Somebody died

While in Udaipur, we decided to walk out along the shore. We saw women washing their hair in the gross water. After they seemed to be all clean, they all lined up to go in to a church and ring a bell. I asked a passerby what was going on. He said someone had died. I don't profess to be up on Indian tradition and have not read anything about it. But this is what I perceive to happen. When someone dies, everyone needs to go to the church to pray for them. Before they do that, they need to be cleansed. The women and men have to do this separately. So, in Udaipur, the women come down to the filthy river to do the cleansing. Once they are clean, they go in to a church, or actually a temple, to pray and ring a bell to a God. Then, they go back to the person's house who died. It was interesting to witness this.

Udaipur

We went on a weekend get away to Udaipur, which is about 6ish hours from Mota Fofalia. In India, it is common to travel at night. So, when in India, do as the Indians do. Right?!? We left at midnight and drove all night, arriving in Udaipur at 6am. Our driver dropped us off at our hotel and left. Our hotel was a bit of a maze. No lights were on. But, we followed signs and went up stairs until we found a desk. No one was there! By default, we were left to sit on the balcony until the sun rose. Udaipur is a beautiful city, and the sunrise was spectacular! I'm not a morning person, and would not have chosen to wake up to watch a sunrise, but I'm glad our trip turned out that way. We sat on that balcony for 5 hours until the workers arrived, and we were able to check in to our room, which had an equally amazing view. In Udaipur, we went to the temple, the palace, the spice market, and took a boat out on the lake. All were nice experiences, but the sunrise was our favorite!

Helping Babies Breathe

At the Mota Fofalia Hospital in India, the babies are delivered by a Nurse, a Ward Boy and a Sweeper. Yes, the same one that sweeps the floor. That's just the way they do it. They need an extra set of hands, and any will do. The sweeper is the one that takes the baby after delivery, so they are primarily responsible for resuscitation. We offered a "Helping Babies Breathe" training course today, and that is who we invited. We got most of the nurses, 1/2 of the Ward Boys. And 1 of the sweepers. They all did a pretty good job. The goal of Helping Babies Breathe is just that. To help babies breathe. 1 in 10 babies born require help. In India, that 10% often times will not survive, because nobody helps them. We talk about stimulating, suctioning and bagging if needed. All this should be done within 1 minute of the baby being born. I think back to the baby that died the last time I was here, and how many things went wrong. Things that could have been prevented if I, or someone else, had intervened. I hope those things don't happen anymore! The nurses seem to be grasping what we are teaching them. The new ones seem especially eager and open to it. Even if the training helps to save one baby, it's worth it. Isn't it?

Kite Festival

Today was the Kite Festival! A National Festival. Wikipedia says that they celebrate over 1,000 festivals in Gujarat State. I don't know how that's even possible, since they are only 365 days in a year. The Kite Festival is a 2 day festival to celebrate half way to Spring. Which is worth celebrating! Even though, here the weather is quite nice in the Winter, and miserable in the Summer. It is cold when the sun is down at night, but so warm in the daytime. I even took off my sweater.

We were invite over to Ashok's for breakfast this morning. Breakfast in India is basically cold cereal that is spicy on a plate with no milk. This morning, they also served yellow rice with lots of things added to it, because it is a holiday. After breakfast, we walked to the farm to relax. They grow all their own food here. There are no places in Mota Fofalia to buy food. After the farm, we ate lunch. We pretty much ate all day! Because after lunch, we walked in to town for the festival, where we also ate! Just like we do for holidays in the states. While we were eating, we flew kits. I tried to get some going, but was unsuccessful. Everyone stands on top of their roofs to fly the kites. We had a stack of kites on our roof. There is competition to 'cut' each other's kites down by running your string into there's, which literally cuts it, and it falls to the ground at an unknown location. This went on for hours. After dark, they let off lanterns, balloons, and fireworks. It's pretty neat to see all of these things going on! And, people where masks and glow in the dark bracelets and necklaces. Kind of like on Fourth of July. They do this two days in a row, because the weather is not always favorable for kite flying. So, they want another chance! I sure hope we can get some education done tomorrow, though! We actually did get some done today, since there were nurses working, and they sent all the patients home for the holiday!

Malnourishment in India

A while ago, the Government did a survey for Malnourishment in this area. They found 7 of 100 children were malnourished, and ordered them to go to the hospital to be treated. They didn't go. They didn't want to go. They are busy and in survival mode. Eating is not a priority and being hospitalized would be a huge inconvenience. So, this week, the government got serious. They sent a van out to the houses and picked the children up. Their mothers and siblings came with them. Their dads, who were working in the fields, were not even informed. Then, they were dropped at our hospital. After weighing and assessing, they were checked in. These children are extremely malnourished. An 18 month old looks the size of a 6 month old. The first test is called an appetite test. They are given a small bowl of something that looks gross. If they do not eat 90% of it, a feeding tube has to be placed. That's the protocol. It just doesn't happen here. The nurses don't feel comfortable placing feeding tubes. So, they just repeat the test until the children pass. We'll see how these admissions go. The children must either gain 15% of their body weight, or stay 21 days. Whichever comes first! This might be a long 3 weeks!

First Class

Apparently, I am a first class passenger. I checked in for my 2nd 8 hour flight on my way to India, after traveling for 24 hours. I was exhausted, and planned to sleep. I showed my boarding pass to the agent, and heading down the hallway to the plane. After waiting patiently in line to get on the plane, I heard someone trying to get through. Excuse me, excuse me, he was saying as he tried to make his way through the crowd...to find me! Agent: "Miss Janes, we had to change your seat." "Is it still an aisle seat?" In truth, I don't care where I sit, as long as it is an aisle seat. I have a routine! "Yes" he said. "It is an aisle seat in first class." A million questions came to my head that started with Why? But I didn't ask any of them. Instead, I got on the plane, tried to stay awake for dinner served on china with real napkins, before reclining to a horizontal position for a long Winter nap! Thank you Jet Airways!

Daily accomplishments

We went to one of the villages to get heights/weights and screen for malnutrition or other reasons children should see a doctor. We did see some severely malnourished children. One child that is 1 1/2 years old cannot hold her head up or sit on her own yet. We referred these children. I enjoy going out into the villages to assess the children, so I'm glad we got to go. Here at the hospital, I in-serviced on feeding babies, and on the emergency carts we put together and the documentation form we are rolling out. We also made a bulletin board. We just cross out fingers that any of this will have an impact. It's scary to get sick here! Then, we took a ride in the ambulance. That's when we got the low down on the baby. We spent about an hour with them. We didn't get any calls. So, they just took us to several food stands, and didn't seem to understand, "no thank you". So, we tried something they called mango ice cream, but was not ice cream at all. It did have ice in it though. We had some mango juice, and bananas and tried a guava and some other fruit.

Regular Day

We did a few other things between all that! We went to Jeetu's farm and picked mangoes yesterday. Then, in the afternoon, we went to Baroda shopping. We got medical supplies, and also went to the mall for some India attire. We wanted to go to a grocery store to buy some supplies, such as water, stuff for breakfast, toilet paper and chocolate. But, we couldn't figure out how to describe grocery store to our driver. He took us to a fruit stand, then a little shack that sold this and that.  A bakery. We couldn't figure out how to communicate what kind of store we were looking for. So, we just had to get a few random supplies where we could. So much for the chocolate and toilet paper!

Tragedy

There was a birth 2 nights ago. It did not go well. The nurses deliver the babies. The mother was pushing for a long time. After 15 minutes, it is the protocol to call the OB. It probably took him 15 minutes to get there. The nurse said she wasn't properly dilated. I think the babies head was facing the wrong way, and the cervix was probably mis-shaped. The did an episiotomy (they always do). They cut it bigger, but no progress. Dr Mikwana came, the mother was tiring but kept pushing. The baby was finally born after probably 50 minutes of pushing. There was a lot of blood and the baby aspirated and didn't start breathing. They have been taught neonatal resuscitation, so I was auditing to see how they did. The problem was, the equipment wasn't checked ahead of time. I had made sure there was a bag and mask there. But, the oxygen tank didn't work. So, we did what we could. The doctor asked me to prepare a room in the ICU. I ran there, but the oxygen did not work there either. We had to get oxygen from the ED. This all took 1/2 hour. So, 1/2 with suboptimal oxygenation to the brain. And, once the baby got oxygen, we still was really struggling to breath! I was so worried. I stayed with the patient until 1am. And, the nurse in ICU was brand new. Not ideal. I knew the baby had suffered from anoxia, but I was hoping it would be minimal.

 

That doesn't seem to be the case. Yesterday, he started having seizures. Today, I was in the room working on the emergency cart we are putting together. The alarm went off. The baby wasn't breathing. I stimulated the baby, but the baby would not start breathing. I called to the other nurse and asked her to get the bag and mask ready. I called to someone else and asked them to call the doctor. The baby did not breath for 1 full minute. He was very grey. He was breathing when the doctor came, but then stopped again. The doctor had to resuscitate. We ended up sending the baby to Baroda. This is beyond what we can take care of here. It's very sad! :(

 

We heard later that night that the patient passed away at 11pm. It's a tragedy! The hardest part is, knowing this patient would probably have had a better outcome if we had equipment that worked!

Marriage

India is running into a huge problem. Male children are preferred. Because of this, since ultrasound was introduced, abortion of female children is common. Also, families are more likely to seek medical care for a male child than a female. With these two factors, Males outnumber females with a 100 to 70 ratio. The Patel community is struggling with this, because there are not enough women within their community for the men to marry. The leaders had a meeting and made some decisions. They are willing to pay other high caste communities to marry their sons. They are absolutely not willing to allow their sons to marry from a lower caste. And, if their daughters want to marry someone from a lower caste, "honor killings" within families are common. The Patel community held a matchmaking meeting this last week to help with this problem. 400 eligible Patel men were invited. 100 Patel women were invited. The men introduced themselves and told of their qualifications. The women were able to select someone that they would want to marry. Every women was able to find a match. Now, the parents have to get together to discuss this match. There will be another such matchmaking meeting on October 12th. I've been invited to participate. It's no problem that I'm a foreigner! :) Can't wait!

Hindu Culture

Culture. I love it! It is one of my favorite things about traveling! We are coming upon a brick wall in India, because of the Hindu culture. They believe in Gods. Many of them. And fate. Everything is supposed to happen the way it happens. You don't question that. You just accept it. That makes health care a challenge. If you are sick, you are supposed to be sick. If you get better, the Gods wanted you to get better. If you die, that is the way it is supposed to be. You should not try to change these things and mess with fate. So, providing medicine, are medical care or even coming to the hospital, sometimes can mess with fate. You are playing God. That is why they don't feel it necessary to assess and intervene if something is wrong. They have ordered 17cc's per feeding for our Low Birth weight baby. That is less than what is recommended. The baby got 10 cc's today for 3 feedings in a row. I asked the nurse why. She said the baby was asleep. I tried to feed the baby, and she took 22. This nurse did not seem fazed at all when I told her the baby must have more! I'll check back, but am not hopeful. And, they wonder why the baby is not gaining weight! :(

Nurse Education

My purpose here is to Educate the nurses on taking care of Pediatric Patients. But, I have learned my job is much bigger than that. These nurses have gone to nursing school, but the practice here is much different. They have been giving meds and delivering babies. I can't deliver a baby, but I do a whole lot more than give meds to my cute pediatric patients. So, I am teaching vital signs and assessment. Seems so elementary for a nurse, but that is what they need. And, of course, hand hygiene! I have been given a list of educational needs by the Pediatrician. My goal is to get through all of them. That includes: Hand Hygiene, Newborn care, IV, Feeds and temperature. I am adding vital signs to that. I have introduced vital signs in October, taught them in Jan, but found that they weren't being done when I arrived this time. I audited the first week, educated again yesterday, and showed up before doctor rounds this morning to walk around and do vital signs with them. I will continue doing this week. And, have asked the medical students to audit after I leave, to see if they are still being done. I have a nurse coming in July, so I will have her re-evaluate and re-educate. That's the name of the game around here. Re-education about vital signs! The UofU asked me to stay for a year, to tackle some of these problems. I said I would like to, but I also enjoy a stable job at home. And a clean bathroom is a plus! (As a side-note: I asked a sweeper to clean my bathroom. They cleaned my entire room, threw away the trash, and didn't touch the bathroom! I really think bathrooms are considered filthy here, so they are not cleaned. I have never had a clean bathroom here. Makes going into one less desirable. That, and the fact that there is no AC in there.)

Mount Abu

We took the weekend off to go to a cooler climate. We went to Mount Abu. The temperature was still 100 degrees, but it was not as humid. So, it was nice! We took a trek into the mountains, and so where the nomads live. Every day, the Nomads hike their goods out to market. They balance them on their heads. Then, every night, they hike back to their homes in the mountains. The hike was pretty strenuous! They are nomads, because during Monsoon, they have to move to higher ground. We also saw the caves they live in during monsoon season. These people mainly raise grain and milk cows. They also pick berries and fruit. There are many edible berries and fruit in the mountains. We had blueberries, mango's and limes that grow wild. It was a fascinating journey

Visit to the Villages

Today, we visited a small nearby village. Our goal in visiting this village was to see some of the low birthweight infants that have been born at our hospital over the last 2 years. Low birthweight is any infant that weighs less than 5 lbs at birth. There were 4 children from this village. We were only able to find 1 of them. But, when people found out we were there, many wanted their children to be seen. We saw about 15 children and the same number of infants. We set up clinic outside under a tree. We did measurements and vital signs. We assessed for malnutrition. Most looked healthy. There were a handful that were malnourished, but none severely malnourished. We did refer several to the hospital for respiratory problems, diarrhea, malnutrition, and a child that had yellow eyes and a fever. Since it was 113 degrees outside, I thought for sure we would find more fevers! Loved the village visit. Planning to do an another one next week!

Day 1 accomplishments

Held two in-services on using the Open Warmer in the ICU. Had great attendance. Hands on and Return Demonstration.

 

Held 2 in-services on hand-washing. Had great attendance. Demonstration and Return Demonstration. There are no sinks in the old part of the hospital. I spoke to the hospital administrator about putting hand sanitizer in each room. He said the nurses can just bring it with them. Will have to audit.

 

Made 2 bulletin boards on hand washing.

 

Set up an emergency cart for the ICU.

 

 

The Caste System

In India, there are 4 Caste's. The highest Caste (Brahma) are the elite Caste - wealthy and well educated. The lowest Caste is know as the "Untouchables". The Untouchables are very poor, not usually educated, and considered "dirty". They are the ones that live in the blue tarp slums you see on TV. The government as made an effort to equalize the huge societal divide. They have mandated that a certain number of "untouchables" be accepted to colleges and in to programs that, in the past, only Brahma's have been accepted in to.

Our new OBGYN is an  "untouchable". He looked and looked for a job in the City where he was from, but no one would hire an untouchable. I applaud our hospital for being willing to help these people be successful! The problem is, people don't trust untouchables and don't want them to be their doctor.

How do you break this cycle that India has created?

Conflict of Interest

We have a newborn baby (actually, lots!). But, when we rounded on one of them yesterday afternoon, the mother complained that the baby was not eating well, and had not had wet diapers. The nurse said the baby had a fever. I asked what the temp was, and of course, she hadn't taken  it. Tactile fever! :) So, we took the temperature, and it was 102.4. I asked her to notify the doctor and he said to give Tylenol. I rounded again last night, and the temperature was 103.2. I told the nurse to call the doctor. This time, the doctor said to give the baby a cold bath. That's all fine and dandy, but it does nothing about why the baby has a fever. Being from the western world, I was very concerned and felt the baby should be treated for an infection. That can be serious in a newborn. This morning, I explained it to our doc when he arrived. He agreed with me. We weighed the baby and the baby has lost weight. Normal within the first few days of life But not when you only weigh 4 lbs to begin with, you're not eating, have no urine output, are irritable and still have a fever of 101. Unfortunately, not our hospital. Dr. Jha feels like the baby has a fever because it's 115 outside. Healthy infants can still maintain their temp. I don't like it, but the baby was sent home. One more down.

Being a Tourist

I have been to India 3 times in the last 7 months, and have only seen the Hospital. I decided, on this trip, I should venture beyond the borders of Mota Fofalia, and see what other people come here to see, The Taj Mahal!

The Taj Mahal is the resting place of the 3rd wife of Shah Jahan and is known as a "temple of love" because of that. Shah Jahan was married to 2 other women, but the 3rd wife is the only one that provided him with children. I feel sort of bad for the first 2 wives, that are buried outside the walls of the Taj Mahal. Plus, Shah Jahan's son imprisoned him.

Regardless of those facts, the Taj Mahal is incredible! It is one of the most beautiful buildings in the world  and truly a world wonder! Even seeing it in person, it looks absolutely unreal!

On this journey, we also saw the Agra Fort (where Shah Jahan was imprisoned by his son for spending too much money), the monkey temple, The City Palace in Jaipur, the Wind Palace and took elephants to the Amber Palace. All incredible sites.

I also had one other interesting experience in Jaipur. I got a full body massage. And when I say full body, I mean full body! No part of you is untouched! The human body is sure seen differently in different parts of the world! :)

Attract a crowd

I went on a walk through town today. I've done this many times. I enjoy it. And, usually, it is uneventful! A group of men called me to them. I went, wondering if they were going to tell me I didn't belong there. They wanted to speak to me, but in Gujarati. When they found out I speak English, they just smiled and looked at me. And, the crowd got bigger. And bigger. Finally, I asked if I could walk into the neighborhood. They said yes. But, I took a following. A group of kids followed me all through town. I turned around to take a picture, and they scattered. But, pretty soon, they gathered again. After finding out my name, they said "Zulie, photo." and pointed to something. I got all sorts of random pictures of people and things. But, the most fascinating thing was the crowd that followed me! What a site! I felt like a movie star! :)

Funny thing

Our NICU had been opened and is running well, with 1 glitch....  I typically come up to check on the nurses and patients before going to bed. Last night, when I came up, I found the NICU was locked. No nurse was inside. The mother was also coming to feed her baby. I went to find the nurse. When I found her, she could not get into the NICU either. They installed a new security system today that requires a fingerprint. Great idea, but they did not enroll any of the nurses. Not a great idea! So, the baby was locked inside the NICU and all the people that could take care of him were locked out. I went to find the people who run the hospital in their house, and the problem was solved! Luckily! No harm done!

Two Problems

There are two problems we are running into starting a hospital in a rural province in India. First, people cannot afford to pay. We accept and want to treat all patients! There is a nominal fee for cares ($1.50 for a delivery). But, most  people cannot afford to pay that. So, we accept and treat them anyway. It is difficult to figure out where the money will come from to treat these people, but we will find a way.

The other problem is, in other areas of India, people are still very poor. But, they know when to take their child to the doctor. In this area, they don't. They don't bring them until they are very sick. Sometimes, it is too late. I asked the doctor if he thinks they are not recognizing that there is a problem. He said, "no." He thinks they don't bring them until they start interrupting the daily life of the family. This is a farming area. Many families work in the fields 7 days a week. That's the way they earn money to support their family. Any interruption to that can result in them not having money to feed themselves and their family. So, they are hesitant to take the time to accept that someone is sick enough to get care. The quandary is, how do you change that? I, of course, think the answer is education. Which this family is trying to do. They run a school as well as a hospital. But, some poor families don't take the time for that!

Traditional Meal

Last night, I enjoyed a traditional Indian meal. A friend of the Patel's wanted me to have that experience. We sat on mats on the floor. Like every other Indian meal, we ate with no utensils, using only the right hand. The Roti that was served with this meal was very thick. So, it was hard for me to tear with one hand. I have not mastered that art yet. And, it was hard to pick food up with it. So, I ended up scooping. The food in India is spicy compared to what I am used to. I have been able to tolerate it just fine, but there was something served with this meal that made my eyes water. They were all very worried about me, but I survived! They serve a sweet thing with the meal that tastes like brown sugar. They also had homemade butter and milk. I have noticed they don't serve water until the end. Then, they use the leftover water to rinse off their hands onto their plate/bowl. I always enjoy new experiences!

NICU opening

We opened the NICU yesterday. We admitted a patient in Cardiac Failure. The patient came to the Emergency Department with trouble breathing and poor feeding, and was found to have a loud murmur. The patient had been to a couple doctors, but the mother was told the patient had a cold. I was here for the opening of the Pediatric Hospital in October, but there were problems with the NICU area. so, they were unable to use the beds until now. Exciting that I was here for the opening of the hospital, and for the first patients using the beds! I had to read the manuals to find out how to use the equipment, because no-one knew. I taught the nurses how to use them today! Unfortunately, the baby had to be sent to a bigger hospital for an echocardiogram and heart surgery today!

Dinner

We went "out" to eat the other night. When they said, "out" I had no idea where we would end up. Mota Fofalia is very remote. There is nothing that looks like a restaurant in town. We drove for about 20 minutes past the village. I thought we would come to another village, but we didn't. Instead, we pulled off the side of the road by a farm. There was a green tarp that had some lawn chairs underneath. People were harvesting a grain. Then, they served it to you for dinner. It was pretty good. And, like most meals in India, an interesting experience. We ate at the nursing school yesterday. The staff there were anxious about serving me India food. Meghna said, "Don't worry! She's used to it!"

Female culture

We interviewed a perspective new nurse. The "nurse" didn't have any training in healthcare, and wanted twice as much as this hospital is willing to pay. So, they didn't hire her. What I thought interesting is, first, that this girl had not been to nursing school. Second, that a man came with her. I asked Meghna about it. She said it was her husband. She said this is typical in India, because it is still very male dominant. She said if the girl is not married, her father or brother will come with her.

That lead to further discussion of the male dominated society. The things you read are true. Women are getting more education now days. And, they are working outside the home more. But, it is still at the discretion of her family, and husband after she gets married. A very educated women may not be allowed to continue her education or to work once she is married. And, men are still educated more often than women. In India, there is 85 women to every 100 men. There are more men than women. Because boy children are preferred, and ultrasound has been introduced, women will illegally abort a child if it is a female. Also, male children are more likely to get healthcare if they are sick. I think these things are progressing, but they are still happening today. For some reason, the society hasn't realized that if they only have male children, pretty soon, the population  will die. Because, without females, you can't have males. It doesn't make a lot of sense. The good news is, if you are a girl that survives to adulthood, you are more likely to get married than you are in Utah or the US! My problem would be solved! :)

In the hospitals, all nurses are female. They don't do any procedures or assess patients. They are taught assessment, and recognizing certain conditions in nursing school, but really the doctor takes over that responsibility in practice. One good thing is, there are more and more female doctors. In Medical School, there are 4 females to every 6 males. That may not seem even, but in this society, it's pretty remarkable. In my visits, I talked with some female doctors that practice the same as the males.

Museums

Because we were in the city for a wedding, we decided to stay. So, I got to be a tourist for a day. The price for a tourist to get into the museum is 10x that of a resident. I didn't think that was a very good deal. The museum was a typical museum. Nice, with interesting artifacts about history. I ended up being the biggest attraction for many attending. I didn't see any other caucasion people there. Groups of young people kept milling around. Occasionally getting up the nerve to say, "hi" or "hello," and then giggling. Finally, a girl mustered up the courage to ask for a picture. When I said yes, the flood gates opened. I ended up being in people's picture's more than the artifacts at the museum. The girls I was with got a kick out of it. So did I!

Traditional Wedding

I attended a Traditional India Wedding. In India, weddings are still arranged in most cases. There is a lot of tradition that surrounds the engagement and wedding day. This includes the bride's family offering gifts to the groom's family. And, then, a cleansing ceremony that takes place at the Bride's house 2 days before the wedding. The bride cannot see the groom for those 2 days. The bride is then taken to the grooms house is a special carriage just for that occasion. I did not get to participate in that part. I just went to the celebration. We ate Indian food. Then, we were given roses. I'm not sure what you're supposed to do with the roses, but the girls I was with ate theirs. So, that's what I did. It turns out, roses smell better than they taste!

Hospital Work

This is an exercise in patience! I am still struggling with getting the low birth weight baby fed. I've been working with the nurses on that. Today, I scheduled a meeting with all of the nurses to talk about the importance of feeding. It's sometimes difficult to understand! :)

Other things are progressing a little bit. I met with Meghna today to talk about my goals my stay. One of them is educating the nurses. I'm also going to meet with the community Health Care Workers. I'll hopefully go to a Nursing School and government hospital as well. Today, I met with the supply room to find out what supplies they have and what they need. I also followed up with a few malnourished children. 1 is the baby from last time. He has a name. It's Vicar. Often times, people in India don't name their babies until they are 1, because the survival rate is not good. Despite it's advancements, India still has one of the highest infant mortality rates in the world. But, Vicar is doing well. I told some of you that when one of our doctor's followed up with Vicar in November, at 1 month of age, he was almost dead. She brought him back to the hospital, where he stayed for a month. Then, he was sent home with formula. He is now up to about 5 pounds, which is double his birthweight. That's good. They are following him, so it's looking more promising.

Mota Fofalia village

I went into the village this afternoon. I ran across a marriage party! Everyone was so excited to see me! They invited me to come in and eat. I politely declined! But, they insisted I at least take pictures!

Then, I found a little neighborhood. People were on their roofs flying kites for the International Kite festival. I waved and got some little girls giggling. Then, put another little girl in a fit of tears. I must look so scary to some kids!

India in January

I am back in India. And, the saga continues. This is an exercise in patience! We have another low birth weight patient. This time, the mother can stay. The doctor ordered the baby to eat 5 cc's every 2 hours. I checked on the baby in the morning, and the baby had taken 3 cc's, and skipped one of the feedings. I emphasized the importance of giving the baby all that the doctor has ordered. I came back later, and they had placed a feeding tube. I was so impressed! I thought they were learning! Then...the baby only took 3 cc's the next feeding. They didn't use the feeding tube. Sometimes, I don't understand! So, I tried to be very clear. I hope that they understand, and that the baby continues to get fed. It's really not right that a baby should be born healthy, although small, and then starve to death. That shouldn't happen!

Indian adventure

During my first visit to the Mota Fofalia hospital, I found that the nurses and facility were unprepared to provide care to Pediatric Patients. The structure is beautiful! But the nurses are untrained. I taught them how to do vital signs. That's right, they didn't do them! I taught them how to count a heart rate, a respiratory rate, and take a temperature. And, what these numbers mean.

We ran into some bumps. The most significant to me was a low birth weight baby that was born while I was there. This baby weighed less than 3 lbs. The mother started coughing up blood, so we knew she likely had TB. The hospital was not equipped to care for a mother with TB, so she could not stay there. We knew that if the baby did not stay, he would die. He was too weak to breast feed. This was against the culture. In India, family members are required to stay with the children to care for them. We talked them into going against the culture. I tried to teach the mother that she must keep hand expressing breast milk, or she would loose her supply. The grandfather insisted he take the baby and mother home, but we convinced him that wasn't a good idea. So, the baby stayed. The doctor ordered a minimum amount that the baby must eat. The baby wouldn't eat that amount, but the nurses didn't realize that was a problem. I reinforced time and time again that the baby must eat that amount!

That's not the end of the story. The doctor followed up a month after the baby left, and the baby was almost dead. Mom hadn't pumped and lost her milk supply. They couldn't afford formula. It's really sad that a baby born healthy could die.

India Adventure

In October, I learned about a new charitable hospital that was being built in a small town called Mota Fofalia, India. The next week, I booked my airline ticket. The hospital was built by a family called the Patel's. Their father worked really hard, and saved enough money to send his kids to the US to study. All 3 boys stayed in the US. the father then built a small school in Mota Fofalia, so that other children could stay there and get an education. The father had a dream of a bigger school. He finally got permission from the government.Then, he had a stroke. He told his children, before he died, that they had to fulfill his dream. After he passed away, His oldest son took out a loan on his house to build the school. They were very poor. But, after the school was built, he believes God blessed him. He sold a business for 1.5 billion dollars. He then went on to buy and sell more businesses. He is now a multibillionaire. So, he didn't stop with the school. He built a hospital. Then, a children's hospital.
That's where I come in!

Machu Picchu is one of the most amazing places in the world! I had every intention to hike to Machu Picchu, but that didn't happen. The trail permits were all taken by the time we tried to book. So, we took the train. I had a friend that hiked it say, "We got to the top. We were all hot and sweaty. We hadn't showered in 3 days, and all the Japanese tourists got off the bus looking clean and fresh!" Yep, that's me! I'm kind of glad in a way! We got to spend more time actually at Machu Picchu! We took several hikes up and around Machu Picchu, including the Inka Bridge, Sun gate, Huaynu Picchu, and another one that doesn't have a name. At least not that I'm aware of. That one is less traveled. You have to use a rope to pull yourself up some of the steep rocks. It is all pretty amazing.

The Inca were amazing! All development during their civilization is so precise! They didn't use mortar, because they didn't have to. Their buildings fit together like legos. And, they have withstood the test of time. They have even withstood earthquakes. That's amazing! It makes you wonder what happened in the years since. That the technologies they used were somehow lost! The purpose of Machu Picchu is unknown. It was not inhabited for very long, and seems to have been abandoned while still under construction. Why? That's the question. And the mystery.

They valley below Machu Picchu is known as The Sacred Valley. And, it is sacred. There is a special spirit there! Despite the chill (and it was cold...no indoor heat) I would go back! Save me a place on their side of Heaven!

What an Adventure!

I've always wanted to go to Israel! Because of political unrest off and on through the years, I didn't think I'd ever get the opportunity. While planning vacation for this winter, I saw a cruise that included Israel. I thought this might be my chance to see the Holy Land. Booking the trip went fine. I felt good about the decision to go and did not foresee any issues. Then, political unrest (for lack of a better description) broke out in the region. The cruise was not canceled, and the unrest seemed to blow over. We were scheduled to fly through JFK in New York. One week before we were scheduled to depart, a hurricane blew through the East Coast, shutting down the airport and canceling thousands of flights over several days. The airport opened back again and all seemed to be well. Then, within days of our trip, I got an email reminding me of requirements to have a valid passport. I had a valid passport and was fully aware it expired soon. But, it was still valid. Then, I read the fine print, "a valid passport is a passport that does not expire within 6 months of travel." I didn't know what to do. I really didn't know if I had any options. And, didn't imagine they wouldn't let me fly, since my passport was still valid. Then, I talked to a friend who used to work for Delta. She said they would not let me get on the plane if my passport expired within 6 months. As ridiculous as I felt this was, I flew to Denver the next day, costing me hundreds of dollars, to expedite a passport renewal. So, 3 days later, we were on the plane to the Holy Land. The coast was clear! Or not! We got to JFK, now up and functioning normally, until a storm hit the day of our flight. Not so "normal" anymore! We were in New York. It was snowing. We boarded the plane. Sat for 1 hour. Got off the plane. Wandered for 3 hours. Got back on the plane. Sat for an additional 4 hours before taking off. Exactly 1 minute to spare before the flight was canceled entirely, because the crew cannot legally work longer than 18 hours. Despite the set back, we arrived safely in Rome less than 9 hours later, and 8 hours late. Luckily, we had planned to spend  a few days in Rome before the cruise. Our days were shortened, but we crammed in as much as possible! Now, we could rest easy! Nothing else would go wrong, right? The weather was lovely. Seriously! Sun every day. We cruised to Turkey and saw a castle. Alanya really is a nice town. I was proposed to there. I said, "no", but am not above an Internet relationship. Next, off to Cyprus. Another fantastic day, seeing amazing sights. That night, we were notified that the political situation was not good in Israel. We were supposed to dock near the Gaza strip. Since Gaza was shooting missiles into Israel, our captain decided that wasn't a good idea. We docked at another port higher north on the coast. We still drove into Jerusalem, it just took several hours. Some of the streets were closed, because of Intelligence they had received. That night, there was an explosion in Jerusalem. We missed it! I felt perfectly safe the whole time we were in Israel. On to Egypt. We went to Cairo. Cairo is a big city in a third world country. It is dirty and impoverished. And, the feeling on the streets were very politically charged. I didn't not feel safe in Cairo.We witnessed a scuffle, that added to my unease. We still saw amazing things! I don't need to go back to Cairo. But, I do need to go back to Israel. I think I'll check out a book about it tomorrow! Off to my next adventure!

Nicaragua

In May, I travelled to Nicaragua. Compared to many places I have been, travel was super easy! 3 hours to Texas, then 3 hours to Nicaragua. And, no jet lag! They are on the same time zone we are! We arrived in Managua on Wednesday night, and drove to Esteli Thursday afternoon. It was a 3 hour drive on a school bus with no air conditioning. Which is par for the course in Nicaragua! We had the windows down, until it started to rain. Then, it actually got a little cool.

Our hotel was nice and clean. There were 3 people to a room. This was a local mission, so there only 3 of us from the states. Everyone else spoke Spanish. Because of this, my roomates spoke Spanish. They were cute! One tried really hard to communicate. And, we used a lot of sign language. And, a lot of smiles! Our water only had an on or off switch, so you got the temperature you got! Sometimes, mildly warm, sometimes freezing cold.

We went to the hospital the next day to screen patients. We screened over 90 and 62 were selected for surgery. We selected several 3 month old infants with primary cleft lips. One struggled in surgery, so we cancelled one the next day. In all, we did cleft lip repair, cleft palate repair, burn and scar revision, and seperating finders of patients born with syndactyly.

The next 4 days were spent doing surgery! I was in pre/post op. Although the OR was in good condition, the pre and post op area was not. Mattresses were old and dirty. We had sheets the first day, but ran out after that. We used sterile drapes to cover the beds. When those ran out, we taped together chux. We didn't have IV poles, so we taped bags of fluid to the wall, or tied them to the ceiling with string. Always creative! Always an adventure! And, the bugs! Mostly flies! But, we also saw our share of cockroaches, rats and dogs in our pre and post op area.

Language was a bit of a problem. I worked with 1 nurse and 1 doctor. Neither spoke English. I made them repeat communication several times until I could pick up enough words learned in 7th and 8th grade Spanish class to figure out what they wanted. This is scary when they want is a medication I'm not familiar with, in quantities I don't understand. Some of them, narcotics. I always showed them the medication and syringe before giving these meds to make sure we were on the same page. Somehow, everyone survived!

The last day, we got to do a little sight seeing! We rode our bus up to a waterfall! The bus broke down on the way, so we had to get out and walk! We waited for hours for another bus, but finally found one. There was no place to turn around, so the bus had to back down the mountain. it was scary! Once we made it back to Managua, we went to a town called Grenada that was an old colonial town build by the Spanish. Very quaint! We ate dinner there, and flew out the next day! It was a good trip, and a good mission!

Dominican Republic

In January, some friends and I travelled to Dominican Republic, just for fun! We stayed at an all inclusive resort. It rained a lot, but the sun came out most days too! We went out on a glass bottom boat, whale watching, and relaxing on the beach. The highlight of our trip was hiking up the 27 waterfalls. We literally hiked up 7 of the waterfalls! It was not easy, but we had help! The water splashed in our face, frequently upsetting the integrity of my contacts. It was pretty cold too! But, what a blast! The waterfalls have smoothed away the rocks enough so that we could slide back down the waterfall!