Mumbai

I’m going to Mumbai for work (and pleasure)

Senior VP of PH, Stuart Myers visited India earlier this month to attend (one of the many) a meeting with Pfizer India to see if there could be collaboration. Pfizer India is based in Mumbai.  One of the possible topics discussed was an awareness campaign for the 13 valent Pneumococcal vaccine in India.  It was approved here earlier in the year.

My Pfizer job in USA is in the 13 V pneumococcal clinical assay group.  After the visit of Pfizer India colleagues I sent an email requesting a  follow up meeting with them and try to facilitate the PH Pfizer collaboration.  If my fellowship ends and my only success is to start negotiations I would feel I accomplished something that would benefit Pfizer and Project Hope- Bonus.

Dr. P suggested that I fly out Monday morning and return in the evening.  No way!  Swati, a woman  I met early on during my stay moved to Mumbai.  I contacted her; she immediately  replied and we  have plans to get together this weekend.   Wow- the arrangements were made within 12 hours and I am leaving in three days.  This shows me that things can happen quickly in India.

 

Wish me luck with Pfizer!

You Can't Always Get What You Want

When I accepted the fellowship I had great expectations that I would contribute to improving health. It's been four months and I haven't made any impact to health care in India. My understanding of the health care system came from my visits to Doctors and pharmacies. Today my only accomplishment is to improve the organizations skills of PHI. This is NOT what I had hoped to do but have taken the challenge to be a goal. Travelling 8000 miles, leaving during my favorite season, spring with the beauty of the flowers and fresh green color and arriving in a HOT city with lots of people, garbage, and noise has not made me very happy. Repeatedly I need to remind myself I am here for work and not pleasure. Makes me appreciate my job at home (almost).

My friend Sue is coming to visit and is planning on travelling around India and I want to join her! As the travel planner I am I have completed her itinerary, even though she only told me of some of the places she wants to visit, a trek to Nanda Devi valley, visit the Dali Lama in Dharamsala and visit me. A native Indian co worker from Pfizer, Khushroo, told me I must visit Nandi Devi valley but I haven't the vacation time to do it because to experience the locality requires hiking. Not just a day hike but a two to three trek into the valley. I could accompany her if only I could take vacation.



Ready for the mountains

My dilemma is that I really do not feel I am really contributing to PH so why not go? It's because the GHF program states we are not supposed to travel during this time. Big sigh! Rules are made to be broken, right???? I need to ask my PH manager first. How to convince him that this is a valuable experience that would add to my GHF fellowship. I could suggest I would talk to the people in the remote location and evaluate their ability to receive health care, could take an inventory of some to evaluate their diabetes and HBP conditions, what else? But I don't even have the clothes for the trek. I could borrow from my friends... Or I just put it out of my mind. Don't think I can do this as I want to go. I know things don't always go my way, a perfect example is this fellowship, but I have to make the best of it and that would include this trek.

But if you try sometime, you just might find you get what you need. Am I "getting what I need"?

 

Positive Attitude

Having a positive attitude helps! When I go out I try to find sights that are interesting and unusual. Not every time can I accomplish this task but I try.  What’s new – pigs and cows in the neighbourhood, people walking in the parks for exercise (usually overweight people), the moon (it was clear the other night!), and rain.  The monsoon season has begun causing flooding making it a challenge to get to work as the drainage system is poor or non-existent, brings out the mosquitoes which are much smaller than at home but bite just the same and puddles (drivers do not care if they get you wet!). 

This was a busy social week for me. JC, the other Pfizer GHF at Project Hope has come to the end of his fellowship.  The office will be much quieter without him. I’ll miss him and his positive attitude.  His project allowed him the independence to complete his project through his determination to help others and hard work without the full support of the office.  JC is in sales for Pfizer, our personalities are very different but we had the bond of the new experiences as a GHF.  The office had two going away celebrations and last night I met my friend Pryia at Costa coffee for a mint lemonade and a hot fudge Sunday (Yum).  Today I am going to experience the metro system to Delhi center with Pryia.  The metro system is the best way to get around during the rainy season.

My greatest highlight is the travel plans of my Aussie friend, Sue, who will be visiting next month.  Something to look forward to!!!!!  I met Sue in Nepal during my Everest expedition in 2004.  We were both hiking solo and hit it off.  She has visited me and Eric a few years back and it will be great to see her again along with having companionship. The only bummer is that I can’t take vacation time to travel with her. The fellowship doesn’t allow any vacation (I have already stretched the rules on that!).  Just booked Taj Mahal hotel in September so Sue and I will visit during the full moon.  I say that the only beauty I have seen in India is the Taj and I hope that the moonlight exhibit will make the experience even more magnificent.  To share with a friend will be extra special.

Puzzles are what keep me entertained. How will I adjust to being home with chores? The apartment has a cleaning service which I am taking full advantage of. It was a shock when I noticed that my hairbrush had been cleaned! I still have the responsibility (I have put that upon myself) to take care of “my puppies”.  I no longer think about bringing the dogs home.  Eric had a good point when I mentioned that it would be nice to have one or two as pets.  He said that we wouldn’t want to bring them in the house at 8 months old because they were not housebroken.  Good point!  Last night confirmed this as right after I fed them, Whiskey took a poop right there!  I will miss them but being home should ease the sadness of saying goodbye.

This week Eric is on vacation for two weeks in Yosemite and we haven’t been in contact. I miss speaking with him a lot.  During the week we usually talk through Facetime at least two times per week.  I do keep in touch through Facetime or Skype with my sisters, Iris, Kristin, Jacek, Marian and Tricia.   I love the ipad as it allows me to connect with home. 
So long for now!

Have I adapted to India?

Walking back from the store I was thinking that I have adjusted to life here. Knowing where I can purchase what I need and how to get around, either by car, auto rickshaw or hire a taxi allows me to feel comfortable in my surroundings. The first month or two after I arrived, I wanted to explore Delhi and see the tourist attractions. Now, not so much. Most of my time is spent at work; doing puzzles either Soduko, solitaire, playing games on the iPad. Or checking social websites. I do spend enough time with others preventing me from living in isolation. My daily routine of feeding my four street puppies allows me to fulfil my nurturing needs.

The blog allows me to keep friends up to date on some of my more adventurous activities. Almost every day I visit FB to see what others are up to. I never used FB at home to follow my friends but while in India it is a nice way to keep up with a few. This is completely unlike the Sue from the states who spends most of her time "doing things". I don't have any hobbies here. What can I do? What interests me here? I have been doing exercises in the morning and going for walks. Every day I do get out.

I have to remember I am here to work for Project Hope.

I haven't written much about work as I have been unfulfilled. Work ethics in the US are MUCH different than what I have experienced from most people here. Of course there are exceptions.

Friday, over three months into my fellowship, I was called into a meeting to discuss my Scope Of Work., SOW, 3 1/2 months since the start of my fellowship!!!! I was requested to prepare a presentation which spotlight your Fellowship work in India describing Aim, objectives, Activities, key accomplishments, learning’s, suggestions for future. I created a presentation in an upbeat manner highlighting what I have done. I included some challenges with the fellowship: a fellow should not be invited for a project that had not started, they need specific goals and to be included in group discussions, When I arrived the director mentioned they had weekly meetings, in my three months here there was NEVER a weekly meeting! There are four employees of PHI, Vishwa, HR/finance, Cheena and Ciju, project leaders and the director Dr. P. Juan and I are Pfizer GHFs. An example of the inefficiencies: the director sends and email requesting that Cheena, Ciju and I create a questionnaire that would be used for evaluating the people in the NCD project study groups. I do not feel that this is a productive way of distributing work. I thought that we would have a meeting to discuss thoughts, but the next thing was sample questionnaires from each. Last week I got so frustrated that I requested that we have weekly meetings on Monday. The office staff thought it was a good idea as there is also frustration among the others.   

During the SOW meeting, Cheena and Dr. P got together before our meeting to discuss the presentation. They then proceeded to TELL me what I have done and my accomplishments. I was stunned as we didn't discuss. You might not be surprised but I lost my cool. I laughed and proceeded to rant about the disorganization, how unproductive I have been and that they are not making use of the GHFs.

They responded.  Overall: I felt the meeting was productive as Dr. P explained that both Juan and I were "senior" and most of the people he has supervised were very junior and he was unsure what to do with us. For his benefit, maybe he thought it was best to leave us alone and allow us to do what we do best. Good thing he knows as I didn't know. Maybe this is part of my developing and "growing experience". Dr. P can be very professional and sound very knowledgeable but he also can be disruptive.

Oh well, again I hope things improve and I will try to assume role of project manager for the NCD project.

Happy Puppies:  Spritey, Whiskey and Alpha (standing).  Nimba was camera shy.

Kerala, South India

Traveled with Vishwa, Melinda and Kristin
Today is Thursday, I had my steroid injections on Wednesday morning and today I fell great!  I have energy and can enjoy myself again.
Fly into Kochi. Stayed at Villa Romantica. Very nice, even went for a swim after arrival at 11pm
After a healthy breakfast of fresh fruit, eggs and dosa (Indian fare) we drove to visit Athirpally waterfalls, one of the best waterfalls in India and one of the most famous tourist destinations in Kerala. 

It was raining. Lots of water.
Look I am holding my umbrella with my right arm! Went swimming again in the morning. After visiting the waterfalls we drove about 3 hours to the backwaters. Driving is as crazy here as in Delhi. I find it even worse as there is more open space and it is ALL filed with billboards obliterating the scenery. It's so intrusive. We then took a turn off the main road and spent another 1/2 hour on narrow roads filled with crazy Indian drivers.



Lakesong

We finally entered the gates of LakeSong resort and it was Gorgeous! Peaceful.

                                                                                                                  Lakesong is great. The grounds, accommodations, service and location, right on the lake removed from the "outside world".
Food OK, not great.
Kerala is known for its ayurvedic massage, had to try it!

Long strokes then steam bath very relaxing. One lays down on a hard teak table, no towels and lots of oil. Entire body.  It was difficult to move as you would just slip in all the oil.  Coconut oil is used. The smell was unusual, a bit like thyme but then they told me its coconut. There are plenty of coconuts here. When I think of Kerala I will associate it with coconut oil (not a pleasant memory). Even after my shower I still felt the smell was on me.



Houseboat tour.
Wow! We are treated like royalty. The houseboat only sleeps four, for the four of us. Nice lounge chairs complete with foot stools. Hop on boat at noon right from the resort. Yea, no driving today. Lunch at 1:30. We stopped on the side of the canal for lunch. It was good. Two kinds of rice. The rice in Kerala is big thick rice. Had fish, cabbage, beans, two chutneys, poppas, and of course dal. Very good.
Just sitting here doing nothing! Melinda and Kristin downstairs and Vishwa and I are up top. No need to sit with them as they are very poor conversationalists. Vishwa and I do very well together easy conversation.    I am having trouble with the formatting of the pictures and text.  My apologies, but thought the pictures help describe the trip.

Our private houseboat.  Sleeps four.

We are sitting upstairs and I start smelling the coconut oil again. I thought it was me but then realized it was dinner being cooked. Guess what oil they use? Yup, coconut! The good thing was that it wasn't me who smelled. Lunch was very good but then dinner, all the same tastes. Coconut oil. I have had enough of that.

Houses on small islands in lake.  Each house has a canoe

Lotus Flowers
                     Sunset on Lake Vembanad in Kumarakom

                             People use the lake for all purposes, bathing, clothes washing, playing, transportation....

Wake up time at 6:30am as air conditioner is turned off. Ok let's go! Went for a nice brisk morning walk as we had about 1/2 hour before we departed. Rice fields. Lots of old people. Men here were a towel wrapped up as a skirt, never seen that style before. The look of the south Indian are quite different. Most of the men have mustaches and chubby cheeks.
People using the canals for all their cleaning chores. Kids playing in the water. Simple life, I think. The language is different than in Delhi so Vishwa cannot communicate in Hindi.

When the boat was approaching the end we were given a sudden jolt. We crashed into another boat! The engine didn't start. Now I don't know if there was a problem with the engine that caused us to crash or after the collision. Minor damage to our boat, but the other one had the deck wood damaged. Everyone was very calm, no yelling. We were then taken by a row boat to the end. Excitement!!

                                                      Chinese fishing nets In Kochi

                                                     We paid for this picture!  Helping pull in the fishing net

The remainder of the day was spent touring Kochi. We visited the sea, the Chinese fishing nets and a few churches as this is where the Dutch settled. Many Christians in Kerala while very few in Delhi. In one of the churches was a tomb dedicated to Vasco de Gama, a famous Portuguese sailor/explorer. It was very interesting to me as I have visited many sites in Lisbon dedicated to Vasco de Gama, so I felt I had a connection. What is amazing to me is the distance the boat would have had to travel in 1502 from Portugal to southern India. 
Another good trip away from Delhi.

Plans for Laos and Cambodia!

Just wanted to let everyone know that western medicine works! My steroid injections in both shoulders did the trick, no more pain. Back to my old self - YEA!

It is amazing how different my attitude is.

Ready to start blogging in an upbeat manner.

Things are looking up.

As the injections worked I can now be positive. I just booked my vacation to Cambodia and Laos for after my fellowship, October 31st. I had thought about this trip before my departure but wanted to see if I wanted to travel around India after being here for 6 months. The answer is NO! I do not want to be in India any more than I have to. The adventure trip is hiking, biking and kayaking in two quiet, peaceful countries. It will allow me to unwind before returning to USA.


Laos A land of beautiful temples and lush vegetation.

Medical Care

No pictures for this one.
I had a previous post discussing a Dr visit.  This is an update to discuss medical care in India.
My shoulders have been dysfunctional for over one month.  Dr took Xrays, said I have arthritis and a bone spur.  Recommendation: take some medication and do physiotherapy every day for two weeks.  It's been almost 4 weeks and I do not feel any better. 
Medical insurance is offered by a few of the private companies but most people pay out of pocket for private practices.
My initial visit with physician was $30 USD.  Each session of physiotherapy is $7.  At home my co-pay is $12. 
Care:  all the physiotherapist does is heat, ultrasound and electric stim. Nothing else.  Didn't even give me exercises, probably because I wouldn't be able to do them as it's difficult to lift my arm to my shoulder. It's been three weeks and I don't fell better so talked to the Dr again.  He gave me different drugs and added a few more medications.
The diagnosis and medications are all written on a 8x11 page of paper with the Dr's info at the top.  I take this piece of paper to the chemist aka pharmacist. They fill the drugs. My first visit for 4 medications was about $10.  I could have taken the "prescription" to as many chemists as I wanted.  One of the drugs was an opiate (to help me sleep) and there is NO regulation. 

I asked for an MRI and scheduled it for the next day.  Clinic was OK.  Cost up front for MRI was $160. What is it back home, $1000?  I was asked to wait outside the MRI room until they finished up with the previous person.  Outside the room the banging of the magnets used for the MRI was REALLY  loud.
My Dr said they don't usually schedule MRIs as India is not an affluent country and he would not recommend an MRI unless he was going to operate.  I guess the conservative approach has its merits and can  save people money.  But on the other hand the USA might way over use technology as its there.  As always there's good and bad with everything.          

Nubra valley

Nubra valleys' original name was Ldumra (the valley of flowers). Nubra or Siachan River forms a large valley that separates the Ladakh and the Karakoram Ranges. The average altitude of the valley is about 10,000 ft. Most accessible over Khardung La the highest motorable road from Leh. Nubra is a high altitude desert with rare precipitation and scant vegetation except along river beds, where irrigated, and on high slopes. The villages are irrigated and fertile, producing wheat, barley, peas, mustard for oil, and a variety of fruits and nuts, including apple, walnut, apricot and even a few almond trees. Most of the Nubra Valley is inhabited by Ladakhis who speak Ladakhi; the majority of them are Buddhist. A rare species, the Bactrian camels has two humps on its back are seen in the valley. The Nubra valley opened to tourists only in 1994 and is still virgin territory for travellers.  

Drive to Khardung La Pass from Leh. Up mountainside following switchbacks from 11,562 to 18,380 feet.

 

 

 

 

 I would definitely recommend people to come here. The road was much better than Pangong but there were a few scary moments. The Khardung La pass sat at 18,380 feet, 5602 meters, the worlds highest passable road in the world. Great views and you could look into the valley towards where we are going. Soon after crossing the peak the road became paved that made for a more pleasant ride.

Didn't really increase speed as many sections were washed out. Before we went to the tenting site we went for a camel ride in the dessert. This was a first for me. Only walked, but a comfortable ride sitting between the two humps. The camels lay down, A pad and rope were placed between the    humps then I swung my leg over. i was instructed to hold on tightly to the pad as the camel rises- off we went. OK. We walked into the sand dunes, stopped for a picture and returned. The experience was only 15 minutes but that was enough time to enjoy the experience. Good!     The drive to the tent site, Mystic Meadows, was along the valley floor. Passed a couple of towns, Disket and Kurdu, small nice towns in patches of green areas. The valley floor consists of sand dunes and the river that runs through the color of grey mud. It is hard to distinguish between the the sand/mud from the river. Crossed the river and climbed up into the green hills, traveled along washed out dirt roads to our resting spot. Mystic Meadows is an oasis of gorgeous flower and vegetable gardens mixed together. Owned by a native Ladakh woman, Aganeo who works the gardens.    The sunflowers standing tall and proud welcome guests to the place. The gardens are so lush and full, never seen such a productive garden. The secret is the tons of fertilizer from the donkeys and cows. Sandeep, the manager of MM said that they compost human waste and use this also. Most of the people are vegetarians so why not.   Nubra valley is the entire area, not just the place we stayed. MM is located in the town of Summur. There are many guest houses all with gardens. On this trip I am a complete tourist. There is a 2 km walk to a monastery but I don't have the energy or desire to go.                       

Whys that? Probably as my arm pain keeps me depressed and zaps my energy. This place would be great to stay for a few days, take short walks and rent mountain bikes to explore the area. The valley is relatively flat and town is up on a hill, so there would be much to explore, the locals, the monastery, views of the mountains. MM doesn't rent mountain bikes, but maybe one could rent in Leh and bring along as they drive to Nubra Valley.  The season is only June to mid September. Already in September the chance of snow is there and can make traveling difficult.  I did see ONE bicyclist riding up the mountain - WOW is all I can say, all up with NO relief.

Ladakh Day 3, Pangong Lake

 Pangong Lake trip
 Admired for the different blues and greens the lake displays while nestled in the stark hills/mountains.
Romila was not able to join us today as she probably is having altitude problems. She stayed in bed all day, I felt sad for her that she couldn't join us. We started the day at 5 am. Packed lunch to eat at the lake. The drive took about 5 hours to reach the Lake. 

The drive to Pangong might have been more exciting and adventurous than the lake itself. The drive is 167 km and should take about 5 hours. The driving is slow, even though some of the roads are paved, they are narrow and large trucks travel the same roads.


We are slowly climbing into the hills, all of a sudden the driver,Yontun, turns right up this dirt path that went straight up a hill. Looked more like a hiking trail than a road.     
We climb up and up along switchbacks there were some large boulders that look ready to go, very scary! The driver makes the trip about 2X per week. I felt very safe with him. The paved road turned to dirt and gravel for the remainder of the trip.  The vehicles are not 4 wheel drive but probably all wheel drive similar to a Toyota 4runner. The road was all switched backs until we came to another paved road. We were told that it was a short cut and saves about 15 minutes.

We crossed a Chang La pass at 17,348 feet. The third highest motorable pass in the world. Tomorrow we will go over what they claim is the highest motorable pass in the world. Very cold up top they said it was -6C at 8 am. Saw this man attending to his Yak. He was more than happy to have us take a picture with him, for a small price. His Yak looked better kept than he did. Had a nice cup of hot Chai tea. Going down was quite a challenge.

Other obstacles we encountered were flooded roads that are piled with rocks so the vehicles can make it through.  

We passed one landslide area that was very difficult to pass, can't imagine doing this on motorcycle. Traveling these mountain roads is a highlight for many bikers. A real spirit of adventure is needed to ride the (often)  single lane road with other trucks, blind curves and road obstacles. The landslide happened two weeks ago during the day. All traffic was stopped. People were stranded at the Lake and had to wait 2 days before the road was reopened. That's a bummer as many of the tourists only travel to Pangong Lake as a day trip and might not be prepared to stay overnight, Oh well.

Blind curves are plentiful.  You are supposed to honk as you enter the single lane turn. More than on one occasion we rounded a bend and another car was approaching - Yikes!

The military put dips in the road to slow you down. There isn't any warning so if you don't know the road.... I can just imagine a motorcyclist hitting one of them.

Over the pass we go down and down passing two valleys. In the first one we saw cows, yaks, horses, and sheep. Looked nice.


Pangong lake has only become a tourist attraction within the last two years, no wonder the road is very primitive. Only one truck, at least that we saw had fallen off the road. That surprises me as I felt that we would at times.

Arrived safely to Pangong lake. The lake is nestled amongst many mountains/hills, nice. Some of the hills were different colors, brown, beige, whitish which gave the lake lots of character. We only came for the day, good thing as the shops and accommodations were very minimal.

We bought lunch to eat but were told that we could not eat it by the lake as there are many establishments selling food and they want tourist to buy from them.
It is a nice long lake that runs into China. Sun was high with some clouds which took away from some of the deep blues that we would see at sunrise. Made it back to Leh around 5pm which gave time to relax. My patience at the end of the day was wearing thin as the bumpy car ride was not good for my body.

Dinner is included In the room. It's a buffet with good variety and tasty food. Bed early

Ladakh Day 2 - Monasteries

On the way to Hemis Monastery with Stupa

 July 27, 2012 day to visit Monasteries.


There was 3 scheduled on the agenda, Romila requested that we visit a fourth, Hemis, which is the oldest and quite a bit out of town. The drive was really nice. The barren mountains in the hills closest and then a few higher mountains in the distance that still had snow on them. Sindhi river ran through the valley.





Tibetan prayer wheels are devices for spreading spiritual blessings and well being. 
The practitioner most often spins the wheel clockwise, as the direction in which the mantras are written is that of the movement of the sun across the sky.

Hemis monastery was up a long hill. Tiered garden plots which people were attending. I like the Facial features of the people here much more similar to Bhutan and Nepal than the Indians I see in Delhi. Each monastery has multiple temples, after a few they are pretty similar. Two of them had these giant 3 story Bhuddas in them. This is neat to see. At the feet are many prayer shawls, money, food and gifts as blessings and thanks. Monks are living at many of the monasteries and take care of the premises, one of duties is to collect the entry fee.



 

Other monasteries visited were Thiksey, located above the village and beautifully maintained.  The last place we visited was Stok, built into a hill. 

I took a few pictures of the dogs as their coats are long haired and thick needed to withstand the cold winters.  This area is only accessible by road between the months of June to September. After that the snow falls with road closures and dangerous driving conditions.  One can visit in the winter but travel around is limited.  Busy day.  Didn't return until about 6 pm. Need to get up at 5 am for our 6 hour drive to Pangong Lake. Todays weather was perfect. In the sun hot, but in the shade there is a cool breeze. Needed sun screen for the first time since been in India.

Along the curvy roads are motivational sayings. Some have a sense of humor, here are a few
Time is money life is precious
Drive the curves do not test them
All will wait better to be late
Accidents do not happen they are caused
I'm curvaceous be slow (thought Christopher would like this one)
After whiskey driving is risky
Better late than never

Leh, Ladakh Day 1

Morning flight from Delhi to Leh.  Read that it is good to sit on left side of plane as the sun rises on the right.  Partly cloudy nearing Leh so couldn't see the mountains clearly.  The area surrounding Leh is dry, brown with small patches of green where people live.  The snow covered peaks are off in the distance. 





Ah how nice it is to be away from Delhi! The air is fresh, the sky beautiful blue with white puffy dream clouds, and the mountains are such a nice change from Delhi. The altitude is 11,000 feet, as we are departing the plane the pilot told us that there is 40% less oxygen in the air. That's a significant decrease. Just walking up a slight hill I could feel my heart rate increasing, climbing stairs made my legs weak. I completely understand when they tell you to take it easy in the first two days. I took a nap soon after we checked into Ladakh Regency, nice hotel with beautiful flowers- you know how that makes me happy.

There are three of us on this trip. Vishwa, from PH office and Romila who is a friend of Priya who I met through Yoga. The planned trip doesn't leave much room for free time so I didn't have to worry about each of us with different agendas. Vishwa is great as he's so easy going a kind nice guy. Romila on the other hand is taking a bit of getting used to, but it's OK.

In the PM the driver, Yontun took us up to the Shanti Stupa, a Bhuddist monetary. All the monasteries are Buddhists. 


We attended a prayer and meditation service where monks were chanting along with methodical drumming. We sat for about 1/2 hour and it was great. The drumming definitely helped me enter the mediation mode. A positive experience. The stupa was at the top of a hill, so the views were really nice. Got to see Leh from above, the green areas amongst the barren hills. Had a cup of Chai tea when we got back to the hotel. The tea is already mixed with sweetened milk. Quite good, much better than the instant coffee. Walked around town a bit, many tour companies to help with planning trips and souvenir shops very similar to the ones in Nepal, prayer flags, pashmina scarves, singing bowls, tee shirts, and misc items. Dinner at hotel is included, the buffet is fairly good. Bed early for the busy day tomorrow.