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!

A reflection of Cambodia

When arriving back in the United States, the man at the Department of Homeland Security said, "Thailand and Cambodia? There are a lot of temples in Thailand and Cambodia!" That certainly is true! And I visited many of them. I had been to most of the temples we visited in Cambodia, but we visited some I hadn't been to. Kings of this area would build multiple temples, relatively close to each other. Sometimes I wondered why. The temples were built at a time of prosperity in Cambodia. It was the peak of their prosperity. After the attack of Thailand in the 12th century, Cambodia has never regained it's prosperity, and did not gain independence until 1993.

When visiting the temples this time, I was struck by the carvings on the outside wall. On the walls, there are carvings of daily life in Cambodia at that time. The temples I visited were built between the 9th and 12th century A.D. That is 1,000 years ago. The significance of these carvings to me is that the way they lived 1,000 years ago is pretty much they way they live today. Although development took place, probably for centuries, that development was lost due to the Khmer Rouge. Their history was essentially erased. The carvings showed people cooking meals over fires....95% of the population cooks over a fire today. The carvings showed people going to witch doctors for consultation in who they should marry......the people of Cambodia continue to attend the witch doctors today. The carvings showed people obtained their water from a well.....70% of the population continues to obtain their water that way. As long as I have been in Cambodia and as many times as I come back, their level of development never ceases to amaze me. While they do talk on cell phones and drive mopeds, and many have access to electricity, the lights and mirrors are still of very poor quality. A common person wouldn't not recognize a Cambodian house as habitable. Many can't afford soap or toothpaste. This never ceases to amaze me. The Cambodian nation is a very, very poor nation with very, very poor people that have very little. I asked a Cambodian how much money he made. $70 a month working 6 days a week. That's less than $1,000 a year, less than $3 a day. The orphanage I volunteered at served a little bit of rice and a little bit of meat for lunch. That is not much more than they ate during the Khmer Rouge, and people were starving to death. People starve to death still. That is why the orphanage is so full. It's incredible. And, sad!

Politics

Politics are everywhere! And, unfortunately, politics are alive and well in Cambodia! Maybe even more so there. Last year, one of the things I enjoyed the most is getting to know the tuk tuk drivers. I got to know some more than others. I rode with many of them, and gave each one a gift when I left.They remember this gift still. There were politics amongst them then, but I think I got around it because I was here so long. I was able to use many of them and they seemed ok with it. The way it normally works is you come to town for a few days. The hotel sends a tuk tuk driver to fetch you from the airport. This is a free service they provide. The tuk tuk driver drives you around the rest of the time you are here and you leave. I knew this, and wanted to use my favorite tuk tuk drivers, so I got a taxi instead. I didn't worry much about a particular driver when I got here, because I took a bike to the orphanage. But, in the evening, if I wanted to go out, I would use whoever was here. This one particular guy, Mr. Thai, was always here. I was familiar with him, so he drove us a couple times. So, the weekend comes and I want to go to the temple. This is a coveted job, because it is significantly more money (up to $30 per day). I wanted to arrange with my favorite driver from last year, Mr. Thet. It was his turn, so we were in luck. But, then Mr. Thai came up and said that since we rode with him, we are now committed to him. He has to drive us the rest of our stay. We cannot get another driver. I tried to reason with him and agreed to go with him one day and Mr. Thet the other day. He refused and said he wanted to take us every day. We cannot go with anyone else. So, I said I would just go with Mr. Thet every day, but he said I could not because I committed to him. I complained to the hotel, and they said I could go with who I want. I went back out there, and Mr. Thai continued to be adamant. The hotel worker came out, and after a heated discussion, we were told it is better to go to the market and use another driver. We cannot use any of the hotel drivers if we do not use Mr. Thai. Mr. Thet just stayed out of it. He doesn't want to ruffle any feathers. He emailed me later to say he is sorry, and that Mr. Thai has always been like this. All of the drivers are afraid of him and let him have his way. It is unfortunate, because he and the other drivers lost our business. Nobody benefits. Everyone loses.