This week was an interesting week. During clinic days there were a number of good ultrasound teaching
cases including a DVT US which was positive. There was a unique opportunity to go the regional hospital
in Linden which is a mining town and more resource poor in terms of medical care.
The last 2 weeks have been a whirlwind. From the moment I saw the sign with my name held by the friendliest driver I’ve ever had at the airport in Nairobi all I have seen are smiles. Every person I have encountered has been nothing but kind and welcoming.
As women, sometimes we can be consumed with the needs of all the people right before us in our homes and communities. Yet, there is a longing in each of us to be part of something bigger than ourselves. We experience empathy and concern for others, our neighbors, both near and far.

Jamie Cirbus MD, giving a lecture on trauma care at weekly Emergency Medicine Conference at Georgetown Public Hospital, August 2017.

The past month taking care of patients, teaching, and learning from my colleagues in the A&E at GPHC has been a wonderful experience as always. I have learned a great deal and I have also had the opportunity to teach in a variety of settings, which has been very gratifying. I never leave here not in awe at the great work these physicians do with the limited resources they have available. I also rarely leave without a memory of some patient that we were not able to help as much as I would have liked due to these limitations. This month in particular it was a lack of streptokinase (the medicine they usually give here to break up the blood clots that cause heart attacks as they do not have a Cardiac Catheterization option available at GPHC). Over the month we unfortunately saw many patients with heart attacks and there was little we could do for them. Still, the physicians here push on and do the best they can with what they have.  I am looking forward to my next trip back in a few weeks so I can continue to work alongside these excellent physicians providing the best care possible to the people of Guyana.

Hi Ryan Van Nostrand here in Georgetown, Guyana. This is the end of my second week and it has been an educational and enjoyable experience working in the GPHC. Over the last two weeks I have been able to gain an insight to the difficulties and similarities between medicine in the US and Guyana. It has been a pleasure to work with the doctors and staff in the Emergency Department and I have really enjoyed being able to teach and learn from the residents here.
This is now my third trip to Guyana to work at Georgetown Public hospital, fondly referred to as GPHC, in the Accident and Emergency Department (A&E). Each trip has been eye-opening, motivating, inspirational, at times frustrating and heart wrenching, and always immensely rewarding. I am fortunate to be the current Global Health Emergency Medicine Fellow at Vanderbilt, meaning I will spend much of my time this year working in Guyana.
I am sitting on the terrace of my hotel in Kathmandu, sipping spicy masala tea and looking out at the cityscape for the last time. Below me, the pudgy, fresh-faced toddlers of affluent Nepalis learn to swim in the crystal-clear swimming pool, a far cry from the muddy, leech-infested floodwaters of the nation’s rivers and lakes. The all-seeing eyes of the Boudhanath stupa, the holiest Tibetan Buddhist temple outside of those in Tibet, gaze placidly down at me from their towering perch above Kathmandu, watching over the nation. In the distance, somewhat obscured by the dust and smog of the capital city, I can see the Himalayan foothills, their dark, untamed beauty seductive in its wildness. I think of my ten SBA students, scattered now throughout isolated villages in those very mountains, providing contraception services and prenatal care and delivering babies in remote clinics. I offer up a silent prayer for them, and for the women, children, and families they are serving.
Yesterday, the ten SBA participants, their nursing instructors, two representatives from One Heart Worldwide, and I all celebrated the final day of the program, during which the students received official certificates testifying to their new status as skilled birth attendants.
Last week, I traveled from Dhulikhel to Dhadingbesi, the center of one of Nepal’s more remote districts, Dhading. One Heart Worldwide has supported the upgrading of many of the health facilities and birthing centers in this area and has also funded training for many local birth attendants, nurses, and other healthcare providers in the region. With the assistance of One Heart’s talented, good-humored field training officer, Malati Shrestha, who gamely put up with my love of walking despite her preference for the bus, I spent the week visiting many of these health centers, observing the physical buildings, performing needs assessments and quality of care analyses, meeting with the skilled birth attendants, auxiliary nurse-midwives, and nurses who provide maternal care, and assisting with skill development as well as providing hands-on patient care.
Many people I know, both here in Nepal and back in America, ask me why I am drawn to global health and development work, especially in light of the inherent difficulties of such pursuits. My Nepali friends cannot understand why anyone would voluntarily leave what they perceive to be the abundant comforts and riches of the United States in order to work in a country with limited resources, endemic corruption, myriad systemic challenges, and a lack of basic necessities and rights, such as gender equality, accessible healthcare, running water, and effective sanitation.I try to explain to them that I enjoy helping those in need, that I find answers I do not even know I am looking for when traveling, and that America is currently also dealing with a flood of social and political problems, and thus is not the proverbial Promised Land that those in the developing world frequently perceive it to be.

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