Working in the HIV/AIDs clinic for the second week has helped me to see the pluses and deficiencies of the hospital as a whole. The hospital is the poor relation of the main general hospital sited elsewhere in Kathmandu. The nature of the speciality means that it deals with the very very poor section of the community.It is the hospital for tropical diseases, focusing on treating patients who suffer from D&V, Malaria, Tetanus, dog bites (Rabies ), snake bites , TB, Dengue fever and countless others which I have never heard of.
It is difficult to understand the politics of management here. The director of the hospital (equiv to Chief Execs in UK ) changes every 3 to 6 months. What that means is that there is constant upheaval and changes of direction in the way the hospital is run, or rather not run. It is not my place to judge. Suffice to say , the front line staff are working as hard as they can , with no support from the senior management. And we think NHS is bad. Well, you aint see nothing yet
To cut a long story short, there is an Emergency department in the hospital. However, there is no basic resuscitation equipment here. If a patient is brought in following a snake bite. and collapsed as a result.There is no airway, mask or anything at the hospital to revive and keep the patient alive. S/he will be packed off in an ambulance to the main hospital. Often s/he does not survive the journey. life is cheap here
It is only natural that I have alot of questions like' How can a hospital function for how long ? without the most basic equipments ?' , 'You call this a hospital? ', 'What is the government doing about it ? ', ' What is the director doing ?' ,'I can't believe you can have an Emergency department , and not have the most basic stuff to sustain life ', and so on.
Having met with the senior doctor( =Medical Director ) Dr Pandey, we agreed that we would spend the funding raised from the sponsors to purchase the equipments for the resuscitation trolley, plus a printer for him .He has just acquired a computer, but the money didn't quite stretch enough to include a printer.So there you go
The way things are done here suit my approach totally.I have sights of the purchase, and checking through the list to make sure that nothing is amiss. We purchased a suction machine with tubes x4 for both adults and children, Ambu bag, cloth masks x2, laryngoscope , auriscope with connectors for children and adults , nebuliser with relevant tubes, sphymometer with cuffs for adults and children and some other items I cannot remember. Last but not least, a trolley to put all these euipment on .In addition, 2 heaters for the nurses working in the clinic.
This lot has come to approximate 550 pounds give or take the plunging forex.It was 123 Rupes to a pound when I first arrived on 28/10. Last week it went down to 112. I will need to do an average of the 2 in order to get a fair rate.
It is a rather emotional experience when I have been going round the hospital with Dr Pandey .There are patients who were brought in and not being visited by a soul. No treatment can commence because they are unable to verbalise or they were unconscious. They just lie there day after day, incontinent of both systems. Its pretty horrendous for the poor nurses as well. I am pretty sure I have been in contact with TB patients. So I need to check out with my GP on my return to UK
The poor nurses are working in the most extreme conditions here. In the clinic where I have been based, there is a window missing. One of the nurses is seated there everyday, dispensing the drugs for Retroviral therapy . The winter mornings are very cold now. There is no such thing as central heating in Nepal. Period. The weather has been getting colder in the past week. She is getting a stiff neck and shoulder through the exposure. .There is nothing the hospital will or can do about it. Without realising it, I was sitting there helping her dispensing this morning. Though I was only there for 3 hours, I was frozen stiff. They don't complain because they have given up trying to get things done, because nothing ever gets done. So I told her to go and buy a large clear plastic sheet. Tomorrow we will double it and pin it to the window frame. And I'll find the money for it. She was very happy.
The nurses here work very very hard , under the most difficult conditions . Yet they gave me time, explained things to me repeatedly and very patiently.. I must admit at times I wonder where my grey matters have disappeared to. The second week have seen me in a better position to help more intelligently. We are now working as a team , according to them ! Fast work if you can call it that.There are so much unmet needs here, at every level. I have to accept that they can never be totally met.
My time to leave is fast approaching. I have 3 more days at the clinic.I have had a good run for my money.I have learnt a great deal, gained better underatanding of how and why things happened in Nepal.For that I am grateful