For our English and Spanish speaking friends I decided to write a little article in english so you guys can keep up with what we are doing here without having to rely solely on google translator! So we (Marcel and me, both working as residents in internal medicine in Berlin) have been in Nepal since August 2nd and are currently working in a Hospital in Banepa, a town an hour east of Kathmandu… We hope you could enjoy at least some of our photos so far and we might also post the occasional English article here in the future, too.
Why Nepal?
Marcel has a Nepalese friend, Birat, who studied medicine in Germany. They both went to med school together and back then they had made some vague plans to go to Nepal together sometime in the future. Birat always wanted to go and give something back to his country, he first worked as a doctor in Germany after graduating, then went back to his homecountry to help after the earthquake in 2015 and is currently back in Germany again. You can read a bit about him and what he has been doing in Nepal in Marcel’s article from a few days ago… (you will need the translator though..) Marcel wanted to go with him and visit Nepal sometime, maybe work here as well but there had never been any definite plans. Anyone who knows me knows I can never stay too long in one place and want to see the whole world, so I had planned to go and work in the field of medical development aid sometime during my residency. So we decided to go to Nepal more than a year ago, asked our boss for 6 months of unpaid leave which he kindly granted us and then began making plans.
What are we doing here?
During our research and planning phase we found a German organization called Brepal [Title](www.brepal.de), which was founded by a German doctor, Dr Klaus Eckert, who has frequently visited Nepal and wanted to improve the medical care for people here, which is still rudimentary or absent in the remote and rural regions of the country. So some years ago he opened a health post in Banjakhateri, a village too small to be found on google maps in the western province of Gulmi. There’s two regular staff members, Bishnu, a Nepalese medical technician and Laxmi, a Nepalese midwife, who live in the village. Additionally, visiting German doctors come to stay and work there for a few weeks after the monsoon season, training the local staff in small procedures and providing healthcare to the community. For example some dentists have been there in the past to teach the medical tech how to pull teeth!! Klaus had already told us, that it would be impossible to reach the village before September, due to the heavy rainfalls in the Nepalese monsoon season, which cause landslides that make the roads leading to the health care post impassable. Krishna, the local manager in Kathmandu will take us to Banjakhateri on September 12th, the journey involves a day long bus ride, a 4-wheel drive up the mountain roads and then a 3 hour hike… We will work in the health post for 3 weeks until the next doctors arrive and are planning to do some trekking in the Annapurna Region (Annapurna circuit) afterwards.
Because we had planned to stay in Nepal for 3-4 months to work and travel here, we still had a lot of time left, so asked Klaus if he knew any other hospitals or organizations operating in Nepal that were looking for volunteers. He told us about the German rotary voluntary doctors, an organization which supports local hospitals in Ghana and Nepal. We contacted them and arranged a 4 weeks placement in a Hospital in Banepa (Scheer Memorial Hospital), where we are working right now.
What we have done so far
We arrived in Nepal on a rainy night of August 2nd. Birats brother Samrat and his father picked us up at the airport and we spend the first week with his family, savoring his mums tasty Nepali cooking and taking in the sights of the Kathmandu valley. The first days were a sensory overload of sounds and sights – crazy traffic on dusty roads with no apparent road signs or traffic lights, constant honking of horns, whether to alert pedestrians to a motorcycle behind them in a narrow road, to indicate one’s intention to overtake another car or to offer a taxi or bus ride to aimlessly wandering tourists like us. The roads are overflowing with motorcycles and tiny busses transporting at least three times the maximum passenger capacity, boys holding on to the open doors of these shouting out the buses destinations to potential future customers. Dogs are sleeping on the smaller streets during the day and barking during the night, the occasional cow sits by the road, unimpressed by the passing traffic. We visited several Buddhist and Hindu temples, the backpacker district with all its bars, cafes and tracking equipment stores and the old towns of Bhaktapur and Patan (two former separate kingdoms next to today’s capital Kathmandu) and their respective Durbar squares – the sites of the ancient kings‘ palaces and temples, once the glorious centers of their cities, now UNESCO world heritage sites, that, despite suffering extensive damage from last year’s earthquake, still retain the grandeur and beauty of days gone by. You can see the devastating results of this natural disaster that claimed so many lives last year in severa regions of the Kathmandu valley: many houses still lie in ruins, piles of bricks and wood are being stacked by the sides of the road to reconstruct the buildings, some people live in only half finished houses with large parts of the walls still missing, others are still relying on the provisionary shelters – sometimes hardly more than a tent.
During our time in Kathmandu, we had the opportunity to meet Birat’s friends Ripu and Raja who live here and who invited us to their homes, showed us their cities, assisted us in the difficult art of bartering and celebrated their local festivals with us; Birat’s brother Bishal organized our first ever custom-made item of clothing – a fitted white lab coat – and our stomachs slowly adjusted to the spicyness of the Nepalese cuisine. Two weeks ago, we were picked up by a van from Scheer Memorial Hospital and left the big city for a smaller, quieter town closer to the green hills that surround the Kathmandu valley. Welcomed by K., a lovely American lady who has worked here as an English teacher and her husband R., who is the hospitals anesthesiologist, we moved into our spacious appartement on the Hospital grounds, which to our delight has a hot shower and a western toilet (for anyone who has never been to Asia, the traditional local toilet consists of a porcelain coated hole in the ground with two footrests on each side to place your feet while you squat down to do your business and a water bucket – nothing that can’t be learned or hasn’t been practiced on the odd camping trip in the past, but if given a choice, we still prefer our regular potty…).
The Hospital
Scheer Memorial Hospital was founded in the 1950’s by missionaries of the seventh day Adventist church. Many doctors and nurses who work here belong to that church, the patients of course are mostly Hindu or Buddhist. It is a 150-bed private mission hospital run by the church providing care to people of the surrounding area who sometimes have to walk several hours to get here. There are about 20 doctors working here, among them locals as well as 3 ‚expat‘ couples who have been working and living here for several years. There is no health insurance in Nepal, so everyone who comes to be seen by a doctor passes by the cashier’s desk first. Afterwards people either go to the emergency room (comprised of 5-6 beds) or the outpatient department (OPD), where we are working. Unfortunately, our paperwork is still being held up in some bureocratic limbo and the Nepali medical board hasn’t issued our license yet, so that we can only see patients together with a Nepalese Doctor. During the monsoon season, many patients present with fever, infectious diseases are a lot more common than back home in Germany. We have seen medical conditions that we had only heard about in medical school, not expecting to ever actually see them in patients like typhoid fever or poisoning with organophosphates (compounds used in some insecticides) which is a frequent attempt at suicide here. In the OPD the patients are interviewed and examined by a doctor (we are getting help with this from the two clinical assistants Sanu and George who kindly translate for us) who then decides if they can be send home with a prescription for medication, if they are admitted or if they need further examinations. If for example a blood sample, a urine test or an x-Ray are ordered (a CT is not available, patients need to be transferred to another hospital for those), the patients go back to the cash desk, pay for their examinations and then get them done to present with the results at the OPD again in the afternoon. Sometimes though the patients are too poor to pay even the few cents for certain examinations and can’t afford those. From 1 to 2 pm there is a lunch break which we usually spend at the hospital’s canteen which serves the national dish dhal bhat (copious amounts of rice with a small bowl of lentils, some veggies on the side and a spicy chutney/pickle on the side), egg fried rice or noddles or – very popular with staff and ourselves and therefore quickly sold out – momos, the Nepalese version of ravioli filled with veggies, chicken or buffalo meat. Afterwards it’s back to the OPD till 4 pm, when our work day officially finishes. The Nepali working week has six days, Saturday is everyone’s day off and on Friday work finishes early at 1 pm. This conveniently matches the seventh day adventist’s sabbath, which lasts from Friday sundown to Saturday sundown.
Interestingly people can buy just about any medication over the counter without a doctors prescription – every doctor’s nightmare if you see 16 year old girls with a common cold who have already taken 3 different antibiotics in the last week or people with (wrongly) self diagnosed diabetes who started treating themselves without consulting a physician first. If someone is admitted to the hospital, one relative always has to stay with him or her, some rooms even have a small bench on which they can sleep. This in not only tolerated but required by the hospital, since these relatives have to run errands such as buying newly prescribed medicine or infusions at the hospitals pharmacy, provide food for the patients, feed or wash them. If patients are very sick and modern medicine has reached its limits, it’s common for the families to take these patients home so they can die at home in the presence of their family instead of the hospital, which is viewed as a very bad omen. In Hindu religion, the deceased are being burned after death, for example on special cremations sites by of the Bagmati river in Kathmandu, which is considered a very spiritual and holy place.
