Last week our family took a week to visit Pokhara, the local tourist town, with Luke’s parents.  They visited Tansen in one of the hottest weeks we had experienced and spent some time working on water infrastructure at the local orphanage, so a few days next to a pool was a welcome relief. And we slept an awful lot.

We were also in Pokhara at the time of the first Nepal Earthquake, about six or seven weeks ago on April 25th.  A lot has changed since then.  It is now off season, pre-monsoon.  That means the temperatures are soaring and everyone is waiting for the rains.  This is normally a quiet tourist time, but this effect has been compounded by the earthquake.  My daughter played “Spot the Tourist” last week and was not winning.  There simply were a lot more Nepali people (bored Nepali people) than foreigners.  For us, that was great – we had good seats at restaurants, fun bargaining with shopkeepers, easy choice of taxi.  But it’s clearly an indication of the negative economic impact the earthquake has had on this country – not only do they need to spend money to rebuild, but one of the major income streams (tourism) has suddenly dried up.

Meanwhile, work goes on in Tansen.  Yesterday we did a few paediatric burn cases, three or four hernias and hydrocoeles and a laparoscopic cholecystectomy.  I met a five day old child with duodenal obstruction, who was luckily well enough and rich enough to travel to Kathmandu for treatment.  I met an 18 month old child who had pulled a pot of hot daal on his head and suffered 15% burns.  I saw a 35 year old lady who attempted suicide by lighting herself on fire a few weeks again.  She is going home now, with skin grafts to her upper trunk and neck.  I met again the diabetic with a overwhelming soft tissue infection of her upper limb, who was the first forearm amputation I have ever done.  She is healing well, but is still prone to recurrent infection in her healing stump.

Living in Nepal constantly confuses me. Everywhere I look I am being confronted by something different to my previous normal. Natural disaster here, which destroys villages and the national economy, is so different to even major bushfires or floods at home. Endemic healthcare insufficiency here creates a two tier rich and poor system which I have never experienced before and kicks me in the guts every time I am confronted by it.

Maybe this is why we’re tired all the time. It mostly feels like a holiday, or a normal job, with my family and clever colleagues. However, when I reflect, I realise I’m living on the other side of the planet, where my world is upside down.