I hope you all had a heart-fluttering Valentine’s Day…I know I did! We treated ourselves to hot chocolate, grilled cheese and soup at one of the fancier restaurants in town (not quite as good as Momma Evans’s grilled cheese though). Prior to our romantic group meal, we babysat Lizzy, Ben & Sarah’s 2 year old daughter so the two of them could have some alone time- we watched Beauty and the Beast, thanks to Elisabeth! Lizzy was very well behaved (as usual) and on a daily basis is having lots of fun memorizing all of our names and saying “wow!”. She’s a little trooper…prior to Ben and his family joining us in Dhulikhel, the three of them (or make that four- Sarah’s 26weeks pregnant!) went trekking in the mountains for 2 weeks!! Brave souls, I tell you.
This week has been a really nice balance of different specialties: 1 day of orthopedics, 2 days of pediatrics, & 1 day of OB/GYN - mostly consisting of rounds-seeing patients in the morning with the team with some teaching here and there and lectures (with lots of tea breaks in between). Here are some interesting tidbits:
Ortho: By far and away one of the busiest services at the hospital- 70-80% of cases due to trauma. The most common traumas are related to RTAs- road traffic accidents. RTAs are also Nepal’s #1 cause of death (in America, it’s heart disease). For more details on ortho, please visit Katherine’s blog as she is our future “haad” (bone) doctor.
Pediatrics: Also a very busy service and very popular among the students. Many of the children in Nepal are faced with similar diseases as American children, the biggest difference is that children here are malnourished and have difficulty fighting off infections, etc. In stark contrast is the prevalence of infectious disease (in both adults and children). An interesting aspect of infectious disease is the presentation of seizures in Nepal. In America, pediatric seizures are usually febrile (high fever causing seizures) or epilepsy (seizure disorder, usually runs in families). In Nepal, infectious causes are always high on the differential diagnosis list. Tuberculosis can present with seizures caused by a tuberculoma in the brain or by way of tuberculosis meningitis/encephalitis. Another infection, by the tinea solium helminth, or worm, can present with seizures. Patients are infected with this worm by ingesting undercooked/infected pork or other meats or by the fecal-oral route (an infected human sheds the worm or larvae in their stool and passes it to another human, possibly by preparing food without washing his/her hands). These little worms work their way up into the brain and can cause seizures, once a patient has proven neurologic disease, the diagnosis of Neurocysticercosis is made. Worldwide, it has been shown that Neurocysticercosis is the #1 cause of new-onset seizures. Crazy!
OB/GYN: The lectures given were fantastic, but the patient-rounding was less than desirable. There are so many OBGYN patients that the team has to do rounds with lightening speed to see them all. Not surprisingly, with the language barrier and less time for teaching, it was not so fruitful for us. On the other hand, the lectures were fantastic! We got to learn all about childbearing and maternal mortality (death in childbirth- before, during, after) in Nepal. As of today, 82% of Nepalese women still deliver their babies at home! Several factors determine this rate: access to care, cultural beliefs. The OBGYN doc lecturing us said that most women would prefer to deliver in the hospital but don't have the means to get there. The government in Nepal has even begun providing substantial monetary compensation for delivering in the hospital to mothers. More training is becoming available so that smaller communities can have “skilled birth attendants,” like a midwife, available for safer deliveries at home.
General surgery is next...then a fun weekend of travel and trekking! Miss and love you all, xoxo.
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