Final Days in Manang!

HRA Patient Waiting Area










We are leaving Manang on Monday. For the sake of our knees, we are flying from a dirt airstrip near here (two hour walk) to the city of Pokhara. From there we'll travel on through Kathmandu to Singapore for a few days of warmth before heading home.
Lexi treated and evacuated another case of High Altitude Cerebral Edema, and treated a Nepali man with pneumonia that had been living at 17,700 feet for six weeks!




"Take your medicine!"

Looks like the cold weather has started. This morning we woke to sub-zero temps and gray skies. At this elevation, with no sun, it feels quite cold. We have a little propane heater in the kitchen, but we're otherwise in our down jackets and hats all day long. There is some precip in the forecast for the next few days. We really can't complain, as you've all seen from the photos, we've had nothing but blue sky here for 6 weeks...but all good things eventually come to an end.

We're on the 2 week countdown to leaving Manang and the clinic. The numbers of westerners and locals is slowly tapering off. We did have another HAPE (high altitude pulmonary edema) heli evac this week. He was a 26 year old competitive nordic skier from Czeckloslovakia, the fittest one in his group withh an O2 sat of 70%. We heard he did well once he got to Kathmandu (at 1500 meters, much lower than Manang) only needing oxygen and meds for a few hours after his arrival there.

Martin and I will fly first down to Pokhara (only 800m elevation and much warmer!) the town where we stayed when we were here in 1998, and then on to Kathmandu for a couple days. I think we're both starting to dream about sushi and yummy seafood in Singapore after that. We're almost up to 60 days of dahl bat, the national dish of thin lentil soup and white rice, which is plenty.

Thanks to Dick and Mary for taking such good care of the house and yard, you are truly great neighbors! Amy, fun to talk to you, good wishes to Brian on his elk hunt!

Tiger is Dead and a Good Save

Well, the good news is that Tiger was a good horse. The bad news is that he died the morning after our fantastic outing. The whole village knew this horse, he carried many sick people down safely from the high pass here. I asked our Nepali medical assistant Gobi if they bury dead horses in Nepal and he replied "yes". Then I went for a hike down by the river and saw a big dead Tiger lying on the bank of the river getting eaten by the vultures. Pretty grim.

I was feeling pretty down about that whole deal when I was told that a 60 year old British man collapsed on the trail 15 min away from the clinic. Several locals brought our portable stretcher down to get him. When he arrived, he was semi-conscious, clutching his L chest and had a pulse in the 30s. His friends told us he started having chest pain and fell down on the trail. We assumed this guy was having a heart attack (but didn't have a cardiac moniter or ECG to confirm it). After giving him some recsusitation meds to help boost his vital signs, he was given oxygen, aspirin, blood thinners, pain meds and a primitive nitroglycerin drip (with NTG exp date 2005!).

Our assistant Gobi was able to divert an already booked helicopter to come here ASAP. We had more local people help carry the patient by stretcher the 15min walk to the heli pad and he was flown directly to a hospital in Pokhara. We heard this morning that he survived the transport and after they confirmed his large inferior MI, he was miraculously able to receive thrombolytics (clot buster drugs) in the 6 hour timeframe for giving them. We were all very happy and amazed that he survived a big heart attack, not only in Nepal, but literally in the middle of nowhere. The photos show the patient being carried, Martin helping transport the portable O2, and Steven and Misty, our partners and new friends here, taking a last minute BP before sending the guy down.

Horse Ride on Rainbow and Tiger

Hello everyone!

Yesterday we hired some horses and went for a ride into the mountains down the valley from Manang. It was a gorgeous day, and aside from one skittish horse it was a great time. I was especially happy that Martin got to ride the horse named Rainbow. I got Tiger, a real sweetie without a sketchy bone in his body.

We went out for yak steak last night and it was actually very good. It was a single cut of actual meat without any extraneous hair, skin or bone attached. This is the season for the yak harvest, so it's the best time of year to eat it (no refrigeration/freezers available). Manang area is also apparently known for its good yak meat. Not as good as the new elk harvest I hope is happening right now back at home, but at least not totally gross!

From Cobras to Snow Leopards!

This week I climbed a peak with the uninspiring name "4890" to the west of Manang. The summit offered spectacular views in all directions: south to Annapurna, north to Chulu Peak, west to Manang 4500 feet below. If I only had a paraglider! On the descent I was treated to a meeting with a Snow Leopard! I saw it cruising the tundra near a flock of Blue Sheep. Similar to my mountain lion sighting, the leopard disappeard as soon as it saw us.
Today the lecture was attended by about 4o people and was well received.
This morning Lexi and I visited a nearby water powered grain mill and were able to watch two women grind buckwheat into flour with a very ingenous mill.

Kang La

Stephen and I hiked up to Kang La pass two days ago. It is a seasonal route that connects the Manang valley with the next valley to the northeast. "Naar" is it's name, and it's the home of the snow leopard. The pass is at 5300m elevation, and is the highest I have been so far. Also shown are Brandom's friends from Whitefish, Karen and Jen, dancing with the local kids in the courtyard of the HRA outpost. So far we've meet very few Americans, and most of them seem to be from Montana! The final picture shows a Manangi woman who was the lucky recipient of the few pairs of glasses that we have to give away. Today the patients have all been Nepali, with complaints ranging from scalp lacerations to burns. - Martin

To Tilicho Lake:

We're back at work after four days off. Lexi and I hiked up to Tilicho Lake at 5000m elevation. We had perfectly clear weather. The approach included traversing several kilometers of scree slopes with some rockfall hazard.
Today the clinic is slow. It's been europeans with chapped lips and gastroenteritis. Yak meat for dinner tonight. Our next hike will go to Thorung La Pass at 5400m elevation.