MMH Updates

Hello everyone!
I'm sorry I have not been updating recently! I have been busy with work at the hospital. The last week has picked in occupancy so we are getting alot of good cases. Here are some recent happenings around MMH:

-A few days ago I watched a bilateral inguenial hernia surgery. This was quite an interesting one. Before the surgery I read up on all types of hernias in the medical encylopedia they keep at the hospital. I was so surprised to learn how kinds there are! The definition in the encyclopedia says that one cause of hernias is lifting heavy objects. There must be a TON of hernias here in Nepal because people carry almost unthinkable amounts of weight on their backs. It is not uncommon to see on the street what I call a "walking sofa" or a "dresser with legs." Men who are about my size carry sofas, chairs, tables, dressers, and all other types of furniture on their back with a rope that wraps around their forehead. Also all the moving of bricks for construction is done by carrying the bricks inside wicker baskets with a rope that goes around the head. I think the Nepalis must be some of the strongest people in the world comparably with their body size. Anyway all the heavy lifting must cause a lot of hernias. So there were two incisions made on this man right above his groin. The first hernia went quickly, and the surgeon reinforced it with some sort of mesh. The second hernia was a bit more difficult and the surgeon was getting quite frustrated. But finally he did it. This was a great one to watch.

-I have been seeing a woman in the ER lately but have not gotten a chance to talk to her. It turns out she is American, from Illinois. She always is bringing in the young street boys who are sick, and I think she pays for their hospital fees. I think this is quite a noble thing to do. The other day she brought a boy in with a horrible fever, and then a few days ago a boy with a foot abscess. She is very nice and says she comes to Nepal a few months out of the year and can't help falling in love with these children (who are incredibly cute!) So I played with these street boys for a bit and found them incredibly happy and resilient. I pushed the one with the foot abscess around on one of the wheel chairs and the rest of his friends who came in (all about age 12) thought it most hilarious. I taught them how to high five too. The thing about these street boys is that although their life is quite unfortunate they are always happy and playing and laughing. (A few exceptions.)

-A man today had cut his finger with glass a month ago and his finger became infected so he covered it with duct tape which killed all the tissue around his finger. This did not look good, and the finger may have to be amputated.

-The following case has been my favorite so far (warning to readers: do not read if prone to queasy stomach!) A woman was in the ER today who has 78 years old. I believe she was from the villages outside of Kathmandu. Her 4th toe on her right foot had become gangrenous and her whole foot was beginning to rot. The 4th toe was blue and purple and was basically rotting off completely. It was dripping brown fluid and leaking blood fromt he healthy parts of her foot. I have never seen gangrene (sp?) before so was quite interested. One of her sons who brought her in let me examine her foot and what popped out during my examination but maggot!! A fly must have laid some eggs on the rotting part of her foot and there were now a small family of maggots rooting around her toes. I told the doctor there were maggots in her foot and they were a bit puzzled. The doc that was on duty had only seen maggots in dead bodies so I think was not sure what to do. But soon after, one of the nurses was bequeathed with the duty to pull out all the maggots with tweezers. I stood by fanning the gangrenous foot to with my notebook to keep the flies from landing on her foot while the nurse pulled out all the maggots. I think we got them all out but there might have been a few more lurking. The whole foot will likely be amputated in the next few days.

-A man came in with a snake bite! Well, actually he didn't "come in," he was brought in by his son because he had been comatose ever since he got the bit. A kind of cobra called a karate cobra bit him on the ear. He was about 71 or so. He was unresponsive to anything but was having seizures and coughing up strange things. The day after he came in I was trying to find him but no one seemed to know anything about where he went. Dr. Om thought he had little hope of surviving, so I think maybe they let him go home to "expire."

-A woman was in the other day with epilastic (sp?) anemia. She was covered in bruises. Basically if she even slightly banged something she would have a huge bruise. She had bleeding gums and was constantly tired and always had a head ache. She was only 20 years old and had been having symptoms for 6-7 years. I asked everyone why she didn't come to the hospital for 7 years, but no one really understood what I was saying. I think it was either too far, or she didn't have the money. Anyway, she also had a bleeding disorder. Something like hemophelia, but we learned that with hemophelia woman are carriers but men are the sufferers. So she had some kind of variation of hemophelia.

-The usual cases of TB have come in. One thing I have learned is that tuberculosis is not just a disease of the lungs which I thought before I came here. I have since learned that you can have TB of any organ, the only place you cannot have TB is of the hair and nails apparently. Well a young girl about 18 came in with a distended abdomen. She had ascitis, which is a build up of fluid in the abdomen. She had a TB test which came up positive, and she had abdominal tuberculosis. So in the ER we had to drain her abdomen of this fluid. The doctors missed about 5 times with a enormous needle, but finally the fluid started to flow out. She had to lay on her side while the fluid drained into a water bottle on the floor.

-Tomorrow we are going with the doctors to a free clinic they are putting on for the elderly people about 10 kilometers away from Kathmandu.

-I was walking around the wards and met a man with gout and septic arthritis (i think this is what it is called.) He was an older man but knew English surprisingly well so we chatted for a while. His had was very interesting looking, from the arthritis there were bone build ups coming out all over his hand, and it was all bumpy. Also he had just had his leg amputated above the right knee. He was in high spirits despite just having one of his limbs cut off.

-Dr. Gupta (MMH director) arranged for us volunteers to go meet his cardiologist friend at the Heart Hospital of Nepal. Gupta's driver drove us out to the heart hospital and the doctor gave us a tour. They do anything heart related at the hospital, except they do not do heart transplants. I was very impressed by the hospital, it was incredibly busy and very very modern. Our hospital is very nice too (relative to circumstances) but the heart hospital had some very modern high tech medical stuff. A very impressive place. We toured the pre op and post op areas, the ICU, CCU, rehabilitation center, exam rooms, surgical theaters, and canteen. A great little field trip. In the next week we are also going to get a tour of the teaching hospital.



A few observations about the hospital in general:

-Pretty much every day I sit in Dr. Om's office while he takes patients. I have noticed that going to the doctor is a complete family affair. I don't think I have ever seen one patient who has come in by themselves. The patient usually comes in with 2, 3, 4 or even 5 relatives. They all sit around in the exam room while the patient describes what is ailing them and while the patient is examined. They look quizically at us and are anxious to show the Americans what is wrong with them. Sometimes I wonder what would happen if a patient had something "embarrassing" to discuss with the doctor like an STD, or something else of the sort. I think premarital sex, or anything related to sex in general is taboo to talk about, so I can't imagine this would be easy to talk about with 5 of your relatives standing over your shoulder.

-The patient or the patient's family must buy all supplies to be used for their procedures. By this I mean that when a patient's saline IV runs out, a family member must run over to the pharmacy and buy a new one. The nurses and doctors cannot be bothered by this.

-All the patients are very eager to show us volunteers what is wrong with them. They wave us over and let us examine their rashes, boils, burns, IVs, medicines, amputations, and other problems. They are quite excited of our presence.

-In general, although pretty small (100 beds in total, occupancy usually 50% or less) Manmohan Memorial Hospital is a very nice hospital, modern, with great and well educated doctors. They all very professional and extremely knowledgeable. Most of the doctors did their residency or fellowships in the United States. They are all eager to teach us what they know.

-I was talking to the anesthesiologist during the hernia surgery the other day. He told me to make sure I kept good record of what goes on in the hospital. He said I will never see alot of these cases in America (which is true) and that "human experimentation" more readily goes on here in Nepal. He said life in this area is not valued as much as it is in the west so people will do more brazen things in the name of medicine. I thought this comment was interesting.