Our first week in Nepal
गत छ नेपाल (Svāgata cha nēpāla) or, in english, welcome to Nepal. Just over one week ago our family landed in Kathmandu, Nepal to live and work at Scheer Memorial Adventist Hospital. Moving half-way around the world is an adventure any day! I think I have redefined the word Adventure: traveling 36 hours with nine checked bags, eight carry-ons, a stroller and car seat, two cats, one baby, a wonderful wife, and awesome mother-in-law.
Our travels commenced in Portland, OR, our US home, the evening of February 27. Together with our cats, Milo and Marmite, we (Allie, James, and Allie’s mom) checked in with 450 lbs. of checked baggage. Thankfully the pleasant and helpful Alaska Airlines clerk didn’t charge us for the extra piece of luggage. I think she was a little overwhelmed with from cat paperwork and baggage tagging. After a yummy airport s
upper and good-byes, we were off to San Francisco International (SFO) airport.
I love our cats! However, the reader must understand the process of flying with two felines isn’t the easiest. At SFO it took about 90-minutes to check them with China Southern Airlines, our international carrier. After filling out many forms and answering many questions they were off to security for a pat down. The cats were so confused as to why they had been locked up in a cage for hours, little did they know of the hours ahead.
By the time we arrived at our security check-in, baby James had had enough of traveling. Amid the crowd, surrounding by TSA officers, he loudly proclaimed his disdain for having to wait so long to get his evening meal. I must say, it is quite something to proceed through security with a stroller, car seat, and a total of eight pieces of hand luggage and personal items. The stroller had to be completely disassembled for it to fit through the x-ray tunnel. It’s amazing that we were still smiling after we collected our computers, shoes, belts, wallets, liquid items, and reassembled the stroller. What an adventure!
We were so proud of baby James’ during his first international flight. He traveled the 14 hours from San
Francisco to Guangzhou very well, sleeping almost three-quarters of the duration of the flight. We touched down in China shortly before 6 AM local time.
Now you must understand that we were concerned about the transiting the cats through China. Airline regulations require animal owners to collect their animals and recheck at every transit airport. It’s nearly impossible to get a clear set of instructions from any source. Prior to departure, we spent hours scouring various travel blogs, pet travel websites, official government websites, and the airline website to better understand whether the cats would need to go through a 30-day quarantine process during the transit. We had a Mandarin speaking friend call the Guangzhou airport and still we were not able to get an answer. So, despite the potential of having to leave the cats in China, due to quarantine issues, we decided to risk transport.
Upon arrival in Guangzhou, I approached the immigration counter and explained our situation. The immigration official called an airline representative and instructed her to take us through different lines. Of course, I, the doctor, was the one passenger who had a slightly elevated infrared temperature and was pulled for a secondary screening to ensure that I didn’t have a contagious disease. There I sat, in a tiny Chinese Immigration Health office, in the middle of the airport, with a mercury thermometer placed in my axilla – all because of our cats! Thankfully my temperature was normal and I was deemed, “not contagious”. A few minutes later we had our passport stamped and were walking out of immigration. At the airline luggage counter, Milo and Marmite were so happy see us! They meowed and licked our fingers hoping that they were done with their eternal trip.
Now came the great moment: Chinese customs. We were hoping and praying that there wouldn’t be a quarantine or any problems. Of course, the airline representative insisted that we had to traverse the “goods to declare” line. I pushed the cart, and kept pushing it since no one told me to stop. And all sudden, there we were, in China :-)
We proceeded to baggage check-in. And of course, it wouldn’t be as easy as just dropping the cat carriers off. Oh, no, we had to fill out more forms and pay more money to get the cats on the last leg of the journey to Kathmandu. We made it to the gate a few minutes before they started pre-boarding for families. I don’t think that I was ever happier to get on a plane :-)
Five hours later we touched down in Kathmandu, Nepal. Words cannot describe the emotions that were going through our hearts and minds as we realized, that for the next five years, and maybe longer, this would be our home. Nepal is known for its beauty. Unfortunately, Kathmandu is a huge, dirty city. Flying over the city you can see the effects of development: partially finished homes, broken pavement on the streets, crowded roadways, and people everywhere.
While preparing for travel, we were also curious to know how we would import the cats into the country as there were no specific guidelines. Well, it couldn’t have been easier. The immigration officials were more interested in petting the cats than they were looking at our documents. In fact, they didn’t even look at the veterinary or rabies certificate :-). Before we knew it, we were outside the doors the airport and loading our goods into the hospital van.
Scheer Memorial Hospital is in the town of Banepa, 16 miles east of the airport. The drive from the airport to the hospital traverses a path along the edge of the Capital. People are everywhere. The sidewalks are lined with fruit and vegetable vendors attempting to make a subsistence income. Cars are weaving in and out, dodging motorcycles and people. Horns, blasting continuously, are essential as drivers navigate the ever-changing maze. If anyone thought the videogames were interesting, then he or she should come and drive the streets of Kathmandu. It’s quite the experience! One must develop nerves of steel as minibus drivers pass trucks, uphill, around blind corners. As we winded out of the Kathmandu Valley we passed multiple brick factories, with never-ending plumes of pollution puffing from tall brick smokestacks. Despite the industrialization, postage stamp sized gardens and vegetable fields dot the landscape–it’s quite a beautiful scene. The steepest assent out of the Valley leads past the world’s tallest statue of Shiva, one of the Hindu gods.
At the crest of the hill, we entered Kavre district, one of 75 districts of Nepal. The town of Banepa is one of the largest towns in Kavre, with a population of approximately 30,000. It was back in the 1950s when Dr. and Mrs. Stanley and Raylene Sturges, with their two infant children, were invited by the King to start what became Scheer Memorial Hospital. At that time, the city’s population was about 8000. They lived with the headmaster and started caring for people in their homes. After a few weeks, the business people of the town built a one-room clinic for Dr. Sturges to work in. As time passed, the need for hospital was recognized and fundraising commenced. The local leaders selected a piece of land to donate and the hospital was built from a donation by a New Jersey family. To this day, the orthopedic wing of the hospital is in the historical building. Since the 1950s the hospital was recognized nationally for its excellence in medical care. It was the first hospital to introduce the concept of palliative care medicine and the first facility to perform laparoscopic surgery. Unfortunately, due to multiple factors, the hospital’s national recognition has been lost. Yet the facility still plays an important role in delivery of healthcare for the district.
We were warmly welcomed upon arrival to the hospital compound. And, we were so ready to crash into our beds that it was hard enough to know our names :-)
Over the next couple days’, we were introduced to the staff of 200 employees and medical staff of 30. Everyone is very excited for us join their team.
On the last two Fridays, we travelled twice to Kathmadu for outfitting trips. We are living in a newly renovated single dwelling house on the north side of the hospital compound. Most of our household goods are coming by container sometime this summer after we secure Nepali work permits. For the interim, we needed to purchase a few basic items including electronics, like 220 V microwaves, that we weren’t bringing with us. Kathmandu is a city of a million people. Like many developing cities globally, almost anything can be found if one is willing to look long enough. We were pleased to find some of the same brands that we purchase at home (Ya! Senosodyne toothpaste). Prices are reasonable, except for forks and knives. One would think that you could buy a set of silverware for a few dollars. Oh no! $80 for 24-piece set. We were so frustrated as we didn’t want to pay $160 for silverware. After expressing our exasperation, the clerk led us to baskets of silverware on the floor. For the next 45-minutes we sorted through hundreds of pieces of silverware to find what we needed. What an adventure!
Grocery shopping is fun. We usually buy most of our fruits and vegetables after our morning exercise. One of the great benefits of living at your place of work, is that you have a 1-minute commute time. Therefore, you can get up in the morning and go for a walk with your family. It’s fun to hike the hills and meet the local citizens. Our morning walk leads us up past the Chandeshwori Hindu temple into the hills. People are very friendly to us, frequently calling out Namaste, the traditional Nepali greeting. On our way back to the house we stop and purchase fresh fruits and veggies from roadside vendors. Of course, all produce must be washed in bleach before consumption.
On both Saturdays, we were privileged to fellowship with the church members at the local Seventh-day Adventist church. It is beautiful experience to travel halfway around the world and hear the some of the same music we sing at home; we’re thankful for a church community we can identify with. Shortly after arriving at our first worship service, baby James, whom I was carrying on my chest in his carrier, started to whimper. An elderly, grandmotherly, lady came over and insisted on holding him. She rocked and bounced him for the next couple of hours. It was a beautiful expression of care, compassion, welcome, and experience of community.
Sunday to Friday of last week, for me, was a busy week of administrative duties. We had a visiting administrative consulting team from the Centura Global Health Institute. The group is from Denver, CO and was comprised of nursing and executive leadership. From this perspective, our arrival to Scheer couldn’t have been timed better. As I will have a joint clinical and administrative role, it was immensely helpful to sit and listen for hours. Topics as varying as hospital patient quality outcomes to development to governance to long-term growth were discussed.
It is a real challenge operating a hospital on such a tight margin. One must consider that we charge about the cost of a US postage stamp for most outpatient visits. Of course, inpatient care cost slightly more, a few dollars a day. Nonetheless, this past year the hospital cared for 74,000 outpatient visits and 10,000 admissions. The prospect of delivering care to so many individuals on such a tight budget is a real challenge. We are looking for creative ways to grow individual service lines to make the hospital self-sustaining. I’m thankful for the strategic partnerships we have with many organizations, including Centura Health.
I’ve only been on the wards a couple of times with the physicians. As I don’t have a work permit, I technically cannot care for patients. Therefore, I have been following and observing the Nepali physicians. Our hospital is jointly staffed by first-year trainees and board-certified clinicians. The patient populations they are caring for our different than what I’m used to in the United States. They perform an outstanding job providing care with limited resources. It’s not uncommon for us to round on a patient with advanced tuberculosis, care for patient with severe COPD (leading cause of death in the country), or treat the sequela of organophosphate poisoning (usually multiple incidences of suicide attempts per week).
I’ll have to save more experiences for future posts. I am thankful for you, as friends and family, who are so interested in our journey. Feel free to drop us a note in the comment section below. We’d love to hear from you! For those of you who have already written, thank you for all the emails and Facebook comments and messages. Stay safe. Thanks for keeping us in your prayers.
