While Erin was teaching during the morning hours I would hop on the packed local bus everyday to shortly arrive at Bageshwari Hospital for four to seven hours of volunteering. The hospital is a two-story “L” shaped brick building on the dusty, heavily-used road leading to central Kathmandu, serving a predominantly poor community and emergencies that needed immediate attention. It contains a ward with three beds, an out-patient room, a pharmacy located street-side, an ER, and an x-ray lab. It was eerily reminiscent of the very hospital I stayed in 3.5 years ago in India but much, much (much) cleaner.To be honest, once there, I mostly chatted with the doctors, comparing and contrasting the multitude of differences between our respective healthcare systems, and having them answer my questions about physiology and diagnoses. While I believe every healthcare system is riddled with problems, this experience strengthened my convictions that healthcare in the U.S., despite all of its alleged flaws, is in really, really good shape. I’m proud to say, “Hey USA, we’ve got it gooooooood!”
The exciting times during this volunteer experience were obviously when there were patients and I would shadow and observe mainly one of two doctors, Dr. Prabin Yogi and Dr. Sabin Yadav. Fortunately, all of the doctors there spoke proficient English and would translate for me and some would have a bit of fun and ask for an educated guess for diagnosis. After a few days, I got the hang of it as we began to see more and more of the same issues, i.e. feverish babies. After several days, I was taught how to take blood pressure and allowed use their stethoscope on patients, with loose instructions on placement and hints on what to listen for. “Is it crackling, liquid-y, or whooshy?” they’d ask, and my response was typically nothing more than a shrug of the shoulders and a guess. Apparently, practice makes perfect. While I always wanted to do more, it makes sense that I couldn’t; I’m not qualified to work directly with patients and can really only observe. Here are some of the highlights of what was observed, and some general thoughts and opinions:
“My” first patient! A young boy came in after an alleged fight with his sister (the family wouldn’t say and the hospital didn’t pry), complaining of pain in his right hand. After some routine manipulation probing for pain and strength of the hand, x-rays were ordered and once printed, it was an obvious metatarsal break, a “boxer’s” fracture, and Dr. Yadav suggested a plaster cast. This is where it gets frustrating. In some slightly heated back and forth, the doc and the mother were conversing in Nepali and next thing I know we’re forming and strapping some cardboard on his forearm down to his palm and wrapping it. A “soft” cast and he was on his way. Privately, with a tsk-tsk motion of his head, the doctor told me this was a common problem in Nepal. People just can’t afford proper medical care and after inquiring into the price of a plaster cast – $7 USD – I realized what they were dealing with. There is no insurance and therefore no uninsured benefits. You either have it or you don’t (most don’t) and while the hospital won’t let you walk away without any treatment, more likely than not, the treatment patients get is based on what they can afford rather than what is necessary. “Chances are,” Dr. Yadav said, “he’ll have limited mobility in his third and little finger for the remainder of this life.” Obviously frustrated and yearning to help, he confided he had already left this hospital once when chastised for re-using sanitized leftover sutures he’d saved from previous procedures on the poorest people and not charging. “I just want to help but the administration is all about the money,” he finished. These conundrums, amongst others, held true throughout the rest of my time there.
Another thing I noticed was many feverish babies. I’m not sure if this is common stateside but most were prescribed antibiotics and sent along their way. This brings up another big point: In Nepal, you do not need a prescription to buy medications. This has led to rampant overuse of antibiotics, people “popping Cipro like it’s candy” at the first sign of a cough, and has resulted in the average antibiotic dosage being given at 40% higher than the norm! Doctors here suggest that most of the population of Nepal are slowly developing immunities to common antibiotics and it’s only a matter of time before they stop working altogether. In one instance a four-month-old baby had a fever of 103-degrees, dangerously high, and it was recommended to keep her overnight for monitoring. Yet again, cost was an issue, and the family walked out with nothing more than five days’ worth of antibiotics and a fever reducer.
From broken feet to dog bites, drunken fist fights resulting in broken clavicles to broken arms from falling off motorbikes in Kathmandu’s notoriously crazy traffic, two things became certain in this bloggers 7-day experience: the continuous under-treatment and over-prescription taking place is a dead-end street and the pay-to-play healthcare system in Nepal is broken and in need of a serious revamp. But unfortunately, by the time this happens, most doctors will be gone; there will be a continuation of the 20-year brain drain, which this country and its neighboring India have already realized. The doctors here are sitting for the USMLE in a few short months: Dr. Yadav will be in Dallas, Dr. Yogi in Chicago, and Paramedic Manoj, he says he’ll “go anywhere but here.” More than anyone, they realize fully the difficult problems their nation faces yet know full well, when rampant corruption at the top is the norm, nothing they do can help.
Should our JustABuck™: Nepal Notebook Campaign continue at its current pace and everything is executed perfectly as expected, our next JustABuck™ campaign will be a free health clinic in Kathmandu in collaboration with the Nepal Volunteers Council. Business plans are already being finalized and both Erin and I are really excited to see this project through. Stay tuned for more details and updates and as always, thank you for reading, commenting, and your continued support.