05/13/2019

Nepal: Days Three and Four

 

Rick had many cases these two days. He helped reduce multiple carpal bone fractures and four metacarpal dislocations in a man with a crush injury.

Rick had many cases these two days. He helped reduce multiple carpal bone fractures and four metacarpal dislocations in a man with a crush injury.

A man with a prior high voltage electrical burn who had a left arm amputation and prior right nerve grafting with a groin flap needed flexor tendon transfers to support thumb flexion, thumb opposition and finger flexion. He and Dr. Shilu spent five hours on this complex case. 

Next came a child with a fingertip injury.

There were three special consultations. First was a patient with a congenital elbow dislocation and other upper extremity issues. The team chose  watchful waiting. Surgery was planned for an unusual rupture of the EPL tendon, and also for a complex symbrachydactily.

With all the patients, shared decision-making is essential. The goal is to provide the patient with the function they desire, often what they need to  perform their jobs. They do not want surgery just for differences, but for use.


Maureen and Alan paid a visit to Kathmandu Medical College as guests of Dr. Dil Mansur. The medical school is located on a beautiful campus in the foothills above Kathmandu.They gave lectures, observed PBL, and toured the school, the hospital, the dental school, and the university. They accomplish so much with very little.The students and faculty were quite enthusiastic and Maureen and Alan were invited back next year for several days.


We managed to fit in a visit to Swayambuh, the Monkey Temple. It was impressive, with many shrines and carvings. People of all religions were spinning prayer wheels, making offerings, and performing other devotions. We look forward to more adventures this weekend.