The best 24 hours ever!

In the common room of the guest house before the trek to Nagarkot! Aarti, Katherine, and Joanna, our friend from Switzerland!

This weekend we hiked to Nagerkot! 10 miles up MOUNTAINS! The trek was everything I expected a trek to be, through farmland and small villages. It was a beautiful day with unreal views of the Himalayas the entire way. We are a group of CHAMPS! I felt like we were on some epic mission to get to Nagarkot, over the neverending staircase, up to the misty mountains. Thank you, 21 years of fantasy book reading! Haha! :) We stayed at "The Hotel at the End of the Universe" and woke up to a sunrise over the Himalayas, with a view of Everest and the Anapurnas as well. I'm just going to try and load some photos,because every word I type seems to detract from the experience :)

At the End of the Universe. That's not a backdrop! :)

Tomorrow, we visit the leprosy hospital! On the curriculum front, the experience continues to amaze me. We had a fantastic experience last week from the derm faculty and general surgery. We learned about typhoid fever and the dreaded complication of bowel perforation. I saw my first x-ray with air under the diaphragm! (secondary to bowel perf, please see Aarti's blog). There were three patients in the hospital with perfed guts from typhoid--a completely preventable disease. Most cases advance here due to mistreatment with antibiotics, which are available over the counter. Super interesting. Dermatology seems to translate into "money maker" no matter which culture you're in! The department was beautiful. They told us they take from the rich (with cosmetic procedures) and give to the poor. Noble cause! And they were excellent teachers. We saw what was likely a presentation of lupus (malar rash, joint aches, difficulty breathing) so the rheumatology nerd in me was going nuts. The leprosy lecture was fantastic--far more in depth than the 15 minutes dedicated second year of med school! Aarti and Niki took pictures--and will hopefully post on their blog!

The staircase to inifinity! The upward going parts were slightly more difficult, but how beautiful is this??!!!

I also spent time in the procedure room, and I seem to attract vasectomies, so I got to see another one of those! Interesting to have seen several different techniques at this point. This was still no scalpel (so no actual incision), but using suture (rather than clips or nothing) to tie of the vas and while the surgeon claimed he was using fascial interposition (hiding one end of one tube under a separate fascial layer), I just saw a little hand waving...benefit of the doubt? :) Hopefully no reversal needed because I'm pretty sure that's not an option! Interestingly, most people wait here until they have a son prior to permanent sterilization, and they also wait until their youngest child is over 4 years old due to the high infant mortality. Those issues did not arise in my vasectomy counseling in the States!

The sunrise over the Himalayas! Those are mountains, not clouds!! Also, a very nice moon.

Another topic that we brought up was pain control. This is a really controversial discussion even in the States, and we had some really interesting conversations about it. There is what I consider to be very limited pain control here. Patients seem to get opiates only if they are terminally ill from cancer. We have collectively seen things like wound debridements, post op pain, vasectomies, and suprapubic catheter placements without the use of what we would consider adequate analgesics (post op patients get ketorolac--a strong form of ibuprofen). I have mixed feelings about this. I don't think it's dangerous to give a patient some morphine prior to a wound debridement and would be infinitely more comfortable with the procedures. I also think that with the over the counter pharmacies that exist, oral opiates would present major issues. We obviously are dealing with serious consequences of opiate over-use/abuse in our country. It's tough to weigh the pros of pain control and cons of the abuse, tolerance, hyperalgesia, and criminal activity of opiates. Sometimes I think they're the worst drugs we've discovered/invented--but then seeing the patients in pain here makes me think otherwise. By no means straightforward!!!

Vasectomy in the procedure room--a fun place to learn, and the language barrier is slightly less detrimental!