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Today was a very busy day. The day started when 3 people from the town, we were supposed to look at in a few days, walked down the mountain and told us they had extremely urgent patients in their town.

We decided to send a scout team to look and see what their needs were and treat any urgent patients.  I volunteered our team, and of course this was the start of another adventure. I took our team and 1 other nurse practitioner who specialized in pediatrics. The road getting up there was impossible. It was full of rocks and mud. After we drove for about 30 minutes the road became impassible. A huge rockslide had totally blocked the road. The only way up to the village was climbing up a very steep mountain. Our guides took all of our gear and easily climbed up the mountain wearing flip-flops taking just a few minutes.  For me, it was extremely steep and had poor footing but we all eventually made it.

Once we got up to the town they told us they had medevacked 2 people from the village yesterday. They told they had 5 other emergencies. We said we would go to their homes to see them. The town representative said that despite being severely injured, the patients could still climb these mountains better and quicker than us. I believe him. They asked us to head over to the schoolhouse which was now just dust. There were no other emergencies except 1 woman who had a severely broken leg with internal bleeding.  We splinted her leg and sent her to the hospital for x-rays. That would be about an 8 hour ride in the back of a pickup truck over these incredible bumpy roads.  Ouch!! Most of the other cases were routine. We exhausted our supplies and returned to the main campus. They were continuing to see patients. We joined them and finished things up. 

We asked one of our translators if there was a place we could get dinner. There was only one place within many miles.

Always up for an adventure we went with him. The food was rice with a small amount of chicken and chicken sauce. We heard them kill and pluck the rooster while we waited.   As we ate we couldn't help notice that all the Nepalese were eating with their hands. I hate to be judgmental but eating the sauce over rice with their hands looked pretty barbaric.

While we were walking we asked our host for some lessons on life. We asked him about how happy he was.  He had just had his home destroyed in the earthquake. His father was in the hospital. He owned nothing.    So I asked him to rank his happiness on a zero to 10 scale .Without hesitation he scored 10. I subsequently asked the same question to our translators and guides.  They all had the same answer. Basically, it was communal living that they each answered as the reason they were so happy.   This is a lot to think about.

We had am amazing amount of rain today but luckily it happened after clinic. . We will go back to the same town today and finish seeing the rest of the patients. We are already starting to see our supplies diminish

For dessert today I had dehydrated key lime pie. Adding   2/3   cup of water created a delicious dessert. I am ready for the cooking channel.

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Would we or wouldn't we. That was the question. Would we be able to get in country or not. Days before the trip we ere told we would not be taken because they were only taking bigger, self sufficient teams and assumed, because of our relatively small size that we were not self sufficient. Along with our sponsors, Deerwalk, we convinced them we were self sufficient and we ended out being the last team aloud in. Then, we hear the runway is cracked and they weren't letting in Medium to large jets Well that sure sounded like us. The first flight from Abu Dhabi was canceled and, at that point, we were figuring out how to go about getting back to the states.

We kept our eyes on the departure board and we never saw the word "canceled". The trip was 3.5 hours, and the landing was rough. The flight went well enough. As I predicted, we were in the terminal for over 3 hours mostly waiting for luggage. Like in Haiti, there is no such thing as a line or waiting for someone in front of you.  You push to the front and an amorphous mob is created. We stayed back until everyone else got their bags. They had special sections for rescuers and gave us a free visa. We sailed through customs and met the Deerwalk van.

At this point we were told that we were the hundredth group and the last to get an assignment. Our assignment is to go to different towns in the remote areas and don't come back until we have taken care of all these towns or run out of supplies. So tomorrow we head with out camping gear for a 4 1/2 ride to some tiny towns.

Today we toured Katmandu. Most of the severely destroyed areas are off limits because they are still trying to rescue people.   We saw a number of buildings that had been destroyed but not nearly as bad as Haiti after their earthquake in 2010. In Port au Prince, Haiti, with a smaller earthquake, every single building was destroyed and they did not open for 6 months. Everything was closed for 6 months and the hospitals were mandated to give to give free care for 6 months. Although no one knows for sure it is believed that 250000 died in the Haiti earthquake and so far far fewer have died in this one.

At least in the parts of Katmandu we saw it was business as usual. Streets were packed and people seemed to be spending money. However, there are no tourists here and some industries are hurting. Our hotel has 90 rooms and only 20 are occupied.   
I did go on a ten mile run and saw a couple of candidates for our new front office opening.

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Today is day one of our trip to Nepal. I was scheduled to run a marathon on Sunday, May 3. I have trained for the last four months. This is a marathon of a different kind. 

Believe it or not our destination today was Abu Dhabi. I am traveling with Paul my friend and ultrasound technician; Allison, a registered nurse and wound care specialist; and Jodi who has been with me to Haiti and has made a number of other medical missions. She is a premedical student. They have all volunteered despite the incredible expense and sacrifice that they will have to make.

The trip to Abu Dhabi was 16 hours. It was relatively comfortable. Many of the workers for the airlines, as well as in the United Arab Emirates, are Nepalese. Evidently, Nepalese men work all over the world because there is so little work in Nepal. In fact, many towns are without men and just have women and children. The male workers send back their wages to their family. I was wearing a shirt with the name of the organization we are going with which is RAM. This stands for remote area medicine. They are based mostly in the United States and only started doing foreign disasters after the earthquake in Haiti. I went to the Philippines with them after typhoon Haiyan. Getting back to the Nepalese. Upon leaving the airplane they gave me three bags of leftover snacks, meals, and general food. I hope the kids in Nepal like potato chips. The temperature at 8:30 PM was a balmy 95°.

Included with the cost of the flight is an airport hotel. That is because we will be on the ground for over 12 hours.Our hotel's attempt at market differentiation is pillow comfort. They have firm pillows on the bed but have pillows of every firmness in the closet. You may select your pillow. Our flight to Nepal leaves at 230 in the afternoon on Monday, May 4.

Things are going smoothly so far. I only made two screw ups at this point in the trip. I did not realize that our luggage would be going straight through to Nepal. So I will be wearing the same clothes that I wore today again tomorrow. Fortunately all the necessities were in my backpack. Secondly, I didn't realize that we would require electrical converters. Paul has two so I can charge my computer with one of them. We feel like we are in the lap of luxury so far. We know tomorrow will be in  stark contrast as soon as we land in Nepal. The airport is supposed to be chaotic. We are prepared to be there for a few hours.

The news from Nepal  is not good. They continue to find more dead as they get into the remote areas. I believe the number is now 6000. Many more are expected. Conditions on the ground are not good. They have been having monsoon type rains although the monsoon season does not start for one month. Many of the roads are impassable. There have  been a number of serious mudslides. We have been told we will be up and running as soon as we hit the ground.

We are prepared with tents, sleeping bags, water purification systems. The temperature in Kathmandu is relatively moderate. Once you go out to remote villages most of them are at a higher elevation and it starts to get chilly. We were told we need to be self-sufficient when we go out to those remote villages. For the first time I have bought dehydrated food. I am curious to see how dehydrated lasagna will taste. And how about dehydrated ice cream for dessert.

I am hoping that communication will be good. An IT company will be our host while we are in Kathmandu. They are called DEERWALK and have a very nice campus. You can look them up on the Internet if you are interested. They have pretty good Internet. My phone carrier is T-Mobile. They have been nice enough to offer free calling and 2G data for the volunteers in Nepal. This will end May 16 which is the day I return. Hope to be in touch soon.

Dr. Siskind - Nepal            May 2015

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Last day

Today was an emotional and painful day. Excuse any change in tone/emotion.

Paul gave away all his extra food to the poor. Jodi left her 6 person tent in the last village. I gave all my stuff away to the Nepalese. Our gear on the return trip would be half of that on the way there. 

We hung out at the cafeteria and as we started to leave there the building started shaking. Allison was in the elevator. She grabbed the elevator attendant and did not let go. Electricity went out. Eventually generator kicked in and she was able to get out. Paul ran down 4 flight of stairs as fast as humanly possible. Trust me, it was fast. Sometimes I think of him as superhuman. I stood in a door frame with 4-5 Nepalese. It felt like the building was being alternatively pushed and pulled by a giant. I had just read that the chance of another earthquake in this region was less than 1%. I just waited and waited thinking it would end. But it did not end. It lasted 55 seconds. When it did finally end everyone ran out into open ground. Everyone was petrified. Many aftershocks hit immediately. Our hotel was condemned. It would not open again.  Paul and I cautiously climbed the eight flights of stairs to our room to get our luggage. Parts of the wall had separated from the floor. There were areas where bricks had fallen off the walls. And there were lots of large cracks that we had not noted before. After taking our stuff out we went back for Allison's. Luckily none of the aftershocks hit while we were in the building

We offered to our "lead" at RAM to stay longer and redeploy but for various reasons he didn't take us up on our offer. 

We wanted to stay and help all those that we had met. For various reasons it wasn't to be. With lots of difficulty we made it to the airport and were pleasantly surprised that things were operating normally. 

 I was so proud of our team. Treating patients in the worst of conditions. Scaling mountains carrying all our gear to treat people who had never seen a doctor before. Wading through the bureaucracy and getting things done that we knew others couldn't. Treating people in dangerous situations with no thought for their own well being. And offering to stay in Nepal despite   great personal sacrifice and danger. It is something I will never forget.  Allison, always even keeled keeping the rest of us grounded and organized. She is the organization queen.  She is destined to be a leader. When we set up clinic she told everyone what to do and people just did it. I can't wait to see what becomes of her. I can't say enough about Paul.  Paul, not me, found solutions to every obstacle that we encountered. He has the gift of gab and I think he can talk anyone into anything.  I have not found anything he can't do either physically or intellectually. And Jodi, at her very young age willing to do anything to help the team.  She is a college student who did blood pressure, blood sugars, triage, set up and always made us laugh. 

Our hearts are with the people of Nepal. They are the sweetest people we have ever met. There were no exceptions-not one. We hated to leave them but at that point we could do no more for them. We had given away all our camping gear, all our supplies, and all of our medication. We had nothing left  to offer other than our hearts. I'm sure RAM will send another team with the proper supplies right away and I will keep you posted as much as I can. For now all we can do is shed a tear for Nepal and help them any way we can.

Allison, Dr. S, Jodi, Paul

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The government thanked us and said they no longer had need for outside groups and we could go home.  It was hard to believe after what we had just experienced but we were very respectful of their wishes. We were able to change our flights to leave earlier and we had one day to kill.  We had already seen most of the sites when we first arrived at Katmandu and were getting ready to deploy.

We sat at a café and watched the traffic. In a short time we learned everything that must be in the DMV book of Nepal.

No matter what you are doing or where you are each individual always has the right of way.
You are obligated to pass every vehicle in front of you. Do not concern yourself with how fast it is going, if it is going around a steep curve, or even if it is in the process of passing someone.
 Finally, a one lane road actually means 5 vehicles of all types should be sharing the one lane. It doesn’t matter if they are trucks, cars, motorcycles, bicycles or whatever.

So if you ever go to Nepal I strongly recommend you don’t drive and whatever you do DON’T RIDE A MOTORCYCLE……

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We started at 10 a.m. from Katmandu. This was supposed to be a four and one half hour drive. I made a bold prediction at 10 a.m. I said we would get to where we are going at 8 p.m. It turns out I was precisely right. The farther we got from the city the worse was the destruction. At first one or two houses from a village were destroyed until the end of our ride when there was nothing left to any village. Everything was destroyed including hospitals and schools.

The first stop for us didn't occur for a few hours. We reached the county capital which was full of aid workers. We saw the American Red Cross, the Norwegian Red Cross, the Chinese Red Cross, us aid, the UN and multiple other aid groups. We were a little disappointed thinking we were going out to a remote area and would be the only ones there. That proved to be true.

We left with 3 vehicles. Gear went on top of the roof of the vehicles. All three vehicles were some type of jeep because we knew we would be driving on unpaved roads for at least 17 kilometers

Once we arrived at the county capital we needed to have 2 forms stamped before we could go out to the villages. That may sound easy but believe me it was not. A county Administrator had to sign one form and that happened quickly. However, getting the stamp from the Health Minister proved to be nearly impossible. First we were told we would see him in 30 minutes and then in 1 and one half hours. We saw him leave the premises in a vehicle and our hearts sank. However Paul was able to find his assistant and we pitched our case. He gave us a list of 4 towns that needed the most help and he would like us to go to and spend the next 7 to 10 days there. We asked him about the stamp.  He asked me to put my hand up palm up. I did so and he took his fist and punched it and said we now had the appropriate stamp.

The trip to the villages started out well enough. Once we hit the unpaved road the ride became very treacherous. We were going along a path that took us on switchback roads right at the edge of the mountain. We had to speed up to get over some of the steep hills. The roads were also very wet. Imagine going up these hills on the edge of the road flooring the car with it slipping and sliding. There were a number of times that we had to get out of the vehicle. Finally, at precisely 8pm we arrived at our destination. That is where we have set up Camp. We are on the grounds of a 2 room schoolhouse. School is canceled due to damage of the structure. I am sleeping in a sleeping bag in the schoolhouse. Most everyone else is sleeping in tents on the school grounds. We start clinic at 9 am. Without describing the bathroom facilities let's just say there is a spider the size of a dog in the outhouse so no one is going in.

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