Tuesday, November 13, 2012

Internal Medicine at Patan Hospital, Nepal

I am currently halfway through my two-week Internal Medicine rotation at Patan Hospital. Patan is the 2nd oldest hospital in Nepal. It was founded as a mission hospital with the goal of providing care to Nepalis, especially from rural areas, regardless of their ability to pay.

Some reflections from my experience so far ...
The patients - they are so strong, so stoic, never complaining.They wait weeks, months, years to seek medical attention, likely due to a combination of culture, religion, lack of education and access. For example, we saw a lady in her 30s who lost 25kg (~50 lbs) over the course of a year. I asked the residents why she waited so long to come in, what changed to make her seek care at this time rather than before. They simply replied "this is Nepal."

The doctors - I have actually been impressed by the emphasis on evidenced-based medicine and quality education here. There are a few physicians - some on staff, some visiting from other countries - who are really trying to improve the Internal Medicine education at Patan, both for students and residents. I have noticed a difference in the way the residents and interns approach problems and interact with the attendings compared with my experience in the States. They are very smart in terms of answering basic science questions, knowing the recommended treatment, or stating the reference ranges for lab values (I'm assuming they are very good test-takers). However, they are often timid and hesitant in answering questions on rounds or in morning report, and they seem to struggle with evaluating the nuances of a patient's case to formulate a comprehensive treatment plan. This is quite different than the largely Type A, "gunner" personalities that seem to be over-represented in medicine in the US. I'm not sure one style is necessarily superior to the other - it is probably best to be somewhere in the middle - but it is just an interesting reflection of the culture and education system here.

The pathology - Alcoholism and COPD are the 2 most common diseases I have encountered. There is also a lot of tuberculosis - some pulmonary, some disseminated. There have been a few cases of organophosphate poisoning, which we very rarely see in the States. Up to this point I had never considered how culturally dependent even suicide attempt methods are. The lack of primary and preventative care here makes for good learning in the hospital, but it is sad that these people suffer so much before getting the care they need.

The politics - This is a very interesting time to be at Patan Hospital. There is a daily "strike" going on, where a group of doctors, nurses and medical students stand outside with placards for an hour each morning. They are protesting against the Vice Chancellor of the hospital and medical school, who apparently was appointed by the prime minister. People are concerned that she doesn't appreciate the mission of the hospital and has started giving leadership positions to her friends. I'm sure I don't fully appreciate all the nuances of the situation, but the presence of riot police at the hospital every day has made for an interesting experience.


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