Pokhara: CBID Goes West

After delaying our trip to Pokhara by a day, we went to the airport once more on Wednesday morning hoping that the rain would stop long enough for the Pokhara airport to open. Only a few more hours of waiting later, the airport opened up and we were on our way!

A short flight and a drive later, we made it to our scenic hotel in Lakeside, one of the neighborhoods in Pokhara. Once we had dropped off our things (we stayed in the penthouse rooms, with an amazing balcony and a view to go along with it), we sat down for lunch downstairs for some delicious momos, curry, and fried rice. Our first meal in Pokhara set the bar high, as Aaron said his veg. curry was one of the best curry dishes he has ever had--needless to say we were excited for what the rest of the area had to offer.

Hotel Lake Star, Lakeside, Pokhara

Once we had finished lunch, we piled into the hotel car and went over to the Gandaki Medical College Teaching Hospital, a fairly large private hospital that cares for patients in the Gandaki zone (one of 5 current "zones" in Nepal, where zones contain many districts, of which there are 75). Here, our teams split up and the MIS team (Aakash, Patience, and I) put on our scrubs and went in to see Dr. Bhoz do a laparoscopic cholecystectomy. It was harder to believe the similarities than the differences between GMC and JHH (Hopkins), given limited resources, but they managed just fine. With one set of laparoscopic instruments, including a Stryker camera, which was recently purchased by the surgeon, not many procedures could be done in one day when sterilization, turnover, and maintenance of the instruments and other resources were taken into account. The day we went, he was scheduled to do 4 lap choles, but had to move 2 of them to the next day due to insufficient drapes and surgical gowns, in part due to the rains that kept the surgical cloth wet on the railings where they are normally set to dry. Additionally, with a room a third the size of the average OR at JHH and no fan or system for circulation of air, the room was quite hot and stagnant. Despite all this, and the fact that his instrument set only really had the basics, he finished the procedure in just under an hour (one of his longer times). It was a privilege to work with one of the initial pioneers of laparoscopy in the Kathmandu valley, and he gave us very helpful feedback about all four major areas for consideration regarding minimally invasive surgery: 
- Training
- Instrumentation/Technology
- Sterilization/Maintenance
- Safety

Gandaki Medical College Entrance Desk

Team preterm had a positive experience as well--there was a promotion where Gandaki was giving patients free surgeries (including delivery!) for the whole month and patients only had to pay for medications. One of the largest issues was a social one. Mothers would come in asking for a 100% guarantee that the delivery of their child would go off without a hitch, but providers are hesitant to make this promise, since it just isn't feasible--complications cannot always be predicted.

In addition, Aaron and Allie discovered that people tend not to adopt KMC because they think of it as a low-tech solution, and overlook it in favor of flashy, high-tech solutions that seem more effective (but in reality, are usually not--simple design is key!) like incubators, or in the case of breast feeding, formula feeding.

After seeing a case at the hospital, Dr. Bhoz was done for the day, and we headed to Fewa Lake, just below the Annapurna mountain range. On the way, we had our afternoon chai at a local restaurant, and then drove over to the lakefront. We took a catamaran out to a small island temple with Dr. Kusum and Sheetal, and took in the amazing view as the sun went down.

The view of the mountains from the catamaran on Fewa Lake

Dr. Kusum: The best guide (BG)

To end what had been our best day yet in Nepal, we had local Nepali Thali, a special all-you-can-eat meal consisting of rice, potatos, dal, curd, mutton (in this case), saag (greens), and bitter root. Aakash, Aaron, and I enjoyed this the most, eating with our hands, as is traditional, and only looking up when more rice, dal, or mutton was brought out. After day 1 in Pokhara, we had decided it was our new favorite part of Nepal--after all, it is a well-kept secret, and we haven't even seen it all yet.

Eating local cuisine, Nepali thali, in Pokhara