A birth

Warning: this post may be a bit intense.  The other day the health post was very exciting.  It started when an elderly woman with high blood pressure came in with a really gnarly wound on her palm.  She clearly needed stitches but I guess people were a little concerned that the extra stress might kill her off.  We determined that she had been taking her pressure meds and so decided to proceed with the stitches.  The wound was very deep and had plenty of exciting fat and stuff squishing out of it.  Since she was going to need quite a few stitches we decided to give her some numbing.  So the young lady I work with stuck a needle into her gaping wound and started applying lignocaine into the tissue.  This did not look very pleasant for that old lady, but more excitingly I did not pass out or even feel light headed.  Then I got to hold her hand still while my co-worker started stitching her up.  The first stitch was too close to the edge of the cut so when it was tightened the thread just pulled through the skin.  At this point my counterpart intervened who has more experience with jagged wound stitching and just flew through the rest of the stitches.  I was impressed.  It was like watching a tailor.

As we were closing down for the day a lady in labor came in and I was invited to stay and check out the birth.  I ran and grabbed us all some snacks and then settled in for the ride.  The lady was put onto the stainless steel birthing table then we just waited.  It was just me, the soon to be mom, and two of the health post ladies.  I was told that if I was asked if I were a doctor to just say yes.  The younger lady would occasionally put on a glove and stick her hand inside the mother to check on the baby position.  This would make the mother gasp in pain, but I’m sure it was nothing compared to what was coming.

The younger lady is a pencil thin but very pretty 20 year old.  She is probably 30kg soaking wet.  She has really gorgeous light brown, sparkling, almond shaped “Indian Princess” eyes that are offset a bit by a slightly abnormally large gap between her two front teeth.  The older woman is tall for a Nepali with very good smile-crinkles around her eyes.  She tends to slouch some which makes her appear as if she has a bit of a belly.  She is not very good at communicating with a non-native speaker.  She speaks very fast, and tends to garble her words a lot, but I’m learning to understand what she is saying.  I remembered the preggers lady from her pre-natal visits to the health post because she has these insanely striking, almost golden eyes.  Every time I saw her she looked a bit haggard and uncomfortable from being close to 9 months pregnant, but I can imagine her eyes would light up like a sunset when she laughed and would be like staring into the eyes of a wolf when she was angry.

We had to insert an IV drip for oxytocin, and I was really nervous about watching this go down since last time I was around an IV I passed out.  But, as I’ve mentioned, I gotta nut up.  So I watched all of it.  The whole set up, then slapping the back of the lady’s hand while she made a fist to get a vein to pop out.  Then the little needle was inserted, and I still had it together enough to tape the IV down.  Later on in the process something didn’t go right with the IV and the lady’s blood started working its way back up IV tube.  This again made we feel a bit queasy, but I didn’t pass out.

Before we knew it, the time had come to start pushing out the child.  First we had to drain the bladder.  So the younger lady inserted a tube up into the ladies bladder and judging by the way the patient cried out this was not a comfortable experience.  I got light headed at this point and had to stare out the window for a bit.  The urine was drained onto some absorbent pads that were placed between the ladies legs, ready to catch the blood that was surely coming.  I was given the task of supporting the lady’s head and keep her chin on her chest when she was pushing really hard.  I’m not sure why this was necessary, but I did as I was told.

I could see a little head of full of black hair starting to pop out.  The ladies kept telling the lady to push and she kept trying to get the head out, but was having trouble.  After about the third attempt the younger lady takes a deep breath and in English says, “Shit.”  This just struck me as interesting for some reason.  Each time the lady gave up the little head would slip back in a little bit.  At one point the head got really close to coming out, the patient started to relax, but the young lady says, “Do it!!”  So I didn’t let the lady lay back down and rest, and she gave it one last push and out came the baby in a whoosh of thick, dark red blood.  The baby had a very elongated head and looked really pale and almost bluish and I thought, “Oh no, something is wrong!!”  But it turns out I know nothing about newborns and the little alien took a deep breath and let out a good throaty wail.  It was a girl, which I’m sure the family was bummed about, but I thought was pretty great.  The ladies put two clamps on the umbilical cord, leaving about three inches sticking out of the baby’s belly and cut in between the clamps.  The baby was taken over and weighed, and then the older lady tied a few small strings around the rest of the umbilical cord, the last being as close to the belly was she could get it.  Apparently it falls off in about 24 hours or so.  I cut the strings for her.  While this was going on, the younger lady pulled the rest of the placenta out which was pretty bloody as well.  It looked like a purple and slimy old leather wine skin of the sort you might find as part of an old trapper’s clothing.

Now it was time to clean the lady up.  The younger lady did most of the dirty work on this.  She put her hand in and scooped out as much blood as she could, and then started inserting absorbent pads to get the blood that had pooled up out.  Then she grabbed a stitching needle and some thread and stitched up a tear inside the patient’s vagina.  Holy shit.  That looked intense as hell.  At this point the ladies decided that the patient was bleeding a bit too much for their comfort and decided to give my counterpart a call for instructions.  Since their hands were covered in blood, they asked me to dial him up, and hold the phone up to the younger lady’s ear.  I did this, and now I’m getting all sorts of shit from her because she says that my hand was shaking.  I don’t buy it.  We gave the baby to the waiting family, and my counterpart showed up and took a look at the lady.  She was okay.

They got the patient up started to walk her out to her family.  She had lost quite a bit of blood and had just fucking given birth about 30 minutes earlier, so of course she passed out.  They carried her out to the second of two rooms in the birthing center, and laid her on the bed.  I guess they really wanted to clean the room up and get home, but getting her up that quick was a bit too soon in my very uninformed opinion.  One last disturbing thing happened on my way out.  The family had brought their own cloth for the birthing table since the health post doesn’t have any. I thought it was understood that those sheets would be thrown out in some sanitary way.  Nope.  The grandmother comes in and collects this cloth which is just soaked in blood and carries it out to the other room with blood dripping all over the floor and shoves it in her bag with her other things.  Um… okay.  The cloth was just scraps, but maybe they needed it for something.

VIP status

The other day I was invited to a very exclusive Puja (or worship ceremony). Only men were allowed and only men from a couple families. The person in charge decided that I was acceptable material for this puja and asked me to go along. The person who was in charge is the husband of the eldest of my younger sisters. I was very flattered that I was invited. We left the house around 7 AM and hiked for a good three hours until we got to a temple way, way up on the hillside. They had leashed a goat up, and we brought that along with us and when we arrived we killed the goat. I had been told that we were going to have lots of yummy food like vegetables, rice, and goat. We ended up having the rice and goat only. I am not a big goat meat fan though they prepare it very well. But if you are given a tire to eat there is only so much you can do to make it taste good. They cooked all the organs separate from the “what I would consider normal” meat, and I got a heaping plate of organs before they served up the other meat. I tried to resist, but they forced the plate on me so I took one bite of intestine and decided that it in fact tasted like intestine, which is where food is slowly turned into poop and therefore I think tastes remarkably like poop. I have a lot of trouble opening my mind when it comes to eating organs, and also I just truly do not like the taste of any of them. Anyways, after the first bite I sidled my way over to a corner and chucked the meat for the birds. Then came the meat course, and then the three hour walk back. I enjoyed the Puja the other week that served rice pudding more. Not only because of the food, but well, I’m not totally sure why. I think I just had a bad attitude about this one because I wasn’t feeling awesome; I was very, very hungry by the time we got to the temple as we left before breakfast and didn’t eat until 3 PM; and there was a serious lack of pretty Nepali girls which, in my opinion, is a must for any good celebration or ceremony. But it does mean a lot to me that they already accept me enough to invite me on such a sojourn.

Looking across the valley at another settlement

Man talk

The view from the temple (very nice!)

Rota-tiller

 

In other news, I helped stitch another kid’s forehead.  Almost the exact same wound as the first kid, uncanny really.  The kid came in later for a checkup and is now terrified of me.  As soon as he sees me he minimum starts crying and usually just starts screaming.  And I went to the government school.  This was a good time.  I taught English to 6^th, 8^th, 10^th grades and health to 6^th grade later in the day.  In English class I talked a lot about America and had very simple conversations like “What is your name?”  “Where do you live?” “Who is in your family?” etc.  The English at the government school is way behind the boarding school because at the boarding school all the subjects are taught in English except Nepali, and at the government school all the classes are taught in Nepali except English.  This is unfortunate because in order to get almost all higher level jobs in Nepal you have to be able to speak English fairly well.  (Also I find it humorous that when people here say “government” in English it comes out “gument” just like a good Murcan would say it).  I actually found it easier to teach 6^th grade than I did 10^th which is the opposite of what I was expecting.  This is due to the more conservative nature of Nepali society: kids here mentally mature a bit slower than in America.  This isn’t necessarily good or bad, but just different.  The 12 and 13 year old 6^th graders were all very engaged and interested and were quickly able to overcome the embarrassment of their poor English skills.  The 10^th graders were 15 to 18 years old, and the class, surprisingly, was probably 75% girls.  These 17 to 18 year old girls were just giggling wrecks.  I would ask a question and everyone would start giggling and when I’d turn to one side of the class a girl on the opposite side would murmur the answer and when I’d turn and ask the person who answered to repeat what they said because I didn’t quite understand or I wanted the whole class to hear she would just turn red, hide her face, and giggle.  The class turned out to be fairly productive, but not as much as the other grades.  In America I would expect the 6^th graders to giggle uncontrollably when a dangerously sexy man (self-description) walked into the room to teach, and the 18 year olds to hold it together a little better due to them being a bit more mature.  I still had a lot of fun though because I just enjoy teaching, and it was a good way to get face time with the kids in the community.

I also have become friends with one of the teachers at the gument school, and she asked a very surprising question today while we were walking back from the school: “Why can’t men give birth?”  I thought she was joking and was going to continue the joke a bit, but when I turned to look at her she was dead serious.  This young lady is very smart, but just has clearly had a serious lack of sex education.  I think she is 26, and is pushing 4 foot 3…literally.  She is probably the tiniest person I have ever met, and is also super rad.  I didn’t get too detailed with the answer as there were other people around and things like penises and vaginas are pretty taboo here.  I know she could handle the conversation one on one, but everyone else would be pretty weirded out.  So I just said that you need to have eggs to be fertilized and a uterus to carry the baby, and only women have those things so only they can give birth.  This was done in a Nepali/English mix because I definitely don’t know the Nepali for words like 'uterus.'  But good times.

Christmas etc

Just a couple of things to write about now.  I went to Pokara for Christmas, and celebrated with my friends.  I came into Pokara on Christmas Eve, and immediately went to a restaurant and ate some delicious pizza with a bunch of the other volunteers.  After that we went out to a cool bar with live music, and stayed out until about 2 AM.  I got back to the hotel and slept for an hour then got up at 3 for a sunrise hike.  I hiked up to a town called Saranghot with two of my friends which we thought was a three hour walk, but it only took us 2 hours.  So we got there an hour before sunrise and I was able to climb a nice cell phone tower.  From the top of the hill we watched the first light hit the Annapurna Range which was spectacularly beautiful.  I got a few pictures:

Early, early morning light on the snow covered peaks of the Annapurna Range (LtoR: Annapurna Dakshin w/ Annapurna I behind, Macchapucchre, and Annapurna III)

Shawn and Matt

Ethan!!

(LtoR) Macchapucchre, Annapurna III, Annapurna II, and Lamjung Kallas

The (publicly, at least) unclimbed Machhapucchre  (I'm convinced at least one person has climbed it illegally).



Some sweet sunlight and glaciers on Annapurna II

A hazy Dhaulagiri

Annapurna Dakshin (south)

We hiked back down and I took it easy for a few hours until Christmas dinner where we did a “white elephant” gift exchange; I got a light-up bouncy-ball.  Then back to the bar from the previous night.  The other volunteers here often get too drunk because I guess they are children.  I usually find them fairly entertaining, but occasionally that can be a real pisser as I end up babysitting.  (Of course, I can’t complain too much as it is my choice to help my idiotic friends, but I feel for them.  Being in a foreign country can be scary for many people so I can’t blame them if they occasionally need to drink away their fear).  Anyways, on Christmas one of my friends got way too drunk, and I wasn’t about to walk his ass back to the hotel and luckily a couple of other volunteers…volunteered to do this.  I went and grabbed him a bottle of water and met them on the street just as my friend stumbles into the back of a taxi and breaks a light.  They just start walking faster, and I am standing there surrounded by six bewildered taxi drivers.  I decided I should try to fix the situation, and started talking to them.  They started demanding exorbitant amounts of money and say they are going to call the cops, so I said I can’t pay and they can get whatever they want to.  They tell me to go get my friend.  I say I don’t know him and that they can go get him if they want.  They tell me to stay there, and they are going to get my friend and the cops.  I say, “Nope.”  And start walking back into the bar.  I was wondering why I even tried to fix the situation in the first place.  When I start walking away two of them grab me, and I whirl around and yell in English, “Get your hands off me, boy!!!”  They let go, took a step back and I walked into the bar and had no problems.  I found it funny that I called the taxi drivers boy since I only call my brothers boy, but I guess when I am angry, and I was, I confuse people with my brothers… or I am just a huge racist which is also a good possibility.

The next day all the other volunteers headed back to their sites and I decided to go para-gliding.  I haggled a decent price and then got in the company’s jeep and went up the hill a ways.  I was just a passenger on the paraglider as there was a pilot who actually knew what he was doing.  It was pretty fun; we quickly caught a few thermals and shot up way higher than our take-off spot, and soared out over the lake.  I get motion sick pretty easily and so I barfed (there was a barf-bag).  This was a bummer, but the whole experience was still pretty exciting.  I recommend it for those who either don’t get motion sick or who have a lot of motion sickness meds handy.

Looking out at the lake just after take off

Stoicly trying not to barf

My feet!

Another hang glider!!

I think the pilot is more stoked than me... I think I'm just concentrating on not barfing

I'm flying it!  And trying not to barf.

Back at site, I went to a puja with my host sister and her friend’s family.  They did some various religious activities and I sat on a rock and napped in the sun then had rice pudding and vegetables: great success!!  A few pics of that day:

Having fun weaving a grass and flower necklace thing

Cutting up potatoes for snack

Making the flower thingy for some ceremony or another

HAHAHA.  My older sister's child

Hanging out

My health post

My village

My sister (left) and her best friend (right)

Sister, random girl, Ethan, and sister's friend (left to right)

And recently, I helped give a two year old boy stitches on his forehead.  That was a very loud experience… lots of screaming.  I also found my first positive deviant.  A positive deviant is someone who doesn’t do what most people do when it comes to some activity, but in a positive way.  In this case it is mother-baby nutrition.  I had just had another conversation about improved flour with a young mother and how to make it out of various bean flours, corn flour etc.  And again, the mother asked me for money even though all the ingredients to make the flour are readily available in like 99% of the households around here.  Breast milk and plain rice is just not enough for a one year old, so most babies are on definitely on the small side.  I was thinking, “I need to find someone who is doing this right, and who actually has the results to prove that it works (aka a healthy baby).”  Ten minutes later in walks this beautiful, radiant woman with a one year old baby that has a light fever.  So, while she is waiting I approach her to talk to her about improved flour to make porridge.  I do this with all the women who come in with babies and usually get ignored, misunderstood, or asked for money.  I ask her what she feeds her baby and she says mother’s milk and improved flour porridge.  I did a double take, and then asked her to weigh her baby.  I plotted the weight and age on the baby weight chart I have and sure enough the baby was at the highest end of the curve.  At one year old, you really can’t have a baby that is too fat and hers looked very healthy despite the fever.  I was so happy that she came in and that the practices that we are preaching really worked for her.  My counterpart and I talked to her, and he said that she is the only one in the village who comes in regularly for check-ups and who follows his advice.  I asked her if she could come to the trainings we do, and she said that she never has free time…bummer.  But I got her name so when we actually have a training scheduled I’ll go find her and ask her to come again.