The Best Laid Plans of Mice and Men Oft Go Awry

Wednesday March 30, 2011

1:08PM

I arrived back in Pheriche yesterday around lunch time after nearly 4 days on the opposite side of the mountains to the west. The plan was to hike down-valley to where two major rivers converge, set off up that particular drainage and return over a high mountain pass to the east which ultimately leads down to Pheriche. It was the same hike that Alun and Lauren just did and I was optimistic that I would have equally good weather. Plans did not turn out quite as anticipated.

Day 1: Pheriche to Macherma

After a quick Skype session with the wife and parents to let them know my plans I headed southeast into light winds and sunny skies. My plan was to descend through Somare and Pangboche to Phorche before heading up the opposite river valley to Dhole and Macherma, where our friends with IPPG have a medical outpost similar to our own. I had decided, based on my colleagues’ experience, to travel fast and light with waterproof shoes, a few extra layers, snacks, water and sleeping bag. I figured that with this setup I could make better time than they had assuring completion of the trek in the three allotted days. I let the family know my schedule and that I would be in contact when I got back to Pheriche. 

The first few hours of walking were pretty casual and the weather was warm and sunny. The trail gradually descends from Pheriche to Pangboche and allowed me to make good time without working too hard. From Pangboche to Phorche the way changes from a broad thoroughfare to a narrow path carved into a steep hillside. At times there were sections that had obviously washed out in the past and were now rocks and dirt supported by logs on wooden pegs. Not exactly North American construction standards but I figured it must hold up several tons of yak each day so surely it would hold me. Nonetheless, I tended to hug the cliff-line as much as possible where the ground looked a little more solid and a slip wouldn’t result in a tumble to the river channel 1000 feet below.

After reaching Phorche the trail descended sharply to the river where I crossed a bridge and started up the other side toward Dhole. This was harder work by far, but having descended a couple thousand feet thus far, I was well within my acclimatization range and felt surprisingly good going up. The trail on this side was a little more crowded and I passed around 2 dozen other trekkers on their way up. 

Upon reaching Dhole, I decided it was time for a break, as I had been at it for around 5 hours, was out of water and had eaten only a granola bar since breakfast. I refilled my bottles and sat down to a warm bowl of Sherpa stew and a small pot of hot lemon tea. While eating I inquired about the remainder of my journey to Macherma and was informed that it was another 3 hours walk. It felt like I had been walking pretty fast but I was going to have to pick up the pace a little if I was going to avoid finishing my hike in the dark. I resigned myself to the fact that this could no longer be a relaxing lunch break and scarfed down my food. 

The trail immediately ascended around 600 feet up and over a ridgeline to the north of the village. By the time I reached the top, my stomach was in a serious knot due to the exertion and preceding gorging. To make matters worse, it began to snow. Initially there were only small little pellets but this quickly transitioned to large fluffy flakes. The trail remained easily visible but the rate of snow fall and accompanying wind started to concern me a little bit. As I had just turned myself inside out getting up the hill, the idea of turning back didn’t appeal. So I proceeded onward with the thought that I could go back to Dhole if conditions deteriorated. Along the way I passed through another small village consisting of 2 houses and again told myself that I could return to this place if things got worse. A short while later the snow really started coming down and began to fill in the path, but navigation remained relatively easy as there was only two ways to go, forwards and backwards. Just when I thought that I might have to turn around and make for one of the houses I had passed, I pulled over a small rise and looked down into Macherma valley.

It was a relieving site to see the clinic at the top of the valley and I walked through the door just as they were finishing the afternoon altitude-illness lecture. I welcomed a cup of milk tea and visited with Laurie and Helen while warming up by the stove for a few minutes. They recommended the Namgyal Lodge in the village proper, so that is where I decided to call home for the night.

One of the great things about trekking in Nepal is that you don’t have to carry much equipment because you typically go from village to village where there is always a warm stove, bed (not usually warm), and good food waiting. The other nice aspect is that one can travel alone and usually find company with whom to share dinner and a few stories. 

At the Namgyal, I enjoyed my nightly dahl-baat with Christine, a retired elementary school teacher from Paris, and Karen, a high school physics teacher on a 6 month sabbatical from her job in Montreal. Our discussion mainly revolved around cultural differences between our respective countries. After the effort from the day, I retired early, but agreed to walk up to Gokyo the next day with my new companions.

Day 2: Macherma to Dragnac

Again the weather was warm and sunny, and in fact, was so nice that after breakfast at the lodge I enjoyed a cup of tea at the IPPG post wearing a T-shirt. After a slow morning, I hit the trail and quickly caught up with my companions from the previous night who had made friends with 4 French climbers from Chamonix. Our group of 3 had become 7 and the company was welcome, but the climbers’ English was about as good as my French so Karen was stuck translating as she was the only one of us fluent in both languages.

The hike was initially pretty easy but then reached steeper terrain along the margin of a large glacier. The trail ultimately flattened out and traversed the banks of a chain of 3 glacial lakes. Surprisingly we were greeted by the calls of creme colored ducks with bright orange heads swimming in the few partially melted areas of the lakes.

As usual the weather began to turn gray as we reached Gokyo and my hopes of climbing Gokyo Ri on the banks of the upper lake were dashed. Instead I decided to enjoy a last lunch with my new friends before doubling back and crossing the glacier to Dragnac. Unfortunately, the service was slow but my meal of vegetable egg fried potatoes topped with copious amounts of ketchup was worth the wait. 

Outside the weather was looking more ominous, so I wrapped things up and made way for the village on the opposite side of the glacier at the base of the next day’s effort, the Cho La Pass. Vincent, one of the climbers, had made the same trek 2 years ago and was kind enough to show me the way to the start of the path. Glaciers, however, are a very dynamic land form and the route that Vincent had taken 2 years ago, which was the route on my map, was no longer passable. It really barely existed. I spent 2 exhausting hours trudging through glacial till and hopping over unstable rocks trying to find my way across the barren landscape. Meanwhile the weather was not improving, so I decided that if I could not see my way to Dragnac by 4 PM I would return to Gokyo. 

I finally found what I thought was the right path, and it most likely was a few years ago, but I was turned around by a wide glacial stream that had washed away the trail. There was no choice but to return the way I came, which proved to be no easy task as cairns marking numerous paths went in almost every direction. Thoughts of spending the night on the glacier crossed my mind and I actually scoped out a few sheltered areas amongst the rocks that would make the night survivable, though highly uncomfortable. Once again, like the day before, a little good luck was on my side, because just as thick clouds rolled in reducing visibility to about 50 feet, I arrived at the large cairn marking the main trail to Gokyo. My friends were surprised to see me emerge from the developing snow storm, exhausted and a little frazzled. Over dinner, I discussed my route-finding difficulties with two guys from England who had come over from the other direction. They had been informed by a guide that the old route really no longer exists and that the new route has not appeared on maps as of yet. That would have been good to know.

Day 3: Gokyo to Dragnac or ?

I woke up in the middle of the night debating with myself on whether or not I should go to Dragnac the next day and then do the Cho La Pass the day after that or whether I should try to get over the pass to Zhungla or even all the way back to Pheriche. The latter, however, would be an enormously long day. Ultimately, I decided on trying to email the HRA and family back home to let them know that I would be delayed an extra day and then climbing Gokyo Ri before proceeding to Dragnac and on to the Cho La.

Again, all of my plans were forced to change as I woke up to 3 inches of fresh snow. Gokyo Ri was out of the question and the likelihood of getting over the Cho La in the next 2 days was unlikely, especially given my lightweight gear and lack of familiarity with the route. The only choice was to go back the way I came. I waited a couple of hours to let other groups pack down the path a little so that the snow wouldn’t continually spill over my low-top shoes.  I enjoyed a breakfast of pancakes smothered in honey along with some milk tea before hiking back down to Macherma in yet another driving snow storm. 

I arrived back at the IPPG post cold and with soaked feet. I think they must have felt sorry for me, because I was treated to one of the best lunches I have had in Nepal - grilled vegetable and cheese sandwiches. 

The snow continued to fall outside and was now blowing horizontally, so I was far from inspired to venture further down the trail. About the time I had conceded to staying in Macherma for another night, Christine, my Parisian friend, came through the door looking for a quick check of her oxygen saturations. She was going to continue on with her guide to Dhole, so I decided to go along. 

The trail was surprisingly easy to follow due to the deep ruts cut by Yak trains. A few areas were difficult where the ground was smooth and exposed to wind but still manageable. The pace of Christine’s group was frustratingly slow so I forged ahead with the thought of possibly continuing on to Phorche or Phorche Thanga. I stopped briefly at a lodge in Dhole to call the HRA so that they would know where I was and so that someone could email the family my whereabouts, but the cloud-cover prevented a decent signal. My plans of going on to Phorche came to a screeching halt when I rounded the first bend and started the descent out of Dhole where the snow had stopped but the trail was icy and the visibility minimal. 

I returned the long 20 feet to Dhole and stopped at the lodge belonging to a woman who I recognized from my flight to Lukkla several weeks ago. The lodge was a little on the cold side but still better than the post in Pheriche and the company was good. After an excellent dinner of tomato egg drop soup and fried potato momo’s, I spent the remainder of the evening playing strange Nepali card games with the lodge owners and a group of trekkers from Lithuania, Germany, and Argentina. 

Day 4: Dhole to Pheriche

Waking up and putting on damp, dirty clothes is never fun, but after a couple of days of gradually increasing sogginess it was tolerable. I said goodbye to the previous evening’s company and set out for the post. I had the thought of getting back in time for lunch, which was doable, but I also was feeling a bit beat down from the previous days so I wasn’t really interested in trying to go too quickly. I also hadn’t taken many pictures of the surrounding country in the previous days due to the horrendous weather so I definitely had to do a little photo-documentation along the way. 

Shortly after arriving in Phorche, the desire for a hot meal, hot shower, and a clean change of clothes took over and I turned up the pace significantly. I also noticed that I was going to be racing the weather yet again as the clouds were starting to build in the lower valley. 5 hours of nonstop hiking later, I pulled into the post just as the group was finishing lunch, but not too late to get my shower and 3 peanut butter on chipati sandwiches.

The previous days didn’t go nearly according to plan but they did have a few semi-epic moments and I’m happy to be back relatively intact. My feet are suffering from the numerous miles in soaking wet shoes and socks, but they should recover within a day or two. I’m not sure that the Himalayas are the place for fast and light, especially when you don’t have access to a weather report. Sometime next month I’ll have to make the trek across the Cho La but suspect I’ll just go directly up from here and then back rather than down and around the whole valley. 

Gone Hiking

After 3 days of, essentially, sitting around it's finally time to stretch the legs a little bit. Alun and Lauren got back from their hike over the Cho La Pass yesterday afternoon and were very enthusiastic about the route. After some Skype chat with the fam, a little milk tea and just a little time to let the sun warm things up above 20F outside I'll set off for Macherma. That should take me most of the day today and from there it will be up to Gokyo with a side venture up the Gokyo Ri tomorrow and from there back across the pass to Pheriche. Monday morning, east coast time, I should be back in communication with updates on the hike, some good pictures and, hopefully, a spirit ridded of cabin fever.

A Good Day

Thursday March 24, 2011

2:43PM

Although there are many hours left in this day I’m going to, perhaps prematurely, deem it the best to date here in Pheriche. Although nothing all that extraordinary has occurred since my last entry, there have definitely been a few more things to smile about and life is beginning to have more of a rhythm again.

I had initially planned to go for a run yesterday afternoon with the added benefit of returning to a tank full of hot shower water, but plans were quickly laid aside for more important matters. Just prior to closing time yesterday afternoon, as I was squeezing in one last page of my book, a faint jingling sound seemed to take presence in the back of my head. It was definitely getting louder so likely wasn’t some altitude produced auditory hallucination. I peered over the edge of the sunroom windows and was both surprised and disappointed by what I saw. Regardless, I knew that two men unloading a third from the back of small horse whose saddle and bridle was covered in no less than 50 small bells, very similar to those found on Christmas trees, meant that my afternoon run was shot. After spending the day couped up in the clinic and seeing a total of 2 patients, it was almost demoralizing to see this group pull up just as about to go inside and strap on my shoes. Being the only doctor within 2 days hike, I reminded myself of what I had signed up for, put a smile on, and headed for the inside. It was a good thing that I hadn’t left sooner, because this kid was sick. 

Like many other people in the region who depend on the trekking season for income, this teenager drives his yak train up and down the mountains carrying gear and supplies for expeditions and trekking groups. Even though he spends 6 months or so a year tromping up and down the mountains behind his yaks he lives at low elevation and this happened to be his first trip of the year, so he wasn’t yet acclimatized. In an effort to get one quick trip in to Everest Basecamp he had ascended something like 7 or 8 thousand feet in 24 hours. That may sound like a lot of vertical ascent, and it is, but what is deceptive about the trails here is that the elevation gain occurs over a relatively short distance, one that is easily accomplishable in 2 full days. 

My Accommodations

Needless to say, the outcome of such rapid ascent  was poor and resulted in the development of both Acute Mountain Sickness and, worse yet, High Altitude Pulmonary Edema, which is the most lethal form of altitude illness. He happened to stumble across a group of Iranian medical students and one intern who assessed him and correctly diagnosed him with AMS but failed to merge his low O2 sats, tachycardia, rapid breathing, pulmonary crackles and breathlessness into the much more serious diagnosis of HAPE. They gave him some lasix, which is unlikely to help much, but, fortunately, they did recognize the need to have him evacuated and being in Nepal a horse is as good as an ambulance.

Upon my initial evaluation he was falling asleep in the chair in the front office where his rescuers had dropped him but fortunately remained responsive. His heart rate was quite elevated in 130’s and his O2 sats were fairly dismal at 68% (normal here is 85-90). The treatment is pretty simple and involves a few anti-hypertensives for the HAPE, steroids and diuretics for the AMS and oxygen for all of the above. With a little extra oxygen his sats bounced up and I felt relieved but an hour later his lungs sounded worse, his sats dropped slightly and I started to think of how to get this guy further down the hill. Unfortunately, darkness was rapidly approaching, the clouds were thick and this kid was highly unlikely to have the funds to support any dramatic evacuation. Luck and likely youth were on our side, however and a few more meds, a quick prayer and another hour later he started to turn the corner and I knew we were in the clear. Govi and I took turns waking up to check on him and we made up the bed next to him for his friends to sleep in. At 7AM this morning we packed him back on the same bell-laden horse and sent him down to the next medical post in Kunde, probably a 10+ hour walk.

The Panorama keeps me connected

Following a little more confident after my first successful HAPE diagnosis and treatment the remainder of the day has been gravy. It was definitely a great way to start the day skyping with Charlotte and then there was the added treat of a skype call from the good Dr. Samuelson who was enjoying a night out with the Cochrans and the Moore/Walls. I was sorry that my first meeting of the youngest Cochran occurred via skype but I’ll take what I can get. I think I would already be suffering from major homesickness without, at least, email, but I think that skype is likely what will get me through 3 months up here with the majority of my sanity intact. 

To make things a little better I got out for my second run of the week at lunch time and felt some improvement over my last venture, which was hampered by the sensation of a bowling ball bouncing around in my stomach. I managed to make it a little further up the valley, but the minute the hill went from slightly up to slightly more up I was left completely breathless. I haven’t had problems with my asthma in years, but today returned thinking that I need to start taking a few puffs off the inhaler before my next run. I don’t know why I’m surprised. It’s not like I’ve ever tried to run at 14,000 feet before. 

The Aforementioned "Sunroom"

 It’s now a little after 3PM and no one showed up for the afternoon altitude sickness lecture. Maybe that’s because it’s cloudy or foggy, super cold, super windy and now snowing. In fact it’s snowing into the sunroom, which means I’m packing it in and retreating to the kitchen where the structure is a little more solid.

On a final note for the day - the book total is now 5. This one I particularly enjoyed. Growing a Farmer: How I Learned to Live Off the Land by Kurt Timmermeister details a man’s transition from successful restauranteur to small-time local farmer who raises vegetables, beef, pork, lamb, milk and predominantly cheese for both personal and local consumption. I kept envisioning this as being the way many places back home, like Smiling Hill, may have started. 

Back on My Feet

Wednesday March 23, 2011

8:32AM

This morning has started far better than most of the previous days. Health-wise, things seem to be functioning normally, which is uplifting from both a physical and emotional standpoint. Now it’s time to get out and explore the country a little more before the thick of the trekking season arrives and the clinic gets really busy. 

Yesterday, I got up early and made for the top of the ridge between Dengboche and Pheriche. On the way up I felt reasonably good and found myself approaching the summit after only about 2 hours of climbing. A little acclimatization must have occurred since my last jaunt up the hill, because I didn’t lose the rhythm of climbing and breathing at 16,000 ft as I did the other day. Instead, I maintained the 2 steps for each breath beyond my previous high-point. It occurred to me that my normal breathing rate while maintaining a good running pace at home is 4 steps per breath. The ratio has been gradually declining as we have gone higher, and at some point in the near future, I suspect will actually invert so that there are more breaths than steps. 

As I approached the boulder strewn summit, I anticipated a fantastic view down into the Kong Ma La pass below but instead was greeted by yet more ground to cover. Where I was standing was a false summit at ~16,700ft. The apex of the ridge I was ascending tapered down to a rock path about 3 feet wide that lead around a vertical walled cirque toward the summit of Pokalde. I briefly contemplated going onward, as my goal had been to reach the top, but seeing the thousand foot vertical drop on either side of the off-camber “sidewalk” quickly changed my mind. Had I actually spent some time looking at my topographic map I would have clearly seen the futility of my route choice.

Hiking back down, I passed ~40 people coming up the hill. Of course, they were all staying in Dengboche, but nonetheless I did some advertising for the HRA and our daily altitude illness lecture. Unfortunately, the most recent edition of the Lonely Planet Guide to Trekking in Nepal describes Pheriche as “a cold, windy, inhospitable place”, and apparently this is diverting many groups to the other side of the hill. My hope is that as more groups pass through either the lodges in Dengboche will fill up forcing people to come here or as the weather warms up people may ignore the guidebooks recommendation. I say I hope, because I passed more people on my hike yesterday than I have seen in Pheriche all week. Govi and the lodge owners don’t seem very concerned, so I’ll defer to experience. 

When I arrived back at the aid post one of “my” patients was waiting for me. I say she is mine because I don’t think anyone else wants to deal with her injury. She’s a 15 yo local who burned her right index and middle finger in a stove fire 3 days ago. She waited 24 hours to come see us and by that time the skin was bubbling and peeling. I was able to remove much of the damaged skin and fortunately found good tissue underneath indicating an injury that will likely heal with significant time and care. (For the medical folks - 2nd degree partial thickness). Now we’re on a schedule where she comes back every 48 hours for a dressing change and usually removal of a little more dead skin. I think the thick calluses on her hands saved the underlying tissue. This will be labor intensive on my part in a clinic with few supplies so it’s no wonder the others don’t seem too interested in dealing with it. The most difficult part of it all is getting her to stop working and to keep the dressings clean. These people are tough to say the least and not much short of death prevents them from attending to their daily labors. Deep inside I wish there was somewhere else to send her, maybe the tertiary burn center, since dealing with the long term care of significant burns isn’t really at the top of my skill set. The problem is that I am the burn center here, so I should probably look at my discomfort as a good motivator to learn.

Today Lauren and Alun are heading out to hike to Mocherma and around the Cho La Pass. It will take about three or four days and is supposed to be an excellent route with fantastic views of the high mountains. We have a group similar to our own working for the International Porter Protection Group in Mocherma, so we’ll be paying them a visit soon. After my colleagues return I’ll be setting off to do the same route and should get back just in time for the “Everest ER” team to arrive in Pheriche. I hear we throw down for a couple of nights with them before they proceed up-valley, but I can’t imagine getting too rowdy up here. 

Finally, my daily observation of Ang Rita: He appears to enjoy the bluegrass mixes I play on the computer while blogging or typing emails. He seems to particularly enjoy Dolly Parton which has him dancing around the kitchen, humming the tune 4 seconds behind the actual song all while eating soup from the pot in which he cooked it. 

1 Week Down

Monday March 21, 2011

4:51PM

Really, not a lot to report for the last 48 hours, although yesterday was interesting. We had enough sunshine to warm up the water tank, and I started to get the idea of a shower in my head. With the recent weather patterns leaving us with limited hot water, you really have to jump at the opportunity to bathe unless you just like submersing yourself in direct snow melt. Ang Rita had been here the least amount of time and so hadn’t gotten his shower turn yet, so I deferred to him figuring there would be enough for two if not three showers. After what seemed like an exorbitant amount of time, I poked my head in to the bathroom and found a clean and, luckily, clothed sherpa smiling and laughing his trademark cackle through the thick the steam while stirring his dirty laundry in the bottom of the shower with a mop handle. He seemed to have had so much fun it was hard to be angry when we discovered that he had used up not only all of the hot water but also all of the cold water as well. Oh well, have to be dirty for another day. The event got me thinking about some of the other odd behaviors I’ve noticed in our clinic caretaker but I’m still trying to decide whether they are due to cultural differences or just wierdness. I’ll have to save my analyses for the current time as I think I need to gain more insight, but at some point expect some elaboration on the personality of Ang Rita.

Whatever is going on in my stomach seems to be settling out, although I still am not entirely sure why, as nothing has really changed. My suspicion is that it is likely the rapid dietary change from my usual fruit, veggies, etc to the strict rice, pasta, potatoes menu here in high Nepal. I’m going to see if there is some altitude-related explanation, but I’m not aware of such from my previous studies.

Unfortunately, Alun has passed along his cold to Lauren and I, and we’ve been rapidly depleting the stores of tissue in the aid post. Hydration is really difficult when the air is this dry and your nose won’t quit running, so my water bottle has been even more attached to my hip than it is normally. I was finally able to have a successful Skype session with Mom and Dad this morning, and if I recall correctly, Mom’s comment was something like “You look bad.” Thanks. 

Despite the constant stream from my eyes and nose, today was the previously determined date for getting back on a running schedule. We’ve been here a week and upping the level of exertion really shouldn’t put us at much risk for developing altitude illness, at least if we stay near this elevation. Lauren was feeling pretty bad so she took a nap and Alun had already made arrangements to go hiking, so I was left manning the clinic solo for the morning. After the rush of 3 patients just before lunch, during which time I realized that we have only used ECG stickers that no longer stick to anything, I was finally able to go out for a little exercise. 

The day was nice and warm, 45 or so outside and 34 inside, with a little breeze that was helpful in running up-valley and not too much hinderance when coming back down. The dusting of snow we received overnight was long since melted off and it was easy to to follow the trail due to the deep ruts cut from the yak trains. I ran up to the next village and felt like I was working really hard to keep a pace slightly better than Parkinsonian. The way back down was much easier, even though the angle of the valley is hardly steep. It took a solid 15 minutes to fully catch my breath once I got back to the post, and after consulting my map it appears that I covered a whopping 2-3 km. I double checked the time on my watch and realized that I could probably walk that fast at sea level. We’ve been questioning the accuracy of the local maps, but I suspect that if I really want to quit deflating the ego I should probably stick to running downhill or, worse yet, just not running at all. 

Even with all of this activity, I still managed to complete book #4 for the week, and at this rate will read every book in the village by April. Tomorrow morning I’m planning to hike up to the top of the ridge to our east, the summit of which I have not been able to reach yet. From camp it doesn’t look all that high or far, but yesterday I turned around at 16,000 ft, 1800 higher than Pheriche, and still had a significant height to gain.

Slow First Week

Saturday March 19, 2011

12:47PM

Ugh....There’s really no other way to describe the way I have felt for the past few days. It started with abdominal pain in the middle of the night on the 15th and persisted throughout the next day. I wish there were symptoms consistent with a bacterial infection because, at least, that would be treatable. Feeling generally uncomfortable for most of the day is really unpleasant, especially when you add in being cold and dirty. I thought things were looking up this morning for a few hours, but as soon as I ate, it was back to square one. That seems to be the pattern that has developed. All in all, I haven’t really eaten much and am pretty sure I have lost a few pounds in the past 5 days. There has been a small amount of improvement and I’m sure things will declare themselves for better or worse in the next day or two.

Looking down on the clouds before
they swallow Pheriche

Mornings do seem to go ok and I was able to go out for a short walk yesterday. I got up early and hiked up the ridge behind the post that separates Pheriche and Dingboche. I didn’t think it went all that far, but after an hour plus of going up hill I was at over 15500ft and wasn’t even at the top. The clouds started to blow in, as they have everyday, and the temperatures subsequently dropped so I headed back down to the clinic. Along the way I passed 20 or so trekkers coming up the hill from Dingboche where it is apparently less windy and cold.

With the exception of the walk, none of us have strayed far from the clinic. We’re really a pretty pathetic lot as each of us is suffering from some ailment. Lauren has a GI bug; I have some sort of GI illness; and Alun has a GI bug and a cold. We spend most of the day moving from room to room looking for the warmest spot while reading books or playing the occasional card game. We started the Planet Earth series last night and episode 1 was a definite high spot for the week aside from the 2 hour period of sun that thawed out the pipes long enough for a quick shower. As you can imagine when a patient does show up they are practically assaulted by all three of us at the same time.

See Charlotte, I do know how

There have been a total of 12 patients in the past 4 days and really only one was sick. He was a trekker from Australia who needed us as he was suffering from pretty severe altitude sickness. By this morning he was good as new and left on his own two feet headed down-valley to Namche. The rest have been locals who have obviously been waiting since December for the doctor to arrive to discuss their fussy child, rash or cough. 3 of the 12 have been family members of our clinic manager, Ang Rita. 

Business will, no doubt, pick up at some point, but until then it’s work to keep occupied. Charlotte would be amazed to see how clean and organized my room is. I have swept it three times and reorganized it twice. I’ve also read 3 non-medical texts in the last week which doubles my total for 2011 and probably for the last 6-7 years as well. Today was laundry day and we did it all by hand, as the lodge that supposedly has a washing machine hasn’t yet opened for the season. Currently, it’s all hanging on the line outside enshrouded in icy clouds. It won’t get dry today but maybe the Himalayan fog will get it a little cleaner. Once we get over our respective illnesses, I suspect we’ll start dividing up the clinic time so cabin fever doesn’t set in. I’m looking forward to being able to explore the area a little more.

Home Sweet Home....Sort of, and Another Year Gone By

Tuesday March 15, 2011

3:01PM

So...32. Today is, indeed, my birthday, and I have to say that it is, at least, the most unique birthday I can recall. We made it into Pheriche from Tangboche yesterday and have set up residence at approximately 14, 137 ft depending on which map or altimeter you believe. After several hours of sweeping, dusting, unpacking and reorganizing we enjoyed a delicious dinner of dahl-baat courtesy of our in-house chefs, Ang Rita and Jeet. I was happy to find most everything intact with the exception of my sunscreen which I know I left on my bedside table in Tangboche and more disappointingly my favorite running tights, which I thought I had packed in the yak-transported bag.

During the night the winds really picked up, to the point I honestly thought that the roof might require repair this morning. Between the constant rattling of the tin roof, shaking of the windows, constant whumping of the windmill outside and the wind literally whipping through my room it was an endurable but restless night from 3AM onward. Today the wind has continued and has recoated everything we cleaned yesterday with a fresh layer of dust and dirt. Those things that were clean upon arrival were also quickly browned by the constantly blowing sediment. 

Probably the thing with which we are most disappointed is the water or lack thereof. There is a decent plumbing system with running water and a solar heated shower, but we arrived to find multiple pipes broken and those not broken, frozen solid - frustrating to our group who passed up paying for a hot shower yesterday after 6 days of hiking in the same clothes. It appears, however, that the heating system is working, since we can see steam coming out of the pop-off valve on the roof-top tank attached to the solar panels. The good news is Govi, our clinic manager/translator, has contacted the plumber. The bad news is the plumber comes from Kathmandu and must repeat the 6 day trek we just made. When I asked Ang Rita which lodge in town might have a hot shower he said to just wait for the plumber. I hope he just didn’t understand what I was asking. Besides the shower issue, using an outhouse at 4AM when it’s 15 degrees and 50mph winds is a major bummer.

So for now, it’s more cleaning as soon as the wind dies down and tomorrow we will officially open for business. It’s probably ok that I don’t have my tights right now because I can’t stand up without getting short of breath. Hopefully, that will improve over the next few days/weeks as acclimatization progresses. I feel sure one of the lodges has to have a beer, although cold beverages don’t really appeal when it’s below freezing inside. Despite all of this, when you look around at the scenery it doesn’t seem too bad.......at least for now. Am I just getting soft? Here’s hoping 32 yr and 1 day is a slight improvement over today. 

Namche Day #2

Saturday March 12, 2011

3:25PM

I awoke to the sound of beating drums and chanting this morning at 6AM. Maybe it wasn’t the most convenient time, but I have certainly heard far more unpleasant alarm clocks. The biggest problem getting out of bed wasn’t the time of day but rather the 34 degrees my thermometer read in my room. After a generous breakfast of oat porridge, sauteed potatoes, a fried egg, mango juice, tea and two fried tibetan bread cakes with honey we managed to plod our way up the remaining hill behind Namche toward Khumjung. Along the way we passed a half dozen or so Japanese tourists who all had matching jackets and pants and covered themselves nearly completely from head to toe.

The view from the top of the ridge was amazing, to say the least, as Everest, Lhotse, Peak 36 and Ama Dablam were all clearly visible. We got an Aussie trekker to take a picture of us with the giants in the background. Then it was down a slippery, mud and snow covered path to Khumjung for lunch.

The hot lemon tea and fried momo’s (a lentil, carrot, potato filled egg roll) weren’t the best I’ve had but certainly did the job. I tried to take a picture of some children playing but they promptly looked up at me and yelled “NO PHOTO”. Among some groups in the Himalaya there is still some belief that taking a photo removes some amount of life from the subject.

From Khunjung we hiked up the valley a short distance to Kunde and paid a visit to the Kunde Hospital. This is our referral center for our Aid Post in Pheriche, unless the patient just needs to be evacuated to Kathmandu by helicopter. Scary to think that I may be referring patients to a 12 bed hospital with outdoor plumbing.

The 2000ft descent back to Namche was a little hard on the knees but far easier on the lungs than the way up. I suspect we’ll spend the remainder of the afternoon and evening drinking tea and eating some variation of lentils and potatoes. 

Finally to Lukkla

Friday March 11, 2011

3:01PM

Our prayers came true and we awoke to clear, calm skies which allowed us to finally make the flight to Lukkla. After a relatively short wait in comparison to the previous two days we boarded flight 601, which turned out to be a small, 2 engine turboprop plane that seated about 15 people. Ear plugs were handed out at the door and it quickly became apparent why, as the engines were super loud. I was seated next to the emergency exit door and noticed a draft. After ruling out the normal ventilation fans, my attention turned to the door which had a small amount of daylight peeking around the edges in a few places. 

The scenery outside steadily improved though-out the duration of the flight and by the time we had landed became outright breathtaking. My altimeter read just over 11,000ft, and since the cabin was obviously not pressurized, I suspect that this was reasonably accurate. As we crested ridge after ridge the terraced farms below gave way to rougher terrain and, ultimately, the mountains around us rose above our flying altitude. There was a brief view of Mt. Everest with it’s near constant plume of snow blowing off the summit before we rounded one last bend in the canyon. We crossed the final ridge before dropping down into Lukkla, and our clearance couldn’t have been more than 100ft as I could clearly make out crows sitting in the trees just below the plane. 

Immediately after the ridge the pilots hands went to the controls and we took a rather steep dive down the other side. Rather steep may not be the right description because the plane made the same high pitched sound I associate with Kamikaze dive bombers in the movies. Fortunately for us,  all went well and the pilot guided us in to the 12 degree runway, slammed on the breaks and safely parked us next to the airport to a hardy round of applause from all passengers on board. After this experience, I completely understood why the previous flight of the past 2 days had been canceled due to “ugly air”. 

Following a quick breakfast of Tibetan bread, honey and Nepali tea, we met our porters, 2 young guys probably around 16 years old, and headed up the valley steadily following the river. It’s hard to describe the terrain here. Sublime is a word that comes to mind. The river below is crystal clear blue and peaks  around us rise steeply for thousands of feet. Off in the distance larger peaks glow brightly as the sun reflects off their snowcapped summits. These mountains are far and away bigger than anything I have ever seen before and the ones that are visible are really only in the 6000m range. (For reference, Mt. Everest is 8800 meters.) 

Initially, I didn’t notice any ill effects of the rapid rise in elevation, but it became apparent once I started walking uphill. We started the day on relatively flat ground and then actually descended about a thousand feet or so over a couple of miles. I felt great....until we started heading back up the thousand feet we lost to our stopover in Monjo. Going up hill didn’t feel bad. There was just a noticeable increase in my normal exertional work of breathing as we steadily rose up and away from the river. 

When trekking in Nepal, you really don’t have to carry much of anything, which makes the going much easier. It’s well accepted to hire a porter in Lukkla to carry your bags as you walk from one village to the next. In fact the local people are somewhat disapproving of “rich” westerners who do not provide employment to a porter during the trek. Accommodations can be found in tea houses at very regular intervals negating the need for a tent on most circuits. The result for most is a relaxed pace, a light load, and an enjoyable trip. 

Along the way, trekkers share the trail with other trekkers and their guides, local people, yak trains transporting a variety of goods, as well as porters who carry both luggage as well as goods for the villages up-valley. The porters range in age as much as the loads they carry. The youngest I have seen was probably around 12 and carried a relatively small load in a wicker basket, while the oldest looked ancient and also carried a smaller amount. A full-size, able-bodied porter often carries an enormous load that must far exceed his own body-weight. Most of the loads consist of commodities but there is not necessarily a pattern. I saw one porter who carried 2 cases of whiskey, 200 rolls of toilet paper and a DVD player. The strangest consisted of several cases of commodities, which is standard, but on top rode 6 live chickens in a wicker cage. Whiskey here flows uphill as there is almost always at least one case of beer or whiskey on their backs. Despite their back-breaking loads they advance slowly but steadily up the trail, taking frequent breaks. To aid in taking a load off they carry a short staff with a flat top on which they can rest the package. All porters bare the weight via a tumpline, a strap which goes up and over the top the head spreading the weight over the entire axial spine.

I was happy to not be a porter today as the trail rose around 3000 vertical feet from Monjo to Namche where we will spend today and tomorrow acclimating to our rapid ascent. Unfortunately, I have been reluctant to allow the porters to carry all of my things (laptop, research stuff, etc) and so am carrying significantly more than my colleagues. During the climb I, more than once, contemplated the environmental impact of littering the trail-side with several hundred doses of metoclopramide and ibuprofen as well as the corresponding consent forms.  To improve the situation I spent much of the 3 hour work-out on nature’s own stair-stepper machine staring at the back-end of a slow moving yak train, a view considerably less desirable than the previous day’s endless scenics. 

I now find myself in Namche Bazaar, which lies carved into the edge of a steep hillside at around 11,200ft. We’re staying the next two nights here at the Panorama Lodge which lies at the near the top of the town. I am currently sitting in a large dining room with richly stained hardwood floors and tables, and the shelves are full of Tibetan styled brass and copper pots. In the corner a TV is showing Bangladesh vs. England in the Cricket World Cup. This is a far cry from the rustic huts I was expecting, however despite the seemingly luxurious appearance, there is still very little heat and all water must be either boiled or chemically sterilized. In fact I’m going to stop writing, because my fingers are getting cold and numb.

Tomorrow, we’re going to hike up to Kunde and, hopefully, find some boulders to play on along the way. Then it’s on to Tangboche and the day after, Pheriche.

Stuck Another Day

Wednesday March 9, 2011

4:22PM

There isn’t really a lot to report today in terms  of events, aside from another 5 hours in the airport, only to have our flight canceled due to “ugly air” in Lukkla. Really, I would prefer ideal flying conditions, because my understanding of the Lukkla airport is that it is comprised of one runway  about 200 meters in length perched somewhat precariously between the higher mountains surrounding the village. We’ll be traveling in a 4 engine turboprop plane that is only able to stop or take off on the short runway due to the strip’s 12 degrees of slope. Sounds interesting. Maybe tomorrow will be our day.

After collecting our bags we headed back to the Marshyangdi riding with one of the more aggressive taxi-van drivers I have encountered. It seems that traffic rules in Nepal are few and the largest car on the road has the right of way. This guy definitely used the slightly larger size of his vehicle to intimidate motorcyclists and smaller cars when he pulled into the right-hand lane for most the trip. The scary part for us is that traffic here drives on the left. He also wasn’t afraid to barrel down small one-lane alleyways, one hand constantly on the horn, scattering pedestrians, BND’s and chickens. 

The vans that transport groups of people or larger quantities of baggage are similar to but smaller than the old 1980’s Toyota (Nissan?) Windowvan, and are about the middle of the traffic pecking order. I would estimate that 50% of the vehicles on the road are motorcycles followed by tiny 5 passenger Fiat Pandas or Suzuki somethings. A very small proportion are full-size trucks, cars or SUVs. Most of the taxis fall into the Fiat/Suzuki category. The remainder of the roadways are occupied by pedestrians, bicycles, rickshaws, tuk-tuks, buses, and on occasion sheep or cows. 

Traffic Light

It is humorous to see 4 Westerners pile into the tiny taxis with their baggage, because the cars are so small that my head touches the roof of the vehicle while sitting upright. This has resulted in two good-size lumps on the top of my head when I failed to notice an upcoming pothole or speed bump and duck accordingly. The important thing is that they are maneuverable, because traffic flow consists of a continual race from one bottleneck to the next. Communication between drivers is a combination of the rare turn signal, more frequent hand signal and nearly constant blowing of the horn. Amazingly, I have neither witnessed nor been involved in an accident, but I have seen very few vehicles without some sign of previous damage. My suspicion is that minor accidents are common, and the likely outcome is a brief inspection of the vehicles by their respective drivers before continuing onward if still mobile. I also suspect that significant injuries are not common as it is rare to break 20 mph. 

As I previously mentioned, horns are the primary method of communication on the road and some drivers honk incessantly for no apparent reason while others only at times of necessity. Most of the time it seems to be a declaration of position, as if to say, “Hey, I’m right here and this is my piece of pavement.” Like the taxi drivers who use them, the horns themselves have some degree of individuality as well. Most are a high-pitch, nasal honk and there is similarity between the scooter, mopeds and small taxis. Others are slightly more robust but nothing that approaches the full-bodied tone of my Tahoe back home. The ones I can’t stop chuckling over take the high pitched nasal sound and turn it into a two- toned “diddily-diddily, diddily-diddily”. It seems to me that a truly effective means of getting other driver’s attention and clearing the road would be to install a deeply bellowing fog horn. I can’t imagine that no one else has thought of this, so they must not be available here.

It’s raining here now and as you can probably tell, I’m starting to get a little stir crazy over the lack of activity in the past few days. My thoughts on traffic patterns, taxis, drivers and horns may not be terribly exciting or even interesting but it does give one an idea of daily life here in Kathmandu. If we don’t have any activity tomorrow, I may have to resort to discussing local religion or economics, so pray for clear skies and low winds in Lukkla tomorrow!

Stuck in Kathmandu

Tuesday March 8, 2011

8:02PM

The last few days really haven’t been all that eventful and, consequently, my journal entries sparse. We have, essentially, spent the last 2 days packing and attending meetings to go over the logistics and in particular the finances of making the clinic operate. 

Today was our originally scheduled day of departure, but after spending 6 hours in the airport watching Japanese tourists wearing matching pink jackets and hats take pictures of each other with the airport staff the airport, our flight was, finally, officially cancelled due to cloudy weather in Lukkla. Our clinic manager told us that this is not an uncommon occurrence, and in the fall, it took the group 6 days of waiting for the weather to clear before flights resumed. As much as I like it here, I would prefer to not hang out in Kathmandu for another 5 days.

In an effort to get out of Thamel and away from the majority of the tourists, my colleagues, Allun and Lauren, and I decided to spend the remainder of the day in Patan, another district of Kathmandu on the opposite side of town. There we hired a guide, Junga, who toured us through the old city and gave us quite a bit of additional history on the area as well as explanations of the Hindu and Buddhist relics there. When I refer to it as being old, I mean like 16th century old. Along the way we were witnesses to a traditional Hindu wedding and met the 10 year old high priest of the active Buddhist temple. 

The wedding was quite an elaborate affair in comparison to western unions within the Christian faith. All of the women including the bride are dressed in brightly colored sari’s adorned with gold embroidery. The actual ceremony was taking place across a large courtyard and we could not hear anything being said. After a period of time, during which I presume the marriage was being blessed, a band consisting of several drummers and a variety of horns would start playing and the bride would be paraded around the temple. Then it was back to the original spot for more blessings before a repeat parade.

After wandering amongst the temples, we, ultimately, finished in the shop of a Thanka artist and teacher. Thanka is a Nepali art-form that consists of oil or acrylic paintings depicting some aspect of Buddhism that is usually then sewn into a silk tapestry. We were able to watch the master artist practice his craft for several minutes, which required painstakingly meticulous work. He told us that it typically requires 10-12 days of continuous work to produce one scroll. I decided that this would be a great wall decoration back home, although without the accompanying 5 foot tapestry,  and so purchased a painting depicting the Eyes of Buddha surrounded by a Buddhist mantra - Ohm, ma, ni, pad, me, hum. 

After leaving the artist’s parlor, we grabbed a little Indian curry and lemon tea, and now it’s back to the hotel for bed. Tomorrow is another early day and one that will, hopefully, lead us into the mountains. After a 45 minute flight to Lukkla, we’ll be traveling on foot for 4-5 days to the outpost in Pheriche. Our gear is going up in front of us by yak. Along the way we’ll likely spend 1-2 nights in Namche Bazaar at around 11,000-12,000 feet acclimatizing, so I’ll try to send another update then.

Well, I Found Thick Air

Saturday March 5, 2011

4:23PM

Saturday - the national holiday in Nepal. What better way to start out a holiday than with an early morning run up to the top of the monkey temple? At least, that’s what I thought, until I ventured outside and was nearly choked to death by the nearly tangible smog just down the street from the hotel. I know I’ve complained about the poor air quality before, but today really stood out as being by far the worst to date. Within half a mile or so it actually started to hurt to breathe. The main difference in today’s air was the presence of a high concentration of thick, acrid, nostril-singeing, lung burning, black-snot producing foulness - burning trash. It’s, unfortunately, a fairly common source of heat and cooking power amongst the poor here and you periodically catch strong whiffs of the stuff depending on the direction and strength of the wind. It just seemed like every shanty had a small fire burning as I crossed the river heading toward the temple. I can’t really say exactly why, because it was a pretty warm morning in comparison to the previous week. 

Once I left the river behind, the air cleared just in time to cough a bit, sort-of catch my breath and start up the however-many hundred stairs to the top. As I approached the base, I noticed someone else, a local, starting up the stairs for exercise as well. I was expecting him to speed up and out of site momentarily, but within a couple of minutes, I actually caught and passed the guy. Obviously not a sherpa, because if he had been he would have effortlessly levitated up the stairs while carrying an absurd amount of weight and smoking a cigarette simultaneously. Instead he looked like any 40-something jogger you might encounter at home, dressed in a 90’s style dark blue sweatsuit, the kind with matching tops and bottoms.

Just as on previous mornings I was turned around by the toll collector at the top. The locals get in for free but those not going to worship must pay. There’s just no blending with the local population when you’re wearing a gold hat, bright blue shorts and green shoes. Then it was back down through the asphyxiating haze to a shower and breakfast.

This afternoon a few of us got out of town a bit to the Nagigumba temple within Shivapuri Nagarjun National Park, which provided a bit of a respite from the exhaust, crowds and honking. We hired two taxis to drive the six of us to the park entrance, around 20-30 minutes away. After an hour or so of hiking up to the temple one got a great view of the Kathmandu valley and the surrounding hills. Upon our arrival I checked my altimeter and we were at a little over 6000 feet of elevation, higher than anything on the east coast with the exception of Mt. Washington and Mt. Mitchell.  As it turned out we were only slightly more than half way up the trail which lead another 6 km and 4000 feet to the top. It’s rather humbling to think of something this big as being the “hill” outside of town.

The temple is carved into a series of terraces on the side of the hill and houses Buddhist nuns. I, honestly, wasn’t aware that nuns existed in the Buddhist faith, but we met two. They wear the same shin length, blood-red and gold robes as the men and they also shave their heads just as the monks do. Our hosts were kind enough to provide our thirsty and hungry group with a plate of home-made pretzl-like snacks, two bags of chips and a large thermos of milk tea for the whopping donation of $1.75. While enjoyed our unplanned picnic on the lawn in front of the nunnery, the house BND (Basic Nepali Dog) quickly befriended us upon noticing our readily accessible snacks. She was, however, surprisingly well-mannered and gladly accepted a couple of fallen chips in exchange for her good behavior. Our new companion then escorted us all the way back down to the park gates before loping off back up the hill to her home.

On another note, I finally got the picture thing figured out. It's just a painfully slow direct upload, so may not be able to add too many :(

Temples and Trouble in Paradise

Friday March 4, 2011

8:53AM

For the last 48 hours, I have totally fallen off the horse in terms of keeping the blog/journal updated. Yesterday, instead of writing, I decided to try to upload photos into the blog. One hour, 14 error messages and multiple internet connections lost later, 3 photos made it into picassa. Not exactly the volume of material I was hoping to use to give some visual appeal to the blog. I have this mental picture of small Nepalese squirrels or maybe even BND’s (Basic Nepali Dogs), jogging along in a little hamster wheel which is connected to a generator that powers the internet. Every now and then they must get tired and hence the internet goes down. The power really isn’t much better and there doesn’t seem to be any connection between the power and internet services. I just know that if the power is on when I wake up at 1AM to the cooing of 100 pigeons outside my window, the computer, phone and camera better all get plugged in quick, and I might as well fire off some emails while I can.

On the day of my last entry there was a festival to honor the Hindu goddess Shiva. Being naive tourists, we, of course, decided to visit the monkey temples on the edge of town. The walk lasted about an hour and was capped with several hundred steps leading to the temple on top of a large hill. The last few were bordering on vertical, yet there was no shortage of frail appearing pilgrims at the top. Needless to say that on a religious holiday, a place of worship might be slightly crowded, and, as is the custom here in Nepal, where there are people there are always a slew of trinket salesman hocking their wares.

The temple, known to its pilgrims as Swoyambhunath or sublime trees, is a combined place of worship for those of both Buddhist and Hindu faiths, and Nepal is one of the few places in the world where these two religions intermingle in worship. In the middle part there were monks chanting amidst a drum circle and on an opposite side shrines of multi-armed gods and goddesses were plastered with flowers and fruit. In the center of it all was a large spire on top of a bulbous base with large blue eyes painted on the sides - the eyes of Buddha. 

The chants were quite fascinating and if one sat there long enough you almost felt yourself falling into a sort of trance. Obviously, I had no idea what they were saying but there was a definite flowing rhythm that escalated as the chant progressed. Rhythm was kept with a large bass drum. When the rhythm reached its height a high pitched bell was rung and then two 6 foot long horns droned a long cord. The cycle then started off slowly again.

Most people here seemed to be like us, however, just taking in the sites and happy to be above the noise and smog of the city below. After walking around for an hour or so we found a back portion of the temple site where there were scattered statues and then, finally, a road - the way all those people who looked like they could barely walk had made the journey up the hill.

Returning to the city proved to be an interesting process as we missed a turn and ended up in the heart of the festival. The streets were crowded to the point that it was difficult to make headway, especially when you’re not sure of the proper direction. A few hours of wandering and one policeman’s vague directions lead us back to the Marshyangdi.

The next morning I planned to go for another run and what better idea than to head back to the temple. Running up the stairs proved to be slightly more difficult than my ascension the day before. The crowds, however, were much easier to negotiate. I made a point to return the same way I went out so as not to repeat the previous afternoon’s misadventure.

The remainder of the day proved to be somewhat frustrating, the details of which I will spare any reader here. Essentially, things like research project proposals aren’t really top priority, even though there is an entire office whose sole purpose is to review such documents. When I arrived for my “meeting” two women dug my file out of a cabinet and proceeded to look through it for what appeared to be the first time. They then wanted to collect the $100 USD application fee in Nepali Rupees at a higher exchange rate than anywhere in town. Too bad I had brought USD as per the instructions, and too bad the bank closes at 3PM. After looking through my file it was decided that several parts would have to be translated into Nepali. I could go on but I have already vented about this interaction several times and reliving it is becoming rather painful. The bottom line is that in order to not lose 6 months of work which is the main reason I am here, I need to find a Nepali translator, reliable internet connection, and computer with a Nepali alphabet and bring them all together sometime in the next 3 days. No sweat right? With any luck, I’ll get all that done and between the hours of 10 and 3, as that is the standard work day here.

Last night we met up with another group of physicians working with the International Porter Protection Group, an organization of similar aims as the HRA. One of their group has been here on several previous occasions and knows the area well. She lead us to modest but clean establishment down a back alley that serves fine local fare at very reasonable prices. My dinner consisted of a healthy portion of dhal-bat (rice and lentils), a plate full of mo-mo’s(veggie or meat filled dumplings) and a pot of lemon tea, all for the incredibly reasonable price of 200 Rupees ($2.50). Most of the group went home but a few of us decided to have a night cap at a more touristy bar, raising my dinner total to around $5. 

Another restless night due to some generator alarm going off all night preceded more bad news on the research front this morning. At this point, whatever... I think we’re all ready to head out of Kathmandu. I just need to tie up a few loose ends before we leave civilization behind. 

First Few Days

Nepal 2011

Sunday February 27, 2011

3:17 AM

What time is it? Apparently, it’s 8:19 here, but to me it feels like a bad call night. Trip over was relatively uneventful with the exception of an 11 yr old boy with a headache. Luckily, there were two MGH physicians on board. Unluckily, there was no otoscope to take a look in his ear that seemed to hurt.  Airlines seem to put more of an emphasis on ACLS meds than evaluation and treatment of pediatric otitis. Alas, I think he’ll live. Both the family and crew seemed very appreciative of our help, and when I woke up from one of my very short naps there was a bottle of Robert Johnson Chardonnay at my feet. Not being much of a white wine drinker I passed it along to the passenger next to me, who seemed pleased with the good fortune. 

There was a beautiful sunrise over the UK as we pulled into Heathrow.  The airport here is enormous. There is a large duty-free mall in the terminal that would get Charlotte pretty excited, and, So far, the only picture I have taken is of the Jimmy Choo storefront to show her. 1 leg down, 2 to go. 

8:06 PM

Ok, I’m switching over to local time here in Bahrain. I think the bad call night analogy was appropriate but my general ill feeling has progressed to a level more reminiscent of a mild hangover. I’m definitely dehydrated and a little hungry but my system is seriously out of whack right now. The flight here was fine - far from a full flight so I could actually stretch out a little bit. This allowed for sleeping the majority of the flight with the exception of the pasta dinner that was served at 9:00AM local time and 4AM my time. Didn’t really feel right but probably would have had a beer been served with it. 

Charlotte and I just attempted our first international Skype call. Apparently the internet here is a bit slow because there was a serious delay during our conversation and I couldn’t see her face for the majority. I hope this isn’t a harbinger for future Skype difficulty. I really have my hopes up for using to communicate. 

Leaving this AM was seriously difficult. Much more so , than I had originally anticipated. Our good-bye on the sidewalk outside of Logan was so brief and sudden. It’s probably for the best, because any longer and I think it would have been harder to leave. I’m getting more soft and emotional in my old age. 

Bahrain is an interesting place. Maybe it’s because I’m in the airport and there is much more cultural mixing here, but this place feels very westernized. I’ve been sitting in a Costa Coffee Co. for the last few minutes where I ate some sort of hard cheese/tamponade sandwich and have been listening to US Top 40 music. Seems strange in comparison to the women next to me jamming away in Arabic and wearing burkas. 

Monday Feb 28, 2011

12:10  AM 

After feeling pretty good for a while after my cheese sandwich, I’m feeling rough again. I bought a delicious chocolate brownie (tasted like Toblerone in a slightly more cake-like format) just so I could  get a bottle of water with it. The dessert just hasn’t picked me up the way I had hoped. The exchange rate here is pretty poor but prices don’t seem too far off from the standard airport gouging in the states. 

Also contributing to my ever worsening travel hangover is the difficulty I’m having changing my return flight. The closest yet came here just a little while ago. With the help of Farah, the local arabic gate administrator, who likes my first name (William),  I found out that it will only cost $600 to vacate Nepal 7 days earlier than originally intended. Farah did go far out of her way to assist me despite the hoards of people from Malaysia, who were arriving to find that they had missed their connection and wouldn’t have another one until tomorrow. Her bright white smile and fingers dripping with diamonds  reminded of the wealth that I suspect is pretty common around here. 

Just another hour and a half to go ‘til boarding for Kathmandu....  Never mind.....flight delayed. Make that two and a half.

12:10  AM 

Maybe it’s sleep deprivation, but suddenly paying $600 dollars to avoid spending an extra week in Kathmandu by myself makes a whole lot of sense. Of course, that isn’t counting the whatever extra it’s going to take to get me from London back home. Women in giant, baggy burkas with only their eyes exposed are also starting to look attractive, so I suspect that my thought processes are very, very muddled right now. Here’s hoping the hospital will cover the flight change. It is all in the name of research.....right?

5:28 AM

Nice sunrise from the plane this morning. Looking down outside (Somewhere over Northern India?) it looks like a wasteland. Reminds me of flying over the Grand Canyon region or Southern Utah. The   plane is surprisingly full, and most of the passengers appear to be late 20-40 yo Nepali males. None of them speak English, so I haven’t been able to ascertain from where they are returning. There also appear to be a fair number of trekkers, judging by the zip-off hiking pants, backpacks and fleece jackets, most of whom are speaking European languages. The French lessons paid off when the crew brought around our visa applications. I didn’t have a pen and the couple didn’t know how to answer the questions. Between their broken English and my very broken French we were able to get the forms completed. 

The closer we get to Nepal the more anxious I become. Mainly 3 things are bothering me: 1) Is someone from the HRA going to meet me to help get me to the hotel? 2) Am I going to be able to negotiate my enormous bags through the airport, customs, etc? 3) Are the customs people going to confiscate my research meds?. I’m supposed to enter the country under a tourist visa and then apply for the work visa later, but it’s pretty hard to disguise two bags full of pills and a bunch of research forms. I guess if I have to choose between having difficulty obtaining my visa or being arrested for smuggling “drugs”, I choose the former.

Mountains outside are getting bigger and land a little greener. Must be getting close...

Tuesday Mar 1, 2011

4:28 AM

I stayed awake as long as I possibly could yesterday after arriving but that only got me to about 4PM. After 12.5 hours of sleep I’m feeling pretty good, except it’s o’dark thirty outside and wandering the streets of Kathmandu alone at this hour doesn’t seem like a great idea. 

Yesterday afternoon’s events went much smoother than I had anticipated. Customs consists of a guy checking your bag tags with you receipt to make sure you aren’t taking someone else’s bags out of the airport. That in combination with applying for my visa took about 15 minutes. Transportation was smooth as well, thanks to the HRA rep who met me at the airport. I am so thankful for that because by the time I arrived I was so tired I couldn’t remember where I was going.

Driving to the hotel was a bit of an adventure. It’s just like the pictures of SE Asia that you see on TV - a combination of motorcycles, pedestrians, rickshaws, small cars and small trucks all seemingly converging on the exact same narrow piece of pavement in an effort to get to their destination. Most of the motorcyclists and many pedestrians wear masks to help filter out the exhaust. There are definitely not emission laws here, which results in smog so thick it’s almost difficult to see the horizon from in town. 

After throwing my bags down in the Hotel Marshyangdi and firing off a few emails to let the homefront know I’ve arrived fully intact, I decided to try to make my way over to the HRA office to check in. The directions I had been given consisted of: “Go straight down this road, then a little left, then a little right and you’re there”. Maybe fatigue interfered with my understanding but once out on the road, it was clear I was not going to get close. I walked around for maybe an hour then realized that the chances of me getting very lost were far greater than the possibility of finding the office. Walking down one street I found myself boxed in by several men in long orange gowns. One reached in a bucket, dipped his finger, and placed a bright red smudge on the center of my forehead. Despite my efforts to duck, I found myself dotted. Then came their chants of “money, money, money”. I reached in my pocket and gave them a coin, feeling like such a tourist. After walking a few more blocks it occurred to me that I hadn’t acquired any coins in Nepal, so I probably gave them a Bahrain Dinar....oops. At that point I knew my stealth tourist skills were not working and it was time to return to my island of safety at the hotel. Back at the hotel, I made it three sentences into my book on basic spoken Nepali before I passed out cold. 

Now I’m looking forward to a fresh new day. So far this morning I’ve managed to write a little journal entry, do a little stretching and my morning crunches. Too bad my room is so small that there  is no way to practice yoga. What I really want to do is run, just waiting for the sun to come up. 

Tuesday Mar 1, 2011

7:41AM

After a few hours of dinner and drinks last night, the group seems to be coming together pretty well. Too bad they’re all going to Manang and I’m going to Pheriche. However, There is still the mystery of Bill who,  apparently, no one has heard from. Maybe I’ll be holding down the Pheriche aid post solo. 

We decided to have dinner at a local place called Rumdoodle, which is the title of a British parody about mountaineers who “accidentally” climb to the summit of the 40,000 and 1/2 ft peak of the same name. It is a tradition for Everest climbers to party here and write their names on the walls after reaching their objective. You definitely get the impression that people throw down here on the right occasion. On this Tuesday night it was pretty slow, however. Food was good and the company better. Unfortunately, due to my jet lag I was fading fast around 8PM, or maybe it was my standard 8PM drowsiness. I think I’m almost on the schedule here, th0ugh.

This morning, I got up early in an attempt to catch the soft morning light for some good pictures. Light turned out ok, but when you’re the only westerner on the streets in the morning, you get completely inundated with requests from passersby to ride in their rickshaw or taxi. “Monkey gardens? Temples?” they ask over and over. Even though I tried explaining repeatedly and slowly that I’m walking and don’t need a ride, there would soon be a gathering of drivers competing with each other for the business of a non-buying customer.The result for me was a handful of poorly focused, hastily taken shots. Back to the hotel to eat breakfast and review my Nepali lessons.