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.

Manang District, Nepal

Trekking

Dentist "office" at our health camp

Me, Nick Busch and Eric Lee (all 4th year SLU medical students)

Beautiful Nepal

Nepal Medical Trek Updates

After nearly a week of traveling in rural Nepal, I am finally back in Kathmandu where I have some internet access. The medical trek part of my trip is over, and I have started my rotation in internal medicine at Patan hospital.

So much has happened in the last week, but I will do my best to hit the highlights of our medical trek. Last Monday we (a group of about 30 US and Nepali doctors, nurses, medical students, dentists, social worker, etc.) took a 6 hour bus ride north from Kathmandu. When the paved road ended, we switched to "jeeps" (which were really more like pick-up trucks with seats in the back) and continued driving for another 3 hours on a narrow and very rocky road. I had the interesting experience of riding in the back, where I think I sustained a few minor concussions from hitting my head on the bars overhead. After staying overnight in a village called Chyamche, we trekked about 5 hours to Thonche, the village where our health camp took place. The scenery is just beautiful - a blue-green river raging through the valley below, lots of waterfalls, snow-capped mountains peeking over the foothills.

On Wednesday and Thursday we conducted a health camp at the secondary school in Thonche. It is pretty nice by rural Nepal standards, but it was very different than what we are accustomed to in the US. For example there was only one room with electricity. Over the 2 days we saw around 500 patients. We performed minor procedures, gave out free medications and eyeglasses, screened for cataract surgery, and performed dental extractions. People traveled many hours, even days, from the surrounding villages to receive care. One patient in particular that really touched me was a 12 yo girl who had stepped on a nail the previous day. She walked 5 hours with her brother on a foot that was swollen and infected and I'm sure quite painful. She was the bravest little girl I had seen - she didn't even flinch when we started her IV antibiotics. I'm so glad we were able to help her and hopefully prevent dangerous complications.

On Friday we trekked up to Tilche, the village where our founder Dr. Devi States was born. The whole village came together to welcome us. The prepared us a feast (for which they slaughtered 3 sheep) and performed cultural dances. Then we all joined in and danced the night away under the stars. It was a beautiful glimpse into Nepali life and culture that I will not soon forget.

Saturday and Sunday we made our way back to the capital, and Monday I started at Patan hospital. I will post more updates soon and hopefully upload pictures (internet is not super reliable here).

Landed

I have finally made it to Nepal after delayed flights,missed connections, and 2.5 days of travel! There were definitely a few moments I doubted I would ever reach Nepal, but here I am. Our group is heading out tomorrow from Kathmandu. We will take a 10 hr bus ride tomorrow then trek to the village the following day. The next updates will probably come after we return to the capital. In the meantime keep us in your thoughts and prayers! Charity

Medical Trek to Nepal

My name is Charity Kaiser, and I'm a 4th year medical student at SLU. In less than a week, I will be boarding a plane heading for Nepal to take part in a medical trek with Himalayan Family Healthcare Project (HFHP). Our team includes two other SLU students and a team of American and Nepalese doctors and nurses, and we will be providing medical care at a health camp in a rural village.

I have been interested in global health for some time, and I hope to practice international medicine in my future career. Naturally, my interest was peaked when I saw an announcement about this medical trek opportunity. After meeting HFHP founder Dr. Devi States and hearing his inspirational personal story, I knew this was a project I wanted to be a part of.

Dr. States was born in Nepal and was orphaned as an early adolescent. After living on the streets in Kathmandu, he was adopted by an American physician and brought back to the United States where he received his education in public health. He has fulfilled one life dream by opening a restaurant, Everest Cafe, where he and his wife Connie serve delicious Nepalese food (I especially recommend the lunch buffet!). Now he is pursuing his second life goal of bringing medical care to the impoverished people living in his native Manang District. The goal is to establish positive relationships with the people and community leaders through these annual medical treks, and ultimately to build and staff a hospital in the region.

Throughout our trip, I will post updates here as often as possible. In the meantime, if you are interested in supporting our trip by attending the "Night in Nepal" fundraising event this Saturday October 20th or by making a tax-deductible donation, please check out the website here.