Cry me a river..................

So on the 20th of Sept, which seems ages ago now we made our way from Kathmandu to Chitwan National Park on what for a while we didnt think was our bus but unfortunaelty was. Sam our travel agent who we booked with even came and meet us and made sure we were on the right bus, bless him, a very sweet man. So we did make it after a cramped journey up until we dropped off some rafters from then we had a row each and could try and lay back and relax. But finally after 6 hours and 30 mins we arrived to a parking lot of jeeps, found our one and was on our way to the national park - Tiger Camp. We enjoyed our welcome drink whilst watching a father and a baby rhino. Then we were orientated around the camp and after freshing up we went via a jeep to the elephant breeding centre. So many beautiful elephant and we even got to see 18 month year old twins!

Then we walked through a local village and took a caynoe ride back across the river which was very nerve racking at first as the lake had crodiles in!Laura looked very scared, bless her and hopefully she was preparing herself for tomorrow as again we were caynoeing down the river to the jungle. That evening we sat under the stars with two girls we had met during the day, Anna and Isobel and sipped our cocktails.

Day two in Chitwan started with an early morning call and a scrummy breakie then shortly tackled the caynoe again which I was starting to enjoy but being strong for Laura who was very nervous, Iam hugely proud of her as this time it was a longer journey plus we spotted some crodiles on the side of the lake. But she did it and we got off and walked through the jungle the grass was as tall as us, i felt like indian jones!searching for tigers!During our jungle walk we only saw some bugs, deer and birds but the best was yet to come.

That afternoon we went for the elephant ride and our elephant who we named Ellie saftely took us throught the jungle and we were lucky enought to see a baby rhino and a mother. The ride was amazing we went thought lakes on the elephants and saw lots more animals including wild pig, deer and even a cheeky little monkey. That evening we walked to the local village and watched a culture show which included they different dances, again we ended a brillant day with some gorgeous dinner and cocktails by the beatiful river.

Its a bird, Its a plane, Its Laura!!!

Sorry for delay in posts!! Sam and I are home safe and sound, but want to update you on our travels prior to our last blog that we will do together. Sam will do Chitwan and I will now fill you in on beautiful Pokhara!


Pokhara is the chilled out version of Thamel, with Phewa Tal, the second biggest lake in Nepal, the world peace pagoda, rows of shops, restaurants and great variety of bars with endless hours of happy hour! Pokhara's first visitors from the west were hippies, so I figured I would fit in quite well. We arrived after a scary bus ride from Chitwan. They had overbooked the bus and as it wasn't high season yet, the only buses travelling to Pokhara are local buses....i.e. young driver, taped up windows and people sitting on the roof! Luckily for us, the roof was full of luggage, so Sam sat next to a man who should have played for the NBA he was so tall and I shared a cushion, between the driver, with 4 others. Great views of what was up ahead....but not sure if that was good or bad!?!?



After kissing the ground and dancing we were met by our accommodation's staff who drove us back to our home for the next 4 days, The Sacred Valley Inn. It was a great location, the staff would do anything for you, and it was crawling distance from the bars!! Unfortunately it rained the first two days, but this didn't stop us walking around Pokhara and enjoying the shops and happy hours. Pokhara is so much quieter than Kathmandu, no honking of endless traffic and you could actually walk on the sidewalk and even sometimes to road!!!


Our first night we went to the famous Moondance Restaurant, where we drank their specialty cocktails and Nepal Ice Beer...after a few too many of those we played pool and ended up singing to Brian Adams and twinkle twinkle little star with the rest of the restaurant....strange but loads of fun!


We were told by our hosts that we should get up every morning at 6am to see the sunrise from the roof of the hotel, in case we might get a glimpse of the Annapurna mountains, and finally on Friday morning we saw them glow! Sam was still shocked I was up and outside without even a second shake, but this was the most beautiful thing we had ever seen. The mountains glowed an amazing yellow and orange and although it only lasted about 2 minutes before the sun was up and the clouds were beginning to hide them, we were totally hypnotised. The pictures we took did not give them justice!



Sam could see me smiling like a Cheshire cat, as she knew today I was actually going to do what I have wanted to do since May!! Well I couldn't jump out of a plane, they don't have skydiving in Pokhara, but I was going paragliding! I had booked to go since we arrived, and today the sun was shinning, I was flying!! We were picked up at 11am and taken to the offices of sunrise paragliding and that is where we met Lydia. Lydia was jumping too and we both ate mints to keep our nausea at bay. The drive up to the Sarangkot viewpoint, which is 2000ft above Lakeside, was quite an adventure. Sam, Lydia and I decided that after arriving there safely, we had nothing else to worry about!

After a quick discussion on how to take off, I was strapped in and sailing through the air...well eventually anyway. The wind changed directions and few times and I fell down the slope once, but third time lucky and we sailed off gracefully...ok no we didn't but I have paid Sam big bucks not to show too many people my taking off video! The fly up and down and through the Himalayas was amazing. I could see high above Pokhara and was told we got to 3000ft! I saw hawks and mountains for miles! After 30 minutes my pilot, Vimal, asked if I wanted to do some tricks, so we did!! We spun and zoomed and I thanked God for the gravol I had taken before take off. Vimal then decided this was a good time to tell me how to land...LAND!!?? I am already in the air....and with skydiving we only had to raise our legs....Vimal explained I needed to skimmy out of the seat and once my feet hit the ground .... run! Sam missed my graceful....ok I landed on my feet and then my bottom..... but we go to see Lydia's! Poor Lydia was with an equally tall pilot and they decided to show off and do a somersault landing! We agreed to meet later that night and Sam and I were off to climb the World Peace Pagoda!



We hired a boat and we were rowed across by a lady who looked to be in her late 80's, but she meant business, so we just smiled and tried not to giggle too much. The Lake was beautiful, the mountains reflecting in it and people kayaking and sunbathing all around us. The pagoda is a massive Buddhist stupa and is situated on top of a hill on the southern shore of Phewa lake. Apart from being an impressive building itself, built by Buddhist Monks, the pagoda is a great way to see views of the Annapurna range and Pokhara city. We were told it was a bit of a trek up, but what they didn't tell us is that it would cause us to lose feelings in our legs and be so steep, that coming down was even slower than going up!! We enjoyed the views of Pokhara and wined the whole way down that we were so sore....then we saw about 5 Sherpa women, in their late 50's, carrying baskets of flour, rice and fabrics come racing up past us. We felt pretty pathetic then and decided we needed to train quite a bit more before we returned in a few years to go trekking!!




We enjoyed our last night in Pokhara with Lydia at the Boomerang restaurant, which had great naans and even better some Nepali dancing and music! We then escaped, as Lydia was having marriage proposals left, right and centre off the waiters and went back to our hotels to sleep before our next bus ride. We are travelling Greenline this time, a big tourist bus, it has to be better.....RIGHT??!!??!!

PESON

Yesterday was again a day to remember, we were up early to meet Kiran in Kathmandu and visit the health camp that was happening in a local area, offering gynae, paed, and general health clinics. It was great to see the local community working together, and all the doctors and nurses there were volunteers...imagine not being paid to work a Saturday...I dont think I know a GP who would do that??!! We then spent the day at Kirans, relaxing, having lunch and preparing for our talk on Antenatal Education in the UK. Before coming to Nepal, we knew about presenting to some nurse-midwives, but we were asked by the president of the PESON (Perinatal Association of Nepal)2 weeks before the event to also share this with them and maybe add a bit more research.....so we added qualitative, RCT's and even a few notes we had made from being in Nepal ourselves....you should be very proud Jane Boulton!!

We made our way to the venue, which was very posh!! Even had an infinity pool...but Sam and I behaved and didnt jump in!! After hearing lead consulatant Obstetricians and Paediatricians speak about the importance of AN care it was our turn....vomit!! Our EBL skills were put to the test, and as we imagined everyone in their knickers we presented our powerpoint. Everyone really enjoyed it, especioally the TENs demonstartion on Kiran and Sams superb birthing ball positions! To make our heads swell even more we were given an award for speaking....so mayeb Surrey Lecturers could dip in to their pockets and invest in some ribbons or atleast some tea for our presentation skills!!??

I lost Sam to the ex-president and professor so I ordered the wine and waited for the two intellects to remember I was there too before heading off to dinner. We both felt like stars that night and even now smile at eachother like school kids.

today we got a tuktuk to meet Kiran on route to the university hospital. We thought the impressive 8 in the tuk tuk was good, but the 22 that rode with us to the hosiptal in an 9 seater mini-van blew that out of the water (see photo which does not give justice to fear we felt...especially going up hill lol). Did we mention no seatblets in Nepal lol?? The univeristy is amazing, beautiful hill backdrop, huge hospital and so many happy students...the uniforms were even cute! We attended a lecture on body, mind and medicine....which was in Hindi, but we managed to grasp some of it and even got blessed with a bindi...which has proved very useful. There was a landslide on Friday closing the main road to Chitwan...so we need all the luck we can get so that we arrive there tomorrow to wash elephants and see the sunset!!

we have had an amzing time in placements all around Kathmandu Valley but we must admit we are looking forward to a week of fun in the hopeful sun! If we dont update for a while or are not on fb dont worry, we are probably having too much fun and if we are stuck on a road to Chitwan..... we are on route to get junk food now!!

Love and miss you all loads,

Sam and Laura xx

So many babies so little time................

Hello England,
So after eventually falling asleep after the cockroach adventure, we walk to work for the last time and worked on the labour ward. Which consisted of three rooms of three patients in each, we quickly observed a delivery, the woman amazingly in her pain squatted on the bed to gain the help of gravity to deliver her baby which helped straight away. But sadly the baby had the cord around its neck and was whisked away to the resuscitaire for resus, the team straight away gave the baby oxygen and started compressions. The paed was quickly on the scene and inhubated the baby and the baby was taken to SCBU.
Another lady was admitted and everyone was very excited to hear she had twins on board, she was progressing well but nearing to the end of our shift it was decided to go to theatre to deliver her twins.
Meanwhile another patient was admitted from A & E in the second stage, on examination the nurse-midwife found thick meconium stained liquor, so they encouraged the mother to push well. Quickly after she delivered after bonny little pre-term boy, again straight to the resus and after suctioning the meconium he gave the alomost biggest cry from this tiny baby.
In one of the delivery rooms the sweetest image of the three mothers asleep and all the babies lined up in their cots asleep, so so cute!
So that sums up our last shift at the hospital which we have throughly enjoyed and leanrt lots and mostly importanlty gained an invaluable experience.
Tomorrow were goign with Kiran to the teaching hospital..................
take care england love Laura and Sam x

SPLAT!

Today we had a great day. We observed on the IUI (intra-uterine insemination) which has a 18% success rate. Which is similar to worldwide rate of 20%. The nurse-midwife, who had been trained in India, explained the whole process to us, showing how the spin and seperate the sperm from RBC and WBC. I even made them giggle when I said those poor sperm, get spun around a 2000 rotations per minute and then got to get to the egg first....I guess kind of like pin the tail on the donkey lol!?!? We got to see the sperm under the microscope and then with permission from the ladies, observed the insemination. They use a catheter and allow for ten minutes before the woman can go home, and return again in one week to try again. The hospital charges 5000 rupees (about 50 UK pounds) per session. We then got to attend the Atenatal Clinic (ANC) where we, along with 5 other nursing-midwifery students got to assist with the examinations. The government of Nepal encourages a minimum of 4 visits in pregnancy and this was this ladies 2nd visit. She was 27/40 and was given a very thorough head to toe assessment. Very similar to the UK. The one major difference was the waiting room.....they have 250+ women per day!!!

Kiran then took us into Kathmandu where we enjoyed some more window shopping and had some very yummy snacks, We had a huge pancake and nan bread like food with very yummy chickpea dips and spicy soups. We had a very unique desert, that was sweet and sour, I made Sam eat more of it than she wanted to!! hehehe

We then headed off to Patan Hospital to see Rashmi, sadly again we missed the babies being born, but got to see their pharamcy, record keeping and A&E department. I must say I was very tempted to sneak back in when I heard about the police cases locked in the back....guess I will always be nosey! We were going to have tea when the pressure I had earlier put on Sam to be polite and finish her sweet and sour desert came back to bite me....and sadly more her in the ass!!

After a what seemed like a long taxi ride home for Sam, we arrived back at home to settle down and discuss our day. Just as we started to relax watching Sex and the City we were under attack!! a COCKROACH the size of my head....ok not my head, but hand..was in our room, we both did what any good girl would do and jump to the couch and scream at the top of our lungs. Sam who was frozen in fear left me no choice but to act responsibly, so I threw a book at it.....luckily we were saved by our neighbour downstairs, who spoke no english, who came in took the cockroach and threw it outside...what happened next was even more worrying, as she gestured that we should have eaten it!!?? What was in that sweet and sour desert....maybe a cockroach??!!

Antenatal Education...............in Nepal.............

Hello England,

Tuesday we were suppose to meet the Matron but quickly found out she was holiday so there was nobody to introduce us to our next clinical placement, so we practised more for our presentation on the roof top and made the most of the warm weather for a change! Whilst bathing in the sun on the roof top, Laura heard a click like a mobile phone, we then turned around and discovered a builder from across the next building took a picture of us!ha ha, good job we weren't in our bikinis!We then went to our local for some lunch and tried there pizzas which were very nice and some cheesy balls which were interesting. The time had come to do our presentation, ahhhhhhh, after one last practise in the sun the sister came and found us to take us to the room.

The MIDSON group gathered and Kiran started off the presentation by discussing what the MIDSON had done recently, their goals and how to achieve them. Then totally embarrassed me and laura by thanking us for choosing Nepal as our elective and accepting their invitation to do a presentation for them. The presentation went very well, we made it as interactive as possible which included me demonstrating the TENS machine with Laura, Laura explaining about water birth which they found very interesting and me on the birthing ball showing different labour positions and exercises postnatally. We also got the group to conduct the labour line which I feel they enjoyed and discussing how they would conduct antenatal education in Nepal and what they feel would be the main issues. We had done it and received a warm congrads and well done from the group, Laxmi went on to say thanks again to us which was very lovely, everyone is so kind at times it is very overwhelming.

At the end of the presentation, Laura handed Kiran and Laxmi a thankyou card from both of us with the donation from the SANDS organisation from Chicester and from us too. Which was very appreciated and Laxmi straight away said this will help her patients pay for cervical screening and the midwifery society of Nepal will be using it on training on perinatal death. So a big THANKYOU to SANDS, in Chicester.

We then went back to our local restaurant where we had lunch and had some nepalise milkshakes and snacks with the Matron and Laxmi. We tried bbq/fried chicken, fried vegetables, more moomoos and Laura tried a peanut dish. All very nice, so THANKYOU to the Matron who treated us.

Sadly thought the food was short lived and on he way home I had to leave Laura and run home as I had a tummy upset, sorry again Laura, I don't think Ive ever ran so fast!! and then Laura had a tummy upset too................. so we had a chilled out evening after a very busy but successful day.

Take care England x

Another day for them, but a lasting memory for us

This post should have been before Sam's last post, but we both wanted to write it together so we do it right. We spent our first day on SCBU yesterday. There were babies needing blood transfusions due to rhesus status, those with infections such as meningitis, those who had been born premature due to their mothers PIH or Pre-Eclampsia, twins, low birth weight, and even sadly those who had been abandoned. The abandoned babies are very loved though, Sam and I fight over who gets to cuddle them first everyday and dont worry James and Ashley, we aren't allowed to bring them home :(.

We spent our first day observing the staff bath, feed and care for the babies, only 2nurses and 2 HCA's for over 25 babies!! The nurse had explained that two babies had sadly passed away in the night, one due to hypothermia from a homebirth and second from a hospital birth that choked on its milk. Although their equipment here is old and not as up to date as ours in the UK, it is better than we expected.

Two babies were on CPAP (continuous positive airway pressure) and one was not doing very well, although the doctors and nurses attempted to resuscitate this baby, he sadly passed away in front of our eyes. I was not as strong as Sam and had to leave the room, neither of us have ever witnessed a Neonatal Death and were not quite sure how to react or what to say. When we asked the nurse if she was ok, she replied, "When I first started here I used to cry all the time, I even asked to be switched to a different ward, but the longer I have been here, the more I know I need to be strong for these babies and their mothers." The young doctor had also told us that she too used to cry, cry and cry, but now she was just "emotionless." Sam and I felt completely lost at the end of that shift. We both reflected on how lucky we are in the UK, and although we knew neonatal mortality rate is high in Nepal, we both weren't really ready to witness it.

There were two in the bed and the little one said move over move over..................

Hello England, Me and Laura did not sleep very well last night went to bed early like good girls ready for the week ahead and got waken up and stupid o'clock by some dogs next door barking. Then barking to the whole dog population in Nepal it sounded like, so apogilises if this is short and gumpy!ha ha........ So we had our second shift on SCBU today and this time we got stuck in straight away, cuddling the crying babies and even cup fed them which was an experience, using these small metal cups with spouts and slowly letting them suck on the milk flowing. So cute, we also helped a little bit more today and changed a few dirty nappies! Meet one of the sisters in charge of SCBU who is coming to our presentation tomorrow which makes us even more nervous. We found it very hot in the intensive care part with all the equipment which I suppose gets some getting used too. But loved our last shift on SCBU watching the nurses hard at work, bathing the each baby, then cup feeding, placing cannulas in their tiny hands so carefully, it has been a wonderful experience with again some lovely,helpful and kind staff and some very very cute beautiful Nepalise babies and mothers.
This afternoon were off to visit Bhaktapur the third major town of the valley, traffic free , the traditionally intact town is also in many ways the most timeless! Will let you know soon how it was and if we get lost!ha ha, goodbye for now England, Take care, can you believe only two more weeks left of our trip and then no more blogs:(
love Laura and Sam x

Lady in Red is dancing with me

So Teej was amazing. Rashmi, a member from MIDSON, met us at Patan Hospital and took us to Durbar Square to take in all the excitement. Teej is a festival celebrated by Nepali Hindu women, they fast for 24 hours and dance and give offerings to their god in the hopes of getting a healthy husband or protecting their current one. Everyone wears red, as this is the wedding colour. Sam and I wore red, and I even wore a bindi, with bling of course. We watched tarditional dancing and really enjoyed the girl power! Next thing we know we are both being dragged into the middle of the circle and are dancing with Nepali women, who put Shakira to shame with the way they can shake their hips! We must have been good...or more likely funny, as we are asked to do an encore!! We then visited Rashmi sisters house, where we met her niece and enjoyed talking to her so very much. Her english was excellent and gave us great tips for our trip to Pokhara next week. After some now much loved Nepali tea, we headed back home to enjoy some drinks under the stars.

A bbq with a difference...................

Hello England, So yesterday me and Laura had an extra day observing the theatres as the previous day we were only there a couple of hours due to my tummy upset. Again very interesting, four more c/sections for various different reasons including a breech, PPH (post partum haemorrhage) and APH (antepartum haemorrhage). After work we bought some bannanas from a fruit stall and some lovely milk, ice-cream (butterscotch - yummy) and paneer (which were yet to cook) from a dairy shop! Freshed up and had a quick power nap ready for an evening out, we went into Thamel to a bar that had happy hour, we quickly found out we didnt like the Margaritas so stuck with mabilbu and coke on BOGOF! After tucking into a tradional nepalise bbq, which was very deliclious the live band started to play, Layra was very happy as they played classics hits by Jimi Hendrix. Some tradional nepalise music and some english classics too, what a way to end nearly two weeks in Nepal chilling out wuth the Nepalise at quite a popular open air bar.

I' ll be watching you.............

Hello England, So it was my turn today to experience the upset belly but unfortunately it was in the middle of observing a hysterectomy in theatres, was very hard using the toilets and squatting with poorly belly. So we left work early and made it home OK and I slept if off plus some good old Imodium!And I now feel much better, this afternoon we jumped in a taxi to The Boudha Stupa which is an amazing site and was built some time after AD 600! The weather was beautifully from a roof toop terrace with amazing views of the mountains, the pray flags hanging and the sun shining. We are now in settle as it is pouring down with rain. I have enclosed an internet link for photos as the cable for my camera doesn't work on this computer, enjoy, we did, very peaceful and religious. Tomorrow we are observing on the antenatal clinic, wish us luck, take care England. Love Sam and Laura xxx

A day in theatres...................

Hello England, another beautiful warm day in Nepal, the sun was sunning when we left for work!We observed the operating theatres today and tomorrow, today we saw four caesrean sections, very impressed with their equipment, very similiar to home. The staff were very friendly and we had lovely Nepal tea made for us in the staff room. At lunch we went to our local moo moo restuarant near the hospital and had a tradional nepal dish which consisted of rice, spinach, i had chicken for laura vegtables, curried pots and sauces with poppadoms, yummy, i chose to use fork but iam proud to say Laura got stuck in with her hands just like the Nepalise. This afternoon we went to visit Patan hospital not sure about the transport we used a tuk tuk a small type van that on the way home fitted 13 people will saw you pictures when home. The hospital is a semi-goverment run hospital, which was very lovely, big, clean and some of the lay outs of the wards are like england. We were kindly shown around by the supervisor who we had a really nice chat we over some more nepalise tea which i love now!very sweet and cinamon. On the way home me and Laura got distracted by a spa and might of booked a few pampering treats for the end of our trip and got lost, but hey we found out way but to the cyber cafe obviously and gained more exercise ready for a takeaway pizza if they understand english, wish us luck, good night england all our love from Nepal Laura and Sam xxx