Back to work at the hospital

2012-02 Suzanne leaves: Presentations, Spring time and back to work.

Well, here I am back in Kathmandu. As it often do while starting a blog post I will discuss coffee briefly. At the moment I’m sitting in the dark and sipping cold Nescafe which I’ve mixed with tap water. This tastes just like it sounds, absolutely disgusting, and of course for those of you who have read my previous posts this is due to two factors: having smashed my cafeteria on the flight back from Janakpur to Kathmandu and the fact that in Kathmandu I am back in the clutches of load shedding.

Anyway, it is self-inflicted so I won’t impose upon use my grumblings about coffee any more. Needless to say as soon as power kicks in either with the generator or load shedding is mercifully lifted I will have a nice hot cup of coffee. Until such time then I shall write on. Being in a pensive mood I’ve decided to listen to Joanna Newsom. For me she holds a certain nostalgic remembrance of having lived with Kenzo and Tamsin in my second and third years of university. These really were some of the happiest times. I think we made a good team, a testament to which is the fact that we still are great friends. Curious that I should choose to live and architects, but I guess it underlies the fundamental rebellion I have with doing anything by the book. Medicine tends to railroad one’s sense of destiny and so I have always tried to resist every turn my ultimate fate. Arguably the biggest decisions are still to come particularly this nascent desire I have to try and use all these artistic skills I have accrued over the years together with my medicine. Who knows what will come of it – and being somewhat cautious here I will not elaborate in public some of the schemes which I’m cooking up. Chickens and eggs after all.

So Kathmandu on my return really is a fantastically pleasant place. There is something of an air of European spring to the city at the moment with some of the most gorgeous weather that I have ever experienced. Being from a cold clime on the return from the somewhat sweaty Janakpur the ambience is really is quite pleasant. To the nearsight the ring of hills and In the distance the glorious mountains with their sparkling high-top white peaks, really elevate the mood to a higher plane. Despite my grand intentions to study 24 hours a day I think it would be amiss of my human spirit not to take advantage of this place here and now can see little bit of it, even if that only means climbing the nearest hill.

Back to Kathmandu
Back in the big smoke – with a touch of spring warmth the place feels more like the south of France. Great to be back

This new-found fondness Kathmandu lies in some contrast to Janakpur which very much grew on me. I certainly don’t think my initial impressions of there were as favourable as my return here – but as all things relating to both comfort, the recounting of former experiences experiences together with a fond return to people you know AND the perception that things generally are more pleasant — obviously these will improve your estimation. Simply put it’s great to be back and I really am looking forward to these final weeks in Nepal both in terms of my ability again to study but also the fantastic weather and I’m sure the many interesting, meetings I’m sure to have.
In terms of my immediate return, three events have taken place. The first was my presentation delivered to the Professor DS Manandhar of MIRA on my work in Janakpur. Despite very little preparation time, including within which managing to meet Penny, Christie and Bernie for breakfast at the fantastic Or2K restaurant before their afternoon departure, I pulled together a short but hopefully enjoyable presentation on my work down in Dhanusha. I decided not to focus so much on the scientific component whilst giving the presentation … overall the calibration study really is something of a one-liner in Delan’s thesis. You might wonder therefore that such efforts almost a month of continuous work should be had to get this. But that of course is the nature of research – that often the most difficult things reap very little reward. Hitting analyse on a data set may take mental conception but really is quite simple in contrast to history behind all those numbers which is often a story of pain, difficulty and general travail and really caveat. Yet the history of the numbers, if you will, is not the significant component of the research. It is instead the output, the meaning of those numbers. Of course I cannot entirely sell the calibration study up-river – it does have some intrinsic value in documenting worldwide variance between different populations in terms of the subtleties of their relative tissue hydration. Slowly but surely those who really are interested, amongst which I include Prof. Wells this holds the key to many more grand questions which I won’t profess to know a huge amount about but do have the potential to inform more grand designs.

Thus to complement the relative sparsity of scientific wisdom I imparted I gave an overview of the training that I had conducted and the documentary which I had also begun in Dhanusha – it is by no means finished but having 12 days of solid shooting completed we really have something quite exciting on the cards – by slipping together a few seconds of silent imagery which seem to be generally appreciated. Anyone who knows Janakpur, or who’s been there memories of the railway (the only one in Nepal) and of the animals and of the general busy chaos will recall strong and possibly… fond memories.

Indoor Air Pollution
All that smoke: who knows what the future holds?

As a direct counterpoint Suzanne’s was far more scientific and involved in the really quite complex work she had completed in Janakpur. I have much admiration for her having really completely evolved her scientific capabilities from a UK based epidemiologist to a full on field researcher – the running joke that she was literally “in the field” lost neither its candour nor its impact with the incredible histories like a goat eating the cables to her equipment and head-butting various monitors across the room before being banished to the roof – or even stumbling out of the kitchen where she could barely breathe because of the thick smoke. I think she would agree with me that out of the three of us, Delan, myself and Suzanne – that she really had the greatest change in her perspectives on what she was studying certainly (I won’t suppose other more general perceptions although she did allude to them) and thus arguably really got the most out of being in Janakpur. I see in her a rejuvenated curiosity and strong desire to continue working in this field, indoor air pollution, which she reports has a relative dearth of special interests in it despite its widespread impact across the globe….And in this respect I think in future when I go to one of her lectures as (undoubtedly) one of the world leading experts I’m sure she will fondly recall these times with almost opaquely rose tinted spectacles (she’ll leave off of remembering the bad times, the sickness and the distress when things didnt work or there was “so much confusion”). Granted she will have a bright future in which ever field she chooses to pursue and will make great contributions to such…. But I should hope that the sense of perspective she has gained from her journey here really will inform her work – so that it has the greatest capacity to make meaningful benefit for the people here. I cant recall if I have previously reflected on this but with regards to indoor air pollution really quite simple changes can have profound effects on the problem it poses. I see her work here as the start of a very exciting chance to change the lives of many women not only in Dhanusha but also more widely in Nepal and other places around the world.
With these potentials alluded to – particularly in her qualitative work – it was great to see such enthusiasm from those assembled at the presentation and I hope to see many more exciting studies exploring facets of indoor air pollution and its impact on health growth. On a another level, cooking practices are quite a profound reflection on cultural role of women. I should hope that through the ultimate identification of the issues that the lot of these women can be improved as happy by-product of directing change in methods and means alone. As Suzanne put it “it is empowerment is not just education which we’re after”.

The famous Pink Bike
The famous Pink Bike: no longer to be prowling the streets of Janakpur in search of smokey kitchens.

With the presentations completed I proceeded to interview Prof Manandhar. He really is quite interesting gentleman and we had a good two hour interview in which I was somewhat thwarted by struggling technical issues (not having had enough time really to unpack and organise my things I was scrimping on battery power and generally feeling that a bit stressed that I wasn’t capturing the right things during the interview). Nevertheless, we both felt that the initial foray whilst useful might be very much benefited by a second attempt with the Prof having a chance to reflect on some questions I had asked him and for me at least a chance to get all my gear in order! There were some comments about the general disruptive jubilation that seem to be emulating from the office which makes me smile somewhat. It is always a good thing to be able to be a laughing terms with someone very quickly. In the process of doing this documentary I have received many privileges of access and such a session with Prof is no exception.

That very night (Friday) Delan’s parents arrived in from the United Kingdom. We join together for a lovely dinner, ironically having been there just that very morning with the girls, at the Middle Eastern themed Or2K. Parents together with the usual three suspects – we were also joined by Naomi and James, British researchers also working with MIRA. Very enjoyable evening which saw me sinking into a quiet and peaceful sleep after the fact.

Back to work at the hospital
Back to work in Kanti Children’s Hospital

The morning hailed Suzanne’s departure. We shared together with Delan and his parents a final breakfast before wishing her well on her way. I’ve reports that she made it safely back to base and is missing Dal Bhat already. Delan and his parents have also made moves to travel around the country, something which I regrettably realistically going to have to pass on doing (certainly by my usual frenetic travelling standards). And I shall meet with him again on his return to Kathmandu before he ultimately heads home to United Kingdom – leaving me finally alone to continue what really is now my elective placement at Kanti Children’s Hospital.

I’d say that’s enough for this article now. I have several more which I wish to recant from my Janakpur experiences as well as ultimately going backwards in time to recall my first forays in Kathmandu and who knows even previous to this – celebrating some of the more interesting photos I’ve taken of the years might be a good start on that road. One of these days I’ll write a musing article about the purpose of it all… But now let’s leave it at a simple dual effect of sharing my experiences with you all whilst performing something of a catharsis and what all of this crazy business means.

“See you space cowboy”.

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