Monday, February 25, 2013

Sidha Sadabahar Clinic

February 26, 2013

Every time I've traveled overseas, I've felt a desire to volunteer or give back to the amazing people that I meet. It's one of the reasons I became a nurse. Therefore, it was a priority for travel this time around. Luckily, my friend Mary was interested as well, so we did (a little) research before we left, found an organization called Hands For Help Nepal based on a friend's recommendation, and signed up.

We arrived in Kathmandu, and instead of bargaining for a taxi outside of the airport, we were met by a guy holding a sign that said "Abby Koszarek", and, like royalty, were whisked to our hotel. We spent two days in Kathmandu, learning Nepali, walking the streets of Thamel, and visiting temples as part of our "cultural orientation". Badri, a large Nepali man who has been the head of the organization for over fifteen years, briefly described the hospital we'd be spending our time at, and assured us that our home-stay and everything was all set up. We'd be the first volunteers at this particular sire, but he assured us that he had spoken with the hospital commissioner many times, and were "so excited" to have us.

Khadijaur, the village that we were placed, lies about 60 km northeast of Kathmandu, but takes about three hours to reach. We pulled into the hospital courtyard, and were met by a gaggle of wide-eyed villagers, patients, and clinic staff. Mary and I stood awkwardly in the sun, trying to appear calm and confident. After several minutes, we had a quick meeting with the head doctor, who appeared surprised that two foreign nurses had appeared at his hospital. Turns out the hospital commissioner was out of town, and hadn't told anyone of our arrival. Badri did a quick introduction, then wished us luck, and sped away. The doctor gave us a 30-second tour of the facilities, and then excused himself to get back to work. Mary and I looked at each other with mixed confusion, amusement, and dismay. Here we were, in a random village, without a place to stay, a place to eat, and major confusion as to what we were supposed to do as volunteers. We did a micro-lap around the courtyard, smiled and nodded to some people, and then bolted. We walked up the road, took a little path through some terraced fields, and found a place to sit and observe our surroundings. Not knowing when our next meal would be, we devoured the cookies we had brought as a home-stay gift, and giggled about our circumstances.  We eventually made out way back to the hospital, and after much scrambling around, were given a big room and shown to the hospital cantina for dinner.  Regardless of what came next, we would be well-fed and have beds to sleep in.

The next day we wandered to the hospital in the morning, met the doctor and tried to formulate a plan. I would shadow him for the day, and Mary would hang with the nurses in the ward. I sat in the doctor's office while he saw a couple patients, and then the morning rush was over. Turns out it's the "slow time" for the hospital; the dry season minimizes GI illness, and fewer people travel so accidents and traumas are less common. I tried to make small talk, and he politely answered all of my questions. But, when he suggested I  go outside and enjoy the sunshine, my chattering teeth and numb extremities won, and off I went to the courtyard. I spent the morning talking mixed Nepali/English to the bored hospital staff and some children, and when I met up with Mary at the canteena for dal bhat later that day, she had a similar story to tell.

What were we going to do there for two whole weeks? What could we possibly accomplish? It certainly seemed like there was potential for them to benefit from volunteers, but how? I couldn't help but be a bit angry with Badri, our volunteer coordinator, for failing to prepare us, or the hospital, for our stay. I had assumed we'd be busy with day-to-day tasks, like triaging patients, or giving immunizations, or assisting with vital signs - mostly providing an extra set of skilled hands for what I thought would be a busy, understaffed rural hospital. But, they weren't busy. We talked about creating and implementing a public health campaign, but Mary, a community health nurse guru, reminded me that we needed a comprehensive community needs assessment before we just assumed that we knew all about what would improve health for rural Nepal. We went to bed that night feeling a bit demoralized, but decided to spend at least one more day at the hospital, awkwardly milling around in hopes of inspiring a purpose for our volunteer stint. 

Happily, the following day was better, much better. We participated in morning rounds, showering the patients with our smiles and "namaste!" while they conversed with the staff in Nepali. We learned that in Nepal, and other developing countries, the WHO has developed diagnosis standards for common diseases like pneumonia and tuberculosis that are symptoms-based (like respiratory rate, fever, etc) instead of results-based (like sputum cultures, etc). So if an infant comes in, hasn't been able to feed, has a fever and a respiratory rate above a certain number, the doctor diagnoses pneumonia and can prescribe antibiotics in a rural area without access to a complex lab or x-ray. These are all standardized, and have been tested with great results worldwide. It's quite fascinating, and I made a mental note to research it further later. We watched as a man who had nearly sliced his hand in two on a woodsaw walked into the Emergency Department, was shuffled back to the "procedures area" and after being given a shot of pain medicine and some topical lidocaine, endured a full-on repair of his tendon, placement of a steel rod through his finger and into his palm to set the tendon, and extensive suturing. It was unreal. 

We also got to know the staff a bit better: the gaggle of nursing interns, there to learn for three months before returning to their smaller villages to work; Raju, the lab technician; Sangita, the pharmacist who sold us antibiotics to round out our traveling pharmacy; Urmila, a nurse with moderate English who delivers babies by herself (!!); and Ram, the medical assistant (like a PA) who can start an IV in about 14 seconds. We talked with all of them about their jobs, shared stories about our nursing jobs at home, and actually felt like we were maybe getting somewhere. 

The next few days we busied ourselves with visits to local schools to talk about the health issues they face. We decided to forego the community needs-based assessment, and do an on-the-fly survey while talking with them. We named our presentation "Take Pride in Your Health!" and had a lot of fun brainstorming and then teaching them about basic things like handwashing, nutrition, covering your cough to reduce disease transmission, and other things along those lines.  It wasn't rocket science, but they seemed to enjoy it, and it gave them a chance to practice English and us to practice Nepali. And, for the rest of our time in Khadichaur, kids in town recognized us as the health workers, and would run up to us and say hi. One afternoon, we were playing and talking with a group of kids, and when we said goodbye and turned to leave, we were serenaded by an impromptu chorus of "Please Come Back! Please Come Back!".  It felt good. We also provided some education in the form of lectures for the nursing staff at the hospital, especially targeting the nurse intern gaggle. Again, we stuck to simple things like the Glascow Coma Scale, head to toe nursing assessments, and signs and symptoms of basic diseases. We found health posters on the internet, in Nepali, and hung them on the bare concrete walls of the hospital, adding some color and hopefully generating some conversation and awareness.

We also did lots more "hanging out" at the hospital courtyard, learning Nepali from staff and patients, eating amazing dal bhaat made fresh from Vupindra , the cantina cook*, and escaping for afternoon walks up to smaller communities nestled in the mountains. One afternoon we were cajoled into having tea and biscuits with a man and his mother, father, and grandmother. When we found out we were working at the hospital as nurses, he ran into his house and came back with a blood pressure cuff and stethoscope. Why he had it, I have no idea, but we took blood pressures of him and his family, and wrote them on a torn piece of paper that he carefully tucked into his shirt pocket. They are all subsistence farmers, and run up and down terraced fields all day, so not surprisingly, their blood pressures were perfect (even his 90-year-old grandmother!). Another afternoon we stumbled upon an entire family hand-carving a wooden plow and preparing their oxen in anticipation of the planting season. They also insisted we sit down, eat some roasted popcorn and nuts, and drink enormous bubbly glasses of fresh mohi (watered-down buffalo milk - not the easiest thing to swallow without gagging). Everyone was friendly, welcoming, and wonderful.   

When we came to the end of our stay, everyone seemed genuinely sad that we were leaving, and Facebook addresses were traded frantically. Badri returned to pick us up for the return trip to Kathmandu, and we spoke briefly with the hospital doctor and at-length on the ride home about what went well, and what would be important for future volunteers to aid in their success. I had no illusions of changing the world in two weeks, and although I had hoped to do more, it was a good "first experience" of what it is like to volunteer and share knowledge in a rural, developing nation. I'm excited to do more!

*Funny aside: We called Vupindra "Popendra" for the entire time we were there, and he graciously never corrected us once.  On the last day, we presented him with a thank you card that was filled with our meager attempt at Nepali writing that had his name spelled wrong, and one of the other workers read it and told us it wasn't his name.  Vupindra just smiled and shrugged, then tucked it into his pocket for safe-keeping.

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