So whilst I meant to try and jot down my experiences in Kathmandu during my time in Janakpur the 39 days straight working experience somewhat distracted me from my original aims. Looking back I achieved a huge amount during this time but there are a few niggling things which I wish I’d also have ticked off of the list. I am sure Delan would shrug his shoulders at this as all three of us, Suzanne myself and Delan worked exceptionally hard without a break during this period. Suzanne especially had to combat the fact she was out of action for 10 days with hallucinative illness whilst trying to juggle her clinical and her research work. One thing I am particularly glad of is the fact that I did not get badly sick during this period as really that would have spoiled the party.
Anyway, I’m here in Kathmandu now and I have perhaps belatedly had my gastroenteritis gift from Nepal. This occasion is distinctly less savage than the first bout which I think occurred on a background of burnout from having worked straight from last summer through until Christmas and onwards soon as I arrived in Kathmandu. Nonetheless working at Children’s Hospital is probably not the smartest thing to do with the symptoms I got at the moment so I’ve signed myself off as “incapable of leaving the hotel”, certainly for the next 48 hours until this clears up. Anyone who’s ever travelled through a developing country and especially the subcontinent will be aware of the classic travellers sicknesses that tend to occur in foreigners. Ironically today I have spent my downtime reading the structure and function of the immune system in Kumar and Clark and have thus been evaluating my own thoughts on the gamut of specificity of my acquired immune system to the native bugs of Nepal versus those of the locals here. I’m sure if we turned our respective immune systems into Top Trumps cards they would certainly be the power cards in the deck.
So here is my chance to reflect on the first period of my elective in Kathmandu. Following my arrival I was immediately to work in the hospital. My first morning I got up in good time, chose my most presentable shirt and taxied up to the hospital in the Maharajgunj section of the city which is somewhere north east of the tourist area Thamel and beyond the embassy district of Lazimpat. I had no idea what to expect and I must admit I had some trepidation on my journey there although less so having previously travelled in India. It always seems that I reflect on past travelling experiences whilst engaging the current one and I am sure that Delan and Suzanne passed more than one yawn at my continual anecdotes of India, but one thing is for sure that having experienced the more extensive aspect of the subcontinent really did prepare me for many of the different aspects of Nepali culture – and the hospital was most ways encompassed within this.
Thus my arrival at the hospital was timely but there was no sense of formality in my linking in with the work itself… I asked a few random people, some of whom could well have been patient’s parents and eventually tripped upon an important looking doctor (turns out he is one of the major Prof. of Paediatric medicine for the hospital) walking up one of the main stairs and introduced myself. Somewhat clumsily I was integrated into the ward round and did my best over the following hour and a half to follow what’s going on. The ward round was conducted in English but the special colloquial mix with Nepali s as well as the rapidfire acronyms meant that a lot of the ward round was lost on me. My supervisor who I was supposed to meet was apparently still on holiday and following the ward round I was suggested to go and see “Bishop Joshi” who has a role looking after the foreign medical students. He and I passed some time together during which he asked me if I wouldn’t go to help edit an article he was compiling for the upcoming souvenir of the hospital. I was intrigued and naturally offered my help. We spent an hour or so looking at the history which he had compiled of the hospital before taking lunch…Little did I know that this was a fateful precursor to the next major event of my life – the Kanti Children’s Hospital 50th anniversary souvenir.
The following morning I returned to Kanti. Somehow I managed to bump into Dr Ajit Rayamajhi and we held our first meeting. This was auspicious and really marks the start of a collaboration which has been required extensive over the last two months. I’m not sure if he really thought I was being serious when I discussed my intentions about the website for the hospital and other plans as well… In any case initially the most pressing matters seem to be the business of this souvenir. Essentially every two years the hospital produces a celebratory edition containing many articles from all the departments detailing the various activities of the hospital. What was special about this occasion was that the hospital was actually celebrating its 50th anniversary and in concert with this was having a large ceremony to which the President of Nepal would be coming as well as Senior Health ministers. I’m not sure if it was he who asked or if it was me who volunteered but within a matter of hours I became fully committed to assisting in the publication of the souvenir. After all was I not a professional photographer? Was I not a native English speaker and therefore more than capable of helping out with the editing of a few of the articles?… Oh, What a journey I had subscribed to. Thus it was that over the next seven days Dr. Ajit and I worked solidly from dawn till dusk and even beyond to produce this epic souvenir edition.
In the first few hours the initial forays still had me guessing. I started off by adjoining a few meetings upstairs with the computer manager, Shri Ram, and collected a few articles which had appeared ready for review. Some appeared as word files, some as handwitten manuscripts. We discussed deadlines and decided that seeing as the printer needed all the documents ready to him by the Monday at the latest that we should contact all the relevant people on that day (Thursday) to say that they had until Saturday evening to submit their articles. Looking back I can see how this was such a laughable fantasy at the time but we did try I suppose.
The next day, Friday, I arrived and was presented with “final submissions that English articles”. A small editorial meetings to be held upstairs which Dr. Ajit would be attending for an hour. I installed myself in the repair and maintenance section office and began editing the articles. Having already had a chance to tackle the initial history article by Bishop I was quite prepared for some quite extensive editing of these articles. I won’t be disingenuous to the authors but the range was very quality range was very variable. At times it was genuinely challenging to find the sense in the grammatical confusions which I was presented with. Some sentences were really very ambiguous. I sweated and pained away – expecting any moment for Dr Ajit to appear. The first hour passed and then the next and eventually I gave up hope of his emerging from the upstairs editorial room. I remember feeling really quite frustrated at the time – thinking that they were simply discussing what needed to be done upstairs whilst I was chomping through articles downstairs – after all the actual output of this whole business. I still had no idea what was said or decided on that day but eventually after many hours people came by to review the progress and another spate of articles arrived at my desk.
The next days really were a haze and I’m not sure it serves much benefit in detailing the step-by-step evolution of the souvenir. Essentially Dr Ajit and I worked absolutely flat out. We had meetings at the printing press, repeated calls with the various authors of the articles and one morning dedicated to photographing both the hospital and the entire assembled staff in groups upon the roof. In between times consultants would approach me to make corrections on their articles or to straight up dictate them into my computer with me as acting as something of a secretary, editor and techical advisor to the whole process all the while. All the while I was beginning to feel really quite unwell. Not having really had a chance to stop over Christmas and before that the autumn term and even before that in the summer I felt like I had reached the end… But what really was going on actually was a burgeoning case of gastroenteritis. Eventually on the Monday night after 2 am call at the printing press with the editing team and with the final deadline looming my body gave in and I succumbed to an awful night of “the shits” accompanied by occasional bouts of vomiting. Passing out at some point it dawn I woke in a haze later that day with my hotel phone ringing.
“Excuse me sir there are some gentlemen down here to see you”. The chief engineer and one of the designers had come to see me to find out what had become of me (I’d said that I’d be at the hospital at 10am). By this stage being so enrolled in the whole process really I could not back out despite the fact that I was ill. I woke, opened the door and stole a quick shower whilst the pair looked over the photographs I had taken and together we selected from these and the many hundreds in the back catalogue for publication in the journal. With literally hours to spare before the deadline I rapidly edited together the photo pages and made the final adjustments to the front cover design which as well as the articles and photos I had taken charge of. Thankfully by this stage all the articles were edited and finished and I stole over to the printing press in a taxi – as opposed to my usual mode of transport, on the back of a motorbike – something which I was to become even more familiar with them my time in Kathmandu in Janakpur ) – with my finished submissions.
The final night really was an all-nighter and having completed my job I then spent the remaining hours assisting the designer in finalising the pages. This included all the portraits of the authors, which I had to hunt down by direction of Shri Ram through all of the back catalogue photos, individual portraits which I had taken, or by simply cutting them out of the group photos from the photo shoot on the Sunday. It was times like those which I really appreciated having RAW photo files of approaching 30 MB in size. The fact that you can still whittle a decent size image out of miniscule section of a group photo is fantastic . Eventually with my work done and feeling somewhere between life and death I watched in a haze laying down on the floor by the heater in the printing press as the hero of the final hours Aman chewed through the 150 page journal with the rapid speed. Eventually it was recommended that I go home and I crawled back to the hotel and into my bed just as the Dawn rolled in thankful that it really was all over. The president would be attending on the Thursday and then It would be all over.
One person who deserves some special mention in all of this is Aman. I remember trying to use his keyboard and his mouse both of which as far as I was concerned were defunct. In spite of this he operated using an old XP system on creative Suite 2 at a speed quite remarkable to me. I suppose when one is completely in one’s element things flow like water. Like the skill of expert surgeon he absolutely blitzed his way through the article placements. I’m really glad that in my enthusiasm and having previously mentioned that I could do it that I didn’t sell myself up-the-river on the task of doing all the document linking for this project. Really to produce in a matter of 24 hours such an extensive and really professional souvenir would have definitely been beyond me and little skills idea gaining in design I think make me at least appreciate the complexity of publications which I see nowadays. Aman is a talented designer and mean to revisit with him to try and help him gain a few extra skills which I might be at share with him if only indirectly. I might also buy him a new mouse and keyboard although what he really needs is a completely new system! I have to wonder what someone with his nascent talent could do on more advanced creative Suite and modern, rapid 64-bit system. Ultimately the contribution of my inputs meant that he was able to focus on making the design really solid and I’m quite pleased to say that the 50th anniversary souvenir is something quite robust and certainly special if only by the numbers of hours of my life I burned its creation!
I did however get a small chance to celebrate on New Year’s Eve.
There were times when I questioned why on earth I come to Nepal to edit these articles and to generally work as hard as I did. But looking back now it was certainly one of those “have lived through” experiences and I’m certainly glad of the quality of the production we were able to put together within those seven days. More than this though I think my commitments and media trust and respect certainly of Dr Ajit. And I gained a lot of insight into the process of the functioning of Kanti Hospital. Literally, I now have a comprehensive view of the evolution of every department of the hospital, the history and future prospects as well as the subtleties and the political issues which lie beneath the surface of its daily functioning. I suppose that’s one way to gain insight into a health system at least! The other major advantage was that in so doing the souvenir I gained all the materials are needed to create the website for the hospital. In addition, gaining the trust of the major players at the hospital meant that my course ahead really would be much smoother.
So not exactly what I expected to be doing when I first arrived in Nepal although I did have some suspicions that I would be working hard…. It was a sign of things to come – that’s for sure… Ultimately a great opportunity to put my skills to use and a real privilage to get to work with all of the various departments of the hospital. And of course a friendship started with Dr. Ajit which I hope will continue for not just the coming months but the years ahead as well.