Day 6....our last day as a team :(

Namaste!!

 I am sad today. Day 6  is our last day as a team at NOH. If we had been a bit busier it would have been our last surgery day but alas it was not. Although we saw over 50 people for screenings there where many reasons that only 17 patients were operated on. It turns out we came between two major Hindu festivals and many people don't actually want surgery during this time. After reviewing the patients cases many of them wanted 100 guarantee, which being humans we could not give.

 We had hoped for more neglected Clubfoot but I am hopeful the reason we are seeing less is that the Ponseti method is spreading throughout Nepal, our Host doctors perform the casting technique and I know there are many centers thought Nepal that have trained personnel who perform this technique. What an amazing thing for Dr. Ponseti to have a technique developed that is helping to eradicate this disabling condition!
Our team  started  today with a conference for the doctors and nurses. Dr. Carl spoke about Achilles' tendon rupture  and Macrodactyly, I spoke  about the pediatric exam and common podiatric diagnosis in children, Dr. Tom spoke about posterior heel surgery and posterior tibial tendon pathology and Dr. Michael spoke about diagnosis of scaphoid fractures.

 After our conference we had a thank you ceremony in which each group HTC-NOH discussed our thoughts about the mission and plans for the next one.
This trip was great but could always be improved upon, as with anything we will need a debriefing to figure out how best to benefit the maximum number of patients.

 This truly was a magically warm trip. The team dynamic was very amenable to casual conversations, discussions and lots of laughter. I truly believe our patients picked up on our commraderie because we felt the warmth of our team reflected in our patients.

Tomorrow we plan to come to NOH for final round and patient good byes,
Until then :)

Peace, Dr Jennifer

Day 5, surgeries and sing-a-longs

Namaste!

  As usual, we started our day with a great breakfast at the Norling, discussing the events of the night before and reviewing the day ahead. We had 4 surgeries planned that day so we headed off to NOH to start our day.

  Our team doctor started rounds and for the most part our patients are doing great. Any issue that come up he takes care to discuss with the nurses and make sure it's done.

 While the surgeons were in the OR, Dr. Mike and kristi went on crutch rounds. They bought the crutches from the pharmacy, measured the patients and trained them in the proper use.

 When we arrived we were greeted by our second patient of the day, an Achilles exostosis removal.
The patient decided to wait until he goes to visit his family in the US. One cancelled, three to go. Our first case of the day was a more complicated Clubfoot. The patient only had 4 digits and upon close inspection of the X-rays it showed a fusion of the heel one to the bone that forms part of the ankle-Talus. We got a good correction after a fusion on the outside of the foot and removing a deformed bone that was in a very bad position. We hope she does well but will likely need more surgery down the road.

 Our other two procedure were rather quick, with the exception of the last case of the day. Anesthesia planned for giving medicine to make them sleepy, the we would give local anesthetic, many of the drugs were not as effective as they possibly could have. The local anesthetist seemed to think it might be that that patient drinks. She told us that in many families it is not uncommon for younger teenager to drink and that may have been the cause of the medicine not doing everything optimally.  Amazing.

 After a good surgery day, we started packing up our equipment and set up our wall of donations. Jason and Kristi focused on the inventory, cataloging and photographing all of the generous donations including MTF Bone graft, BME speed staples, screws and plates, surgical instruments, boxes of gloves, fiberglass cast tape, soft roll, wound dressing supplies, Stryker power sets, anesthesia supplies, suture material, OR start sets, drapes, gowns, Ankle foot orthoses and much more.

After a successful pack up and afternoon rounds we went off to the Grand Norling, some of us went swimming while some were still finishing up to NOH. We met up by the pool and Jason started playing his guitar. The guitar playing went from entertainment to a sing-along where the songs ranged from Nirvana, Bush, Don McClean, Journey. It was one of the best team gatherings I have ever been on.

Until tomorrow
Peace, Dr. Jennifer

Whiskey and Wine in some down time

 Namaste!

  Day 4 started with a wonderful breakfast buffett  of mushroom omelette, sausages, veggie stir fry, toast, ham and stir fry pig liver.... Needless to say the liver dish was full after our team of 12 were done eating!

 After fueling up for the day, we started our trek to the Hospital. On the way we observed a typical Monday commute filled with motorcycles, tractors, buses, taxis, and cows. The local butcher shop keeps there goats in the front of the shop,one of the spotted black one was sleeping against the fence, so cute. The puppies were playing with each other amongst the dust and trash on the side of the road.

 As  we approached our team room to get our day started, a few of our patients were out of the ward sitting on the benches getting some much needed sun light. We were greeted with Namastes and good mornings!

 After setting up and preparing for our surgery day, which included a forefoot reconstruction and a rearfoot fusion, we did morning rounds with our fabulous team doctor and made sure everyone was comfortable with their pain  controlled.

 Carl, Marc, Steve and I had a meeting with our gracious hosts to discuss plans for next years trip in which we discussed possibly going out to the mountains for their mission trip. We also discussed patient recruitment and they requested a poster of foot and ankle deformities as an educational tool. We will work on putting together a great visual to send to NOH soon.

 Our team dinner was planned for the evening so after our surgeries were done, our meeting was over and the patients were rounded on, our team went off into the Kathmandu valley to explore the amazing city.

 Jason and I stayed back at the hotel and enjoyed the wildlife in our backyard including the monkey on our roof, the deer on the course and the birds in the air. It was a peaceful view 5 minutes from the hustle and bustle of Jorpati.

 Our joint HTC-NOH-Nepalgung team dinner was at Hotel Tibet International on the roof top restaurant overlooking the stuppah. The whiskey and wine were free and the appetizers were making their rounds as people trickled in. Jason brought his guitar and started playing around the room. Dr Prakash with the specs offered to play a traditional Nepali song on the guitar and we were treated to a beautiful sing a long. The conversations were great as we heard of people's mission trips and vacations, mingling with the Nepalgung team  was great as we were reunited with the best OR nurse ever. Bojan Kuure was embarking on her 88th mission since 1988!!!!!  She deserves a medal and I think that will be my mission once I'm back stateside. It was also a chance to say goodbye to part of our team as Jackie, Bo, Marc and Steve head off to Nepalgung tomorrow.

  We took a great team photo on the rooftop  in our Team HTC-NOH shirts!

 Alas Jason and I had to cut out early as 4 whiskey on an empty stomach can make anyone a little drunk....Jason, not me ;)

Looking forward to a great Tuesday, we have four cases, one of which we will have the medical director scrubbing in with us!

Til tomorrow

Peace Dr. Jennifer

Day 3 is being sponsored by Tuborg.

Namaste from Day 3 of our surgical mission to Kathmandu,

 We started our day with a brisk walk to NOH after a hearty breakfast at our hotel the Grand Norling. This walk although the same distance and path, changes every day. We see things we hadn't seen the previous day, kids playing in a puddle or bathing at the water spicier. We see new people like the school children in their uniforms walking to school. We saw a van almost hit this black calf that was sauntering across the street, the gentleman tried to pat him and shoo him off the road but the calf took his sweet time. The dogs are everywhere on our walk to the hospital and today we think they were barking at Jason but then a motorcycle came by and broke it up!

  As we were entering the hospital through the side door, I saw a poster for the 15th Anniversary of NOH, and whose on the poster but yours truly and Dr. Prakash with the specs from our trip last year! To be honest, it made my day, week, year:)

  As usual Jason and Kristi started setting up our registration area,  making sure it was ready for any new patients, organizing our surgery charts and picking out little things to give to our patients on the wards  as we changed into scrubs and started bringing things in the OR for the days surgeries, as is the case in the US sometimes fate gets in the way. When we were starting to get ready for the OR we found out  that our 2 year old patient had eaten cereal at 7:30am, two hours before surgery time, so we pushed him back to 1300 and teed up the second patient to go first.

  While waiting for the OR to get set up, Mike, Tom and I stared Morning rounds in the post op ward, passing out Carl's "cast cover monsters". Our patients had done well over night with their pain being managed by non narcotic pain medication. The nursing staff is fantastic and really know their patients!

We did 5 cases today including an assist on a bimalleolar ankle fracture by Cameron, one of the surgeons heading out to Nepalgung with Marc,Steve and Bo on Tuesday.  Our cases included a neglected Clubfoot repair, rear foot joint fusion, calf muscle lengthening and debulking of a oddly presenting macrodactyly in a two year old. The cases were good and we worked hard.

  I have to give a major shout out to Bo, our wonderful scrub tech who is dedicated to his craft and is trying to get Marta ready to handle our surgery days without him, as he is on the Nepalgung team with Marc, Steve and Cameron, he was showing her how to keep everything together including out instrument sets when they get sent for processing, teaching her how to open sterile instruments to be put on the field and how to keep track of our stuff.

 Today also brought a visitor to the OR that had never even been in scrubs let alone the OR. Miss Kristi wanted to see a patient she met at registrations surgery, so we suited her up, taught her OR protocol and etiquette and sent her in with her camera! She learned a lot and even got to help circulate.
 We did get a few new patients coming in to be seen as well as patients that were surgical candidates but had been postponed due to pneumonia or coughs. Our fearless team doctor evaluated them thoroughly and cleared them for surgery. We screened potential candidates and made up the remaining days surgery schedule.

As our cases went  long and there had been a crazy rainstorm, we figured having dinner at the hotel would be a great idea. We planned for a 7:30 dinner and everyone relaxed, went running  or swimming. 6 ish came and brought with it a partial blackout so most of us found ourselves in the bar,ordering Tuborg and chatting with one of our hosts Dolkar. She has a talent for speaking her mind about marriage in her culture and and some point with the Tuborg flowing we found out her talent was reading faces, she read all of our faces. You'll have to ask everyone how accurate she was!

 Day three was ended with a great group dinner with the Tuborg and reminiscing flowing freely!!

 Until tomorrow friends!

 Peace, Dr Jennifer

Day 2... So much to do

Namaste,
  We find our missionaries on day 2 starting to perform much needed surgery on grateful patients. After a one hour delay to the OR due to a miscommunication regarding patient deposits, we started our busy surgery day.
   We ran two rooms and treated 6 patients surgically while our wonderful team doctor +Michael Wilson  was helping with a few emergency patients while surgeries were underway and then beautifully managing our post op patients, working in collaboration with our caring Nepali nursing staff.

  Day 2 brought a new surgeon into the mix. Dr. Tom Chang graciously offered his time and expertise to help guide us on our mission. He also brought along generous donations from great people back home. Tom has made a great impact on our mission trips in the past, in fact both Carl and I were lucky enough to have worked with him on previous Nepali Missions and couldn't be happier for the reunion.

  I have to make a special shout out to Team Anesthesia. We are enter ally grateful for you all. Seeing you in action was fantastic. Regional blocks in a developing nation might intimidate some anesthesiologist s but not our team, who are well versed in ultrasound guided regional blocks. Your exquisite work has made our team doc's work much easier. Thank you, gracias, grazie, merci!!

  Kudos and team player of the day... Marta, an ER nurse by trade, she fell ino whatever role was needed, be it runner, circulator, transport, photographer, scrub tech. Great job

  Although the surgeons were busy on day 2 our team administrators  Jason Martin, Marc Estvold and Kristi Wilson  had a slower pace of the day than our initial screening day. New patients came in and they diligently got them registered, took their picture and got them screened but that initial wave of people did not continue at the same pace on day 2 which gave our administrators a chance to organize all of our screened patients into groups for our end of the mission report. We also were graced with Jason's masterful guitar playing and hope to hear more of it throughout the trip.

  Day 2 ended with our checking on our post operative patients, planning the O.R./O.T. Schedule for the next two days and heading back to our gracious hosts at the Grand Norling where some in our group relaxed with some Tuborg by the pool and enjoyed the gorgeous weather, as day turned into night the full moon rose over the mountain top into the most breathtaking site I have ever seen the moon was surround by patchy,fluffy horizontal clouds not crowding but kissing the moon.

  We had our first full team dinner at a restaurant now becoming a tradition with the HTC  mission to Kathmandu. We boarded the team bus and enjoyed a bumpy, loud, slow, borderline scary trip into Thamel to partake of the wonderful ambiance and dining options at Third Eye restaurant. We enjoyed traditional Newari( people of the Kathmandu Valley) meals, Indian curries, Garlic naan and of course Tuborg, Everest beer and we even got Jason to have a shot of Rakshi(Nepali firewater) all while casually lounging in a quiet but traditional music,incensed filled  corner of a darkened room with multiple levels of low lying tables allowing us to both relax and enjoy the whole groups company. We relaxed, drank and chatted about how everyone was doing on the mission so far, reminisced about times before at this restaurant and overall had a great time enjoying the company.

  Day 2 was wonderful and we hope to build on the team dynamic and help as many of the Nepali people as we can.

Peace,
Dr. Jennifer

Greetings and Namaste from Kathmandu, Nepal

It is the end of our first full day in Kathmandu and our gracious hosts, Nepal Orthopedic Hospital was just as welcoming as the many times before. It is amazing to reconnect with our friends and colleagues at NOH. It's like coming home, everyone is excited to see you and no one asks why it's been so long. 

As one would expect, our day was filled. After a filling breakfast at the Grand Norling Resort, we packed the car and hopped into the hotel SUV, we went down the wrong road and still made it to the hospital on time. 

We were greeted by our friends and all the bags we carried with us half way around the world, one by one we opened up  each one, I guess it's kind of nerdy but it was like Christmas, unwrapping and careful organizing all of the generous donations from our friends, family and business colleagues!! We had generous donations of Nitinol staples, Stryker small power set, casting supplies, bone graft, surgical instrument sets, sutures, needles, drapes, or start packs. We are truly grateful to all. 

As we started to organize the supplies  Jason Martin and Marta Eli started organizing all of the charts  with help from Pragya we started making up patients charts and getting our screening process, Dr Carl and myself rounded in the ward with our Medical officers for the week, screening the patients with foot and ankle concerns, although not everyone needed surgery the pathology was vast with everyone from post traumatic arthritis to pseudoarthrosis of the tibia. It's was very busy reviewing the patients sending for X-rays, reevaluating and if they were surgical candidate having them screened by medicine and anesthesia. All in all it was a busy, tiring but productive day. We are starting surgery tomorrow and will continue to screen patients as they come in!! 

So far it's been a mind expanding trip and is stretching people into new roles they never thought they could do! 

A big big thank you to  all of the team?

Namaste

Dr. Jennifer

Less than 24 Hours....

Here we are everyone, less than 24 hours until we start our journey to the Kathmandu Valley
Everyone is so excited and nervous and anxious to get everything going. Thank you all for your support and well wishes, we will see you in Nepal!!!