Ims still feel that the sickness web sites you might very first have to go through cities they encounter is triggered by the scent of the such as Delhi or Calcutta where malaria flowers and alpine vegetation that grow on lurks. Depending on the location, it may the wayside. That is akin to what a lot of be helpful for pilgrim travellers to consider Catholic fathers believed in the early th malaria prophylaxis and immunisation century once they had been crossing these against ailments like typhoid and Himalayan mountain passes. Indeed Spanhepatitis. ish Jesuit fathers in South America were the For pilgrims going to Mecca for the Haj, initially in Western literature to document the meningococcal vaccination could be parsymptoms of altitude sickness. The scent of ticularly valuable. The worth of this was the flowers as the cause of altitude sickness tragically demonstrated when some British doesn’t make sense, as I am fond of citizens succumbed to PRIMA-1 site meningitis on their reminding the pilgrims, simply because invariably return household from Mecca. the patients boost considerably on Pilgrimage medicine desires to become incordescent, even though the flowers are nonetheless givporated in to the broader framework of ing off their scent. travel medicine to make sure that pilgrims are We’ve got attempted to encourage the Nepali aware of troubles and ailments. Healthcare government to campaign to enhance awareprofessionals can then correctly advise ness of altitude sickness among pilgrims. potential pilgrims based on their destiThis has occurred to some extent, but nation and demands. thank God for dexamethasone, a properly established treatment for high altitude cerebral Buddha Basnyat health-related director, Nepal oedema. A lot of healthcare specialists who International Clinic, Kathmandu, Nepal [email protected] have helped out in the Gosainkunda LakeBMJ VOLUME MARCH bmj.comEImaginary conversationsWe didn’t assume a lot of most of our chiefs, our attending physicians in the hospital. We thought they had been boring, irritating, old. “Would you like to wind up like him” asked among my fellow residents one particular day, as we trudged behind the old man on ward rounds that seemed interminable on hot IQ-1S (free acid) afternoons, when the beach supplied a much more appealing alternative. “Most absolutely not,” I replied, with definitely no doubt in my thoughts. Sometimes we would modify the treatment options they ordered. We knew improved. We would even hide sufferers from them on rounds, claiming that they had been down obtaining x 
rays, or drawing the curtains around their beds and claiming that they were indelicately indisposed. We also created up stories about our chiefs. Not true ones, but imaginary stories about made up conditions that would illustrate some trait or characteristic of their personality or conduct. There was the academic chief, incredibly learned, constantly ready to quote a few references, but somehow generally leaving you with no a definite answer to what you wanted to know. “Is it correct that when it rains there is a great deal of water coming down from the sky” “Well,” he would answer in this imaginary conversation, “there is actually extremely small information on this subject. There PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/7278451 is an old paper in the French literature, but smaller numbers, poorly documented, largely anecdotal.” Far more practical but obsessive to the intense was a further chief, a man of fantastic achievements. “We saved this man’s life as we picked him up from the sidewalk, sir. He had jumped from a five storey buildingwe stopped the bleeding, restored his airway, treated his pneumothorax, his rup.Ims nonetheless really feel that the sickness sites you could possibly initially must go through cities they experience is brought on by the scent of the including Delhi or Calcutta where malaria flowers and alpine vegetation that grow on lurks. Based around the location, it may the wayside. This really is akin to what a lot of be useful for pilgrim travellers to think about Catholic fathers thought within the early th malaria prophylaxis and immunisation century when they were crossing these against illnesses for instance typhoid and Himalayan mountain passes. Certainly Spanhepatitis. ish Jesuit fathers in South America were the For pilgrims going to Mecca for the Haj, first in Western literature to document the meningococcal vaccination would be parsymptoms of altitude sickness. The scent of ticularly useful. The value of this was the flowers because the lead to of altitude sickness tragically demonstrated when some British will not make sense, as I am fond of citizens succumbed to meningitis on their reminding the pilgrims, because invariably return household from Mecca. the patients improve significantly on Pilgrimage medicine requires to be incordescent, even though the flowers are nonetheless givporated into the broader framework of ing off their scent. travel medicine to ensure that pilgrims are We have tried to encourage the Nepali aware of problems and diseases. Healthcare government to campaign to boost awareprofessionals can then successfully advise ness of altitude sickness among pilgrims. prospective pilgrims based on their destiThis has happened to some extent, but nation and demands. thank God for dexamethasone, a properly established treatment for higher altitude cerebral Buddha Basnyat medical director, Nepal oedema. Lots of healthcare pros who International Clinic, Kathmandu, Nepal [email protected] have helped out at the Gosainkunda LakeBMJ VOLUME MARCH bmj.comEImaginary conversationsWe did not think much of most of our chiefs, our attending physicians at the hospital. We believed they were boring, irritating, old. “Would you prefer to find yourself like him” asked among my fellow residents one particular day, as we trudged behind the old man on ward rounds that seemed interminable on hot afternoons, when the beach presented a far more desirable 
option. “Most absolutely not,” I replied, with absolutely no doubt in my thoughts. Often we would transform the treatments they ordered. We knew greater. We would even hide sufferers from them on rounds, claiming that they have been down possessing x rays, or drawing the curtains around their beds and claiming that they had been indelicately indisposed. We also produced up stories about our chiefs. Not genuine ones, but imaginary stories about produced up situations that would illustrate some trait or characteristic of their personality or conduct. There was the academic chief, extremely discovered, always ready to quote a couple of references, but somehow often leaving you without having a definite answer to what you wanted to know. “Is it correct that when it rains there is a great deal of water coming down in the sky” “Well,” he would answer in this imaginary conversation, “there is actually incredibly little data on this topic. There PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/7278451 is definitely an old paper in the French literature, but tiny numbers, poorly documented, largely anecdotal.” Much more sensible but obsessive towards the intense was a further chief, a man of excellent achievements. “We saved this man’s life as we picked him up from the sidewalk, sir. He had jumped from a five storey buildingwe stopped the bleeding, restored his airway, treated his pneumothorax, his rup.