Working at the Hospital

26 07 2011

I feel like I haven’t blogged too much about my time at the hospital so here is a nice lengthy summary.  I have a couple blogs written on my PC which I haven’t been able to post due to internet so even though I leave for home tomorrow I’ll probably be putting them up over the next couple of days.

The volunteering aspect of my trip really fell into three categories.  Time spent at the hospital, time spent with the kids at the orphanage, and a mini medical school myself and my fellow classmates put on for the kids on our last day at the orphanage.  My time in the hospital was spent at Chitwan Medical School Teaching Hospital where I was able to gain a ton of knowledge from the doctors and staff on medicine, healthcare in Nepal, and the doctor patient relationship.  My role was very typical of the 1st year medical student in that it was mostly observational and included a lot of “pimping” where the doctors just ask you a ton of questions about patients and their conditions.  This proved to be difficult with one surgeon in particular who took to me on the first day and would always both teach and quiz me whenever I passed him in the hospital.  Passonate about teaching, I learned a lot from him but I had a hard time understanding his thick accent, which lead to me having a difficult time understanding his questions.

 

I divided my three weeks between three departments, one week in each – Internal Medicine, Emergency Medicine, and Ear Nose and Throat.  First up was Medicine, where I rounded in the ICU each morning and saw patients on the floor and outpatient clinics throughout the day.  In this department, I saw some patients with severe dengue fever, tuberculosis and other infections diseases.  I was also able to palpate probably the largest most rigid spleen I’ll ever see, and learn about alcoholic liver disease in patients in their 30’s.  One of the internists showed me a picture of a phone of some skin discoloration on both of her knees and asked me to identify it.  Derm isn’t a strong point of mine to begin with and that complicated by the fact that I’m fresh in my medical career left me completely clueless.  This patient in particular has a bad case of rheumatoid arthritis in her knees.  Unsatisfied with treatment from many doctors (doctor shopping is very easy in Nepal due to insurance not complicating anything not to mention poor medical records which some patients in america rely on) she saw a traditional healer who tried to suck out the “bad humors,” leaving these bruises, essentially giving her knee hickies.

 

Spending a week in the Emergency Department was a treat.  After rounding in the morning with another physician who liked to teach and is very interested in emergency medicine in the western world, I was able to just hang around the ER, talk to the doctors on staff and see the patients.  The open outpatient clinic being in the same hospital and costing less means that unlike EDs in America, people don’t show up with common colds.  People were usually wheeled in on a stretcher, or carried in by a concerned family member.  Respiratory problems were common along with the unrelenting fever which could mean so many serious things in Nepal.  The poor traffic laws and the hospital sitting on a major highway led to some pretty nasty traffic injuries as well.  Talking with the attending physician post rounds made this the area where I definitely learned the most about how the healthcare system works here.

 

My final week I spent working with the ENT docs.  Conversing with these physicians about their specialties, I learned that things are pretty flip flopped comapred to the US.  ENT and Dermatology, while extremely competitive in the US are undesirable by most in Nepal.  Most doctors choose to enter a field like internal medicine.  In Nepal, there isn’t really a big discrepency in physician salary between specialty and one can’t help but wonder if this is part of the reason why these areas are so saught after by medical students in America.

 

There isn’t a referal system here so when you go to the hospital to see a doctor in the clinic, if you have an ear ache you see the ENT instead of the primary care physician.  As a result, I saw a lot of little kids with ear infections and people with soar throats in addition to one cute little kid who shoved a piece of corn up his nose.  I also had the chance to witness a couple of endoscopies since the room was right next to the ENT offices.  By far one of the coolest things I’ve seen so far in medicine was the inside of someone’s stomach and early part of their intestines as it contracted.  It was funny how quickly I pictured my cadaver as I saw the sphincter of Oddi, the place where digestive juices empty into your small intestine.  Also with ENT, I was able to spend two days in the OR, witnessing the removal of two masses from the back of someone’s nose – one with a camera and the other with an incision next to the eye where the nose was flipped back.  An exploratory throat surgery was performed as well.  During the downtime between ENT procedures, I was able to sneak into the other operation theaters, witnessing a C-section (my first live birth), a couple gal bladders being removed, and the removal of a portion of someone’s colon who had intestional tuberculosis, another rare pathology I’ll probably never see again.  While I loved my time in the OR and thought it was very interesting, I don’t think it’ll be something I’d like to do.

 

So essentially, my “volunteer at the hospital” program turned into essentially a 3 week rotation.  As for actual volunteering, Benny and Jon were able to help run a vaccination clinic and Mimi and other people who spent time working with surgery were able to drain some abscesses and do some exams.  I still am happy I came on the trip and believe I learned so much from my time in the hospital that I would never have learned anywhere else.  Also, my desire to give back more was filled in by the children at the orphanage, which is something I’ll go into in another post since this is rather lengthy.  All in all, my time spent in Chitwan was amazing and something that I was very nervous and had doubts about at first.  However, it honestly couldn’t have worked out any better.





Elephantitis

15 07 2011

Apparently there was a guy in the ICU earlier this week with elephantitis. I didn’t get the chance to see it. BUT I did get the chance to ride an elephant and walk through the jungle at the Chitwan National Park this past weekend.  On the two hour long elephant ride, I got to see a wild rhino and her baby, some wild boars, and got some great pictures of the jungle.  In addition to the elephant ride, we did a three and a half hour canoe ride and walk through the jungle with two guides.  On our jungle walk, we were able to spot another rhino, a couple of species of monkeys, and a couple other fantastic animals.  We didn’t get too close to the rhino since he heard us coming and we had to take off, but I was able to get an Ok snapshot of him from afar.  Towards the end as we were walking back to the canoe from the jungle walk I got stuck in the mud and almost lost my shoes, but I think I’d rather suffer that fate than get peed on by the monkeys like Benny and Mary did.  All in all, both experiences proved for some laughs.

After the elephant ride, we had the opportunity to give the elephants a bath which really means ride it into the river and have it shoot water on us.  The trainer then had the elephant tip over on its side, completely flipping myself and Lauren, who I was riding the elephant with, into the water.  Besides being a blast, it was totally refreshing to be completely submerged in water.  I’m pretty sure I’ve been sweating almost non stop since I got here  so it was great to take a quick dip.

Finally, at the national park we had the chance to check out a showcase of some traditional Nepalese dance.  It was great to experience this as someone who is interested in music from many different perspectives.

This past week at the hospital, I spent my time in the ER.  I saw a lot of  crazy stuff since people typically wait until the absolute last minute to go to the hospital since it’s expensive and sometimes far away.  We had someone come in who traveled with severe shortness of breath for two days.  Besides learning about more about the science of medicine, I definitely had many eye opening moments about the importance of a well developed emergency medicine specialty.  In Nepal, EM isn’t a specialty and most ERs are just staffed by their equivalent of family physicians.  While these doctors are very well educated, I think there is definitely a lack of resources sent to this department.  This forty something bed ED (which is generally decently full) was equiped with one heart monitor, an EKG machine from the 90’s that took a good 10-15 minutes between set up and getting a reading, and not too much else.  I know money in healthcare is spread thin here, but I think if there was an actual specialty in this country, they might be able to pull for some more money for the department.  Like I said though, I believe the doctors to a great job on the resources they have.

Currently, we just arrived in Lambini, the birthplace of Buddah.  I had no idea that Nepal was full of so many religiously significant places.  Tomorrow we’re going to check out a bunch of the temples and monastaries and head back to the orphangage on Sunday.  I’ll be sure to let you all know how it goes!





One week and one day in

8 07 2011

I’m at chitwan national park getting ready for our weekend safari where I’ll get to hike, ride an elephant and walk through an area where I’ll hopefully get to see a lot of cool animals.  At this point I’ve met a handful of other volunteers at the hospital and all of them have been here and had nothing but good things to say. 

My past week at the hospital has been very eye opening.  I’ve seen a Ton of pathology that is rare to the US and have learned a Lot from the doctors out here. our group is basically rotating around the hospital at our own leisure and I’ve chosen to spend most of my time in the ICU until today where after rounds I went to the ER.  Emergency medicine in Nepal isn’t a specialty, much like in many parts of the world, but I still think they hold their own as family practice physicians.  The ER consultant which is essentially the guy who heads the ER is currently creating a disaster plan based on information he has on US disaster management.  After rounding with him for an hr and a half through the ER where he throughly explained each patient,  we had a nice chat about healthcare in Nepal, emergency medicine across the globe and other related topics.

Essentially, our “volunteer” work has turned into glorified doctor shadowing. However,  I feel like I am learning a lot about medicine in Nepal and how a system with no insurance where a CT scan costs about 1/3rd of a family’s yearly income works.  As for actual volunteer work, we currently live in a guest house at an orphanage run by the organization I am volunteering with.   In addition to sharing dinner each night (consisting of dal but… See below) with the children, I usually spend a couple hours each day playing with the 25 kids that live here.  My name, Tom, sounds Nepalese (compared to names like Hom and Rhom) so it was easy for the children to remember.  Also,  the kids love Tom and Jerry so they always ask me who Jerry is and I usually point back to one of them.  We aLso have plans to take a day and teach at a local school about first aid and other basic things the students can do to be more healthy.  

Although it is the rainy season in Nepal, chitwan hasn’t been as rainy as Kathmandu.  Kathmandu was a pretty consistent rain about 50% of the day.  Even when it wasnt raining, the sun never came out.  Here in Chitwan  It rains usually atleast once a day and probably hasn’t dropped lower than the high 80s since I’ve been here (and AC is pretty nonexistent except for the ICU) but I just do my best to stay hydrated.  You get used to sweating most of the day and I feel like once I get back to the US I’ll be wearing a coat in august while everyone else is complaining about the Chicago late summer heat.  

The food in Nepal is really a blend of many cultures.  North of Nepal is Tibet and china and south is India so it is common in Nepal to find mixtures of these cultures.  Even some Nepalese people look Mongolian while others look Indian.  Traditional Nepalese food, which is called Dal But (rice and lentil soup) is something that a lot of Nepali people eat multiple times each day.  Usually it comes with slightly different ingredients with the rice but it essentially all involves potatoes some veggies and spices.  Dal but is delicious but I’ve had it at least a dozen times since I’ve been here and am guaranteed to have it at a minimum ten more times before I leave.  Needless to say it’s kind of getting old but it could be much worse and I’m just thankful for what I’m given.  I’m sure I’ll swear off rice for a couple months when I get back though since even when I don’t eat dal but my meals generally have rice somewhere in them.  

With that all being said,  I should probably hit the hay.  I feel like I’m missing a lot of talking points since I can’t update often so comment or send me a msg if you have any questions about nepal or what I’m up to.  

-Tom





On to Chitwan

5 07 2011

Yesterday we took a long bus ride through the mountains to chitwan ,where i’ll be working in the hospital. \Today we had an orientation of sorts at the hospital and tomorrow I should start doing volunteer work. I’ll be sure to update about that experience next time I can get online. internet isn’t as easily available here so blog posts will be very rare and probably brief but I just wanted to check in. to see what the group has been up to in Kathmandu since i didn’t get a chance to write about it check out our group blog at medicineamongmountains.blogspot.com





Initial Impressions on Kathmandu

1 07 2011

We are officially inKathmandu, Nepal, where I’ll be staying until Sunday morning when I head to Chitwan which is where the hospital is located that I’ll be working at for the next three weeks.  These couple days in Kathmandu will really just be some time to relax, explore and get to know Nepal.

The journey over here was long but except for a few crying babies and little sleep was fairly uneventful.  After a 15 hr flight I spent 15 hrs in the airport inNew Delhi over night waiting for the trip to Kathmandu.  It’s funny that how in 15 hrs there wasn’t one flight toNepal, yet within a span of one hr that next morning there were 3 going toKathmandu.  We attempted to sleep, but with flights leaving the airport literally all night the loud announcements every 10 minute made that difficult, even with earplugs.  The airport in Kathmandu was very small.  We stepped off the plane and onto a bus which drove us to the main building where we went through customs and entered the country.  At this point we were picked up and drove from the airport to our hotel.

I was blown away by what I saw on the 20 minute or so car ride from the airport.  Traffic laws aren’t the same as in the US and appear more as guidelines.  The streets are crowded with motorbikes, cars, and the noise of horns constantly going off as pedestrians and motor vehicles dodge one another in everyone’s individual attempt to get from one place to the next.  Parts of the city (might even be outside of it?) appears rundown with abandoned buildings and people living just off the road.  I remember seeing a cow standing off to the side of the road amidst a crowd of people attempting to get around.  The other thing that stood out was one single building being erected about 30 yards back which was being walled with glass like you would see a building in Chicago.  This stood in complete contrast to any other architecture I have seen thus far, and was a small reminder of back home.

For the next couple of days we are staying at a place called Yeti Guesthouse, which is more like a hostel.  My twin bedroom I’m sharing with Jon reminds me of a college dorm with attached bathroom.  The people that work here are some of the nicest I’ve ever met and are very helpful.  Our group and the owner shared tea as he taught us some Nepalese words and helped us exchange money for a good rate.

At this point, I’ve only barely explored the area.  The six of us who arrived yesterday were all running on about 2 hrs of sleep in the past 40 hrs and while we tried to stay awake till the night and walk around a little bit to try to get on the right sleep schedule at some point I just had to call it a night.  Now, well rested, I look forward to the next couple of days of checking out Kathmandu and getting better acquainted with Nepal.

I’ll try to post a couple photos soon but internet is kinda shotty and uploading photos can be difficult.





On the eve of my departure

28 06 2011

Well it’s 11:30 at night which is about 12 hrs away from when I’ll start heading to the airport.  The original goal was to be in bed around now but there’s just still some more I want to get done before I leave.  I guess I have a 15 hr flight to sleep through anyway.   It’s worth mentioning once I’m both nervous and excited, but if I wanted to talk about the obvious then what would the point be in reading?

A close friend of mine said to me today “He who journals lives twice.” which really feeds into why I find it necessary to blog and keep a written journal of what I experience over the next 30 days across the world.  There’s no doubt that I will encounter things volunteering in the hospital, sitting on a bus, and riding an elephant that will change my outlook on life ever so slightly and perhaps drastically.  However, I want to make sure that five years from now I don’t lose sight of those experiences.  For example, I went to Germany for two weeks going on seven years ago and while I had an amazing time and still have great memories, few memories are completely clear.  In addition, a certain professor’s sometimes tedious reflection assignments succeeded in showing me the importance of self reflection.  So through this and other means of documenting my travels, I hope to never lose sight of what I am to learn over the next 4 weeks.  Rereading my feelings is a way to relive my experience and humble myself in the future. I am very grateful of the rare opportunity I am being granted and have plans to fully take advantage of it.

Well with that being said off I go.  As a final note, I leave you with the new blog title and a video to accompany.  I’m considering changing the title throughout the trip.  But until then, to my first destination.  Cheers.

http://www.youtube.com/watch?v=YGApN7bRboQ





My First Post – An Introduction to the trip

21 06 2011

So here lies the first of possibly many posts about my upcoming adventure for a month to the country of Nepal.  In Nepal, myself and 7 other newly crowned 2nd year osteopathic medical students will be working through an organization called the IFRE (www.ifrevolunteers.org).  They offer volunteer opportunities in various capacities all over the world and our specific trip in Nepal is orientated around medicine. 

In Nepal, we’ll be working at the Chitwan Medical College Teaching hospital (http://www.cmc.edu.np/) which is affiliated with a medical school.  I don’t really have an idea of what kinds of things I’ll be doing here, but I’m sure I’ll get a lot of opportunities to interact with patients and staff and learn about medicine in Nepal.  I should get to see all the different departments in the facility and there has also been talk about leaving campus to set up or possibly work in other satelite health clinics.  I’m also very interested in how medical education differs between our two countries and will definitely have the opportunity to learn more about this.

As for me, I leave on the 28th of this month.  I’m excited for both the medical aspects but also the other activities we’ve got planned for the trip.  I’ll be sure to write all about it on this page and feel free to comment if you wish.  I’ll probably blog once more before I leave but until then here’s to one last week in the US!