as compared to Sevagram was that the staff is much more focused on the type of care the mother receives. Each woman gets her own cubicle like area for delivery that can be made private with portable room dividers. Nurses work with the mother to try their best to facilitate a normal vaginal delivery, such as by encouraging alternative birthing positions, delaying episiotomy until necessary, and actually using lidocaine before performing said episiotomy. 

The unit is run entirely by nurses, all of whom have received two months of Skilled Birth Attendant  (SBA) training. This course teaches them how to manage labor, perform normal vaginal deliveries, and perform vacuum assisted delivery (VAD). SBAs in Nepal are not allowed to perform forcep deliveries. 

The yet to be used manual vacuum pump

While watching the nurses perform deliveries and talking to them, we learned a lot about how often women are examined while they are in labor, how nurses can tell if a woman is progressing properly, how nurses know when alternative methods of delivery need to be considered, and how confident they feel performing VAD. Though the labor ward has a VAD device, it has a manual pump, meaning two people are necessary to operate it, and the nurses are unsure how to tell if they have reached the appropriate pressure for use because they aren't sure how to read the pressure gauge. They used to have an electric pump that had a red zone and green zone delineating what the proper amount of pressure is, but that broke and they now only have the manual pump one available. 

3rd year medical student demonstrating how VAD
is performed using a pelvic model and a fetal skull

We were also able to attend a lecture about the indications for use for forceps and VAD and at the end were able to talk to the 3rd year medical student who lead the lecture. We asked him about how VAD is trained for at the facility and he said they currently use a pelvis model and a fetal skull to practice but he prefers to practice on delivering women because on real cases he can't accidentally skip steps and there is a whole team of doctors and nurses to help make sure that he is attempting the VAD properly. He also told us that he thinks a more realistic simulator would help him feel more confident about the skills he can learning while training.

At the Jhpiego office in Lalitpur we were also able to talk to Dr. Kusum, our in country advisor, about the need for a better VAD trainer. She said more of the models they have are not realistic and are not designed with teaching VAD in mind. A lot of time she has to use workaround to demonstrate certain features or scenarios, but these workarounds are not very realistic and generally don't last long.

We hope to learn more about the simulators they use and watch some training in the next couple days!

Pre-Nepal Adventures

On Friday, January 2nd, Kimber, Melody, Jackie, and I were all set to travel to Nepal the next day. Our flight was at 950pm and we were set to leave Baltimore for Dulles at 530pm. However, it was not in the cards for us to be departing the US at 950pm on January 3rd.

My original plan was to sleep in late so as to stay up during the entire flight and sleep during our 14 hours layover in Abu Dhabi to be on a good sleep schedule for our arrival in Nepal. A knock on my door by Melody that morning and a quick "Can you come outside? Our flight got changed" jolted me out of bed much earlier than I would have liked. Jackie had received an email saying out 950pm flight got pushed to depart at 520am instead. Apparently the airport in Abu Dhabi had shut down for a bit due to heavy fog and it had thrown all the flight times off. This didn't affect our plans too much since now we had more time to pack so we called our shuttle service to change our pickup time, however they were completely booked so we cancelled our van and Michael, our kind TA, offered to rent a zipvan and drive us to the airport at 1am. With that being settled, Melody and I spent more time relaxing, hitting the gym, and watching TV to kill the extra hours we suddenly found on hand.

During my mini Friends marathon around 930pm, my phone buzzed with an email from Jackie. Now the last time I had received an email from Jackie it was forwarded message from the airline saying our flight time had changed. With that precedent set I was expecting to open the email to find out that our flight got pushed to even later. I was only half-right; our flight time had changed but was now set to depart at 1230am, 5 hours sooner than we were expecting. After a flurry of phone calls and text messages, we decided we would leave ASAP to head to Dulles to try to check in (hopefully) in time. 

After that having been decided, Melody ran to the bathroom to take the shower she had intended to take right before heading to the airport at 1am and I ran to my room to finish packing the electronics and toiletries that I was going to leisurely pack around 11pm. We quickly got our luggage together and piled it into the zipvan as the rain that had been on and off throughout the day continued in a steady downpour.

Michael raced us to Dulles in a quick 1 hour and we hustled to the Etihad counter at 1115pm. Luckily no one was in line and we were able to check in quickly. We asked the man at the counter if he would be able to call the gate to let them know we were on our way but he reassured us that there was no way the plane would be leaving at 1230am as planned because it had not even landed yet. Even so, we rushed to security and, again, were met with no lines and made it through to our gate. 

Our nice empty flight

True to his word, the flight did not start boarding until 1245am and so we found that we could have actually taken our time packing (which would have helped as I ended up forgetting my shoes) and leaving for the airport. In the end I think all four of us would agree that the rush was worth the tension because with all the plane time changes, there ended up being only around 20 people on our flight, meaning we all got to lay down and go to sleep. All four of us ended up sleeping for almost the entire 12 hours of our flight.

We arrived in Abu Dhabi very refreshed and had 11 hours to kill. Due to the fog, there were a lot of travelers wandering around the airport also trying to kill time. Some had even been stranded in the airport for days and we were lucky that our next flight was still scheduled to leave at the expected time. Due to all the delays, we were also able to get dinner and breakfast vouchers as well as a hotel voucher. After some discussion though we decided not to check into the hotel because it was about 30 minutes away from the airport and we would need to pay for transportation there and back. We also didn't feel like sleeping much more so we decided to pass our time in the airport.

Somehow between freshening up in the bathroom (Jackie repurposed some ziploc bags into shower shoes and a scarf into a towel to use one of the free showers in the bathroom), eating dinner, reading, napping, talking, eating breakfast, wandering around the airport, we managed to make the 11 hour layover fly by and were soon boarding our next flight to Nepal, which was a short 3.5 hours. After an uneventful flight (it was unfortunately completely full), we found ourselves at the Kathmandu airport and waited about 2 hours for our luggage to come in. We hailed a taxi and arrived at the Kathmandu Guest House (heretofore referred to as KGH) to interrupt Allie and Wes playing a romantic, candlelit game of cards. After a quick reunion and dinner, we all went upstairs exhausted and eager to start our adventures in Kathmandu!