Happy Hospital Day + Books Come Alive

On Monday, we had our first clinical experience, visiting Kathmandu Medical College (KMC).  We started off the day at Jhpiego headquarters, reviewing the relevant aspects of labor and delivery and planning out the logistics for our trip to Pokhara later during the week. 

The team planning out the week at Jhpiego Nepal

We then took a 20 minute cab adventure to KMC.  I say cab adventure because between the bumpy roads, oncoming traffic in your imaginary lane, and last second dodging of motorcycles, there really is no such thing as a normal cab ride in Kathmandu. We arrived in one piece and entered into KMC.

Upon entering, we were quickly honked out of the way.  Turns out, the entrance to the hospital is open to cars as well, 'drive through' style.  Most people were able to duck out of the way, but one of our coordinators, Sheetal, saw some hand to metal action as the car brushed by her. Fortunately, she was ok.

 The mix use lane

We met with a variety of hospital administrators and staff, with our host, Dr. Kusum Thapa, leading the way.  After a warm welcome with plenty of customary milk-chai tea to go around, we met briefly with Dr. Govind Sharma.  Dr. Sharma formerly held the post of vice chancellor of health, with the chancellor being the former king before the absolution of the Nepalese monarchy.  We found out that there are a total of only 12 biomedical engineering students in Nepal right now who usually  work for pharmaceutical and device companies after graduation, not unlike the path that some of us may take after CBID.  Further visits with Dr. Karki, principal of KMC, and Dr. Saha, head of OB/GYN, to clarify our purpose and discuss potential project areas gave birth to some cutting edge ideas for both our pre-term and minimally invasive surgery (MIS) focuses.

Team meeting with Dr. Karki and Dr. Saha

One thing you notice in Nepal is the intermitten power cuts throughout the day which range from 18 to 22 hours at a time.  Even though the hospital has backup generators which power the hospital through these daily cuts, the current infrastructural reality dictates that devices must be innovative energy sippers.  As Allie and I visited the NICU area and Kangaroo Mother Care wards of KMC, we saw one device that epitomized the resourceful nature of the hospital in the face of these unique sets of challenges: a locally designed baby incubator.  To provide heat, two halogen lightbulbs below the baby bed were utilized in conjunction with a control system which turned on the lights whenever the temperature dropped to 36 C.  To provide humidity, a pan of water could be placed in the same subspace.  Furthermore, a backup battery was constantly being charged during use in case the hospital backup generators did not produce enough power.  The device was also modular in the sense that virtually any phototherapy light could be incorporated with its clear top lid.  The models in use have lasted 15 years at KMC, a testament to the foresight of its original designers.

Locally made, locally sustained

 After consolidating our meetings and regrouping with the MIS team, we took another cab adventure back to our place of stay, the iconic Kathmandu Guest House, which some credit with being the catalyst for the growth of the surrounding tourist region of Thamel.  Historical or not, we had some more immediate issues to attend to.  I had always wondered why COPD and other respiratory complications were becoming heavyweights in global disease burden projections. Holding my breath through the dusty and smoky streets of Kathmandu put to rest any questions I had.  We picked up some 40 rupee facemasks from the local supermarket and were pleasantly surprised that Nike and Adidas had decided to enter the low cost cotton facemask market.     

"Fakemasks from Afar" at KGH. Ian, Aakash, Patience, Aaron

After dinner at another great momo restaurant, we settled in for the night.  It was the perfect opportunity to finish a book I started on this trip, Second Suns.  David Relin's posthumously published book explores the life of how Dr. Sanduk Ruit, a local Nepalese ophthalmologist, has revolutionized the world of cataract surgery through innovative surgical techniques that drastically reduce procedure time while providing results as good as the leading cataract surgeons in the developed world. I've shadowed cataract surgeries in the middle of the Amazon and in the states and to think that the same 30-40 minute procedures could be done in 5 minutes in a school-converted-to-operating-theater-in-the-middle-of-the-Himalayas definitely took me by surprise. Add in the fact that Ruit's partner in conquering blindness around the world is an ophthalmologist who invented bungee jumping, scaled Everest, and plays top tennis players around the world between performing up to 80 cataract surgeries in one sitting, and you have a story filled with two modern day visionaries.

I can't think of a better book to be lent for this trip (thanks Allie!), as many of the landmarks described are in areas where we have frequented.  Tilganga, the eye hospital mentioned, was right next to the Tribhuvan airport where we arrived.  Ruit's residence is right next to Swayambhuthath, the monkey temple we had visited days before.  Things became too surreal when the lobby of the KGH was described and all I had to do was look around the couch I was nestled in to see where Ruit had conversed with Relin.  Strange coincidences aside, I would still have to say that this was one of the most inspiring stories I've ever read.  My short review here does not do it justice, and for anyone coming to Nepal or interested in eye care, it's a must read.