Nepal, the 1st Test: Saturday Night Fever (Dengue Style)

Day 163 – Friday, October 4th 2013

Having been surprised at the authorities’ efficiency at the border we were on the road around midday, we’d only dared to hope that we might get the paperwork and such completed in a single day. Our first priority was to track down a working ATM, of which there was only one in the border town of Mahendranagar, since the only currency we had to exchange was illegal in the country (the possession of high value Indian notes is a criminal offence, due a long history of forgery problems).

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Bardia National Park was a good distance away to form our stopping point for the night, and since we’d kept up a good pace through the last section of India we awarded ourselves a day off driving, in the hope of getting a safari arranged and spotting some wildlife.

The park itself was distanced from the main road by some 15km of dirt track and one river crossing. We arrived in good time since the surfaced road had been of good quality, and relatively clear – compared to those in India at least, it was probably still horrific compared to those back home. We arranged a parking spot that came with use of a cabin for a shower and toilet for 150 NPR (roughly 1 and a half USD, or a quid to those in blighty). We figured we could afford it since it saved us the bother of an extra day of draining Ivor’s water tanks, or perhaps more importantly, filling the dirty tank. We arranged a guide for the following morning, and dined in a restaurant that was close by – chatting to an eccentric Brit who was touring round the country on a rented Royal Enfield motorcycle.

Day 164 – Saturday, October 5th 2013

Getting up bright and early, we munched our cereal, met our guide, and headed to the park entrance. ‘Going on Safari’ in any other part of the world conjures up images of rugged 4x4s bounding off into the countryside, with the passengers perched in the back with nice chunky frame of welded steel to keep the shutter pressing tourists away from anything that might think of them as prey – perhaps even one of the guides armed and ready with a tranquiliser gun. Not so in Nepal, you’ll be on your own two feet with only three bits of advice to protect you:

1)      If a rhino is charging at you, throw a backpack at it to confuse it, then run in a zig zag, you may climb a tree if one is handy.

2)      If an elephant is charging at you, run in a straight line (they are smart enough not to follow your zig zags), do not climb a tree, they will smash it down.

3)      Should you encounter a tiger at close hand, maintain eye contact with the feline and back away slowly talking in a calm, low voice. Do not run, since a tiger will only attack from behind, and with a running human, there is plenty of opportunity for that.

So what if these three fail and the animal still wants a piece of you, or indeed all of you? Well that, my friends, is why the guide is armed with…..

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…. a stick. Yep, that’s it. How comforting.

On our out way out towards the plains we went past a black rhino and two elephants that were kept in captivity. The Rhino had been blinded by angry locals after it had wrecked the most part of a village, and the elephants were used for forestry, and to transport the odd tourist around on their backs.

But what you really want to know is – Did we see anything properly in the wild? Well, yes we did, we got lucky. We saw a few deer, and some interesting birds, but the real treat of the day was that just up the river from where we had climbed a tree to get a good lookout (not to evade a charging animal), a mother black rhino was leading her infant into the water to bathe. We sat and watched for quite some time, getting to see these animals in their natural habitat entirely unaffected by human influence was a true pleasure.

After a day hiking we returned to the camp, ate at another little restaurant and went to bed early. That should have been the end of it, but instead Vaughan’s temperature started to rise, and he was affected by a few other symptoms normally synonymous with Delhi Belly. He’d been feeling a little unwell during the day, but put it down to a day under the baking sun. He took a dose of paracetamol, which seemed to curtail his temperature for now at least.

Day 165 – Sunday, October 6th 2013

We set out relatively early, Vaughan was still not feeling good so Kim drove. We were aiming for Lumbini, the small town sitting close to the foot of the Himalayas that is widely regarded to have been the birth place of Lord Buddha.

Kim pilots Ivor through the river back to the main road

Kim pilots Ivor through the river back to the main road

We would not get that far though, we were a couple of hours down the road, Vaughan’s condition was deteriorating, and his temperature had bounced back up to 104F. In these areas, despite conscientiously taking our prophylactics every day, when fever symptoms show themselves Malaria should always be suspected. On reaching the next town, we asked around to see if there was a hospital where Vaughan could be checked out.

With a few directions from various members of the public who fortunately understood enough English to realise what we wanted, we finally pulled up outside of the Nepangunj Medical College in Kohalpur – which is in actual fact a small scale hospital, and slightly more capable than its name lets on. We went straight to the emergency ward, where basic heath checks were performed and a variety of tests and medical supplies were ordered.

Nepalese healthcare is carried out on a cash up front basis – so Kim was assigned with a list of supplies that were needed and was sent to the onsite pharmacy to collect and pay for them. We did not have enough cash, so Kim’s first task would be to take a tour of the local ATMs by cycle rickshaw in order to find one that was working. When she eventually found one, she returned with the elusive Nepalese Rupees, and could settle the bill for Vaughan’s needles and drugs.

On her return to the emergency ward, she would find Vaughan had already received a drip (on credit), and was asked to take some blood samples to the lab so that they could be tested.  Finding the lab was a challenge in itself – turns out it was an unsigned, hole in a wall where the test samples were to be passed through.  It was not long before it was decided that Vaughan should pay a visit to the physician so that his condition could be further assessed.

On the short walk across the reception to the physician’s office Vaughan collapsed unconscious, he came around quickly and as he slowly returned to his feet he fainted for a second time. A stretcher was called for, and he quickly found himself back in the emergency ward.

It was decided that Vaughan would be admitted, and partly due to the fact that we were foreigners, and partly because his condition was yet to be diagnosed, we were treated to a private room instead of a place on the ward. As the time for test results came and passed, it was clear we would be getting no further information as to the cause of the illness before the following morning.

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As the sun went down the bugs and creepy crawlies came out in force, so we had to keep the lights off unless they were really needed.

Day 166 – Monday, October 7th 2013

His temperature was still high in the morning, but was beginning to fall, and the test results came back negative for malaria; a promising start to the day. Kim’s day would be filled with scurrying around the hospital picking up prescriptions, medical supplies, chasing test results, dropping of blood samples, and trying to find a working phone with which we could contact our insurance company and postpone the Himalayan mountain bike that were clearly not going to start on the 10th.  One thing we had to get used to about Asian healthcare, is that there is no patient care done by any hospital staff –  it is left to the family members of the patient to provide food and water, wash the patient or take them to the toilet, tell staff if symptoms changed or if the patient needed more medical supplies.  This meant that many families were actually sleeping in the hospital on makeshift beds on the floors in the hallways so that they could be there to respond to any needs at any time.

A young intern took an interest in us, and aside from wanting to practice his English felt a little sorry for our situation. Aslam would come and visit us a number of times over the following few days, normally during his breaks.

Day 167 – Tuesday, October 8th 2013

Still rocking a temp that fluctuated between 102 and 104 throughout the morning, it was only now that we managed to persuade the nurses that their infra-red thermometer was not working. It was showing that his temp was normal, whereas our old faithful glass one showed a high fever. When a hospital cannot even afford to keep its thermometers calibrated, you can’t help but worry about the state of the rest of their equipment.

The initial results of the blood tests showed no signs of Malaria or Typhoid, which was a relief at first.  Kim did notice that Vaughan’s white blood cell count seemed low (according to the normal levels written on the results sheet), but the doctor said it was most likely a test error because the first blood test done in emergency showed normal counts…

A course of medication was started for malaria, just in case of an incorrect test result. This in turn caused a lot of vomiting, and prevented many of the other oral meds from taking effect. On our insistence, a test for Dengue fever was made, but returned a negative result. The doctor was keen to remove the IV drip, but since Vaughan was not able to eat, and was now throwing up we persuaded him to leave it in.

Now that we were 3 days in, and still  had no positive diagnosis we were both getting concerned – both about the illness, and the quality of the institution in which we now found ourselves. The doctor (who was only on hand once a day) had decided that the infection was probably viral, since they could not find any other cause for it – this was not delivered with enough assertion for either of us to take confidence in it.

Day 168 – Wednesday, October 9th 2013

With Vaughan still as unwell as when he was first admitted, and with a cycle of reactions to the various treatments that he was being given, we decided that it was time to get the insurance company involved, and to try and get relocated to a different hospital. The doctors, and our friendly intern even advised us to pursue this option – particularly since there was a festival coming up where many of the staff would be returning to their home villages, under-resourcing the hospital yet further.

The insurance company advised strongly against us taking a private ambulance to the capital of Kathmandu (the best hospitals in the country),  since they felt the 12 hours away from medical facilities would be too risky. Without a faxed copy of the medical report though, they were unable to react. They did suggest that once clearance was given they would get a helicopter to deliver Vaughan directly to a better hospital.

Day 169 – Thursday, October 10th 2013

Finally taking receipt of the medical report, and with Vaughan’s condition still showing no signs of improvement, the insurance company swung into action and a helicopter was booked for the following day – at last we would be leaving this hospital of crickets, wasps nests, and hourly power cuts behind us.

One of the many wasp nests lining the hospital

One of the many wasp nests lining the hospital

Kim readied the truck to be left in the hospital parking, and Aslam said that he would keep an eye on it for us.

Day 170 – Friday, October 11th 2013

Vaughan was in the best state that he had been all week, but the helicopter was still going to whisk us to somewhere more pleasant. The original booking of 8:30 was slipped until later on in the morning since the first chopper had some problems, and a replacement was needed.

By midday we had caught a taxi to the airport, been found by the insurance company rep, and were taking off – accompanied by the rep and a doctor from Kathmandu.

The flight was impressive, crossing the foot hills of the Himalayas, and with view of the mountain range in the distance. We did at times have cause to question the professionalism of the pilot, who at one point picked up his mobile phone to take photos of the co-pilot – who was fast asleep. He told us with a big grin that the co-pilot often slept, but never admitted it, so he wanted to get some proof! We can only assume that this flight across the hills was a walk in the park for a pilot that was used to fetching altitude stricken mountaineers from deep in the mountains, because he touched down on the tiny helipad on the hospital roof gently and with utmost control.

Once inside, the upgrade in facilities from our previous hospital was immediately obvious. The staff wasted no time in performing a whole array of tests to establish the root of Vaughan’s condition. There was no waiting around or sending Kim to fetch supplies here.

Within an hour of arriving Vaughan was diagnosed with Dengue fever, the mosquito borne virus. He would be admitted for a minimum of 5 days, and he would have daily blood tests to monitor the levels of white cells and platelets in his blood – which were very low (52000), in fact any lower and blood transfusions would be needed to prevent haemorrhaging. We’d been totally unaware of just how serious his condition had been. With a need for a transfusion at 40000, we can only assume that he was frightening close at the height of his illness.

Finally with a proper diagnoses, and in relaxed surroundings (that matched, if not exceeded those of state provided hospitals back home), we slept soundly – save for the occasional interruption from a nurse checking vitals.

Day 171 – Saturday, October 12th 2013

With fever symptoms abating, and the tests showing that platelet levels were already on the rise – now up to 75000, there is refreshingly little to report from today.

We were even relaxed enough to watch some shows on the (large, flat screen) TV in the room. In the last hospital, all there was to do in the room was count the spiders on the ceiling (Vaughan once reached 41). What a difference insurance payments make – this place was more like a hotel, looking back you can only feel sorry for those that simply do not have another option.

Day 172 – Sunday, October 13th 2013

Good platelet results, achieving the giddy heights of 87000 – still some way off the ‘normal’ range of 150000, but a good sign nevertheless. The thing that was now concerning the medical staff was Vaughan’s heart rate, which was sitting at around 36 beats per minute, something more akin to that of a professional athlete than that of a guy who’s been sat on his butt driving a truck for the last 6 months. They did not suggest doing anything other than monitoring it though. A recent check on Wikipedia would show that this is actually a typical symptom of the recovery phase from Dengue.

Vaughan did get to speak to his parents that afternoon, and we got through a fair few movies that were being shown on TV. Still with a low appetite and very little energy this was enough excitement to send the patient into a deep sleep again this evening.

Day 173 – Monday, October 14th 2013

It was a similar routine to that of the previous few days, with the blood tests showing an increase to 122000 it was pretty certain that the worst of Dengue was behind him. We called our GP in France, who had said Vaughan’s normal resting rate in his records was around 64 beats per min, so the figures we were now seeing were indeed much lower than we should expect.

Day 174 – Tuesday, October 15th 2013

Excitement for the day would come in the form of ECG scans, and a visit from a cardiologist. V was given an injection to boost his heart-rate, just to check it could be raised. Vaughan would later describe the hour or so of after effects as some of the worst of the whole ordeal – reporting searing heart burn, headaches, and aching body, and anxiety he was provided with no end of things to complain about. As penance for its relaxed attitude, Vaughan’s heart was to be attached to a monitor for the next 24 hours.

Day 175 – Wednesday, October 16th 2013

Very little to report today – just an ultrasound on Vaughan’s ticker that showed all was in order. They just decided to keep him in for a few more days for observation.

Day 176 – Thursday, October 17th 2013

Even less to report today, sorry, this will get more interesting again soon, we promise.

Day 177 – Friday, October 18th 2013

Yippee, Vaughan was discharged, and the insurance company were going to stump up for a hotel in Kathmandu so that we could stay in town until a check up appointment on Monday.

Using the hotel Wifi we had a Skype chat with Mark (AKA Jackson), who would be coming out with another buddy of ours, Jim, in a weeks time. Whether we would be able to go on the trek with them as originally planned was yet to be established – For V a few sets of stairs was challenge enough at the moment, we would have to see how the next week went.

Day 178 – Saturday, October 19th 2013

Today we aimed at an hour of walking around Kathmandu as part of V’s out-patient recovery. We achieved it, but the craziness and heat of the city streets did not make this as easy a task as it perhaps should have been for our fledgling recoveree.

That evening we treated ourselves to a meal out at one of the restos recommended in the Lonely Planet – a place called Kilroy’s, run by a couple of Europeans who knew how to make food as we like it.

Exhausted by the excitement of the day we were asleep within a few minutes of returning to the hotel room – we had a go at watching a film, but with heavy eyelids it was a fruitless attempt.

Day 179 – Sunday, October 20th 2013

The continued recovery was going well, we went back to the Durbar Square that we had briefly visited yesterday. This time we would buy tickets and explore it more thoroughly though, including scaling the 9 stories to the top of the highest building for some good views of the city.

We stopped in at a coffee shop, where Kim shunned the staff’s welcome by smashing a cappuccino glass on the floor (ohpsy), and then took lunch at a roof top restaurant.

Still feeling pretty good, despite the morning’s excursion, we followed a walking tour from our guide book that wove its way through the back streets away from the square.

That evening Vaughan was so exhausted that we had to eat in the Hotel, making use of the room service.

Day 180 – Monday, October 21st 2013

We took a taxi to what we hoped would be Vaughan’s final hospital appointment, and were pleased to hear that he was recovering well. We picked up some more meds, and the doctor agreed to write a prescription for the anti-malarial tablets that we would need to complete our journey.

The insurance company arranged a return flight for us to get back to Nepalgunj, so that we would be able to recover Ivor and get back on the road.

With Vaughan still feeling a little delicate and only being able to stomach the simple tastes of western food, we went to a recommended pizza restaurant. Alas, his immune system was still not as strong as it should be, and some kind of bug sneaked passed his defenses – the rest of his night would be bathroom based.

Day 181 – Tuesday, October 22nd 2013

Still feeling somewhat shabby from the night before, V was not in a state to fly – so the flight to Nepalgunj was postponed. It was a step back of a few days – with very little appetite or energy we were effectively confined to the hotel room for most of the day, but with some rest the sickly boy started to perk up a little.

Day 182 – Wednesday, October 23rd 2013

With V finally back in the game, so to speak, we would board the tiny plane for the 45 minute flight to Nepalgunj. Once again crossing the Himalayan foothills by air, we were treated to stunning views of the Mountains.

Back in the heat of the Nepalese lowlands we checked in on Ivor, who had been waiting patiently for our return, seeing Aslam the friendly intern in the hospital grounds. We checked into a hotel in town and were looking forward to heading east in the morning.

Day 183 – Thursday, October 24th 2013

At last, some 18 days after starting the journey we arrived in Lumbini. It had meant a solid day of driving, which Kim had to do herself since Vaughan was still acting a little faulty.  We’d arrived not long before sundown, and had checked in to a cheap guest house. On grabbing some cheap eats across the street though, our next hit of bad luck was laying in wait for us. Kim, who up until now had been relatively robust when it came to foods, immediately began to feel unwell – it was now her turn for a rough night.

Everything is done by hand here - Threshing, as seen from the road to Lumbini

Everything is done by hand here – Threshing, as seen from the road to Lumbini

Day 184 – Friday, October 25th 2013

So another restful day, this time it was Kim who was in recovery mode. We did venture out of the guesthouse at around 4pm once the sun had lost most of its midday sting, and went for a gentle walk around the Lumbini park to visit the birth place of Lord Buddha. There were refreshingly few people pushing the sale of miniature idols, and both the building that houses the birthplace and its garden setting were pleasantly understated.

Removing our shoes, we joined the small line up, that was predominately Nepalese, Indian, and Chinese, to walk into the building and see the exact spot where the birth was supposed to have taken place.

Since Kim was now running low on energy, we went back to the guesthouse to rest up for the night.

Day 185 – Saturday, October 26th 2013

Back on the road we headed for Butwal, where the Guesthouse manager said that we should be able to get a (slightly overdue) oil change for Ivor, even on a Saturday (It’s Saturday?! We lost track of details like that a while ago!). It was on route to our final destination, the Himalayan town of Pokhara.

We didn’t have to ask around in Butwal for long before we found a car garage that was willing to work on our truck. Please don’t think badly of us – an oil change is certainly not beyond our abilities as mechanics – however, finding out how to dispose of 8 litres of used engine oil is certainly beyond our Nepalese, particularly when it’s less than ten bucks to have someone else do it.

The next stage of our route was unclear, with an option for longer, better roads against a shorter journey of the twisting mountainous variety. There was about 80km difference in it, and we had been warned by a few locals about the perilous nature of the mountain passes. With the advice from the garage staff that we’d be okay if we went slowly and carefully, we decided to go through the mountains.

Our chosen route was in no way as exciting as had been suggested – there had been a few landslides in the early section, where asphalt had been replace with dirt diversions, and it was prudent to stay in from the edge where possible since some of the drops where huge…. but the low volume of traffic meant that, particularly after India, it was relative bliss.

We arrived in Pokhara about 15 minutes after sundown, and picked the first hotel that had parking available.

Day 186 – Sunday, October 27th 2013

With a busy day ahead of us, we were up and breakfasted nice and early. Unfortunately a nasty little surprise awaited us as we left the hotel – Ivor had suffered his first flat tyre!  Vaughan quickly got to work in getting our spare wheel down from the rear shelf and  Kim gathered the tools needed for the job. We had the flat off, new wheel on, and flat back on the shelf in under half an hour – not too bad if we do say so ourselves.  With that additional task out of the way, we could get on with the rest of it.

Today’s list:

–          Meet Jagan, organiser of the bike trip that Dengue had cancelled, pick up a package of bike bits that we needed – work on bikes so they would be ready for our trip

–          Laundry (a constant battle)

–          Hair cut for V, he was turning back into damn hippy again, and we can’t have that

–          Extend our Nepali Visas – We’d decided to do the trip with Jagan after the one we’d planned with Jackson and Jim, so we would be in the country longer than we’d originally planned.

–          Arrange the trekking permits we would need for the Jackson and Jim trip (around the Manaslu Circuit). We still weren’t convinced that Vaughan would be able to take this one on, but figured that if we at least get everything organised, then we have the option if things all work out.

We managed all of these things, though the paperwork side of things ended up being complicated. The visa extension was relatively easy, with just a little haggling over the NPR -> USD exchange rate needed before we could get it arranged. For the trekking permits though, we would have to send our passports to Kathmandu, where it would take 24 hours for to get them approved. We were due at Aarughat Bazaar to start this biking trek in 2 days time, had we cut it a little thin? A very friendly guy at Himalayan Encounters (who Mark had arranged a guide with) assured us that they could fix this, no problem – our passports would be flown first thing the next day, and they would take care of the rest in Kathmandu. After gaining the necessary papers, stamps, and squiggles Mark could then bring the whole lot to us at the start of the trek.

Well we’d decided that Vaughan’s health was back up to a point where we could at least set out on this biking adventure around the Manaslu trekking circuit, even if his fitness was questionable. We would just have to bear in mind that we could turn back if the going was too hard…

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6 thoughts on “Nepal, the 1st Test: Saturday Night Fever (Dengue Style)

  1. Another gripping instalment. Even against all adversity you write a brilliant blog. Excellent pictures too. How the hell you go back to work after all this, I do not know!

  2. what a beautiful story… sorry to hear that you felt so unwell Vaughan, Kim you seem to have done very well in looking after Vaughan; I’m also really impressed with the photos of you driving Ivor into the water. Waw!!! 😉 xx

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