District Hospital

Just for reference - if my blog appears invisible under a visible heading it is because I forgot to change the color from black so you must highlight it in order to read it. I fogot as you can see below in my rafting blog. Anyway...

 

The first night in Khandbari Umpendra took me to the district hospital and I met the doctor there. There is no doctor in the Helping Hands Clinic right now just an assistant. The doctor at the district hospital has been there 14 months and works for the government. However, he will not be staying much longer. There is little incentive as there is no one to learn from and the pay is not good. Additionally, he is not from here and has no family so he would like to continue his training elsewhere. He told me to come back the next day at 9am for rounds so I did.

 

The hospital is 15 beds in 3 rooms plus an OB room. The patients have many lung diseases and there were a number of babies with gastroenteritis. They are able to provide basic treatment much like we do back home. Metronidazole and IV fluids for gastroenteritis, antibiotics for pneumonia, O2 and steriods for COPD, and DOTS for TB. There are 5 beds in each room filled with pts with the above stated diseases. Also, pts with bad but closed fractures were there. Today (now, Sunday), we reduced 2 bad breaks in children. One, a supracondalar fx in a little girl definately would have been surgical management in the states but they cannot do open surgery here so we gave her ketamine and reduced it. There is a guy that is very good with orthopedics and her reduced and casted her and another boy with a Colles fx. Anyway, rounds are quick and there weren't any new patients yesterday or today. Before or after we have some tea and the doctor talks a bit with his staff and does brief notes. I just drink the tea and respond if he addresses me as Nepali is basically impossible for me. I can say Namaste which means both hello and goodbye - you place your hands like you're praying and bow your head when you say it.

 

Saturday is the big market day and on the way to the hospital I walked through there with Umpendra. After rounds I returned to the Helping Hands Clinic and met the assistant. I have no idea how to spell his name...something that starts with a "P". Anyway, I saw some patients with him before returning the the hospital for evening rounds. We saw a variety of complaints. They have an ultrasound machine so we used that and did abdominal scans on some folks. One little boy compaining of abd pain had gallstones that were clearly visible so we refered him for surgery. Unfortunately, that means going to Kathmandu involving the trip I spoke of before. By the way....by my own very scientific method I decided a pressurized cabin does not exist. My water bottle on the way up lost all of it's creases which I expected to happen a bit. However, after taking a drink at elevation the bottle imploded in my hand thus confirming my suspicion. I'm sure the boy would survive the trip as I did but cost is the real issue. After clinic I returned for brief evening rounds. There was also a trauma pt who had hit himself in the head quite forcefully with a machete. He was hacking branches and managed to hit himself in the back of the head hard enough to slice to the bone and fracture his skull. We talked a bit about the management of trauma and today saw the x-rays of his skull.

 

After rounds I returned home and played chess with Umpendra. Apparently in Nepal you get to take 2 moves to start. They call all the pieces by animal names for the most part but still refer to Castling. Anyway, it was nice to play a game and of course I like to win. I hope we can find some other games or activities that allow me to spend time with him and Bimala without too much verbal communication. Alright, lets see if I can change the color on this one the first time.

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