Final PBL Tutorial

I'm pretty sure I don't need to say how great a time I had with my PBL group.  This picture pretty much captures it..

Helping Hands

In the pre dawn darkness we don our headlamps and set out to walk up to a viewpoint to see the sun rise and shine on the Himalayan high peaks.  We are members of the International Advisory Board here to attend the 8^th Annual PAHS Consultative Meeting. 

We have traveled from Kathmandu up to a small resort area called Nagarkot where, aside from these early morning walks, we gather in a conference hall and marvel at the incredible progress made by our Nepali PAHS colleagues during the past year.  There are presentations on the basic science and curriculum that is well under way with the 3^rd batch of students just starting the program. There are ongoing discussions about the upcoming clinical curriculum and the development of two additional schools at PAHS (Nursing /Midwifery and Public Health).  There are medical educators from around the world all here for the common purpose of supporting the PAHS mission to bring better health care to rural Nepal.   We are definitely not here to “give a helping hand” in the traditional sense since the exchange is firmly bidirectional.  Educational strategies that are being tried here will be models for providing care to under-served in our own countries. 

The subset of early morning trekkers made it up to the peak and watch quietly as the sun rises above the prayer flags and lights up the alpine glow on the peaks of the Langtang Range. 

Photo credit of mountain: Darren Nichols

As we walk back down the road we come across a group of Nepali Army soldiers on a brutal early morning training run.  They are in full camouflage, wearing high black leather boots and carrying small metal-framed backpacks and large heavy rifles.  They looked to be about 2/3 of the way through a long uphill run. 

We could see the stragglers much further down the valley on the twisting roads.  I was watching them as they climbed further up the long hill when I heard from behind me what sounded like someone struggling with their breathing.  One soldier, who clearly was having a hard time, went past me bathed in sweat and moving at a painfully slow pace.  As he went past me I noticed the soldier behind him had his hand on his backpack propelling him forward up the hill.  It was such a small but kind and supportive gesture that it stopped me in my tracks.  In this macho-drenched army setting I wasn’t expecting to see kindness.. yet there it was, a brotherly helping hand.

CV PBL Tutorial Group

 CV PBL Tutorial Group:  Batch II

Ritu, CA maam, Monisma, Koomal, Shweta, Napoleon, Raveena, Rabin, Tassi and Ashok.

Donning the "white coat"

On Friday the new batch of students were inducted into the PAHS family in a ceremony where, for the first time, they don their short white coats and recite an oath that symbolizes their commitment as medical students to the underserved of Nepal.

First Dean Rajesh Gongal addressed the students with heartfelt words:

"Now that you are committed to pursue this way of life, we will help you , guide you and walk with you in this journey, for you are not alone in this journey as our destination is a common one, our aim the same , the relief of human suffering. Let the ceremony today be the mark of your entry into PAHS family. We will work together, laugh together, sometimes  maybe cry together but all the  time grow together.

My fellow students, let not the white coat that you don from today be a  symbol of status, nor let it elevate you away from the patients; let it instead be a symbol of kindness, a symbol of respect and a symbol of love. Let it also be a reminder for you to always be humble, a reminder that all that you will study in six years is only a fraction of what is there to know which is only  a fraction of what is already known which is only a fraction of the whole truth. Medicine is not  only about curing, for there are only a so many diseases that you can cure ; it is about caring and comforting.

Let this ceremony also be a symbol of your commitment to PAHS mission, vision and goals, to serve the people of Nepal ,especially those who live in remote and underprivileged part of the country; your commitment to be the leader in field of health, your commitment to make this country and its people healthy."

And if you are so committed then read after me the oath of PAHS Student…..

I pledge that as scholar in the field of Medicine, I will at all times act with compassion and respect towards patients and their families, regardless of their caste, religion, socio-economic status, age or handicap.

I pledge to respect the confidentiality of patients and their medical records.

I am committed to the Mission , Vision and Goals of Patan Academy of Health Sciences  in serving the disadvantaged, particularly those in remote rural areas of Nepal.

I will work together with the local community to help them address the health issues important to them.

I will study to the best of my ability and commit to continue learning and keep up to date for my entire medical career.

I pledge that I will at all times act with integrity, honesty and professionalism, dedicating my life to the service of others.

Oath  Part I

Oath Part II

Chocolit Schmoclit

My niece Angela died unexpectedly from a medical condition in 2010.  I was traveling here in Nepal at the time and was unable to make it home in time for her funeral.   Angela ran her own child care business in Canada and so while David and I were still in Nepal we decided a fitting way to honour her memory would be to provide the children at Sonrisa Orphanage with a day dedicated entirely to fun and play called Angela’s Afternoon.    We have been able to host one per year since then and we celebrated our fourth Angela’s Afternoon this past Monday.

Bishnu rented a van and piled the 15 children, two Aunties (Ganga and Januka), one Uncle (Bill), as well as Bibiana and myself and we drove for 45 minutes up to a hillside village called Godavari.   We spilled out and Bishnu distributed bags of bananas, two huge pots of cooked food (yes pots!!), roti’s, utensils, paper plates and plastic containers of water.  

Loaded down we started to climb..

and climb

It was hot sweaty work and after 2 short breaks and nearly 3 hours we arrived at an idyllic hilltop covered in pine trees whose shade was a welcome relief from the hot sun.   Lunch was sumptuous and healthy: a huge pot of cooked “masala” potatoes and another large pot of flavourful fried rice.  This came along with hard-boiled eggs directly from Sonrisa’s 47 chickens.   Bananas were our dessert!  I was astonished how much food a tiny, hungry well exercised Nepali child can consume in one sitting.

From our lunch spot we continued on and spent the next two hours hiking along a gorgeous ridge high above Kathmandu and the surrounding city sprawl.  The breeze was glorious and it was really comfortable walking in and out of trees and fern grottos.

So when I say hiking ….   I should qualify that hiking with boys and girls’ ranging in ages from 8 to 15 is an entirely different experience then the hiking I am used to.  This was more like a cross between hide and seek, volley ball and the 100 meter dash, with a little Bollywood dancing thrown in for good measure.  Every mound of dirt was climbed, every tree stump was stood upon, streams were jumped, leeches were discovered and flicked off ankles, flowers were gathered, bugs and worms were examined and all manner of wild fruit was picked and eaten.  The smallest children had only two speeds, full on running and stopping.  At one point I came around the bend to see the smallest boy Wonchu holding Bibiana’s hand while they both ran down the trail with joyous abandon calling out “kukur” the Nepali name for dog.

(photo credit: Bibiana Cujec)

Eventually however we descended the ridge and made our way, in the dying light of the afternoon, back to where the Van was picking us up.  

We all squeezed into the van and within 5 minutes ... .  

Life teaches you so much, should be open to learn.  My lesson on this Angela’s Afternoon involved chocolate.  As an extra treat I asked Bishnu to buy each of the children a chocolate bar to be distributed at the top of the long hard climb up.  We gathered together and Bishnu gave the bars of chocolate out.  While they were appreciated by the children, and I got a chorus of “thank you sister”,  I noticed that it wasn’t with the kind of excitement North American children might exhibit.  Bibiana and I talked later about it and concluded that for these children chocolate was nice but not necessary.  Time spent together with each other, with Bishnu, the Aunties and occasionally the visiting didis and dais are what is really valued.  Repeatedly throughout the day as I was walking on the trail or sitting on the grass a tiny hand would entwine with mine or one of the children would cuddle into my lap.   There was no requirement for conversation; it was simply sharing space and contact. 

(photo credit Bibana Cujec)

It made me think back to the times I saw my niece Angela cuddled with children.  Somehow children know what is important... so did Angela.

(wedding photo credit:  Miranda Clark)

The New Batch

A little over one and a half years ago David and I gave a welcoming address during orientation to the 2^nd batch of Medical Students at PAHS.  These are the same students that I am now back to teach.  In between they have completed their “pre medical” course, been out to the community slums in Kathmandu, and traveled to remote villages to take part in their first rural visits.  They have been accumulating some introductory clinical skills under the careful tutelage of their clinical preceptors.

I got to accompany a small group into the hospital as they learned how to use their stethoscopes and perform a cardiac exam. 

These stethoscopes were generously donated by Littman and brought to Nepal by the UBC medical students “Health Trek Nepal” who came here as volunteers this past summer.  Eight lovely cardiology stethoscopes were donated to the clinical skills program to be used by students that don’t own their own.

Earlier this week I gave a welcoming address to batch III PAHS students as they begin their own medical education journey.  

and the circle continues...

Teaching to give back

Children in the Sonrisa Orphanage in Nepal have all found a loving home and shelter under the care of Bishnu Rai and the Sonrisa didis and bhais.  While the orphanage has been the welcome recipient of generous donations from many friends in Nepal and abroad, Bishnu wants the children to understand the importance of giving to others less fortunate then themselves.  It was to this end that all 15 children arrived at the Social Welfare Centre Briddhashram, an Elders Hostel adjacent to Pashpatinath, the Hindu Cremation Site. 

For older Nepali’s without family support, this is where they spend their last years, supported by the charity of others.  While we were there a supply of curd and Biten Rice was delivered as a donation by Indian businessmen.  

The hostel was arranged as a single story of rooms that framed an inner courtyard, the centre of which was a stone platform graced by a centuries old Hindu shrine.   Residents of the hostel were clustered around the stone stairs of the shrine or in corners of the courtyard under whatever shade the trees had to offer.

Many of the didis’ were absorbed with the task of spinning bits of cotton into wicks that would be lit for morning pujas.  Old wrinkled hands crafting each wick with the efficiency that can only come with a lifetime of practice.

Most of the people we saw could get around on their own steam or with wooden canes. The reality was that many of these men and women were only 10 years older then me but the harshness of their existence led to deep lines in their faces and stiffness in their bodies, some bent at the waist from a lifetime of carrying heavy loads.

The Sonrisa children arranged themselves and their instruments (violins, drums, flutes) in front of the assembled gathering of elders.  

The music started and almost immediately the crowd was rapt with attention.  Bodies started swaying and hands clapping.  

Music has incredible power to evoke memories of earlier days when bodies were limber and graceful.  Soon the didis and dais were dancing with abandon, ignoring the piercing mid-day heat. 

In those fleeting moments you could see their younger flirtatious spirits.   With age comes a release from inhibitions and permission to express unbridled joy.    

There is so much to be learned from our elders.