My next posting was in Surkhet, a 19 hour bus west through precarious winding roads. Outside the Kathmandu valley, roads dropped sharply into terraced fields until we hit the terrai. I kept hoping a new bus driver would change shifts, but no one relieved him (or wide-eyed me). Surkhet then was a small rural hospital with a fantastic GP resident manning the show. Together, we saw end-stage wasting from TB, patients too poor or too far for attending clinics for medicine. A thin young baby dying from measles encephalitis, tell-tale dots spotting her mouth. The leprosy hospital, shadowy holes marking noses and digits. The final stages of things I had only expected to see in textbooks (Fournier's gangrene, Ludwig’s angina, and other such uncommon names), patients walking three days or more for care often wait until they must. Or they have to, like the woman who walked that distance to remove the baby who had tried to birth feet-first, his blackened feet still dangling as she walked, growing more septic with each step. She survived, and I could see that this hospital was doing everything it could in the harshest of circumstances. A good, comprehensive doctor with a primary care team made all the difference. A young Canadian who didn't now local context or resources could only do so much.