Nepal: Day One Part II

Source: Blog Post

While Dr. Hutch was in the OR, Alan and I observed in the Emergency Department.  There are almost no EM trained physicians in Nepal–most are General Practice Physicians. Our host was Dr. Nijina who supervised several House Staff and medical students. The various levels of training remain obscure to me! Everyone understood and spoke some English, but the fluency varied. Fortunately, illness and medications were easy to understand.

Although bare bones in design, the actual department has the standard items but in very limited supply. There are no separate cubicles, so patients are not undressed or monitored. Labs and X-rays are quite prompt.

We saw a typical gamut of problems: nausea/vomiting/diarrhea, COPD exacerbation with right heart failure, headache with hypertension, sprains, and a child with likely appendicitis. The most colorful event was a motorbike accident with three injuries, mostly road rash and contusions. One unlucky young man had a complete laceration of his inferior patellar tendon with a small non-displaced fracture of the tibial plateau. Right as I was leaving, a bilateral distal thumb amputation, transferred from the trauma center arrived. More work for the hand surgeons.

Evaluations were thorough, but imaging was used sparingly. Consultants arrived swiftly and admissions moved out rapidly. Quite a few nurses covered the shift and worked diligently, starting IV’s and drawing blood. Alan had a long in-depth discussion with the admitting internist.

Alan was surprised to see the old suction bulb EKG machine, but of course I had learned on that type as an intern.

I was surprised and pleased by the flow of patients between the ED and the outpatient department, and that follow-up care was easily arranged.

One of the main differences, though, was the open-door policy. Most patients were accompanied by a large number of people, who felt free to look at X-rays, quiz the doctors, and visit with other patients. Five police officers (one with a very big rifle) came in to speak with the motorbike riders. Patients talked back and forth. Although I don’t understand Nepali, the exchange between the drivers of the bikes was easy to understand!

All sorts of unidentified doctors, hospital workers, and, I suspect, people off the street wandered about. Occasionally a security “officer” would come in and shoo everyone out. Alan and I laughed about our culture’s concern with HIPPA.

There also was a surprising level of entitlement. When radiologic evaluation of a patient wasn’t proceeding as rapidly as the family wanted, they called the CEO. Our host was not impressed.

Hospital footwear was often flip-flops. The floors were being scrubbed by hand, then squeegeed dry. Still, I felt quite at home.

Alan has gone to hand clinic with his father, while I work and read in our hotel’s lovely fifth floor garden retreat.