What a first working week its been here in Tansen. As I have mentioned earlier we work here from sunday to friday. The weekend is a relaxed saturday only and then its back to the chaotic yet rich learning environment that is Tansen Missionary Hospital.

My first week has been on the medical ward with Dr Theo and his team and I have seen and done things that I certainly wouldn't have in the Uk. When I look back at the first week it is kind of a blur. I have seen so much.

My favourite and most interesting case to me personally was a 21 year old lad (who looked around 12) who came into mine and Dr Mahesh's clinic with a weeks history of palpitations. He had had a flu like illness with joint pain a month previous. When i examined his chest his apex was visible and there were thrills all over his chest. His heart sounded like on big murmur. I went to watch his echo and he had mitral, tricuspid and aortic regurgitation. It sounds like a severe case of rheumatic fever. The sad thing is that to recieve the cardiothoracic operation he needs he would have to travel to Patan hospital in Kathmandu and spend a Nepali fortune. Ofcourse travel and treatment is something that this lad and his family can't afford. I felt so sad after following this case. I really felt for this lad especially when I saw the situation explained to him and I could see that he knew in his eyes that he was just going to have to get on with things.

I spent a night in A&E which was interesting to say the least. One poor 2 year ond had somehow managed to cut his index finger off (see photo). I couldn't help but chuckle. He was completely unphased by it. Another 10 year old had got hit in the phase with a cricket ball and his 2 front teeth were hanging on by a thread. When he sneezed one of them flew out and hit his dad in the face. It was one of the funniest things i have seen in a while. Everyone laughed including the young lad. Genius.

I have had a truly lazy day today in the guesthouse, thoroughly making the most of my one day weekend. The one time i left the house I almosty stood on a snake that was on the path outside. I was in my flip flops and casually bouncing along to some Kanye West on my ipod when i saw it dart down the path. I had literally put my foot about one foot away from it. And let me tell you, the snakes here are pretty deadly. I must have frozen for a good 10 seconds. Its just not an experience I have ever had before, I stood thinking about how friendly the shrews from the other night seemed. This is Tansen.

Tonight has been nice. Every other saturday all the foreigners and ex-pats come together for a service and then food. It was a good chance to hang out with people after a busy week and get to know some of the workers here better. Food was also great, pizza for the first time in what seems an eternity.

I miss you all and pray you are all well. I am doing fine. Time seems to be flying now.