A World Lit Only By Dung

March 17, 2015

The front of the HRA clinic in Pheriche, with the Everest Memorial monument out front.  It lists the names of all the known deaths on Everest, currently accurate through 2012.

The front of the HRA clinic in Pheriche, with the Everest Memorial monument out front. It lists the names of all the known deaths on Everest, currently accurate through 2012.

The plaque on the front door of the Pheriche HRA clinic

The plaque on the front door of the Pheriche HRA clinic

We have made it to the HRA post at Pheriche, and are slowly adjusting to our new routines. The valley that contains the small village of Pheriche is absolutely beautiful, with towering spires surrounding the houses, lodges, and farms. After arriving, we assigned ourselves rooms and got to work cleaning the residential side of the clinic. We then spent the next two days, March 13 and 14, cleaning the clinic, and arranging the medical stores.

View of the Pheriche Valley to the Northwest.

View of the Pheriche Valley to the South.

View of the Himalayas surrounding Pheriche.  Looking to the Northwest

View of the Himalayas surrounding Pheriche. Looking to the Northwest

The "business end" of the Pheriche HRA clinic, the reception area for patients, and the shop for selling t-shirts, etc.

The “business end” of the Pheriche HRA clinic, the reception area for patients, and the shop for selling t-shirts, etc.

The examination room, where we see most patients.

The examination room, where we see most patients, still in the process of being cleaned.

Our "Inpatient Ward" where patients staying overnight will sleep.

Our “Inpatient Ward” where patients staying overnight will sleep.

The kitchen, where Jeet keeps us well fed, and where there is an unlimited supply of hot water for drinks (my new favorite being a combination of Hot Chocolate and orange Tang, delicious!)  We sit around the small table for all meals.

The kitchen, where Jeet keeps us well fed, and where there is an unlimited supply of hot water for drinks (my new favorite being a combination of Hot Chocolate and orange Tang, which I call a Terry, after the British company that makes chocolate oranges.  It’s delicious!) We sit around the small table for all meals.

The common room at the HRA clinic in Pheriche.  My room is the door on the right.

The common room at the HRA clinic in Pheriche. My room is the door on the right.

A Panorama of the staff enjoying the heat of the Dung stove in the evening.

A Panorama of the staff enjoying the heat of the Dung stove in the evening.

My bedroom at the HRA clinic

My bedroom at the HRA clinic

When we arrived, we had the bags we carried, plus one bag carried by a porter. The rest of our supplies, including food, medications, and personal effects, were to arrive by Yak train. This hasn’t happened yet….

Supposedly they’ll be here by tomorrow. The clinic has now been open for the past 4 days, and we’ve seen several Nepali locals and guides, and have diagnosed two people with High Altitude Pulmonary Edema. One has been flown out, and the second is spending the night in the clinic tonight, and will be flown out tomorrow.

We have split up the schedule so every day there is a daytime doctor, a nighttime doctor, and a doctor who is off. The night doc is also responsible for our 3pm altitude lecture, which I gave for the first time today. Our schedule is such that you work each shift twice in a row, which ultimately gives each person 2 days off at a time.

So tonight is my first “night shift”. We’ve had good luck in the past not getting patients during the nighttime hours. We’ll see if it holds for tonight. Tomorrow I will also be on overnight, and then will have two days off. If I get good sleep tomorrow, then Reuben and I are planning on trekking down to the Ama Dablam basecamp, which is at approximately the same elevation as Pheriche, and is supposed to be quite spectacular.

It has been cold, and even snowed yesterday. Our building is powered by solar, with a solar water heater, so our ability to function is dependent upon how much sun we get, and how much we need to use the oxygen concentrators for our patients (our major source of energy expenditure).   It’s kind of interesting to have to be so conscious of our energy use. Many Americans and Westerners would probably be well of to have to live by solar for a period of time to have a better understanding of the implications of power use.

But today was sunny and warm, and we got enough of a charge that I could take a nice, hot, shower. This is the first shower I’ve been able to take since leaving Kathmandu on the morning of March 8, 10 days ago. The good news is that it is so cold here that you never really develop the bad smells that you would in more temperate climates, but I was still happy to wash all the days of travel off of me, and change into some fresh clothes.

Our daily routine is such: Jeet, our cook, has breakfast around 8am. We usually lounge, or work on projects until noon when we have lunch. If it is sunny, one or two people can take a shower after lunch, during the warm part of the day. Then at 3 we have our altitude talk. This usually brings with it a small flurry of business, as people realize that they are actually suffering from altitude illness. Dinner is at 6pm. Yesterday they bought a chicken, which was cooked with the Dal Bhat. I have decided that one determination of whether a country is civilized is how they cut up a chicken. Needless to say, I’ve been carefully picking around jagged pieces of bones here. But protein is still good! After dinner is the real treat of the day: Jeet loads the potbellied stove full of dried Yak dung, and we sit in warmth, the only external source of heat we have other than the kitchen’s gas burners, and the very occasional warm shower. For several hours in the evenings, we relax in the common room in comfort. We are only allowed one stove’s full of dung a day, so when it is done and the room starts to cool, people head towards bed. Renee and I have our bedrooms directly off the common room, so we have gotten in the habit of opening our bedroom doors after the others have left, and letting the remaining warmth of the dung stove heat our rooms before bed.

The following are pictures of the clinic, Pheriche, and nearby Dingboche, which Renee and I visited a few days ago.

The author in a PAC bag, which can effectively increase the ambient air pressure by 2 bar.  In Pheriche (4200m), this  simulates the much lower altitude of Lukla (2800m).

The author in a PAC bag, which can effectively increase the ambient air pressure by 2 bar. In Pheriche (4200m), this simulates the much lower altitude of Lukla (2800m).

Practicing with the PAC bag inside the sun room.  The author is currently inside.

Practicing with the PAC bag inside the sun room. The author is currently inside.

The village of Dingboche, a 30-45 minute walk from Pheriche. It is 200m higher than Pheriche, and quite a bit larger.

The village of Dingboche, a 30-45 minute walk from Pheriche. It is 200m higher than Pheriche, and quite a bit larger.

The village of Dingboche with Island Peak (Imja Tse) in the background (looks like a black diamond).  I am planning on climbing that mountain in May.

The village of Dingboche with Island Peak (Imja Tse) in the background (looks like a black diamond). I am planning on climbing that mountain in May.

Returning home to our small village of Pheriche.

Returning home to our small village of Pheriche.  Hard to see, but the HRA clinic is mid picture.

The Stupa in Dingboche.

The Stupa in Dingboche.

An old Stupa above Dingboche

An old Stupa that sits above Dingboche in need of repair.

The helicopter landing to pick up our HAPE patient.

The helicopter landing to pick up our HAPE patient.

The helicopter taking off with our HAPE patient.

The helicopter taking off with our HAPE patient.

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One Response to “A World Lit Only By Dung”

  1. TJ said

    Such an Incredible journey my brother. Happy for you and that you are helping people there.

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