So, Nepal . . .

There are privileges I’ve always known I had, like white skin, english as a first language, education, a stable and financially comfortable family, and there are privileges where it never occurred to me to know that I had them. Like being warm in the winter. I wear my coat and hat and thick fleece-lined slippers indoors, and the tips of my fingers and toes are still icy cold. Only the most luxurious of luxurious buildings are heated in Nepal, and as the hospital librarian said today, laughing, “in the winter, we just suffer.” I’ve never spent a winter without heat before, or reliable hot water, and no, snarky-pants reader, Israel doesn’t count. Could I get a space heater? Not that easy in a city with scheduled rolling black-outs.
Like, we saw a patient who had had a stroke. I asked the Attending physician about tPA, one of the best treatments for stroke. He said it’s not used in Nepal; patients never get to the hospital within the time window (4 hours) for giving it. Anyway, the price is exorbitant. So there’s a technology challenge, of how to bring down the price of these medicines, and the transportation problem, of how to bring patients to the medicine. Alaska used airplanes, but, cost.
Like, I’ve seen my first tuberculosis patients here. The skin testing we use in the US is useless, everyone’s been exposed. A patient coughing blood is presumed to have TB, then double-checked by X-ray. I should ask tomorrow if there’s a national TB control program; I know there’s a national HIV treatment program not unlike the erstwhile pre-Obamacare Ryan White Fund, except using Indian drugs with busted patents. Technology problems, solved, sometimes. I’m supposed to buy a facemask, both for the TB and for the thick smog that erupts out of hundreds and thousands of tailpipes each morning and is hemmed in by the mountain ranges one can barely see through the smog.
And the mountains. Rising jagged and higher in the horizon than I’ve ever seen mountains before.

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