Chapter 16: An Overview
At the end of each day the team gathered for a debriefing. What we liked. What we didn’t. What was accomplished. What could have been handled better. Supplies needed for next time.
Food: The unanimous consensus was that Kazi was an excellent cook. Servings were ample, delicious and healthy. He prepared a variety of meals. Oftentimes it was lentils (daal) and rice (bhat). Sometimes yellow curry, or bony chicken pieces chopped into small bits, were added. Small green and red peppers, broccoli, cauliflower and all kinds of peeled vegetables, such as carrots and cucumbers. Some were pickled. Spicy hot sauce. Mexican sopapillas-like flat bread, called roti, made of rice flour. Bananas and apples. We never went hungry.
Unlike most U.S. citizens who live to eat (and are overweight), we came to understand these regional hard-working farming families eat to live. Food is sustenance for those we saw in the medical camps, our host families, and all those living in remote rural villages. Food is fuel to keep them going throughout the day. They don’t insist on a variety of foods. Lentils and rice is their daily staple. Our porters, like local families, would like to eat daal bhat twice a day.
Light: Working in dim lighting (or with no lights and no electricity at times) in both villages was not impossible, but it was difficult for all medical providers. The weather and overcast skies kept natural light from the windows. More about lighting and electricity follows.
Eye Exams: Over the course of two camps Dr. Safal and Dr. Tim saw a total of 529 patients. Dr. Tim said, “They were very patient. The two young volunteers were very helpful. One-third of the patients had eye exams
(refractions – measuring the need for corrective lenses.) Most have good eye nerves. Next time bring more eye drops.”
The interruption of electricity during the day created problems for the two optometrists, as this slowed down and limited the number of patients seen. On the last day the number of patients was restricted to 70. This was frustrating for both Dr. Tim and Dr. Safal. The charge on the light instruments was only holding for 10 minutes at a time. “Charging with 220 gets very hot and doesn’t hold a charge. At home I charge these for 10-12 hours with 110 and they hold a charge," said Dr. Tim.
Two patients were identified having retinitis pigmentosa, an inherited degenerative condition often leading to blindness.
One case of glaucoma.
A patient with a scarred cornea and blind from treating conjunctivitis with an herbal remedy. The patient would possibly require a cornea transplant. There are both good and bad with herbal treatments.
Forty-four patients with cataracts. Operations required and treatable at the Himalayan Eye Hospital in Pokhara for $55 (with medical camp referral), which includes the operation and pre- and post-op care and meds, one night in hospital and transportation for the patient and a family member. One elderly patient had previous cataract surgery,
Dr. Tim summed up his experience, “The quiet resolve and bearing of the Nepalese population reminded me in many ways of the dignity of many Native American patients I have had the privilege to serve over the years. Observing the faces of patients and greeting each with ‘Namaste’, a head nod and palms together will be one of my most treasured memories. The patience and the gratitude for the limited care we could provide in the camp setting became a reminder of what many in the USA take for granted.
“I was also impressed by our Nepalese doctors/counterparts for their professionalism and knowledge. Without their assistance the camp would not have been possible."
Food: The unanimous consensus was that Kazi was an excellent cook. Servings were ample, delicious and healthy. He prepared a variety of meals. Oftentimes it was lentils (daal) and rice (bhat). Sometimes yellow curry, or bony chicken pieces chopped into small bits, were added. Small green and red peppers, broccoli, cauliflower and all kinds of peeled vegetables, such as carrots and cucumbers. Some were pickled. Spicy hot sauce. Mexican sopapillas-like flat bread, called roti, made of rice flour. Bananas and apples. We never went hungry.
Unlike most U.S. citizens who live to eat (and are overweight), we came to understand these regional hard-working farming families eat to live. Food is sustenance for those we saw in the medical camps, our host families, and all those living in remote rural villages. Food is fuel to keep them going throughout the day. They don’t insist on a variety of foods. Lentils and rice is their daily staple. Our porters, like local families, would like to eat daal bhat twice a day.
Light: Working in dim lighting (or with no lights and no electricity at times) in both villages was not impossible, but it was difficult for all medical providers. The weather and overcast skies kept natural light from the windows. More about lighting and electricity follows.
Eye Exams: Over the course of two camps Dr. Safal and Dr. Tim saw a total of 529 patients. Dr. Tim said, “They were very patient. The two young volunteers were very helpful. One-third of the patients had eye exams
(refractions – measuring the need for corrective lenses.) Most have good eye nerves. Next time bring more eye drops.”
The interruption of electricity during the day created problems for the two optometrists, as this slowed down and limited the number of patients seen. On the last day the number of patients was restricted to 70. This was frustrating for both Dr. Tim and Dr. Safal. The charge on the light instruments was only holding for 10 minutes at a time. “Charging with 220 gets very hot and doesn’t hold a charge. At home I charge these for 10-12 hours with 110 and they hold a charge," said Dr. Tim.
Two patients were identified having retinitis pigmentosa, an inherited degenerative condition often leading to blindness.
One case of glaucoma.
A patient with a scarred cornea and blind from treating conjunctivitis with an herbal remedy. The patient would possibly require a cornea transplant. There are both good and bad with herbal treatments.
Forty-four patients with cataracts. Operations required and treatable at the Himalayan Eye Hospital in Pokhara for $55 (with medical camp referral), which includes the operation and pre- and post-op care and meds, one night in hospital and transportation for the patient and a family member. One elderly patient had previous cataract surgery,
Dr. Tim summed up his experience, “The quiet resolve and bearing of the Nepalese population reminded me in many ways of the dignity of many Native American patients I have had the privilege to serve over the years. Observing the faces of patients and greeting each with ‘Namaste’, a head nod and palms together will be one of my most treasured memories. The patience and the gratitude for the limited care we could provide in the camp setting became a reminder of what many in the USA take for granted.
“I was also impressed by our Nepalese doctors/counterparts for their professionalism and knowledge. Without their assistance the camp would not have been possible."
Dr. Safal said, “More care should be taken with the instruments. Perhaps simpler instruments should be used next time. There was less pink eye and conjunctivitis than expected. Next time recruiting two more Nepali eye doctors would be helpful. The two boys/volunteers were useful as they helped to give basic vision tests outdoors where the light was better.”
Doctors Tim and Safal agreed they worked well together. "We were both tired at the same time the batteries for the lights finally pooped out."
Doctors Tim and Safal agreed they worked well together. "We were both tired at the same time the batteries for the lights finally pooped out."
Dr. Safal said, “[This narrative] is a … true reflection of the moments we had together. I thank all for providing me an opportunity to be a part of such a special camp. It was great fun working hand in hand with Nepalese colleagues, as well as all who traveled from so far a distance just for the noble cause of serving the helpless and needy people in the remote villages of Nepal. Further, I would also like to acknowledge my optometrist colleague, Dr. Tim for sharing his expertise and valuable experiences. It was great fun working together with him. “
We were told that Dr. Safal was given his name because it means ‘successful’. He is the youngest in a family of all girls. Indeed Dr. Safal has become successful. In all of Nepal there are only 70 optometrists. According to the internet, “Optometry emerged as a new profession in Nepal as an outcome of a National workshop on "Human resource development," conducted in 1997.” After this medical mission camp the handsome young man left for the Philippines for 12 months of additional training.
Eyeglass dispensary: Sukey said, “A total of 247 eyeglasses were issued. The patients seemed very proud to wear glasses. Netra (the Nepali volunteer helper in the eyeglass dispensary) was fantastic. After seeing patients stumbling and wearing their new reading glasses the volunteer told them not to wear these while walking... and showed them why.”
A total of 165 reading glasses were dispensed. Since they nearly ran out of frames Sukey and Dr. Safal took lenses out of 85 pair so prescription lenses could be ordered and inserted into these frames. Sukey suggested next time the glass be taken out of frames beforehand because glass is heavy and adds to the weight for transportation.
“A patient was trying on eyeglass frames - without lenses - and she couldn’t figure out why she couldn’t see any better,” Sukey said. “After much sign language I put my fingers through the opening of the frame to show the patient there were no lenses and tried to explain these would be sent away for her lens prescription.”
After Sukey returned to the U.S. she recalled her experiences. “Mine were more an emotional reaction to the people and the country. What struck me was the countless signs of thankfulness and appreciation when they received their glasses; the patience of the people when they had to wait; and their laughter.
Eyeglass dispensary: Sukey said, “A total of 247 eyeglasses were issued. The patients seemed very proud to wear glasses. Netra (the Nepali volunteer helper in the eyeglass dispensary) was fantastic. After seeing patients stumbling and wearing their new reading glasses the volunteer told them not to wear these while walking... and showed them why.”
A total of 165 reading glasses were dispensed. Since they nearly ran out of frames Sukey and Dr. Safal took lenses out of 85 pair so prescription lenses could be ordered and inserted into these frames. Sukey suggested next time the glass be taken out of frames beforehand because glass is heavy and adds to the weight for transportation.
“A patient was trying on eyeglass frames - without lenses - and she couldn’t figure out why she couldn’t see any better,” Sukey said. “After much sign language I put my fingers through the opening of the frame to show the patient there were no lenses and tried to explain these would be sent away for her lens prescription.”
After Sukey returned to the U.S. she recalled her experiences. “Mine were more an emotional reaction to the people and the country. What struck me was the countless signs of thankfulness and appreciation when they received their glasses; the patience of the people when they had to wait; and their laughter.
Glasses:
Prescription Glasses issued – 82
Reading Glasses issued – 165
+1.00 = 11 pairs
+1.25 = 16 pairs
+1.50 = 99 pairs
+2.00 = 57 pairs
+2.25 = 12 pairs
+2.50 = 34 pairs
+3.00 = 30 pairs
Half of the remaining and unused eyeglasses were given to Dr. Safal for his use. The other was left at Amrit’s home for use during the next medical camp, or for use by the non-profit One World One Heart’s visit in November 2013. The 50 pairs of remaining sunglasses will be given to cataract patients.
Dental:
The two dental hygienists saw a total of 461 patients during the two camps. Kabita and Alija had only local anesthesia to work with. They said if they could have worked together (or communicated) ahead of time they might have been able to plan better for meds needed.
Prescription Glasses issued – 82
Reading Glasses issued – 165
+1.00 = 11 pairs
+1.25 = 16 pairs
+1.50 = 99 pairs
+2.00 = 57 pairs
+2.25 = 12 pairs
+2.50 = 34 pairs
+3.00 = 30 pairs
Half of the remaining and unused eyeglasses were given to Dr. Safal for his use. The other was left at Amrit’s home for use during the next medical camp, or for use by the non-profit One World One Heart’s visit in November 2013. The 50 pairs of remaining sunglasses will be given to cataract patients.
Dental:
The two dental hygienists saw a total of 461 patients during the two camps. Kabita and Alija had only local anesthesia to work with. They said if they could have worked together (or communicated) ahead of time they might have been able to plan better for meds needed.
Kate recalled, "My all time favourite moment, was when I asked a beautiful elderly lady from Ale Gaun, whose face was deeply lined with age, who she wanted to see. She remarked 'the doctors or for her eyes,' I can’t remember which. I then asked if she would like to see the dentists as well, to which she gave me the biggest one-toothed grin going and declared 'Why? I only have two teeth left," at which point we both dissolved into fits of giggles at the ridiculousness of it. Even now I think about her and find myself smiling." (photo Amrit Ale)
Kate and Donna remarked that during registration not all wanted to see the dentists. One medical patient in particular was asked if she had seen the dentist. She didn't want to. Half way around the world people have the same anxieties, fears or phobias about going to the dentist as those in the U.S. There might have been some grimacing among patients, but only one child screamed and probably more from fright then from pain.
Kabita and Alija worked fast as a team. Kabita remarked she could have taken more dental patients and didn’t have many the last day. Kazi, our chef, rounded up a few patients on the last day because dental had the time. They finished early and assisted the medical doctors by taking pulses and oxygen levels.
Mid-wifery and women’s issues:
As anticipated there were more than twice as many female patients (1,043) to the (494) males. Dr. Dinesh suggested next time gear the clinic more toward gynecological needs. The following is a list of a few patient cases.
These village women are not used to talking about female issues. A patient confided that her husband forcibly rapes her. Sadikshya encouraged this woman and other patients to say, “I don’t want it to be like that.”
Several patients have had problems of uterine prolapse for years. Dr. Dinesh said, "This problem is believed to occur because they got married at an early age and gave birth to multiple children, with no proper care during the pre- and post- pregnancy period, poor nutrition, and hard-work both in the household and in the fields to name a few reasons." Next year bring rubber ring/ pesseries. A hospital in Kathmandu does prolapse surgery free-of-charge.
Kabita and Alija worked fast as a team. Kabita remarked she could have taken more dental patients and didn’t have many the last day. Kazi, our chef, rounded up a few patients on the last day because dental had the time. They finished early and assisted the medical doctors by taking pulses and oxygen levels.
Mid-wifery and women’s issues:
As anticipated there were more than twice as many female patients (1,043) to the (494) males. Dr. Dinesh suggested next time gear the clinic more toward gynecological needs. The following is a list of a few patient cases.
These village women are not used to talking about female issues. A patient confided that her husband forcibly rapes her. Sadikshya encouraged this woman and other patients to say, “I don’t want it to be like that.”
Several patients have had problems of uterine prolapse for years. Dr. Dinesh said, "This problem is believed to occur because they got married at an early age and gave birth to multiple children, with no proper care during the pre- and post- pregnancy period, poor nutrition, and hard-work both in the household and in the fields to name a few reasons." Next year bring rubber ring/ pesseries. A hospital in Kathmandu does prolapse surgery free-of-charge.
Dr Del and midwife/nurse Sadikshya acknowledge the health worker's dedication and hard work providing for their fellow villagers. They were given 17 birthing kits (clean delivery kits) to use in the surrounding villages. Information about the importance of these birthing kits is noted below. (photo: Amrit Ale)
The following is from the website: http://everymothercounts.org:
Birthing kit items that fit into a sandwich bag can save thousands of mothers’ lives every year. Sounds too good to be true, doesn’t it? The Clean Delivery Kit has:
The items in the Clean Delivery Kit help to provide a clean environment for the birth and what is called The Seven Cleans:
1. Clean Birth Site – prevents delivery directly on the floor.
2. Clean Hands – prevents the birth attendant from transmitting germs to mother and baby.
3. Clean Ties – prevents bleeding from the umbilical cord for mother and baby.
4. Clean Razor – reduces infection caused by other implements.
5. Clean Gauze – wipes away birth canal secretions from the baby’s eyes, which decreases the probability of future eye infections.
6. Clean Umbilical Cord – prevents infection by washing and drying the stumps.
7. Clean Perineum
Patient issues continued: Many cases of vaginal discharge possibly from poor hygiene.
Patient, pregnant with second baby, was having discharge and advised this is normal during pregnancy.
Patient is 26 weeks pregnant and excited. There were no births during the health camp. Perhaps because the villagers still prefer home deliveries. Seventeen birthing kits were given to lay midwives from both villages and those from miles around.
The Midwife/nurse only had a few patients so in the meantime she assisted Doctors Del and Sanjita. Sadikshya said, “I learned so much from Dr. Del and could have learned even more with time.
Dr. Del mentioned that things are treated differently in Nepal than in the U.S.
Birthing kit items that fit into a sandwich bag can save thousands of mothers’ lives every year. Sounds too good to be true, doesn’t it? The Clean Delivery Kit has:
- A clean plastic liner to put on the ground so the new mother doesn’t deliver directly onto the dirt;
- A pair of disposable gloves;
- Gauze;
- A clean razor blade and string for tying and cutting the umbilical cord; and
- Soap for a thorough washing before and after the birth.
- A pictorial instruction sheet is included as a reminder of the information about the birth process and how to use the materials in the kit.
The items in the Clean Delivery Kit help to provide a clean environment for the birth and what is called The Seven Cleans:
1. Clean Birth Site – prevents delivery directly on the floor.
2. Clean Hands – prevents the birth attendant from transmitting germs to mother and baby.
3. Clean Ties – prevents bleeding from the umbilical cord for mother and baby.
4. Clean Razor – reduces infection caused by other implements.
5. Clean Gauze – wipes away birth canal secretions from the baby’s eyes, which decreases the probability of future eye infections.
6. Clean Umbilical Cord – prevents infection by washing and drying the stumps.
7. Clean Perineum
Patient issues continued: Many cases of vaginal discharge possibly from poor hygiene.
Patient, pregnant with second baby, was having discharge and advised this is normal during pregnancy.
Patient is 26 weeks pregnant and excited. There were no births during the health camp. Perhaps because the villagers still prefer home deliveries. Seventeen birthing kits were given to lay midwives from both villages and those from miles around.
The Midwife/nurse only had a few patients so in the meantime she assisted Doctors Del and Sanjita. Sadikshya said, “I learned so much from Dr. Del and could have learned even more with time.
Dr. Del mentioned that things are treated differently in Nepal than in the U.S.
Pharmacy:
Mike was quick to practice the Nepali language from the time he landed in Kathmandu, which he continued in Ale Gaun when working together alongside Tila in the Pharmacy. She lives in Amrit's village and as a health worker walks uphill everyday to attend the health concerns of villagers.
Mike was quick to practice the Nepali language from the time he landed in Kathmandu, which he continued in Ale Gaun when working together alongside Tila in the Pharmacy. She lives in Amrit's village and as a health worker walks uphill everyday to attend the health concerns of villagers.
At Ale Gaun school the room used for the Pharmacy backed to a wooded area. The two windows facing the woods didn’t offer much light. When the electricity went off for several hours Mike could not see to read the labels on medications. One afternoon Lin assisted by holding a simple head lamp to illuminate the workspace so Mike could fill prescriptions.
A frustrating, but inevitable part of running the pharmacy for Mike was the down-time first thing in the morning waiting for the doctors to see patients and write scripts. Late in the afternoon, after the doctors had finished seeing patients, there was a rush to fill prescriptions.
Mike said, “The doctors were good at prescribing.” He suggested they look at pharmacy each morning to see what meds are still available for each upcoming day.
When Dr. Dinesh worked at health clinics similar to this in the past he said, “We ran out of meds in a day.” At one time Dr. Dinesh mistakenly thought the pharmacy was running out of medications. “In my heart I wanted to prescribe them more. Like in the cases of chronic gastritis which is one of the common ailments here, just as throughout Nepal. We prefer to prescribe the PPI’s for a least two weeks, but here I gave out just 5-7 days of supplies.” Some items were running low.
The general consensus was “If the patient is healthy, they don’t need meds. Education is the most important thing. Give them a toothbrush instead, so they walk away with something.”
The morning of the last day Mike worked with the knowledgeable Kumar, owner of the local pharmacy in Sirkot. Kumar was appreciative and happy with the outcome of the medical camp. He and Dr. Dinesh agreed to stay in touch. He is the father of a young albino boy in the village. With Kumar now in charge Mike moved on to assist Dr. Dinesh.
General Practice: (Dr. Dinesh and nurse Mike)
Dr. Dinesh praised Mike for his nursing skills. “He took vitals accurately and acted very well as physician’s assistant.”
Mike attempted to clean ears of wax. Would have been helpful to have a syringe. Another patient had no wax build up. He was hard of hearing.
Mike said, “Since it was noisy with people milling around oftentimes I could not detect a pulse. By 11:00 a.m. on the last day I asked an officer to enforce crowd control and move people away from our door.”
Dr. Dinesh had a steady stream of patients:
"Three male patients in a row had very high blood pressure. One had atrial fibrillation (A-Fib) and was on blood pressure medicine three years ago and then stopped for reasons unknown. Perhaps he did not get back into the village pharmacy for the refill. When he came to the medical camp he had a partially paralyzed face from a stroke.
Dr. Dinesh found it’s typical for patients to not want to take medicine for the rest of their life. “Patients take meds only when they feel bad, then they stop.”
A man fell from tree resulting in a compression fracture. He brought a copy of his x-ray and complained of hip pain. Prescribed painkillers for a week. Vitamin D one a day.
Several cases of Diabetes.
Man with three testicles.
Patient middle-age man. From general appearance could suspect signs of chronic alcoholism. Black discoloration of skin, tremor, anxiety, low sex drive, etc. No jaundice, ascites, loss of body hair, atrophy of testicles or UGI bleeding or malena were noted. Prescribed Vitamin B12 with Thiamin and counseling. Advised to see treatment at Liver Center consultation.
Middle-age men - Several cases of hypertension from alcohol consummation. From eyes could detect signs of alcoholism. Prescribed Vitamin D. Other signs: losing body hair, atrophied testicle and low sex drive, probably from drinking homemade Roxi.
Most Roxi / Rakshi is a millet or rice wine, fermented or steamed for six weeks. Home-made by women, but consumed in larger quantities by men. Some suggest society in Nepal is ambivalent regarding alcohol use, which is typical with men and can be serious as it often leads to abuse and domestic violence.
Mike said, “Here there is a different interpretation of alcoholism.” A patient with severe hypertension was given aspirin. Doctor Dinesh didn't want a patient toppling over on way home as patient was suspected of being drunk. Mike wondered if the patient’s shaking was from alcohol.
A frustrating, but inevitable part of running the pharmacy for Mike was the down-time first thing in the morning waiting for the doctors to see patients and write scripts. Late in the afternoon, after the doctors had finished seeing patients, there was a rush to fill prescriptions.
Mike said, “The doctors were good at prescribing.” He suggested they look at pharmacy each morning to see what meds are still available for each upcoming day.
When Dr. Dinesh worked at health clinics similar to this in the past he said, “We ran out of meds in a day.” At one time Dr. Dinesh mistakenly thought the pharmacy was running out of medications. “In my heart I wanted to prescribe them more. Like in the cases of chronic gastritis which is one of the common ailments here, just as throughout Nepal. We prefer to prescribe the PPI’s for a least two weeks, but here I gave out just 5-7 days of supplies.” Some items were running low.
The general consensus was “If the patient is healthy, they don’t need meds. Education is the most important thing. Give them a toothbrush instead, so they walk away with something.”
The morning of the last day Mike worked with the knowledgeable Kumar, owner of the local pharmacy in Sirkot. Kumar was appreciative and happy with the outcome of the medical camp. He and Dr. Dinesh agreed to stay in touch. He is the father of a young albino boy in the village. With Kumar now in charge Mike moved on to assist Dr. Dinesh.
General Practice: (Dr. Dinesh and nurse Mike)
Dr. Dinesh praised Mike for his nursing skills. “He took vitals accurately and acted very well as physician’s assistant.”
Mike attempted to clean ears of wax. Would have been helpful to have a syringe. Another patient had no wax build up. He was hard of hearing.
Mike said, “Since it was noisy with people milling around oftentimes I could not detect a pulse. By 11:00 a.m. on the last day I asked an officer to enforce crowd control and move people away from our door.”
Dr. Dinesh had a steady stream of patients:
"Three male patients in a row had very high blood pressure. One had atrial fibrillation (A-Fib) and was on blood pressure medicine three years ago and then stopped for reasons unknown. Perhaps he did not get back into the village pharmacy for the refill. When he came to the medical camp he had a partially paralyzed face from a stroke.
Dr. Dinesh found it’s typical for patients to not want to take medicine for the rest of their life. “Patients take meds only when they feel bad, then they stop.”
A man fell from tree resulting in a compression fracture. He brought a copy of his x-ray and complained of hip pain. Prescribed painkillers for a week. Vitamin D one a day.
Several cases of Diabetes.
Man with three testicles.
Patient middle-age man. From general appearance could suspect signs of chronic alcoholism. Black discoloration of skin, tremor, anxiety, low sex drive, etc. No jaundice, ascites, loss of body hair, atrophy of testicles or UGI bleeding or malena were noted. Prescribed Vitamin B12 with Thiamin and counseling. Advised to see treatment at Liver Center consultation.
Middle-age men - Several cases of hypertension from alcohol consummation. From eyes could detect signs of alcoholism. Prescribed Vitamin D. Other signs: losing body hair, atrophied testicle and low sex drive, probably from drinking homemade Roxi.
Most Roxi / Rakshi is a millet or rice wine, fermented or steamed for six weeks. Home-made by women, but consumed in larger quantities by men. Some suggest society in Nepal is ambivalent regarding alcohol use, which is typical with men and can be serious as it often leads to abuse and domestic violence.
Mike said, “Here there is a different interpretation of alcoholism.” A patient with severe hypertension was given aspirin. Doctor Dinesh didn't want a patient toppling over on way home as patient was suspected of being drunk. Mike wondered if the patient’s shaking was from alcohol.
An adolescent boy was asked to lift his shirt for an exam. As part of cultural understanding Dr. Denish explained that next to the boy’s skin was a white, cotton cord/thread (janai) which is sacred and worn around the waist or torso only by the Brahmin, Chhetri caste, to which the boy and Dr. Dinesh belong. This rite of passage is called Brata-bandha. One should perform this ritual before getting married.
General Practice: (Dr. Del and Dr. Sanjita)
Observations: Patients basically healthy. Eat and sleep well. Most patients were smiling and happy. Most patients here have lower than normal oxygen level. (Oximeter used to determine blood/oxygen level.)
Many patients consulted for total body failure – TBF – complaints all over. Minor aches. Back pain from heavy loads and bending. Knee pain from squatting. General disease, as Kate put it: head, shoulders, knees and toes. They just want the opportunity to see a seldom seen doctor.
Dr. Del gave this general advice to her patients: “As we grow older it’s best to stay active. Not good to do nothing.”
Female patient had a black dot (bindi) on her forehead designating she is a widow. A young son was with her. Dr. Del noticed her young son had a nasty abrasion and caked with dirt – possibly from falling from bicycle
Even though each patient was to have their own registration paper this mother did not get one for him. The child patient was handed over to Mike: Since there was no sterile water available Mike first cleaned the week-old wound by spraying it with a canister of sterile water, then applied Bacitracin and gauze. Doctor was told the patient’s older brother had an enlarged liver.
Typical/ standard procedure/questions Dr. Del asked women during exam:
1. Have you been treated for worms/parasites? Bloody stools?
2. When was your last menstrual cycle?
3. Do you have allergies?
4. Do you smoke or chew tobacco?
Female coughing for three days possibly because of cooking over open fire. COPD, or chronic obstructive pulmonary disease makes it hard to breathe and gets worse over time. Prescribed expectorant.
Several more females came in coughing. Does patient smoke? Yes, the patient said. Dr. Del gave them her typical sermon, “You won’t get better if you continue smoking. Smoking is bad, bad, bad. The next time I come here I don’t want to hear that you are still smoking.”
Female complained of heart burn. Doctor asked if she chews tobacco. The patient did not see the cause and effect. Many older women smoke and aren't willing to quit.
Typical/ standard procedure/questions Dr. Del asked women during exam:
1. Have you been treated for worms/parasites? Bloody stools?
2. When was your last menstrual cycle?
3. Do you have allergies?
4. Do you smoke or chew tobacco?
Female coughing for three days possibly because of cooking over open fire. COPD, or chronic obstructive pulmonary disease makes it hard to breathe and gets worse over time. Prescribed expectorant.
Several more females came in coughing. Does patient smoke? Yes, the patient said. Dr. Del gave them her typical sermon, “You won’t get better if you continue smoking. Smoking is bad, bad, bad. The next time I come here I don’t want to hear that you are still smoking.”
Female complained of heart burn. Doctor asked if she chews tobacco. The patient did not see the cause and effect. Many older women smoke and aren't willing to quit.
Female. Six children. Sister just died in house fire. Only daughter died of bleeding. Another family member bled to dead from a hatchet wound.
Husband died four months ago. Patient was smiling. “He was old,” she said. This seemed an unusual remark as widows are not allowed to remarry.
Female. Massive goiter for five years didn't want it treated. She insisted she feels good and has never been on medicine. The goiter felt cystic, like a water balloon. The other side was hard. Patient should have iodine test for hot and cold nodules. Nepali health workers said local salt contains iodine.
Husband died four months ago. Patient was smiling. “He was old,” she said. This seemed an unusual remark as widows are not allowed to remarry.
Female. Massive goiter for five years didn't want it treated. She insisted she feels good and has never been on medicine. The goiter felt cystic, like a water balloon. The other side was hard. Patient should have iodine test for hot and cold nodules. Nepali health workers said local salt contains iodine.
Young child prescribed calcium.
Elderly woman with A-fib. In pain probably because of irregular heart beat. Most likely had heart attack in past.
Wart on bottom of heel. Recommend keep wart in the dark by covering it with tape for a week to a month. It will drop off. Repeat for another month if necessary.
Woman’s mother-in-law died. Patient is only one to care for extended family.
Elderly woman experienced weight loss and loss of appetite, although her lungs were clear.
Female, age 60, 120/85 blood pressure. Heart and lungs clear. Oxygen good. Multiple joint pain all over. Joint red, hot and swollen. At her age probably arthritis. Prescribed Acetomin 500 mg x 2 day or as needed.
Pain on the left side and weakness in the leg.
“My arms hurt when I walk. “
Patient had spleen removal.
Several cases of heel pain - plantar fasciitis and were instructed how to exercise the foot first thing in the morning before walking and the importance of exercising three times.
Tingling in arm and elbow. Prescribed B complex vitamin.
Female, age 43. Mole getting bigger. Doesn’t hurt. Also growth on skull. Five years since last time she saw a doctor. Hysterectomy. Blood pressure 120/90
Twenty- year old complained of not yet conceiving. Doctor informed patient of statistics that 1/3 time equally divided between a condition with the women, men, or combination of the two. It was recommended the husband’s sperm count be tested.
Young woman had no menstrual periods. Pain with urination going on seven months with no treatment. Fungal infection at this age is usual.
Another was concerned because her menstrual periods were not painful
Patient has three young girls and plans to get pregnant again hoping for a boy. Iron w/ folic acid prescribed for women beforehand during childbearing years to decrease birth defects.
Disclaimer: Patient did not come in for advice. Rather she factually stated what she was determined to do: Pregnant with twins and determined to have abortion because she could not afford to raise two more children. In Nepal abortions are legal up to 12 weeks gestation. After 12 weeks of pregnancy, the abortion is illegal and cost goes up greatly. 1000 rupees per week. Patient was already 16 weeks with twins! The cost would be at least 35,000 rupees. But the procedure is safe if done by someone knowledgeable.
Unusual cases of breast tissue atrophy. Skin matted to the ribs with lesion around right nipple. Left breast normal. Patient wore a yellow dot on her forehead. As a widow she is not allowed to wear a red dot.
Elderly woman with A-fib. In pain probably because of irregular heart beat. Most likely had heart attack in past.
Wart on bottom of heel. Recommend keep wart in the dark by covering it with tape for a week to a month. It will drop off. Repeat for another month if necessary.
Woman’s mother-in-law died. Patient is only one to care for extended family.
Elderly woman experienced weight loss and loss of appetite, although her lungs were clear.
Female, age 60, 120/85 blood pressure. Heart and lungs clear. Oxygen good. Multiple joint pain all over. Joint red, hot and swollen. At her age probably arthritis. Prescribed Acetomin 500 mg x 2 day or as needed.
Pain on the left side and weakness in the leg.
“My arms hurt when I walk. “
Patient had spleen removal.
Several cases of heel pain - plantar fasciitis and were instructed how to exercise the foot first thing in the morning before walking and the importance of exercising three times.
Tingling in arm and elbow. Prescribed B complex vitamin.
Female, age 43. Mole getting bigger. Doesn’t hurt. Also growth on skull. Five years since last time she saw a doctor. Hysterectomy. Blood pressure 120/90
Twenty- year old complained of not yet conceiving. Doctor informed patient of statistics that 1/3 time equally divided between a condition with the women, men, or combination of the two. It was recommended the husband’s sperm count be tested.
Young woman had no menstrual periods. Pain with urination going on seven months with no treatment. Fungal infection at this age is usual.
Another was concerned because her menstrual periods were not painful
Patient has three young girls and plans to get pregnant again hoping for a boy. Iron w/ folic acid prescribed for women beforehand during childbearing years to decrease birth defects.
Disclaimer: Patient did not come in for advice. Rather she factually stated what she was determined to do: Pregnant with twins and determined to have abortion because she could not afford to raise two more children. In Nepal abortions are legal up to 12 weeks gestation. After 12 weeks of pregnancy, the abortion is illegal and cost goes up greatly. 1000 rupees per week. Patient was already 16 weeks with twins! The cost would be at least 35,000 rupees. But the procedure is safe if done by someone knowledgeable.
Unusual cases of breast tissue atrophy. Skin matted to the ribs with lesion around right nipple. Left breast normal. Patient wore a yellow dot on her forehead. As a widow she is not allowed to wear a red dot.
Problems with the Medical Camp:
No privacy between patients. Can hear each other’s complaints. Doctors in same room each with two patients just feet apart.
Inadequate, or lack of lighting in consult/exam room. Therefore louvered windows could not be closed. Sometimes lights went out during exams.
Difficult to hear, using stethoscope to detect irregular heartbeat, as it was very noisy with crowds of patients waiting to be seen right outside door and windows.
Positives:
Dr. Del was impressed with the three Nepalese colleagues she worked with – Dr. Dinesh, Dr. Sanjita and midwife, Sadikshya.
Lots of laughter and hugging between patients and doctors. Dr. Del was good about handling each patient gently. She understands the healing power of touch.
Mike added, “The medical camp/operation ran smoothly and was ‘well-oiled’ and efficient.
Amrit observed that it didn’t seem as hectic this last day; He said he was blessed and honored to have served these two communities. “We have to live with what we have. “
What to Bring Next Time:
Throughout the days a list was compiled of items that might be needed if this camp is to be repeated in the months and years ahead.
Thermometers were ordered but not included in the delivery. These would have been handy, especially for pediatrics. Dr. Dinesh said, "In cases of children ages 5 months to 5 years fever can go as high as 105 degrees and later turn into seizures, sometimes leading to epilepsy at later part of their lives."
Azthromyacian (Z-pak), aspirin, Ben Gay muscle relaxant, K-Y Gel, ACT compound, dental floss, bed sheets to use as room dividers for undressing and genealogical exams, large supply of writing pens, flashlights, or portable lights of any kind in case lights go out, padlock for pharmacy door. Manual pill counter. Vitamin B-complex to increase appetite. Prenatal vitamins. Topical anti-fungal. Topical burn ointment. Ointment for diaper rash. Anti-worm/parasite. Tylenol. Amoxicillin. Ampicillan. Ointment skin infection. Doxycyline. Astma. Eye ointment. Cipro. Oral hydration solution. Something for stomach spasms. Antacids. Multivitamins for children and adults. Calcium. Iron complex. Cough medicine. All-purpose moisturizer. Fetal heart monitor for expectant mother to hear babies heartbeat. Ear cleaning solution and syringe. Eye drops. Pessaries for prolapse. Pediatric thermometer, hydrogen peroxide, more canvas or plastic bags for sorting and carrying to the school
Teeth cleaning next time. Posters and teaching materials for dental. More health education is needed, especially better teeth care. Posted on wall. Proper way to brush teeth, wash hands, good vs. bad, while waiting to be seen.
Next time more teaching of midwifery skills. Massage therapist. ENT. Perhaps educational stations set up to keep the crowd occupied. Volunteers could be used to help teach health and hygiene education. A few more nurses.
Dr. Dinesh suggested next time consult with him if meds needed. C.A.N. – Community Action Nepal has a suggested list of needed meds. Better if could meet with team ahead of time.
Summary of Camp #2
Sirkot:
Male – 286
Female - 639
Optometry/Eyes – 218 patients
Dental/Teeth – 248 patients
Midwife/GPS – 486 patients
Total Registrations – 925
Total Consults – 952
Total of camp #1 and #2 combined :
Male- 494
Female - 1,043
Optometry/Eyes - 529
Dental/Teeth - 461
Midwife/GPS – 840
Total Registrations - 1,537
Total Consults - 1,830
No privacy between patients. Can hear each other’s complaints. Doctors in same room each with two patients just feet apart.
Inadequate, or lack of lighting in consult/exam room. Therefore louvered windows could not be closed. Sometimes lights went out during exams.
Difficult to hear, using stethoscope to detect irregular heartbeat, as it was very noisy with crowds of patients waiting to be seen right outside door and windows.
Positives:
Dr. Del was impressed with the three Nepalese colleagues she worked with – Dr. Dinesh, Dr. Sanjita and midwife, Sadikshya.
Lots of laughter and hugging between patients and doctors. Dr. Del was good about handling each patient gently. She understands the healing power of touch.
Mike added, “The medical camp/operation ran smoothly and was ‘well-oiled’ and efficient.
Amrit observed that it didn’t seem as hectic this last day; He said he was blessed and honored to have served these two communities. “We have to live with what we have. “
What to Bring Next Time:
Throughout the days a list was compiled of items that might be needed if this camp is to be repeated in the months and years ahead.
Thermometers were ordered but not included in the delivery. These would have been handy, especially for pediatrics. Dr. Dinesh said, "In cases of children ages 5 months to 5 years fever can go as high as 105 degrees and later turn into seizures, sometimes leading to epilepsy at later part of their lives."
Azthromyacian (Z-pak), aspirin, Ben Gay muscle relaxant, K-Y Gel, ACT compound, dental floss, bed sheets to use as room dividers for undressing and genealogical exams, large supply of writing pens, flashlights, or portable lights of any kind in case lights go out, padlock for pharmacy door. Manual pill counter. Vitamin B-complex to increase appetite. Prenatal vitamins. Topical anti-fungal. Topical burn ointment. Ointment for diaper rash. Anti-worm/parasite. Tylenol. Amoxicillin. Ampicillan. Ointment skin infection. Doxycyline. Astma. Eye ointment. Cipro. Oral hydration solution. Something for stomach spasms. Antacids. Multivitamins for children and adults. Calcium. Iron complex. Cough medicine. All-purpose moisturizer. Fetal heart monitor for expectant mother to hear babies heartbeat. Ear cleaning solution and syringe. Eye drops. Pessaries for prolapse. Pediatric thermometer, hydrogen peroxide, more canvas or plastic bags for sorting and carrying to the school
Teeth cleaning next time. Posters and teaching materials for dental. More health education is needed, especially better teeth care. Posted on wall. Proper way to brush teeth, wash hands, good vs. bad, while waiting to be seen.
Next time more teaching of midwifery skills. Massage therapist. ENT. Perhaps educational stations set up to keep the crowd occupied. Volunteers could be used to help teach health and hygiene education. A few more nurses.
Dr. Dinesh suggested next time consult with him if meds needed. C.A.N. – Community Action Nepal has a suggested list of needed meds. Better if could meet with team ahead of time.
Summary of Camp #2
Sirkot:
Male – 286
Female - 639
Optometry/Eyes – 218 patients
Dental/Teeth – 248 patients
Midwife/GPS – 486 patients
Total Registrations – 925
Total Consults – 952
Total of camp #1 and #2 combined :
Male- 494
Female - 1,043
Optometry/Eyes - 529
Dental/Teeth - 461
Midwife/GPS – 840
Total Registrations - 1,537
Total Consults - 1,830