A Nepali hospital experience

I dedicate this to all my medical peeps:


Perhaps you're curious about what it would be like to work in a hospital in Nepal. Well, wonder no longer. I'm going to give you the nitty gritty. I'm volunteering at a hospital in the town of Chitwan. As you can imagine, it's nothing like the hospitals in America. The only way I would allow myself to be a patient here is if I was unconscious. We are spoiled rotten by the health care available to us in the U.S. It seems like a bit of a circus act here sometimes, but I wasn't expecting much different.


On the morning of my first day, I slip into my familiar scrubs and realize it's been a month and a half since I've worn them. I can honestly say I truly love being a nurse. It's such a rewarding career, I can't really imagine doing anything else. I know it sounds cheesy, but it's true. I love nursing so much, I'm doing it for free!


My first day I'm picked up by the volunteer coordinator. He picks me up on his scooter from my host family's house and we zoom down the gravel road to the hospital. From then on, I make the 20 minute walk by myself, passing small shops and houses, kids that yell "hello!", buses that spit up cough-enducing dust and exhaust, many curious locals, cows and water buffalo's.

As I enter the hospital, my initial reaction is that it looks like a run down building that should be condemned. It smells like musty lysol. The hospital administrator gives me a tour through the wards. We spend an hour sashaying through the pediatric, NICU, ICU, ortho, ENT, OR, medical and surgical units, finally stopping in the 30 bed ER.

HIPPA is non-existent here. (for all my non-medical peeps, that means patient privacy). The rickety metal beds are side by side with no curtains. There are also no IV pumps, except a few in the ICU. The ICU is the equivalent to the floor I worked on in Alaska, PCU, which is a cardiac floor. All patients wear their street clothes and none of them are wearing name bands. Strangely, there are no gloves to be seen. It's quite something. The hospital is unable to afford a lot of supplies, and the patients are just as poor.  The walls are botched with holes, the ceiling is missing multiple panels. It reminds me a lot of working in the hospital in the Virgin Islands.


In the ER, their system is very peculiar. For example, if one of the doctors orders a bottle of NS (fluids) to be given, one of the family members must walk around the corner to the pharmacy with the prescription and purchase it. If an IV is ordered, they must buy the needle and syringe and bring it to us to start the IV. An x-ray or CT scan must be paid in cash beforehand. A CT scan costs 5,000 rupees, or about $62, a steal compared to what it would cost in the US. But it's a lot of money to a poor Nepali farmer.

ER

The doctor's orders are written in English, but Nepali is spoken with the patients. I was given a 1 week language course which helped prepare me with the basics. A measly 5 years of college is required before you can be called a doctor in Nepal. To give them credit, they seem to be competent.


Some of my observations:
Narcotics such as morphine are kept in an unlocked drawer beside the nurse's station, which is frequently left unattended. I thought about how much we scrutinize about counting the narcotics that we keep locked up tightly in the US. Here they are accessiblee to any Joe Shmoe off the street.


Because of the low supply, a lot of equipment is reused. (oxygen masks, nasal canula, suction catheters, nebulizers). To no surprise, the beds are not washed in between patients. OSHA would throw a fit here!

OR

One of the charge nurses in the ER, Dinesh, speaks English exceptionally well, but a majority of the other nurses speak little English and are younger than 20 years old. They have an almost snotty attitude toward the patients, walking up to them, quickly giving them a shot in their arm, then walking away without saying a word. There is no "this is a shot to help with your pain, it's called Demerol. Ready?" Where's the compassion?! Acting this way is unimaginable to me.The patients don't expect much and rarely ask what medication they are being given. I feel sorry for them.


I feel grateful to have computers at my work that make things run so much smoother, here there are none. I haven't seen any bariatric beds either. Haha, good ol' obese America.


I was introduced to the head doc of the ER, Dr. Diarom, a short, middle aged gentleman with a friendly face and calm demeanor. I instantly liked him. I joined in on rounds with him, along with another doctor and 2 nurses. He speaks Nepali to the others, then turns to me and explains in excellent English. I get the lengthy version. He puts so much energy into educating me, and I soak it all in. Such a great learning experience. So interesting. Later he asked to talk to me in private. He told me how difficult it was to make the nurses follow the rules, that they were young and inexperienced and that their schooling was poor (this was blatantly obvious). He asked me what I would recommend to improve things. Oh geez, where do I begin? Gloves, handwashing, bedside manner, more education... I gave him a professional answer while trying not to sound too criticizing. He asked if I would give a class to the other nurses. Honestly, I believe it would be a waste of time.... their English is so poor and the information would probably go in one ear and out the other.


Medicine in this part of the world is ages behind and it seems so overwhelming to think about how much effort it would take to catch up to Western standards.

in my OR scrubs

The nurses also wear flip-flops! Even in the OR! Blood drips off the table and splatters next to their naked toes.  I would be sent home if I showed up to work in sandals. During a c-section one morning (amazing!), a big blood clot from the placenta plopped off the table, narrowly missing my bare sandaled foot. Eww. Socks are not allowed in the OR. I also saw a nephrectomy, I&D and right femur ORIF.


The bedside manner in this hospital is not up to par. It seems like the medical professionals are so cold to the patients, barely speaking to them. After the c-section delivery of a healthy baby girl, the baby was never shown to the mother. After the newborn was suctioned (with a catheter that had fallen on the floor), the nurse swaddled it and carried it around the OR like it was her own. Where's the bonding?!!


Nurses start IV's and draw blood with their bare hands. Maybe this is due to lack of education. Also, personal space doesn't exist. Nurses talk to me close enough to make me cross-eyed, practically standing on top of me, putting their arm around my waist. I'm a good foot taller than them (than everybody for that matter) and I squirm away uncomfortably.

Nephrectomy (kidney removal)  in the OR

After lunch one day (vegetable curry from the cafeteria), Dinesh asked me to accompany him to visit his cousin's newborn baby in the maternity ward. I wasn't going to pass that up! He was so tiny and adorable. We ooo'd and ahh'd at the little guy, then just as we were about to leave, the maternity nurse asked if we could assist her with inserting a foley in a patient who was unable to urinate after giving birth to twins. By a foley, I mean a tube in her bladder. First, let me paint you a picture.... I would estimate there were about 20 beds fit tightly in this room. The room was full of family members, both male and female. Next thing I know, this lady was spread eagle, exposed to everyone in the room while we inserted the catheter. Her neighbor watched as she ate her lunch of dahl baht. These were my thoughts: Can we just pull the curtain?! Oh, there are none. This is not happening. Oh Lord, this poor woman. Everyone can see her you-know-what. This is so wrong. Where are the rules? I forgot, this is Nepal, there are none. So this is how it is. I see....


Back at the ranch, I mean the ER, I'm standing at the bedside of a suspected lung cancer patient when I see something move in the corner of my eye. I look over to see a rat scampering along the ledge halfway up the wall. My eyes almost popped out of my head. I looked at the patients family members, whom also saw it. They were unphased by this sight. I watched as the rat tight roped his way across some exposed wires to the top of one of the disgustingly dusty cabinets. One of the doctors saw the look of horror on my face and said to me, "What's wrong? Never seen a rat before? Don't worry, it won't hurt you."
Just go with the flow...
The rat is thought to be the vehicle for Ganesh, one of the Hindu Gods, so the rodent that Westerners think is so icky is actually holy to them. You're talking to a girl that has a significant scar on the top of her foot from an injury that involved running away from a family of rats outside of her apartment in New York City. I'm not sure I can convince myself that these things are holy. But I'll try..... I guess the little ones are kinda cute :)