So much has happened since my last post…I apologize to those of you who have been waiting so desperately for an update (hehe)! We thought we struck gold when Katherine got a wifi password to the hospital’s source but we are still having major issues in connecting.

**warning: some mild medical jargon and/or descriptions of unpleasant or unsettling things may be used below (or in any further posts).

A typical work day at the hospital is as follows: 8am morning report, 8:20 break for tea, 9am rounds in respective departments (this part is tricky- we haven’t really been assigned yet because our first 2 weeks revolve around tropical medicine lectures and the 2^nd 2 weeks will be more clinical), 10:30 am lecture, at noon we break for lunch to beat the rush of the 1pm hospital-wide lunch break, 2pm lecture, 3:30 more tea, and at 4:30 we’re usually on our way back to the hostel to relax before dinner. This may sound extremely laid back but a lot of our time and some frustration is spent figuring out what/when/where exactly we’re supposed to be doing thing.

The lovely part is that everyone has been very receptive and flexible. These difficulties and frustrations we’re facing are to be expected considering we are guinea pigs in establishing this international rotation

On Wednesday we took a field trip to the Nepal Tuberculosis Centre and Bir, the oldest government-run hospital in Nepal. The TB center is actually just a place where patients who were diagnosed/suspected of TB in the community are referred to for confirmatory testing, teaching materials and information on where to receive their DOTS treatment. DOTS: Directly Observed Treatment Schedule- designed for countries like Nepal to keep track of the masses of people infected with TB and how they’re adhering to their treatment. As you can imagine, after starting treatment for TB, patients start to feel great and they stop taking their medications…leading to the infection not being cleared and on a larger scale- scary multi-drug resistant forms of TB. The second hospital site, Bir, is a 400 bed hospital with every department imaginable. It is so very different than the fairly new, clean, controlled environment of Dhilikhel hospital. In addition to ill-lit corridors, there is a distinct smell of urine and feces emanating from Bir. On the other hand, the hospital has designed a pretty sophisticated waste management program providing many functions from autoclaving & selling many of the used containers (which makes money for the hospital considering 50% of the patients cannot pay for their care) to production of fertilizer made by worms that digest used gauze and bandages. Sounds crazy but the Nepali people are aware of their resources (or lack there of) and come up with clever ways to improve their situation.

Thursday was fantastic! We traveled 1.5 hours from Dhulikhel to a village outpost. The mountainside road we traveled by truck was interesting to say the least. You might be aware of my anxiety when driving in less than perfect conditions…let’s just say I was put to the test today. When on the road, one would think there would be no way more than one car could fit on it, but SURPRISE, we were playing chicken with buses and trucks around blind corners. After a while, I just shut my eyes and pretended it wasn’t happening.

The outpost was surprisingly well-equipped and clean. There was a common room where new patients were seen and inpatients were kept, a procedure room, a lab and a room outfitted with stirrups, for gyn exams and deliveries. We got to see about 10 patients with the medical officer (resident) ranging from a woman with an axillary mass to another woman coming in with shoulder pain and decreased range of motion. Most of the patients we saw had to be referred to Dhulikhel hospital d/t a lack of resources(ex. 44 yo female with 1 month vaginal bleeding sent to D hospital for further imaging/workup, 5 yo boy with phimosis- when the foreskin become unretractable in an uncircumsized male, he will have to go under anesthesia and have a circumcision performed). The outpost’s staff prepared a great meal for us too. I felt at home during our outpost visit…I’m not sure if it was because I was finally seeing/examining patients or because the problems that the Nepali people face are so similar to the problems presented by my fellow Americans in my favorite environment- the family medicine clinic! Just a thought. More to come, xoxo.