Itinerary Fall 2007 Early November (approximately Nov 10 - 18): Arrive in Kathmandu, where the first week will be spent getting acquainted with the country and its diverse culture. After settling into a comfortable hotel and seeing some of the many fascinating sights, we will visit a number of hospitals and clinics, providing more-or-less modern western care as well as Ayurvedic and Tibetan medicine. We also plan to run a 2-day Emergency Ultrasound training program for physicians from various hospitals in Kathmandu. We will address issues of local health care needs and resources, and challenges of balancing the two. Optional activities will include an introduction to Tibetan Buddhist meditation and yoga practice, acupuncture and massage by local experts, a hike to a monastery overlooking the valley, and a mountain bike ride through off-the-beaten-track villages. From our base in Kathmandu, we will take an overnight trip to a Monastery in Namo Buddha, in the hills just east of the Kathmandu Valley, where we will observe and assist in a clinic for rural villagers run by a monk with informal medical training. On the way back, we will visit the hilltop town of Nagarkot, famous for its early morning panoramic view of the Himalayan crest. Mid November (approx Nov 18 - 19): Travel by van to Chitwan National Park in the Tarai (Indian plains within Nepal). We will spend 2 days there in a tropical resort, discussing endemic tropical diseases such as malaria and kala azar, local snake bites (cobra, viper, and krait), and relevant issues in travel and jungle/wilderness medicine. We will venture into the park on a walking safari with a local guide, where we will likely see rhino, crocodiles, wild boar, various species of deer, and perhaps even a tiger. Late November (approx Nov 19 – 25): Continue on by van to Dharan, a largish town in the eastern middle hills, where we will be visiting the B.P. Koirala Institute of Health Sciences. One of the two major government-affiliated teaching hospitals in the country, BPKIHS is distinguished by a strong commitment to international collaboration. It is a major referral center, which sees a large volume of trauma and acutely decompensated medical illness. We will spend time observing in the E.R., touring the hospital facilities (including general medical wards, ICU’s, and a tropical disease ward), and holding conferences with local staff. We will repeat the Emergency US training course here, and will attempt to create and evaluate a hospital policy for ED use of ultrasound in lieu of reliable access to other diagnostic imaging modalities, and as a procedural adjunct. While in Dharan, we will also visit rural hospitals and health posts, and see some spectacular views and experience the rich local culture in the process. Late November to mid-December (approx Nov 25 – Dec 10): Return by air to Kathmandu (with a spectacular fly-by panorama of the eastern Nepal Himalaya, including Mt Everest); relax, overindulge, and take care of personal business for a day, then hop an early morning flight to Lukla, the gateway to the Khumbu trekking area. We will discuss acclimatization and altitude illness as we gradually climb to a high point of near 18,000 feet at the top of Gokyo Valley. On the way, we will visit several hospitals and altitude clinics. We will likely encounter trekkers and porters with moderate to severe altitude illness along the way, and may even have the opportunity to participate in a rescue. Following the trek, participants will be on their own to further explore Nepal or Southeast Asia as their schedules permit. We would be happy to help with arrangements if possible, and recommend cost-effective strategies based on connections and previous experience.

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