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!