It is Friday … again?

Somehow, the week just seems to fly here and there is so much to do and see. This week I went on a field trip to Godikum Hospital. It is about 12 KM away from Thimphu but takes about 45 to an hour to get to. Bhutan is not a 20 minute away from anywhere kind of city, it depends on where you are going and how many dirt roads and switch backs you are dealing with. While it is a tiny country the roads are very narrow and on cliffs…not for the car sick or weak kneed. Depending on who is driving, I have one eye open! LOL! Therefore I prefer walking. But, I digress… the hospital is in the middle of nowhere because it was the old leprosy hospital. It even has it's own small temple so the patients can pray. It is small but the patients get good care. The orthotic and prosthetic unit is small but they make everything from back braces, AFO, FKAFO, UE and LE prosthesis and orthotics. They equipment and methods are dated and prosthesis are very heavy. They don't use aluminum as in the country it rust pretty quickly. People wash clothes in a bucket, there are no washing machines and the water is not always reliable in the house, so going outside to get water to bring in is a common practice. ( yes, I bucket wash my clothes as well and hang them out to dry AND I have carried water in from outside) But, we do have a housekeeper and she does the majority of my laundry! :) She is amazing and I will miss her! They also have feet that can be used without shoes as some people who live in South Bhutan do not wear shoes..it is warmer in South Bhutan than here or in the east or North. Anyway, it was pretty amazing that they can so all the braces…for free, as many times as needed.
Patient update, I had to discharge my CUTE little boy because he got better…and needed to return home to east Bhutan. His elbow was -20 extension and has wrist extension and MP extension!!! Radial nerve palsy is resolving and he was happy to leave…I sent him home with theraputty and theraband and a ball and exercise program. It is really great that I can give them what they need without having someone tell me I can't! I am really going to miss that! My little girl is getting more control in her fingers and we are getting ready for her to go back to school and she will only get therapy 1x week. She is really sweet and is happy that her hand is getting better. I made her a thumb splint to help her oppose her fingers and hold onto objects…she had a spaghetti wrist, so median nerve and flexors were cut and repaired. Another patient is plotting and is trying to set me up with his friends so I will stay in Bhutan OR guarantee my return!! These people are so great and appreciative of all we do for them. It is amazing and refreshing. I also completed 12 protocols for the department and just in time, they have a new president and he wanted a copy of procedures that the department does! They were so thankful I had done that. I can't believe I have 2 weeks left here. It is so sad, it has been more than I imagined and I am so thankful that I have this opportunity.
We also had our first dinner party here at the apartment and I was taught to make some Bhutanese dishes! We shall see if I can recreate them..I also had some Bhutanese beer! ;)
Well, here's to the weekend!! More hiking and market exploring!!! It is also very cold here lately… i know 20 degrees is nothing, but remember… we have NO CENTRAL HEAT and poorly insulated homes. No heat in the hospital and gusty winds as we are in the Himalayas!!! But I  love this country and its people and all of its beauty.

 The hospital in the middle of nowhere and the workshop.

 The future K Pop star!!! He wants a blonde blue eyed or red headed girlfriend or Korean!!! Adorable!!! He has some wicked dance moves…. really.

 View from my awesome daily runs  in the mountains!

 Seriously, I was freezing and one of the boys moved the heater right under me!! That is how we roll in hand therapy!

 The national dish!! Ema Datse! Chiles with cheese and onions and soooo good!
Our guests and the cook! So fun!

Reason why I am here...

The weekend was amazing and we will get to that but TODAY… the whole reason why I came here was made clear to me. I have wondering if I have been making any impact and if I am truly helping them out. Today, the 3 of us (my co workers) sat down and reviewed the protocols I have written and the evaluation form and was told that I did exactly what they needed. It was not fancy and so over the top it was simple and practical and pertained to what they needed and what THEY would be able to carry through when I am gone. Then I was told that the other volunteer from Australia, while very amazing and helpful brings along a surgeon and fancy equipment and when she is gone, there is no use. I brought nothing fancy, just things I observed that I felt they needed. Number one, big sigh of relief and number two, the question of whether or not I am helping was made clear to me without even asking. Truly an amazing feeling and just affirmation that I am here for a reason and it is being fulfilled. Also, the hospital has a new president and wants procedure protocols and I have just written 10 protocols for them… perfect timing and done! As always though, the patient care is priority and I LOVE these patients and they work really hard and they are getting better.
So, on a lighter note. The weekend was filled with the vegetable market and an amazing hike to Tendin Lhakhang which is a monastery very sacred here in Bhutan and straight up the mountain. As everything is here…you walk uphill and occasionally down but then up again!! Not kidding…even the locals agree. Anyway, I crawled into a cave with very small opening to rid myself of attrition to get me closer to nirvana and climbed a cliff and walked around  rock to do it again. Anyone who knows mw well, knows I am a total klutz and I was fearing for my life climbing!!! There were several meditation caves that we visited as well as temples. It was very unexpected and completely amazing. Words can not describe the feeling you get visiting theses places that are sacred and clinging on the edge of a mountain. The feeling is serenity is unbelievable and it has been so amazing being here and experiencing all of it.

 Scenes from the market

 Some of the temple rooms and meditation caves, you can reserve one for months or years…

 The cave I crawled in and out of !!! I was terrified I would get stuck!!!

 Our monk guide! Who assured me I would not..

 My hiking buddies!!!

 Another of my hiking buddies!

The cliff rock!

What…it is Friday?!

Where has the week gone? Time just seems to fly around here and things are busy. We in outpatient hand are very busy and have not had much time to breathe even go to the bathroom!! But let me tell you, it is all worth it. My little people are making great progress and it truly has been fun treating the little kids. EXCEPT today..screaming 2 year old with a cortical thumb who needed a splint and was out of control. I read the doctor's note and he is highly recommended that she have behavioral therapy. The hairs on everyone neck were standing up and she was not having it! Soooo, maybe I will stick to teenagers and adults!! LOL Other than that, I have gotten the evaluation form done as well as several standard protocols written up for them. They were so happy when I showed them everything!! It was a great feeling because really that is why I am here. Everything else is a bonus! I wore my handwoven kira today and one of the teenage boys looked at me and said "Madame… you are wearing a kira! You look beautiful! You should wear one everyday!" It was the sweetest thing ever!!
We had an unexpected holiday on Wednesday. It was the national day of offering and so no one works! I ran all the way up to Buddha! and my roommate and I walked around a nearly deserted town and explored. It was fantastic! I even had a latte!! My first non Nescafe and it was heavenly…not my Starbucks or Kaldi's latte, but a nice change!
We also had an experience that evening. Our land lady passed away and there are rituals that have been going on for over a month. Well, her daughter came down to our flat and asked if we would open our door because the monks were going to perform a ritual. Well, monks came in chanting with masks and torches spewing fire and throwing rocks and grains in each room!!! It was so amazing and unreal! We were unsure if we could clean the rocks up… so we left it for a day. The ritual was to cleanse the building of evil spirits which may still be here after the death of their mother.
Other crazy things.. the ATM machine ate my card and I called the bank and they came an opened the machine and gave me my card back!! Needless to say, i am a little gun shy to use and ATM again!! The weather is very pleasant at times, but gets really cold really fast. I am now proficient in squat toilets and ALWAYS carry kleenex or toilet paper in my pocket!! There are some things I do miss about the USA! I also still can't get over the archaic medical equipment and wards. But what an amazing place this is and I am so lucky and happy to have this opportunity to be here!!

 My favorite little spaghetti wrist girl!! She is progressing nicely and excited she and touch her thumb to her pinky!!

Sometimes all the patients like to get involved and help me and each other!!!

 Latte!!! :)

 Every morning this little guy waits for me and runs up the mountain, sits here and takes a breather while I run up and then runs down!! LOVE <3

 Seriously the cutest little boy ever!!!

My kira! 

What a weekend!!!

Well, it was my first trip out of town this weekend and what a time it was!!! Totally amazing scenery and to ally harrowing car ride. Sheer cliffs with narrow lanes and no guard rails and hairpin turn as well as switch backs!!
Anyway.. Friday was a whirlwind, but I made the tiniest splint for a 1 yr old with a cortical thumb. It took 4 tries and a lot of coaxing and distraction to get her to cooperate!!! But I got it is soooo cute and fit her well. I also wore a half Kira and that is their traditional dress. My motives were selfish as it is beautiful, it is also warm!! It was like wearing a blanket and I am not sure if I can go back to scrubs! :) I also tied it wrong and had to be put back together immediately!! I will learn to do it correctly before I leave…I swear! I also got my little boy to play ball with me and I let him climb up the window bars to get him to stretch out his elbow! We had a blast and he is now my friend! I am loving the little kids, something I don't get to do very often. I have just about completed the initial evaluation form for them and we will trial it this week.  So therapy friends, stay tuned!!
Now for fun! We started off at the "crazy sex monk " monastery!! I got blessed with a penis and fertility! What?! So funny! But, it says that people who want to get pregnant travel here to become fertile and it works. He was a womanizer and the more women he had sex with were enlightened and brought him closer to it. I know… monks can have sex? they also go on vacation and have smart phones … even take call while chanting in the temple!
The next day we went to Pooghibka Valley to see the Black Neck cranes. They are from Tibet and winter in Bhutan. They are gorgeous but difficult to get really close pictures if them! We also saw several monasteries and temples as well as got stuck at a road block. They are widening the roads… thank god! It really is frightening!  anyway, Punakha Valley and Pooghibka Valley was worth risking my life for!!! Here are a few pictures from the weekend! We had a great hike today to a temple and ate some amazing food!!! Can't wait for Monday!!!

 My tiny splint!!

 My pretty half Kira after it was re tied!!

Prayer flags… I am a little obsessed with them!

 This is at the entrance to the crazy sex monk monastery!! Penis' are everywhere here and it is no big deal to see them painted on buildings!

 Prayer wheels… I love them too!

 Entrance to a monastery in Punakha

 Overlook from a Monastery in Pooghibka Valley

 At the very top of the temple in which the first queen built, you can see the himalayas in the background! Below is the larger prayer wheels.

Wednesday

Life here in Thimphu is moving along. I thought I would share some hand injuries that I deal with. These people receive free care, but the quality of care varies. It depends on the volunteers that are here who specialize in hand or they get sent to India. The ones that are sent to India for repair are very delayed because they have to raise money to go. This one particular gentleman had a spaghetti wrist and it was fixed 8 months later when a woman from Australia sponsored him. The outcome as I stated before will not be perfect but will be functional. He has terrible scarring and adhesions of his tendons and so we work a lot on scar massage and gliding as well as block and bend. He is very compliant and the hospital puts him up in housing. He is from eastern Bhutan and we are in the West. Another teenager lost his ring finger in a saw accident. He was fixed right away and is doing quite well, he has some moderate scarring and adhesions and I told him today that the only way he would have power in his hand again is if he worked really hard on the small finger. He is convinced now, I think. :) It is really fun to work with a wide range of diagnosis as well as age group. I saw a 4 year old yesterday and made him a little splint for his radial nerve palsy. He cried every time we looked at him, but today…he did whatever we asked him to do and smiled ear to ear!! He also injured his elbow… he too is from eastern Bhutan and the hospital is housing him and his mother. Pretty amazing what the the government  does for these people.

On a lighter note, I received another gift ! This time it was a traditional silk jacket… it is gorgeous and the girl I work with insissted I buy a Kira to match, but a traditional woven one. It is beautiful!!  I have finally gotten to to run, as I am used to the altitude and don't get so short of breath!! The run is extremely hilly, because Thimphu is only hills but it is absolutely beautiful.
For you foodies, there is a lot of indian find here and I am enjoying aloo paratha and chickpeas and other yumminess. I also am addicted to mustard oil, which adds some kick to veggies. And everything is served with chili sauce… I LOVE it!!!!

 Spaghetti wrist who was fixed in India.

 Teenager who cut off his finger. He laughs when there is pain, we pretty much laugh the entire hour!!!

 These are scenes from my morning run.. daunting switch backs but gorgeous views every turn!!!

And… aloo paratha with chickpeas. Paratha is a wheat indian bread stuffed with potatoes and spices. Yum!!!

Week one is done...

Ahhhh, I have so much to say and I don't know where to begin. We will start with the hospital life, really it is the outpatient center and we see everyone. There are no schedules, people just show up whenever and we treat them for an hour or so. We are also able to give them equipment. I am working on an initial evaluation form for them as well as a progress note. They try to follow the same patients and the patient's sometimes set up specific times with the therapist.  The system is great but there are flaws, partly from the system and then the patients. There is a significant amount of infection and even a bigger part of delayed treatment with incomplete repairs of structures. The physicians do not always repair fractures and the patients think that they will get all movement beck, but that is not the case. We discuss a lot about function and this is not a concept in which the physiotherapist  here are used too, they want the patient to bee 100%. This is impossible, especially when repairs are delayed for 15 days  or 2 months… so we hope for function.  I have 3 patients that have a set time with me and trying to convince me to see them on Saturday! Here we work 9-3 M-F and Saturday 9-1, but volunteers are not required to work on the weekends. :)
 So, here is how my weekend went… I started off at the vegetable farmer's market which was incredible!! Then hiked up to Buddha point which is about a 5 K straight up complete with switch backs… just when I think I have gotten over the altitude, there is always somewhere to go higher!! I then went to a party with all the PT's for a housewarming… so much fun, they are a great group and we had a great time. Sunday was an early start and we drove to Paro, about an hour away and hiked up to Tiger's Nest. A monastery built on the edge of a cliff! It was absolutely breathtaking and AMAZING!!! Again, hello dizziness !!! But who cares… it was amazing. Once you reach the monastery, they have you leave all cameras and phones outside and they pat you down. It is one of the most sacred monasteries… Buddha was reincarnated and he took the shape of a tiger and built this monastery. It really is a wonder, because it is straight up and hanging on the edge of the cliff (see photos below! :) ) Needless to say I slept like a rock.
And here we are on Monday and I don't even care. There is so much more to say, see and do!

 Our humble little clinic! It is not heated and freezing in there and I wear a billion layers!!! Not new to any of you!

 Buddha Point- Tshering is a PT I work with and Miki is my fellow volunteer.

 Prayer flags that were lined along parts of the trial. There were spigots with fresh mountain sping water which was cold and refreshing.

Tiger's Nest!!! It was amazing and breath taking. Norbu is my "boss" and Tshering is  a PT. 

Two days down …. where to begin.

It has been a whirlwind and talk about jumping right in! OMG! But I LOVE it!!! There are so many things running through my head and I don't know where to start.
First off… the hospital is NOT like American hospitals and it is like what we imagined, old beds with no elevation, no hospital food… there are wards with about 8 beds in each, no privacy curtains… it is incredible. Families bring in food and feed the patient as well as tea and juices. The all chew this betel nut, so their teeth are terrible and red and they spit everywhere. The hospital has signs that say "Please do not spit.", at first I could not figure it out, now I know.
The care is free, so it nice to be able to see patients for as long as you need as well as to give the whatever equipment they need. They come to therapy everyday if they want and stay for an hour or so or less. Documentation is minimal and no productivity!!!!! Inpatient is the same way. People stay in the hospital for months even if they are walking and moving around OK. The big thing here is infection… some of these people live far away from here and that is why they stay. Sound familiar my SLUH friends? But everyone is happy and so grateful for everything and anything you do.
This is my dream job. I work with patients along side 3 therapist and I teach along the way to a captive audience who is interested in hands. It is amazing and it feels good to be able to help people who want to be helped. I could ramble on for hours but I have some lectures to prepare… more to come!!

 Home sweet home!

My walk to the hospital … with a LOT of dogs along the way. :) 

And of course… MT EVEREST!!!  The tall one on the right . This was on the flight into Paro, Bhutan. I am staying in Thimphu, Bhutan which is an hour away. 

It is amazing here!!!!

Made it to Bhutan

Finally here!!! I am just about to go in to the hospital. I got in about 6 last night and had a great dinner. It is cold as predicted and layers are the key!!
This is my "front yard" ... More later. 

Ahhh.. Kathmandu!

I am so amazed by this little country and all of it's beauty. I have learned a lot in the last 2 days and it has been humbling. We as Americans are so full of ourselves and think that the world revolves around us… I met a monk yesterday who was so kind and sweet and had no idea where Hawaii was, much less anything about the USA. He is from Tibet and has lived in India for 20 years. He showed me pictures of his monastery and it was beautiful!!  The people here are very kind and willing to help you because let me tell you … it is very difficult to walk around here without getting lost and risking your life! There are no street signs so a map is useless and they don't care which side of the street they drive on… and motorcycles and bikes will run you over in 2 seconds! Also I was in a  taxi and the driver picked up 4 extra people with me in it!! No big deal except the cars are extremely small and they just sit on your lap, no big deal! The family got out and thanked me profusely… I loved it! Tomorrow I head to Bhutan, I am ready and can't wait! I am also finally starting to feel like myself again, they were not kidding that it would take a few days to adjust.
Oh and the food!!!  The bottom picture is a true Nepali meal!! It was spicy and delicious!!!