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.