Right! We're outa here. Delhi to Melbourne.

We have made it....Business Class!  But a bit of advice to the beginners in the audience...there are easier ways of getting a Business Class seat on an Air Inda 787 Dreamliner.   The qualification period for us was somewhat rigorous, and we would happily forgo hob nobing with the elite.

It is nice though.    Fourteen seperate buttons to control the seat.  Seats into beds.  Fancy socks.    

Air India have 18 Business class seats, the rest for the common folk,and no first class, so being in the front row of the business class is really as First Class as we'll ever get.

What this does mean is that Nathalie is very close to the loo, and she can sleep with her foot raised.

No gin squash....just orange juice.  And those seats have a back massager  button too.

Wheelchair to the door of the plane, and the walking frame the rest of the way.....not easy but the altnative (stretcher) would have taken several more days to organise.....and be at the mercy of that evil empire( the insurers) for a few more days...naaaahhhh, not likely.  The boss cocky of the cabin, let Nathalie keep her foot up during the take off, which was real hand, because the most pain is when the foot is down....

That's. Us...

Hey, in business class, they don't serve all the meal on the one tray, at the same time.....and the hand towels are cold!!!    As long as we kept Nathalie's proactive pain relief up....things worked out pretty well....but with changing time zones had to use my counting side of the brain, to work out whence twice, thrice, once, and once after meals should be given.  just as well I know a nurse.

Bollywood film.  Yes again.'Highway'  2014 film relating to a soon to be married daughter of a rich Delhi family, who witnesses an armed robbery and murder is abducted by the robbers and falls in love with the robber ......absolutely awesome scenery, of many parts of India...stop it, it's creating itchy feet.  But it is a kidnap, murders, etc and her I predicted that it would be the first Bollywood film I've seen with no dancing...until 1:15, yep the star gets an English cd, puts it in the very expensive cd plat in the ancient Tata truck, jumps out and sings and dances....what's  that about?

Got back to Melbourne and for once, there was no ranting,  raving, threatening or stress as everything went well to the transit lounge  in Sydney ..cool, except for the security incident relating to the catheter bag in Andrew's backpack at transit lounge security ...but the least said about that the better.  Then back in the plane to Melbourne.

Ambulance and family waiting for us...it wasn't the one with lights flashing on the Tarmac..would have been too embarrassing, and how would have we picked up the duty free. Our ambulance was sedately parked outside, to reception at Knox, with a big thank you to Peter and Lisa, for making that happen...the hospital was actually were expecting us .  We got here.   More surgery debridement and skin grafts....at least a week in hospital.  Apparently Saturday and Sunday mornings are not good times to arrive.  The line ( that we were wheeled to the front of) was enormous, even for the locals. 

Turns out that our customs dog Linton, while we were away had a detached patella....they operated and then he damaged a ligament, so he needs six weeks of close confinement rest as well.  Out in sympathy with Nathalie, but he will be doing that out at the Kennel.

Linton...the one on top

India summation in the next and final blog....

East-West Medical Clinic, B28 Greater Kailish, Part 1, New Delhi- Day Six and seven

Have made it as far as the Air India Business class lounge...which we never intend to do again..for too posh,

Absolutely no thanks to the insurers, and aft much and constant harassment and very expensive and inconvenient phone calls ( considering the maximum top up of 300 rupees) , and the fact that it costs even to receive the calls, the insurer managed to work out

1. We had tickets

2. That we were noted as special needs/ wheel chair assistance

3, we needed and ambulance to the Delhi airport and....

4. "Their" medical supervisor thought it would be ok for is to take a taxi or a private car from the airport to the Knox private hospital.  ( this was the only time that abc has yelled at poor Kate at Customer Care who are sub contractors to cover more insurance)

And then with 10 minutes before we were due to leave the clinic, the clinic tells us that there has been no guarantee of payment, and we would not be getting our paper work and file  'til this was done.  This is second time they've done this....

The ambulance ride, lights and siren all the way, then pretty tight security at the airport where unless you have passport and eticket you don't get into any building within departures, soldiers and police....all armed, some even have big guns..

Each if these required specific phone calls, and a different person to speak to....so we are really annoyed at the insurance company who has to take responsibility for the work their sub contractors do.

So....make sure you research exactly what experience your insurer has who are their partners in the country you are travelling to, what these partners' reputation is, and that they will return phone calls, and don't always take the one Flight Centre foists upon you.  Do your research. 

East-west clinic and rescue service  was the only thing right they did, and we can not speak highly enough of the medical care we got there.  Enough ranting....

We are on our way home.....leaving soon and arriving back home some time tomorrow morning, straight to the hospital, and get Nathalie settled there.    A big nursing issue in India, appears to be the reluctance to provide sufficient and proactive pain relief....what we would take for a headache at home. 2 x 500 mg paracetamol, they provide less 1 x 650 mg paracetamol post op...we could not make them understand the concept of developed tolerance...they must of thought we were seekers.

Andrew's every day medication is more than the post op stuff Nathalie got. 

Love to youse all and I will finalise once we get back......

East-West Medical Clinic, B28 Greater Kailish, Part 1, New Delhi- Day Four.

Wednesday 23rd July.

Another visit to the operating room for Nathalie, so that the dressing can be changed, the wound cleaned up around the edges, and a backslab put on.

Once again the gingham gown, we thought, was a fashion statement worth noting.

A bit more necrotic tissue was scraped away, but Nathalie recovered from this GA much better that Monday's visit.  The dressing is somewhat more substantial, with a backslab to ensure we don't get foot droop.

Thursday 24th July.

The lovely Dr Sangeeta reviewed this morning, and the pain medication regime was discussed. Considering the issue is post operative pain, it has to be dealt with.  It seems that one and a quarter panadol can resolve all pain for Indian people, and that will only be given when the pain is extreme.  It was ascertained that due to our developed tolerance to paracetamol, it doesn't work as well as the local doctors were expecting.  So we are now on  regular and increased doses of analgesia, as well as oral antibiotics, in lieu of the IV stuff.

In anticipation of a long journey home, the doctors wanted Nathalie to spend a bit of time sitting out of bed, and we managed to negotiate a four hour leave pass.  So a car was hired and a driver, and squeezing Nathalie into the back seat, off we went.

The highlight of the trip for Nathalie was

A.  Sunlight...well sort of

B. McDonalds chips

And

C. The really friendly and talkative Sikh driver....NOT.

You can see the mirth exploding from every pore of his being.

Considering Nathalie has not been at large, or for that matter much out of bed for nearly two weeks it was quite exhausting, and the crappy cappuccino, mango cheese cake, coke, and fries were all a bit much, so back we went to East-Westmedical clinic.  

East-West Medical Clinic, B28 Greater Kailish, Part 1, New Delhi- Day two

Firstly for our own recollection the following time line of our travel bump.

>Sat Night of the 12th July, thought foot was a bit sunburnt, or insect bite, got topical ab from Dev Sanscriti Doctor who visited guest house.

>Sunday Morning of 13th foot a bit sorer, so went to Dev Sanscriti University Hospital and was prescribed Oral AB.  Travelling 12 hrs towards Monsiere - was not keeping anything down was sleeping in car, and pain increasing.  Sunday - Night of 13th first noticed blood pooling under skin on foot.

>Monday Morning of 14th of hospital Haldwani - IV abs and tramadol, admitted to Brij Lal.

>Tuesday 15th site re dressed in ward.

>Wednesday 16th first debridement on ward by Dr Karan skin for drainage and re dressed.

>Thursday 17 debridement on ward and  re dressed

>Friday 18th.  Debridement on ward in am.   Friday evening concluded IV AB 

>Sat 19 th. Dressed and 'ambulance'  to Dehli East West clinic examined and re dressed back on IV ab and IV pain Dr Sangeeta. Travel strongly advised against, risk of DVT too great.

> Sunday 20th examined by Dr Rasan  Plastics specialist recommended further debridement  under ga-  examined by Dr Kamresh gas 

>Monday 21st surgery to debride to clean wound bed.

It does seem quite like a blurr, don't it.

The East- West (temporary) Clinic whilst the real one is having renovations done.

Having a male child is still for marriage purposes, very important in India.  There have been many documented cases of female child either being abandoned or killed.  Our experience is that all conversation is directed to the male, and deferred to for all decisions.  Of recent years the Indian government made pre-birth gender determination illegal, as medical and non medical abortions were rife.

And it is illegal

This area of town I feel is somewhat posh, because within the general area there are several gated sectors, and some shops where there are windows, and doors, and credit card facilities.....not that these are the places likely frequented by the Caulfields.

Nathalie was carted off to the theatre so that Dr Rasan could debride the wound a bit more, reducing the pain, and the necrotic areas.    This was to take about an hour, so ABC got a chance to wander around a bit...all by myself...without supervision, and he managed to find his way back.   During the wandering a there was a police compound, which did not invite photography probably because of the two guards with machine guns, did not seem all that welcoming.   I am sure, however that I could hear an interview in progress, from the street.  There were three big crowd control trucks and tens of the Ambassador brand cars, which look antique, but are in fact very new and apparently are the preferred police vehicle.

The 'Ambassador' brand car, which seems to be the model most favoured for the police and VIP transport.  This one has its blue light covered.

There is an Irish lady here, Elizabeth, who is the founder creator, and manager of the East-West Clinic and East-West rescue , and also is an English trained nurse, so it was lovely to see a bit of nursing style that we are more familiar with.   Nathalie even got a wrist tag today...after surgery though.   

That's the room..the blue curtains....

Anyway, Doctor Rasan tells us that she had to debride a bit more than initially expected but she is happy with the clean wound bed she now has..well the wound bed that Natahlie has.

Nathalie was quite impressed with the Operation gown she was given though....

Sorry, photo of a photo.

So it's now a wait and see.....get the pain under control, change dressings a few more times and then hopefully a 'clean bill of health' to go home.....    

Meanwhile on the next day.....22nd July

Not a real good sleep time, as the reaction to the GA wasn't all that good.

Dr Kamresh and Rasan, both came and attend the redressing of the operation site.  This was quite painful, so Dr Kamresh was able to give some 'good stuff' which eventually took the edge off the pain. Dr Rasan, wants to do another dressing tomorrow in the Theatre, so the pain can be a little better controlled.     

Lat today the pain receded, and it seems that Nathalie is now able to catch up on some well deserved rest. 

See youse all next time.

Brij Lal Hospital and Research Centre, Haldwani, Uttarakhand Day Six thence to Delhi

Stuck in Delhi for. Few more days -more below.

We will not recommend or be using the in-house insurance that is promoted by Flight Centre.  This company is Cover- More Insurance..   They HAVE been named on the blog.

Through the good graces of a friend of Ajay, who resies in Haldwani, we were released from the hospital.    The insurer told us they would settle the account and there was no need for us to max out the ATM every day.  No matter how clear we had made the situation to the insurance company, overt a number of days that the Brij Lal hospital was a cash only, and pay before release organisation, they still had not transferred the cash into the hospital's account.  Mr Paugita, a local bank manager and philanthropist actually fronted with a bank cheque, and deposited this with the hospital as a guarantee that the insurance company would pay.... All up about $1800 au. we will obviously make sure that this has happened and Mr Paugita gets his cheque back.  It was very stressful, at the end if a very stressful time at the beginning of a very stressful journey, brought about by the incompetence of our insurers, who seem to think that all medical establishments in the world are as trusting as those not in far north India. 

Late last night the insurer told us they had booked a flight for us 'tomorrow' which meant that we had to leave at 0200 local time, and we had to arrange an ambulance and we had to arrange payment. Not hey seems to think that 300 ks on the map in India during the monsoon,  is the same as 300 ks in the Australian outback.  It wasn't till several frantic phone calls later that the insurer told us that "Oh we meant our tomorrow".  Can you imagine an international insurance agency using such terminology lightly.  

Pretty annoyed would sum it up.   And we will be formalising a series of complaints upon our return.

Any way, after an expected departure at 0700 the money sorted and the foot dressed again, we said our good byes to the nurses and students.  I think they were really sad to see "ma'am " leave.  The insurer told us to just get in the ambulance and they will confirm where in Delhi we will go...not that we trusted them, we had to get going, lest the really creepy cleaners try to sweep our room for the fifteenth time in an hour...or the nursing assistants attend several time to enquire of our welfare ( albeit they wouldn't bring a meal for Nathalie) )we later found out in the expectation that we would tip them for their annoying, inappropriate and intrusive behaviour.....not likely...even if we did a bit   It is very clear that the Caste system, no matter how denied, is still in existence, even if only informally.   The cleaners, nursing assistants, and food deliverers, are clearly of a subservient class, to all other employees, and barely given any courtesy, or politeness by the other staff.  Very hierarchical.  Apparently this tipping of all domestic staff is standard fare here at hospitals...not that they seem to do much good for the care of the patient.

Ajay and Kisskintha left at 0700 to both travel north to Monsirie.  This was in a 'taxi' a very crowded 'bolero" with lots if stuff on the roof.  It was very sad to say goodbye, but we know how important the temple at Monsiere is to Ajay, and this is the first time Kisskintha will be visiting there.  The have been heavy rains in these parts over the last few days, so the journey for them will take 14 hours...give or take, with more than 300 ks of precipitous and winding roads....should have been us on that road...oh well everything happens for a reason. 

The "ambulance' Journey.

We have to accept we are in India, and that thigs is different in these parts...which we do, but without appearing too judgemental or churlish, we thought we would describe the seven and a half hour journey from Halwani to Delhi.  Other than the fact that it had a blue light' siren (of sorts)on top and 'ecnalubma'  written on the front, and the butchers hook on the wall, maybe for IV bottles (?) this could have been a bread delivery truck.  

It is a Suzuki type delivery van.  It has a top speed of a huge 80 kph, most of the journey was at a greatly less speed than that.   There were however a number of 'divided' (divided in parenthesis because at any given time there could be several vehicles traveling towards you on our side of the road) highway areas that this speed could have been exceeded.  Suspension was negligible, and there were thousands of bumps..   The air condition at best worked sporadically stopping twice to have motor workshop look at it, and even in monsoon, the back was oven like.

The engine did a good imitation of the F1 engine, in noise only, so any conversation was impossible at speeds above 50 kph.   The Australian concept of ambulance, is not really relevant here.  The driver, with limited English, as lovely as he was, was just a driver.   Thee was no paramedic support, no O2, not even a first aid kit.   The siren, when used, just seemed to make the other drivers more detirmined to get in the way.

Poor Nathalie's view

Seven and a half hours later we arrived at the East-West Clinic, Greater Kalllish, Part 1, New Delhi.

East-West Clinic, Greater Kalllish, Part 1, New Delhi.

Maybe our insurers have got something right.  This clinic/ hospital, contracts to insurance companies to cater for foreigners, to treat, assess and repatriate injured and ill travellers.

It was great dealing with someone who knew what was going on.   And us not having to deal with the amateurs at the Australian end of the insurers is a huge relief...they only added stress.

Immediately Nathalie was assessed by Dr Sangeeta, the dressing taken down! and the bad news given.  Her reccomedation is that there will be no travel home for a few days yet.   The biggest concern  expressed is that with the swelling, infection, and open wound, the risk of DVT is too great.  So it won't be to the fancy hotel to wait for the flight tomorrow, but stay at the clinic, straight on to more IV ab, and painkillers to control the pain, probably caused by all the bumping/ and heat  in the ambulance, and Sunday we expect to be further assessed by a Plastics specialist, to express a further prognosis, plan of attack.  It seems at this stage that Andrew's level 1.5 first aid, medical training in Indonesia, and watching many episodes of House ( actually we saw house only two days ago on the TV at Haldwani) does not qualify him to tend the IV abs that may be reaquired on the flight.

Anyway the nursing care here, is far more wholistic, and not task focused.  Many of the nurses are from Tibet...   The poor nurses are subjected to intense scrutiny of the IV monster 'have you flushed that'  'is it running right'.  But she is happy with the positioning and functioning of this cannula.

An IV cannula to Nurse Nat's satisfaction

The two bed room.  

there have been a series of tests, blood urine and swabs run that maybe should have been run up north, and some tests on Nathalie as well .

Sunday am Delhi 

We have just been visited by a plastics specialist, and she is not happy with the continuing spread of the infection, and possible necrotic areas .   The pain has to, also be under control.   As of a few moments ago, it is apparent that further debridement is required under G.A, to provide a clean wound bed, before we travel....which now may be the end of this week, early next week at the earliest.    So surgery Monday morning, unless deemed needed earlier, pending on infection spread.   

The surgery now has been booked for 1130 Monday, and it is heartening to see the barrage of tests already being done...on Nathalie.   ECG with suction cap leads, bedside clotting tests with slide and stopwatch, the anthenististest , anastestists, gas lady doctor visited, a in room chest X-ray...all on Nathalie.....

Waiting waiting waiting.  More later if not beforehand.

Brij Lal Hospital and Research Centre, Haldwani, Uttarakhand Day Five

Nathalie is intent on going home.....regardless of the medical implications that the journey of probably more than 24 will incur.  She is not able to walk, other than a stagger to the loo and shower.   It seems that only after the Doctor provides a fitness to travel letter, do the insurers work out the transport plan....so it may take longer than we planned to get home,   We will see.  It is pretty much confirmed now that Nathalie will be discharged from Haldwani on the 19th, with a stop for some time in Delhi, waiting the first suitable flight home.

That's our room, to the right immediately above the 'emergency ' sign.

There are many people who come and go from the room, from the 0600 barge in with the fresh bedding and new pjyamas,with the fully expectation that one is out of bed and the bed is made in the time the shower is taken.   Then there is the procession of cleaners, one for the floors one for the sinks, etc, and the roles do not change, or cross over.   The security guard bringing in the cold water this morning was unusual.   I think we have been assigned one attendant, who seems to be around all the time.  

Had some difficulty convincing the staff that the doctor had required another bold test for WVC, but eventually the poor resident was called up and signed off on the test, and the result of the to indicates that the infection is at a stage that will permit oral ab, short term.

ABC went out across the road from the hospital to the fruit vendor, and paid nearly $2.50 for three apples and five bananas.   Thought had been scammed, until looking at the apples, were surprised to find apples here are imported from the USA.  Highly curious. 

Product of USA in far North India.

The staff here are mostly very happy, competent within the limited scope of their training but very little initiative beyond teyond the doctors' instructions.  Storage, administration and disposal of drugs  and sharps is not what we understand as standard.  Infection control on the handling of sharps and IV instruments etc, are not quite what we are used to.   I do, however doubt that their is much golden staph, VRE etc. as this seems to be a condition of 'very clean' hospitals.

Sister Priti

It is really sad, that these lovely ladies lament the fact that their skin is not lighter, and they feel that they   have horrible skin and hair..  Very self deprecating, which is a shame.    They always feel that the grass is greener on the other side of the wall....from them.    

We are having some very frank conversations with the insurer, and we have pretty much organised the hospital placement once back in Melbourne. 

Visited again by our favourite students, who are really keen for Natahlie to have her hands hennaed.

 

Ever the teacher- a lesson on the unconscious patient, to student Manpreet.

The students love visiting ma'mm.  It is so they have a foreign FB friend, but demonstrating a deep desire to find out how we live our lives,  and especially how the nursing is done.  They have very low computer literacy so much of their information is still from off line books, and lectures.   To see the information on an IPad, immediately at hand is very confronting.  

But then it happened two operations at the same time

Most importantly the henna...left hand right for

And the surgical bit

At the same time

Hopefully the next blog will be from Melbourne, as after a lot of fanarkling, a. The insurance company has paid the hospital ..we hope and b. There is a flight booked on the 20th getting home on the 21st.

On the 19th we will somehow be got from Haldwani to ' a hospital in Dehli,where we  will stay overnight, have wound re dressed and then final assessment for Fitness to Fly..... 

Brij Lal Hospital and Research Centre, Haldwani, Uttarakhand Day three to four

Thee has been a positive move from the insurance company....they just wanted the paperwork first.  Clearly my expectation of the helicopter from the roof of the hospital, to the C130 on the tarmac at Delhi, with the full medivac team,lights and bells, was a bit of am overdramatisation of the way things happen.   The thoughts of the insurer, and correctly so, is that NJC is safe and receiving the care that is needed here.

In hindsight the only criticism could be that of the time taken to let us know all they have been doing in the background.

As of  Wednesday the attending physician, Dr Karan, looked at the leg, and with an audience of many people including the cleaner, he  cut away the dead skin and it is now draining naturally.  The is the need for further surgery to debride the dead tissue, and the will have to be a skin graft.  Dr Karan is satisfied that this further surgery is not necessary to be done here, and under certain conditions travel home first can be done.   This is contingent upon the white blood cell count coming down from 19000 to a more reasonable level where IV ab are not required. Could be four or five days.

There is no way we can continue this extraordinary adventure, this time.

The view from the hospital bed...uniquely showing something sadly lacking in most placed we have visited...blue sky

Happily, we have just been advised that the insurance company is covering and will sort out  'door to door' transport, so I now have a gazillion rupees (taken from the ATM in anticipation  of having to front with the cash here).... Let's party.....or maybe not.....

So that's the good news...everything is relative...and we're doing ok.

I mentioned a group of student nurses....they are a Godsend, they have taken a shine to Nathalie, and have used Nathalie as a case study.   They practice their English, and are very interested in how we live, and are happy to tell us all bout their world, loves, and arranged marages, their love of dancing....which they demonstrated.    They have served to take Nathalie's mind off the pain and they seem to get along wonderfully with Kiskinda or 'aunty', all the time tending to the blocked cannula, water glass, taking NJC to the loo etc.  

We have genuinely been invited to an arranged wedding in December....not sure we'll quite make it back by then.  They are all very keen to get their nursing qualifications and mostly move out of India, to the 'dream land', Australia.   

ABC went for a wander, a few doors from the hospital, past the enormous bullock chewing its cud right across the footpath, the pony carts, and death defying road crossing, to a nearby mega mart( nothing like the size of the 'mega' marts in Indonesia, to get a few supplies. It is very surprising there are not supermarket riots.  It was amazingly slow disorganised, and queues...don't really mean much.....I am learning.  Generally a bit taller and heavier than many of the locals..used politely and prudently works.  Smaller change is given in lollies.