Saturday, July 7th, 2012

What a day!  We ran a "TT" tournament today at the PAHS dorms.  "TT" is slang for table tennis or ping pong.  TT seems to be a popular sport here in Nepal as we've seen many outdoor tables on our bus rides around the city.  The idea of running a TT tourney came about early this week while we were talking with some 1st batchers about what types of hobbies/leisure they like to engage in during their spare time and TT was brought about numerous times by both males and females.  We found this very interesting because our own student lounge at UBC lies a thoroughly used ping pong table.  Perhaps there's something about TT and medical students that is shared across the world?? Back to the tournament, we had only 1 table to work with at the dorms so we decided to organize a double's tourney that hosted men's, women's and co-ed brackets.  Considering the size of the venue, participation was modest but worked out well.  We had 10 men's teams, 7 co-ed teams and 4 women's teams.  All games were well-played and accompanied by sincere sportsmanship!  We also had a small turnout of ping pong fans who provided big crowd support!!  With only 1 table, there was a lot of lag time between games so we also played some volleyball and badminton on the side.  5 hours later, champions rose from each division: *enter drum roll* from the women's bracket our gracious winners were Srijukta and Rosa; from the co-ed bracket, the dynamic duo of Purnima and Bijay; and last but not least from the men's bracket, through a hard-fought final Abishkar and Nepolean were crowned champions!

Our prizes were a modest new pair of TT rackets and a set of TT balls.  We also brought "North American" snacks that included Oreos and Pringles which are undoubtedly part of a med student's nutritious diet (kidding)! Needless to say, the snacks were popular.  Champion and group photos were taken.  Check in for a photo update shortly.

Namaste.  

Monday June 25th

This week we had the opportunity to sit on the PAHS students PBL sessions.  Leading up to the session we were all very curious to see what PBL would be like here at PAHS and whether it would be at all similar to the sessions at UBC. 

Interestingly, the sessions were very similar to those we have at home with only a few notable changes. Much like our sessions the students all sit at a common table with a tutor guiding the discussion. There are also several chalk boards mounted on the walls of the room to write up differentials and the infamous PBL learning issues.

One difference we all noticed about the PBL at PAHS is the way the students break apart the case and generate a differential.  Unlike at UBC where we tend to use the board space to draw problems webs and diagrams to develop a differential in a haphazard sort of way, the students at PAHS mainly discuss the different possibilities and then neatly organize this information into lists sorted into a variety of different columns.

It was very impressive to watch the student discuss the case material and work together in unison to solve the week’s case.  It was particularly impressive to watch the student present their learning issues in flawless, meticulous detail!

Namaste!

Sunday June 24th

We had a great day today at PAHS! 

We decided to run a fun, cultural-exchange workshop on Bhangra dance.  UBC Medical School has a Bhangra Dance Team, and we were lucky enough to have the team choreographer, Supreet, here with us in Nepal.  Bhangra is the type of dance seen in Bollywood movies, so the students at PAHS were excited to both see us perform and to learn the dance routine. 

We started by showing the students the routine, then Supreet took the whole group through the dance, step-by-step.  It was amazing how quickly the PAHS students learned it!  (20 minutes vs. the 3 months it took us UBC students!)  After that, the students taught us some Nepali dance, and showed us some of the routines they performed at events earlier in the year.  We had a great time teaching and learning from one another.  It was a great bonding experience, and the students were having such a good time that it was hard to turn off the music, even though they had started to lock up the building for the night!  

Namaste.

Supreet teaching the group Bhangra!

Tuesday June 19th

Already on week 2, can't believe how quickly time is passing by! Nepal is never boring that's for sure. it is constantly stimulating all your senses: sights, sounds, smells and tastes. Over the past few weeks we've become quite accomplished at learning to cross the street, a skill that should not be belittled here in nepal as the many "vehicles" never seem to slow down and swerve impossibly in and out of traffic. We've also become better at drowning out the constant cacophony of noises that seems to follow us everywhere in the city.  A simple walk to school has proven to be a bit of a game, as we hop from incomplete side-walks to dirt mounds trying to avoid everything from garbage, sleeping dogs and rusty nails (so far in the past 2 weeks, only one rusty nail has managed to get us, thank goodness for the tetanus vaccine!).

We had our second set of workshops this week on wellness and time management in medical school. We chose to do this workshop based on the feedback we got from the students regarding wanting to hear about time management in medical school. We decided to throw in a wellness and healthy lifestyle section into the workshop and handed out apples to the students for answering questions! In our workshop we also included an example of a healthy Nepalese diet, which entailed Kate having to pronounce a number of Nepalese dishes, which the students found to be hilarious!! Based on student feedback, our workshop was a big success. The major problem we encountered was that the attendance wasn't as high as we expected (about 15 students for each class). The students reported after that they knew that their friends would have come but they didn't know about it because it wasn't on the schedule, and emails aren't a great way of communicating. Despite trying our best to get the workshops on their schedule we were not given permission and had to rely on communication through class announcements and emails which proved not to be good enough. We are currently trying to remediate this problem before our third set of workshops this week. We also are planning on repeating the wellness and time management workshop again this week for the students who may have wanted to come but missed it. 

We can't get over how keen and hardworking the students are and how much of an interest they show in our lives. Despite the students being close to exams, and us being a bit weary of planning too many activities for them because of this, we've had an overwhelming enthusiasm for our two events this week: Bhangra dancing and soccer at the local park!

All in all, we have been settling into life in Nepal quite nicely. Daily routines have become quite a comfort. Highlights include daily shopping at the local veggie market for fresh produce, yoga at a nearby studio and group workouts in our lovely courtyard. On our days off we've bargained our butts off at the Thamel market, breathed in the fresh mountain air of Nagarkot and fell in love with our sweet tour guide "Gopal from Nepal" in Chitwan. 

Namaste.

Sunday June 17th

Namaste,

Time flies when you are living with six energetic medical students in a busy city with so many sites, sounds and smells you can feel the synapses in your brain firing frantically.

 I can’t believe it’s been one whole week since we arrived in Nepal. The six of us girls have settled in at our guest house and are enjoying interacting with the students at PAHS. There are 4 of us that just finished our first year of medical school at UBC: Stephanie, Heather, Lindsay and Skye, and two who are heading into third year in the Fall: Supreet and Kate.  Besides getting used to the heat and sounds of the busy city, we are also getting accustomed to the friendly and welcoming nature of everyone we have met so far here at PAHS.

We spent our first week here in Patan getting to know the students and faculty at PAHS, sitting in on some interesting lectures, scheduling our activities for the weeks to come and taking in the sites of Kathmandu. Feels like we fumbled our way through the first week and have started to scratch the surface on life in Nepal and what school is like for medical students here at PAHS.

Today Lindsay and I did our first workshop: Finding Reliable Resources Online. This is something that we have found challenging at times especially when looking for PBL learning issues.  Based on some preliminary surveying of the students, it seemed they too were hoping to learn more about this topic. After overcoming a few challenges in the scheduling department, the workshop ended up a success (based on feedback) as well as a good learning experience for our next workshops to come. Beyond the content, the students also told us they enjoyed the example we used with a famous Bollywood actor as well as the pictures of UBC, killer whales and sea otters to show them a little bit of “Vancouver.”

We have planned a number of workshops and activities for the weeks to come and I look forward to learning more about Nepal and getting to know the PAHS students! We will update again very soon.

Namaste.

Sunday May 20th

Today is last day at the school before we go on a trek -- the past three weeks have flown by! It is also the most serious bandh yet. There is not a single car on the road, and on the way here we passed a burnt motorcycle. It's still not violent, just more severe restrictions. In the morning we were busy getting ready to leave, but in the afternoon we joined the students for lecture and did a presentation on study skills. Unfortunately the lecturer wasn't able to make it to class -- an example of how the bandhs are beginning to affect PAHS. Before the presentation the students were telling us how useful the last one on time management was, so hopefully this one was as helpful! It seemed like many of the students don't use any study strategies like pneumonics or flash cards. Something we have also noticed is that many of the students will just copy exactly from the textbook. During our presentation we really emphasized writing in your own words, or any way in which you can make the material your own. When we return from the trek we can see if the skills we presented worked for the students! 

Saturday May 19th

Today was the students day off so we decided to go to an orphanage called Sonrisa that Dr. Courneya has been involved in. It was us and 5 PAHS students that ended up making the trek over. The bandh that was scheduled for today luckily fizzled out, so we were able to take a microbus to the orphanage. We were welcomed by Bishnu, who helped start the orphanage. He runs a trekking company, but is involved in many other projects helping in communities in Nepal such as starting medical clinics in rural regions, in addition to the orphanage. He explained it to us that whenever he has the time he thinks of these kind of projects -- a really inspiring person to talk too. The orphanage ended up being one of our favorite places we have visited in Nepal. It seemed like it was giving as much as it could to the kids, from the students being able to go to dance or music before school, or having tutors to help with their homework after school. Since there were only 15 children ranging from 5-15, it had a really homey feel, something that seems like it might not be found in other orphanages that can have as many as 250 kids.

It also had a huge garden they have converted from the trash pile that was there when they moved in, which they can use to grow food for the orphanage or to sell to make money. When we first got there all the students introduced themselves, and then we did a presentation how, when, and why you should wash your hands and brush your teeth. 

After wards the students showed us their abundant talents in dancing and playing their instruments! Following the talent show we worked for 30 minutes in the garden by pulling weeds around the corn.


 Bishnu was very thankful, but it was the least we could do for letting us in their home and treating us as family. It was a great experience at the orphanage and by the time we left everyone wanted to somehow become involved there!

Friday May 18th

Today the students were busy with clinicals this morning, so we decided to use the time to buy ingredients for our Canadian food party tonight! We invited all the students to come over to our place and try some Canadian food. It was kind of hard to pick a Canadian food to make because, well, what is Canadian food? We kind of narrowed it down to poutine and maple syrup, unfortunately making poutine would have been a bit too difficult here! We ended up making pancakes with maple syrup and we added some fruit and whip cream to give it a bit more substance.
After buying the ingredients we went back to the school for PBL wrap up. We really liked it last time, but this session it seemed like some of the students weren't understanding the answers to the questions and weren't saying they didn't understand it. It could have been because the concepts were more difficult this week than last week, or maybe the students just thought they could figure it our later. Either way, it seemed like it wasn't as beneficial as last week. To finish the students immunology block, Dr. Pastor and Dr. Sabita organized a jeopardy session after lunch. When we asked the students if they were excited, many of them said they didn't know what jeopardy was! Despite this, the session was a huge success! It was a really enjoyable learning environment, and might be put in after each block.
The party started at 6pm, so we were busy most of the afternoon getting ready. Although we invited all of the students, we thought 30, maybe 40 would show up. It ended up being over 50 students crammed into our guest house. Everybody had a great time and the students really enjoyed trying our kind of Canadian food!

                                          

Thursday May 17th

Today has been one of the first days of the many bandhs -- a Nepali strike that is occurring now because of the upcoming implementation of the constitution. Although the strikes are very rarely violent, they disrupt transport and shops throughout the city. This can be very frustrating for the students and faculty at PAHS, since they are one of the few academic institutions that continue during the bandhs. Many of the students live in the hostel that is only 10 minutes away, but this isn't the case for all the students, nor for many of the faculty. In a talk today with Dr. Shambhu -- in which he was mostly just making sure our stay here has been as good as possible, something all the PAHS faculty have been so great about -- he mentioned that he has to walk an hour to get to the school now. This isn't even the worst, some of the students have to walk 2.5 hours to school when there is no transportation.

Wednesday May 16th

Today was the students self-study day, but before they started studying we went to a movie with them at one of the theaters in Kathmandu. Afterwards Jordan played in a soccer game with the students, the rest of use decided to take it easy for the remainder of the day!

Tuesday May 15th

For most of us, today was our best day yet in Nepal. The students had organized a dance party for us, and since none of us are the most avid of dancers, we were somewhat daunted by the prospect of having to dance for four hours straight. After attending some lectures and PBL, we met with the students at their hostel and we started rolling over to the “Timber House” dance hall. The students, the girls especially, were unbelievably excited, dressed up in their best party clothes. We were pleased to find out that the dance floor was simply an outdoor terrace, since it was sizzling hot out once again. In the end, the four hours passed by so quickly and we had a fantastic time! Afterwards, we came to the consensus that we much preferred the Nepali dance music to the Western music we find at clubs at home… so we’re definitely going to have to buy some of it. After everyone was exhausted from the dancing, the students invited us over to their hostel canteen for dinner. The huge amount of dhal bhat was the perfect end to a great night -- thanks to all the PAHS students for organizing it!

Monday, May 14th

Dr. Pastor started off the day with a second lecture on signal transduction, which was very well done. Talking with him after, we discussed how in our undergrad we learned much of his lecture over an entire semester, not just 2 hours. Although we did learn it in more detail, it is still difficult to pick up even the basic concepts in such a short time – one of the difficulties with starting medical school directly from high school. Afterwards we helped the students with some of the general concepts from their PBL, such as organ donor matching and blood transfusion. The students use many different textbooks, making it difficult to get the same information -- especially because some textbooks are much older than others -- which can lead to a bit of confusion. 

At the end of the day we did a presentation on time management. Since we have gone through our undergrad, we had a few tips that we had picked up along the way. Overall we thought it went well, and many of the students downloaded the presentation on their USB.

Sunday, May 13th

The beginning of the school week started with an hour-long lecture and PBL. The workload is a bit smaller on Sunday, giving the students some time to go through their PBL learning objectives. Since the students didn’t have any questions yet and mostly wanted to start reading on the PBL, we decided to spend the afternoon in Bhaktapur – an ancient city an hour outside Kathmandu. It had a much slower pace than Kathmandu, and some beautiful old architecture. 

Saturday, May 12

Today is the students’ day off, so in the morning we visited Pashupatina, one of the most famous Hindu temples in Nepal – definitely a must see in Kathmandu! In the afternoon there was a soccer game that we went to with a few of the students. It was a Nepali soccer club vs and Indian club. The Nepali club hadn’t won in a while, so the expectation weren’t very high for this game. Before the game we bought jerseys – the students already had there’s on – and while waiting in line were getting a lot of smiles and pictures taken of us. Our picture ended up being on the biggest soccer website in Nepal, goalnepal.com.

                    

Friday, May 11

Like most Fridays, today was started off with an ethics lecture by Dr. Bruce, an Australian physician who has lived in Nepal for many years. He did a great job of involving the students in a lecture and getting them to think through the problems on their own. Afterwards, there was a wrap up session for the PBLs. Its something we don’t have at UBC – I think? – and everyone in our group thought it was extremely beneficial for the students. It is an hour long session in which the students have the chance to address any questions they weren’t able to answer in PBL. The PBL groups were all present in one of the classrooms, with all the PBL tutors at the front. The tutors went through each group’s questions, and any PBL tutor could answer. It was really interesting to hear the different perspectives of the clinical and academic tutors.

Later in the afternoon we went to the students hostel – the same thing as a dorm in Canada – and played ping-pong. None of us really stood a chance against the PAHS students, who seem like they were competing for the national team. We decided to switch to a sport we might be a bit better at, soccer. We ended up playing a small tournament with the students for the next 3 hours. All in all a great day with the students!

Thursday, May 10

Yesterday we spent most of the day at the botanical gardens with a few of the students who had enough spare time to take us there. It was great to get away fro the hustle and bustle of they city – quiet enough to hear your thoughts and some beautiful scenery as well!

Today was the final day of the PBL. Again, it was very useful to see what the students needed help with, as well as how they went about learning the PBL material. PBL is a huge component at PAHS, much larger than at many of the Canadian medical schools. Consequently, much of the learning is done in the students self study time. This definitely has benefits -- the students are becoming highly proficient in being able to find information on their own, something that will be essential later in their career. However, it does take a lot longer to find the material than if it was presented in lectures and the students still need a bit of help on finding the best resources to use. Maybe something one of the groups of med students can help with!

Tuesday, May 8th

On Tuesday, the morning lecture was a continuation of the adaptive immune response lecture, focusing on the differentiation of T cells. The pace of the lecture improved and it was evident that Dr. Sabita was very keen to improve her teaching based on feedback. Following the lecture, the students went to their respective PBL sessions from 10am-12pm. The day ended with the Canadian culture workshop that we offered from 1pm-2pm. Almost every single student attended this presentation in which we talked about Canadian history, Vancouver, UBC, our passion for hockey and other interesting facts about Canadian culture. Stephen’s knowledge about Canada really made this presentation more educational as well as entertaining. The students were very attentive and appreciated the small Canadian tokens that we handed out afterwards (Vancouver pins and Canada flag pencils). Following the presentation the students were keen on showing us more of the city and playing snooker. Once again a wonderful day, full of educational and cultural growth for the Nepali students and ourselves!

Monday, May 7th

On Monday we attended two lectures with the PAHS students. The morning lecture was in regards to adaptive immune response and interaction between MHCI/II and TCR. This lecture covered a lot of material and some of the students portrayed their confusion to us. Hopefully our explanations to their questions helped. Also Dr. Sabita set a very welcoming tone for additional help and clarification. After the morning lecture some of the students were studying, some went to the computer lab and a few of the boys brought us back to their hostel and we played ping pong. They were much better than we anticipated and the local champ annihilated all of us with his left hand (normally plays with his right). After some games and, once again, delicious meal we went back for the second lecture. This lecture went through important questions used when appraising epidemiological studies. The lecture was interesting and many relevant examples were used. We ended the day with meeting more students, slowly getting better at remembering Nepali names!

Sunday, May 6

The second week of the immunology began with an intracellular signaling lecture by Dr. Pastor.  The students had already been taught the lock and key model for the agonist and receptor, but not what occurs after that. The lecture mainly focused on some of the central intracellular signaling pathways, which are used by many receptors and responsible for multiple actions in cells. There was an hour break after class that we attempted to see if the students had any questions with the lecture. However, many students said they wished to go home and go over the lecture before asking questions, as this was the first time they had seen the information. It also seems like the students will mostly focus on the PBL material and go over the lecture material closer to exams -- it might be better to try and focus on helping the students with the PBL material instead. On the topic of PBLs, today was the first day we were able to sit in on the PBLs. Watching the students work through the PBL was very helpful in identifying any knowledge gaps the students had in their understanding of the material – something we should try and resolve in the tutorials!

May 4th

Yesterday, we spent a lot of time at PAHS. We sat in on lectures about medical ethics and antibody structure and function in B cell-mediated immunity. We also joined the students in their practical session demonstrating a couple antibody-antigen agglutination and precipitation tests used in the laboratory diagnosis of strep throat and syphilis. Today it seemed like the students were struggling a bit with the information presented in the B cell-mediated immunity lecture. The material was very dense and memorization-intensive and it was clear that the students were having a hard time paying attention. We have no particular expertise with immunology, but we recognized a lot of the information from some of our undergraduate microbiology courses. We could imagine how difficult it must be for the medical students seeing it for the first time. It was surprising how much detail the students were expected to learn, because a lot of the details seemed irrelevant to a medical practice.

 After classes were over at 4pm, three of the students took us out to play snooker. It was a lot of fun to see and join in with some of the things that the students do in their spare time.

We have already been able to help a few students understand certain concepts when they were confused, which is really exciting because it means we are on the right track. For the next week, starting tomorrow (Sunday), we will be able to sit in on the students’ PBLs allowing us to fully understand the students’ learning objectives and hopefully be more helpful in mentoring. Tomorrow, after popular request, we will be giving the students a presentation about our lives at UBC, Vancouver and Canada.

Today we made it to PAHS at 8am to sit in with the medical students for two of their lectures. The first lecture was a general overview of the pharmacology of antimicrobials and the second lecture covered the applications of antigen-antibody interactions. The lectures gave us an opportunity to meet some of the students who did not join us at the zoo yesterday. The lectures were well taught and clear and, for the most part, the students did not seem to have any trouble understanding the material. One of the students asserted that the most difficult part of medical school for him and the other students was the self-study related with the PBL cases, not the lectures or the practical sessions (labs). From what we heard from the students, we have started to get an idea about how we can be most helpful to them in their studies. When we offer tutoring sessions our focus will be on sharing our experiences with them to improve their efficiency in research. This will include skills in the use of online research resources, note taking and time management.

Tomorrow, we will continue to reach out to the students in their lectures and practical sessions. Over time, we hope that we will be able to engage the shyer students. Moving towards this, we will spread out through the classroom, so that we sit next to different students in each lecture and introduce ourselves to them.

May 2nd

Wednesday was a self-study day for the PAHS students, but luckily the students were able to take time out of their busy schedules to show us the zoo and take us out for dinner. It was great to learn about the students, their families, and where they were from – despite the difficulty in pronouncing many of the names of the regions, let alone remembering them!

May 1st

The past 2 days were our first encounters with PAHS. Originally, Patan Hospital was a mission hospital and was privately run, but recently it was converted over to being government owned and operated. Dr. Rana gave us a tour around the hospital, and we noticed the facilities were generally well maintained and well equipped relative to other hospitals in Nepal, but it’s still below the standard seen in Canadian hospitals. We then met with the Dr. Karki, the vice chancellor of the hospital and discussed our intentions of going into medicine and our general background. Dr. Karki described Nepal and how its progression only started around the 1950’s and has made rapid changes,  “quantum leaps”, since then. It was inspiring to talk with someone so intelligent and dedicated to improving Nepal’s medical system. We were then introduced to the 1^st and 2^nd year students after their classes, and they were very excited to see us. A brief introduction followed by the exchange of emails, phone numbers and tentative plans lead to the conclusion of our first day at PAHS!

Namaste!

The May group, consisting of Ian, Jordan, Dima, Adam, and Stephen, has arrived in Patan. We are going to meet the medical students this afternoon, and are excited to see everyone!