Wednesday, 29 June 2011

lunch with a view!

Bibiana, Jason, Sabita, Bishnu and Bill (me taking picture).  We had a great hike today on our day off.  We went up a ridge line to 2500meters (about 1000 of climbing up) and had a fantastic picnic prepared by Bishnu.  Our view was looking back down at Kathmandu.

Tuesday, 28 June 2011

Hung out to dry in monsoon heat

Yesterday Bibiana, Jason and I gave a one-day “Introduction to PBL” workshop at PAHS.  We had 20 participants and the programme for the day included a didactic introduction, followed by an actual PBL tutorial (where the participants were students in an actual PBL case), lunch a debrief and then an interactive role-play session in the afternoon.  The PBL Sessions in the morning went really really well.  All participants participated in discussions and finished with a very clear idea of what PBL feels like from the standpoint of the student.  That’s the good news..

The bad news is that I had my first experience with full out refusal to participate while facilitating a large group session with the workshop participants.   Now
grant it,  it was really hot and muggy, coupled with the fact that we could either have the fans on and keep cool (but not hear) or turn off the fans to hear but swelter in the heat…. Not optimal learning conditions for sure. 

Nonetheless I couldn’t get anyone to volunteer any comments in the post lunch de-brief.  I’m not exaggerating when I say I asked for any comments and then waited at least 1 full minute.  Now I have a large tolerance for silence when I teach but greater than 1 minute is a stretch even for me.   I don’t think it was a Nepali issue because today we repeated the workshop at another venue with different Nepali faculty and there was a lively and engaged debate in the large group session.  The room was equally hot and stifling so it wasn’t the ambient conditions that promoted discussion today.  Both sessions fell after lunch so it wasn't post-pradial sleepiness.  The only observable difference was that today (with the chatty group) there were very senior administrators in the room where as yesterday (with the silent group) there was not.  Perhaps having one’s superiors listening in provides incentive to contribute?!

That’s the amazing thing about teaching,  just when you think you have something  figured out and think you can’t be tripped up, you run across a group that breaks all the rules.  Definitely keeps the creative, think on the spot, juices flowing..

Sunday, 26 June 2011

Patan Hospital

Patan Hospital is the teaching hospital for PAHS and this is sign hung on one of the wards.  PH has an over 20 year history of serving the poor in the Kathmandu Valley.

Nepal talk by PAHS med students

Today the PAHS students gave us a talk on Nepal. It was in return for the Health Trek Nepal team giving a talk last week on Canada.  Today's talk was really excellent. I have been coming to Nepal for 12 years now and I still learned a lot from the presentation.  The covered History of the Country, Religion and Politics, Extreme Sports, Flora and Fauna and the Health Care System.
One of my favourite parts was when they said that they have 0.03% of the world's landmass but they have 619 of the worlds species of Orchids!  Gotta love that eh Don?

CA didi and The Wiggers Diagram (of course!)

Anyone who know me know how much I LOVE to teach the Wiggers Diagram!!! My favorite topic ... OK except ECG's...

Saturday, 25 June 2011

Dinner with Health Trek Nepal!

Bibana, CAdidi, Mike, Hasan, Kiely, REnee, Eda, Marion and Jason.  Fabulous dinner cooked by HTN!!  Veggie coconut curry, Aloo-Chez Mike (via Vij's), Dahl, and "a little rice!!!  PLus desserts from German Bakery.  A feast!

14th Dalai Lama

Friday, 24 June 2011

Cardio in action

My colleague Bibiana demonstrates reading an echocardiogram (an ultrasound image of the heart).

A lofty perch

This morning we had our weekly PRE-Tutorial Briefing, where the ENTIRE Cardiovascular Block team (PBL tutors,  PBL Tutors in Training, CV Block Faculty,  Director of PBL and Director of Medical Education) assembled for TWO HOURS in order to go through the PBL tutor guide for the upcoming week.  Issues specific to this week’s case as well as more general issues of small group facilitation were discussed at length.  In addition we spent the last half hour reflecting on how week 1 PBL sessions had gone.  What really struck me was that so many people took two hours out of their busy days in order to prepare for the upcoming week. 

In medical schools in Canada it is difficult to get all the PBL tutors to assemble for 45 minutes each week to reflect on the previous week and prepare for the upcoming week.  Granted many of the tutors in our curriculum are clinical doctors who take time away from their clinical practice to tutor and time away from their offices means they are not seeing patients. I get that. 

Nevertheless it can seem like an uphill battle to get faculty in Canada to prioritize teaching.  In a busy academic world with so many competing responsibilities (research, clinical practice, administration), education can find itself on the low rung of responsibilities. 

Today I looked around the crowded, hot room in Kathmandu and felt like teaching had assumed a loftier perch. 

Wednesday, 22 June 2011

At the top!

Our friend Bishnu Rai, CA, Bibiana (my housemate) and Jason.  Bibiana and Jason are the other international faculty from Canada here working on the Cardio Block.


Top photo was after removal of the beast from my ankle.  Bottom photo was the leeches on Bishnu pre-extraction!  No worries though, they look worse than they feel. In fact you couldn't feel them at all (they deliver an analgesic as they feast).

hike on our day off

Hiking up the trail (for those of you from BC it was like doing the Grouse Grind 3 times in above 30 degrees and 90% humidity.

Reflections on PBL

I am feeling a set of contrasting thoughts as I write this.  Recently a UBC medical student wrote a critique of the UBC PBL tutorials, that was published in Canadian Medical Association Journal.  I respect the student’s opinion, and no doubt it reflects a perspective that we (as professors and facilitators) don’t experience.  

This week however I am having an extraordinary experience running PBL tutorials here in Nepal. The Nepali students are embracing PBL with a gusto that is quite amazing.  They attack “brainstorming” on the first day.  Many ideas are put up on the board, and then later followed up or abandoned.  Opinions are challenged (respectfully) and trains of thought are followed to logical conclusions.  During the second tutorial of the week (this would be the equivalent to our Wednesday tutorials) the Nepali students in my PBL group attacked the learning issues they had researched after the first tutorial.  Discussion was lively and thorough.  While I have had this experience with groups at UBC, one difference here was that the Nepali students seemed to be in no hurry to rush on to getting new material on the case.  At UBC students seem at times to be more focused on the clinical scenario and rush through the basic science learning issues.  Students in Nepal PBL are just finished high school and come in with comparatively little basic science, and that may account for some of the difference in focus between UBC and here.   Regardless of the reason, being surrounded by this much enthusiasm for learning and appreciation for the opportunity to learn is a heady experience for this professor!

Monday, 20 June 2011

CA didi's PBL group!

This is my PBL group in the Cardio Block. Behind us on the white board are all the wonderful learning issues and thoughts about our PBL Case, generated by the students.

Health Trek Nepal welcomes CA didi

Sunday, 19 June 2011

AHED website

First dates

Meeting your Problem Based Learning (PBL) tutorial group for the first time is a bit like a first date; everyone is on their best behavior, with lots of smiles and nervous laughter.  Introductions are made, unfamiliar names patiently spelled out, ground rules are established.  Over the next five weeks the relationship will begin to develop and mature.  As the group becomes more familiar with each other shyness will be overcome, and safety for learning will develop.  In every small group relationship however boundaries will be tested and occasionally bad behaviors may be exhibited.  It will be our challenge to trust that we are working together to learn and that we have our best interests at heart.  In the end mutual respect will be our compass.

First dates

Meeting your Problem Based Learning (PBL) tutorial group for the first time is a bit like a first date; everyone is on their best behavior, with lots of smiles and nervous laughter.  Introductions are made, unfamiliar names patiently spelled out, ground rules are established.  Over the next five weeks the relationship will begin to develop and mature.  As the group becomes more familiar with each other shyness will be overcome, and safety for learning will develop.  In every small group relationship however boundaries will be tested and occasionally bad behaviors may be exhibited.  It will be our challenge to trust that we are working together to learn and that we have our best interests at heart.  In the end mutual respect will be our compass.

Saturday, 18 June 2011

butterflies in formation

So tomorrow is the first day of the block.  First time meeting my tutorial group and first time giving a lecture here.    All things I have done many times in Canada but never here in Nepal.  It's a curious combination of excitement  tinged with anxiety.  I've thought a lot about this over the years and I think it is linked to wanting things to go well for the students.  

Ten years ago I remember being taught by a master teacher at Harvard, whose name was Chris Roland Christiensen. At that time he was in his mid 70's and was revered by students and faculty alike.  As he started his lecture he acknowledged that he had not slept well the night before due to being so anxious about teaching us.  I asked him about it later and he said " Even after 45 years of teaching I still get butterflies in my stomach the night before meeting a class for the first time it's just that now they are flying in formation".

So here's to always having butterflies in formation.

Friday, 17 June 2011

pictures below:

BK the dog
the garden in front of our flat
the house where Bibiana and I will live (we have the first floor)

new digs

Somber Thoughts

Somber moments

1)   walking up to the hospital I saw a family of 5 wheeling an older gentleman on a make-shift guerney (bicycles and a plank between them) up to the entrance of the hospital.  He looked unconscious.
2)   Walking through the halls I passed a hospital staff member wheeling a metal trolley with what could only have been a baby covered entirely by a slightly dirty, drably coloured sheet.

And then I remember why I am here and what this new school means to Nepal.

Wednesday, 15 June 2011

settling in

I arrived in KTM mid day and dropped off my bags at my new digs here in Patan (see pic). It is a really lovely three story house of which myself and Bibiana will occupy the main floor. It has a gorgeous garden and a wonderful guard dog who I have named “BK” for barky kukur. Kukur is nepali for dog. Glad I brought ample ear plugs…

I met up with the UBC med students (from now on to be known collectively as HTN (for Health Trek Nepal), and we had a great dinner together which served two purposes, one was to catch me up on everything they have already accomplished (which is a lot!!) and also to keep me awake until 8pm!

I got home, unpacked and then slept for 9 hours straight!!

Today with a huge amount of help from Mili bahini and Bishnu bhai I got a mobile phone, figured out the internet in my apartment (thanks Jane), got a huge grocery order to stock the cupboards with staples, and organized to hire a didi to come to cook meals for the next 6 weeks! With what is ahead of us in terms of work, shopping for groceries and cooking was really low on the priority list.

Tomorrow is a writing day for me AND I meet my Nepali tutor for the first time.

Dheri dheri khusi lagyo (very happy).

En Route in Bangkok

Ok so here’s the thing.. The blessing (or curse) of so much flying every year is gaining access to the Airline lounges). So here I am in the Thai Airlines lounge in Bangkok and it is 32 degrees outside. I am wearing a T-shirt, my pink fleece jacket, full length jeggings and I’m still cold. What is it with air-conditioning in these airports, I could chill beer in my pockets. I’m drinking yet another coffee just to keep warm.

Despite the Air Canada strike that started yesterday I managed to get out of Vancouver and travel to LA before it officially got underway. My connecting flights on Thai Airlines were not involved so I had no delays on this trip. I got ~ 9 hours of sleep on the flight to Bangkok and that left me time to eat three meals, watch a movie AND work on my first lecture. I was using a lecture I give to UBC medical students as a launching off point and as I went over my slides it really struck me just how North American-centric my lectures are. I use a lot of references to clinical cases to add relevance but they are all specific to tertiary care settings with ample access to care, availability of a myriad of diagnostic equipment, visits to specialists and pharmacological and non-pharmacological treatment options. I only truly took that in when I had to systematically go through the lecture and remove most of it in order to make the case references relevant to the Nepali context. Patients don’t present to their “family doctor’s office”, or arrive by ambulance to the Emergency Department. MRI’s are not routinely available and multiple pharmaceutical options are not accessible. I’ve pretty much scrapped all my clinical scenarios as I craft this new lecture.

So I am cooling (literally) my jets here for another hour then on to KTM (4 hours). In my head are the words to an old Cat Stevens song:

Kathmandu I'll soon be seeing you

And your strange bewildering time

Will hold me down

Kathmandu I'll soon be seeing you

And your strange bewildering time

Will keep me home

Monday, 13 June 2011

Watching the Stanley Cup at Vancouver Airport lounge!

on my way

Well I am ensconced in the lounge at YVR waiting for my flight to LA. My email and phone messages have been programed appropriately, suitcases have been checked (please universe give them safe passage to KTM), and now it is just a matter of ALOT of sitting.

Just found out the flight is delayed by one hour.. that means that rather than watching the hockey game in LAX it will be being played as I fly down the coast. Hopefully I will catch the part where they win and skate around the rink with Lord Stanley's Cup.

My flight to Bangkok leaves LAX just before midnight so I will have some time on my hands when I arrive in LA.

I am trialing a new "travel organizer" that hangs on the back of the tray-table when it is in it's upright position. It contains my kindle, my eye patch and ear plugs, hand sanitizer, Nepali Devanagari script exercises, pens and a place to hand a water bottle. That should keep me sane for the 15-17 hour flight to Bangkok.

More from Bangkok...

CA didi

Sunday, 12 June 2011

The heART of PAHS

OK so here is where my two worlds intersect... my love of all things cardiovascular and my love of artistic expression.

While in Kathmandu teaching cardio I will be inviting the PAHS students to express what they learn about the heart artistically. They can sketch, paint, photograph, compose, sculpt... anything goes as long as it is inspired by the cardiovascular system. This will be the Nepalese version of an Art Contest that I have hosted at UBC Medicine/Dentistry for the past 12 years called Heartfelt Images ( The UBC med students volunteering here in Kathmandu were kind enough to collect and bring some cameras for the PAHS students to use in case they don't have one of their own and we will welcome all submissions throughout the 5 week block. We will announce the winners of the contest during our fifth week *just before exams* and the winners will be presented with prizes (yet to be determined). I will, of course, post the winners on this blog so you will see the products of their labours!

The Nepali word for heart is Mutu. Now I need to find a wonderful title for the contest. Any suggestions?

Friday, 10 June 2011

" Getting to know you "

Friday evening with 2 and a half days to go. Packing is proceeding (or was until my Vancouver bahini Jana lured me over to watch game 5....).

I'm getting wonderful updates from Health Trek Team. All systems go from the sounds of things.

My friend and colleague Gabrielle brought up something on Thursday that I had not thought about. In the midst of me being nervous about meeting the demands of teaching in Nepal, Gabrielle asked me what I thought the students would be thinking about the arrival of Jason, Bibiana and I. She thought they would be excited but pretty nervous about meeting us. I had never thought about the fact that they might be a bit overwhelmed about three Canadian faculty showing up to teach them. I guess there will have to be a mutual "getting to know each other" time when we all arrive.

Tuesday, 7 June 2011

Check out to read the Health Trek Nepal blog!!!

I forgot to list Hasan (another UBC Med student) who is on the Health Trek Nepal team and in KTM now!

Med Student Volunteers

Something I wanted to mention was that for the first time since I have been involved with PAHS I will be sharing the experience with some truly remarkable University of British Columbia medical students. Mike, Kiley, Eda, Renee and Marion are already either in transit or on the ground in Kathmandu. They will be joined in a few weeks by a second group (Candace, Keira and Katelyn ** if I have left anyone out I'm sorry, I will introduce them once they arrive!).

This all started when I posted a description of PAHS on the Global Health Initiative UBC website (, a student led initiative at UBC.

Never underestimate the power of motivated med students! Next thing I knew meetings were scheduled (thanks Kiley!), fundraisers were planned, tutor guides were written (thanks Peytra, Mike and Renee!) and "Health Trek Nepal" was up and running. I think there may be a website for the student group and I will link to it when I get it.
Their main role will be to work with the PAHS medical students as basic science and English tutors throughout the summer. I'll keep you posted as I hear about the initiatives they develop.

Friday, 3 June 2011

my teaching tool kit

As I prepare to head to Kathmandu I have been reflecting on the differences between preparing to teach the UBC medical students and the PAHS students. They are both groups of smart students (that is a given) but there are some essential differences that will influence how and what I prepare. Number one the UBC med students all have at least one university degree already (often in the sciences) and they are on average 24+ years old. Many live on their own, some are married with young children.

The majority of PAHS students are starting medical school directly out of high school and are on average 17 or 18 years old. Particularly the students from rural areas will not be entering the program with a strong science background and English is not their first language. Most of the PAHS students will live at home with their parents.

For these reasons I will be balancing many things as I prepare to teach there. At UBC we teach the basic sciences couched within clinical cases. The pace of delivery is swift and builds exponentially as the weeks go by with each weeks topic building on the one before. At PAHS I will have to speak slower and more clearly so that will mean less content in any given session. There will be a need for more text on slides, which is something I rarely do in my lectures at UBC, where I use my slides for single images or graphs and talk the students through them. I will have to take into consideration that their scaffolding of science topics will be lighter than I am used to.

The PAHS students also come from a background (in high school) of a passive learning model (teacher speaks students write it down). My lecture style is much more interactive and relies on getting feedback from the students. I will have to work hard to establish a level of trust and safety that encourages their participation in discussions (in large and small groups).

So many things to think about as I "pack my teaching tool box" in advance of departing.

Oh and I get my Dukarol (anti diarrhea) booster tomorrow at the travel clinic....

CA didi

Wednesday, 1 June 2011

CA didi in The Netherlands

Two weeks to go before departure. David and I just spent our two week summer vacation cycling around The Netherlands. Given that the Nepali word for older sister is Didi and that I am a cardiovascular physiologist and LOVE teaching about ECG's I figured this picture would pretty much sum up what is ahead...