Patan Dhurba, public taps & things that sometimes happen to patients on their way to proper diagnosis

Elisa and I took some Aussie and an American guest a few blocks from Patan Hospital to visit Patan Dhurba Square.

 

Very common sight: people line up to get water from the public taps (because they do not have water in their homes).  

 

A new leprosy patient reported to our doctors recently. His right hand was swollen from a leprosy reaction. No one had correctly diagnosed him previously. A well-meaning relative had placed a traditional hot poultice on him – which explains the burns. Another patient came in with 3 severe burns on his elbow. Wanting to test nerve damage by sensation of hot and cold, a doctor from somewhere else had taken a glass test tube of boiling water and held it to the patient’s skin in 3 sites around an elbow lesion. “Do you feel this?” The patient felt nothing because the nerves were damaged from leprosy. However, one is supposed to use warm water – not boiling water!

View from within the burned out forest above Anandaban (hilltop)

To see information about the forest fire, see postings from April 2010.

Mountain hawk-eagles and more nature observations

There is a pair of these that stay in the trees about my house for many hours every day. From these steep hillside treetops, they have a nice view overlooking a rural valley of hand-farmed fields. Whatever they are, they’re a very talkative species with piercing cries as they circle and land, circle-dodge ravens– and land, soar – circle and land, etc, etc.

 

Someone saw one of them in the tree with a serpent in its mouth. In the high hills, we do not see many snakes and most are not poisonous. (Snakes/poisonous ones are more common in the hot Southern flatlands, but here we see maybe 2 slow moving rat snakes a year.) Nevertheless, the mongoose and hawk-eagle yard patrol is much appreciated as well as entertaining.

 

The monsoon rains have not officially begun – but the insect eggs from last year are awakening with the pre-monsoon occasional showers. The cicadas, locally called the “boring bug”, have started their monotonous monotones. They won’t begin to die out until the end of July or August. Sometimes they are so loud in the evening, that even with the windows closed, it is difficult to hear someone trying to speak on the other side of the room! I typically do not see many roaches – but the other day sighted one that probably could take on a mouse. The giant slugs (~5-6” length, 1” diameter) and their arch enemy, the slug-tigers with green glow-in-the-dark spots on their rears, will appear within the next month or so. But, thankfully, the summer leeches have not yet become a common sight. J

Mongoose sightings & Nepalese Orange mosquito hawks

 

Nuwakot Camp Pics: last patient

The last patient of the camp: he walks boldly in, declaring vague stomach symptoms to Dr. Pradeep as Dr. Indra looks on. Dr. Pradeep began to ask the standard questions without receiving the normal answers. “Well, it’s not happening now. Sometimes.” A smile and a another question. “Well, really it’s for my Grandma.” Dr. Pradeep writes a prescription for a one dose chewable dewormer (something essentially everyone, kids to Grandmas, needs here anyway).  J   

Nuwakot camp: Dental room

I did not spend too much time in the dental room this camp. They extracted around 30 teeth with anesthetic. Extraction is essentially what Yam and Karuna can do during these camps – and it is amazing to see some people so happy to have a troublesome tooth removed. Honestly, though, when I went in the room, Yam was removing a tooth. And the cracking sounds weren’t pleasant. The next patient looked on indecisive. The receiving lady calmly declared she felt nothing while Yam yanked, cracked and pulled. So…I did not stay in that room that long this time. J

Nuwakot camp: General, skin, women & children rooms

Sylvia, a Swiss nurse, and Neeru (a translator) talk to a patient. Dr. Ponkaj listens to a mother and daughter. Two Swiss nursing student volunteers weigh and take the blood pressure of women patients for the gyne room. Dr. Min checks a baby’s feet while his mother describes symptoms. Nearly everyone has recurring stomach complaints, so antiparisitics and dewormers are essentially given to everyone.

Nuwakot camp: Ortho room

For this camp, I performed door patrol duty mostly for the orthopedics room, which also took in general patients. An 8yr old boy came with a shortened Achilles tendon. It was obvious when he walked that something was wrong. Living in a steep hill area, he is carried to school. A 10 minute subcutaneous surgery, 3 wks in a cast and week of physio could fix it. We’ve asked them to come to Anandaban for surgery. He could then walk to school on his own. Dr. Pradeep checks a man’s leg. Dr. Indra checks a lesion on a girl’s neck to see if it is leprosy. It wasn’t. If it was leprosy, she would not feel his pen touching her there. Skin diseases are a common problem here (fungal sores on someone’s stomach). Also, handing out donated clothes to people (sleeping baby in new shoes). And a baby who was not all enthralled that I was around – so I left his field of vision before he cried. If you notice, his hair is not coal black – a sign of malnutrition. Most kids are also small for their age and so are older than whatever your first guess.

Nuwakot camp: Setting up

Extremely common site of women carrying basket loads of fodder and/or kindling. We quickly sorted the rooms for gyne/pediatrics, ortho, dental, general and skin, clothes and pharmacy with registration just outside of the main doors.  We went to the roof for a quick cup of tea, local donut and a boiled egg for breakfast. Prepped some of the vegetables for Shudarson to cook dal bhaat for lunch and then headed back down to work.

 

In the group photo: anandaban staff, Elizabeth (student, American Leprosy Mission volunteer), Natalie & Isabelle (Swiss nursing student volunteers), Dr. Betty (KTM volunteer), Sylvia (Swiss nurse instructor, volunteer) with her translator Neru, health post staff and volunteers. We were very high up in the hills. If it had been a clear day, you would see a strip of gorgeous white Himalayas behind us. But clear days like that only happen maybe 60 days total out of the year! They are breathtakingly beautiful when do they happen.  

Nuwakot camp: Getting there and arrival

3 hrs bus ride there + 3hrs bus ride back = 6hrs in a bus

6 hrs at the camp

377 people provided free medical checks

About 30 teeth pulled

 

We drove to the Kakani Health Post, which is VERY high up on a steep hill. For the final steep descent into the driveway, we had to get off of the bus. J Pictures never show enough depth to do mountain justice. Good picture of Kedar, our bus driver. On narrow mountain roads, we much appreciate his skill. When the clouds threatened rain, he laughed and said that he would take the bus downhill if it began to rain. There was no way we could navigate that thing loaded downhill on slick clay roads (mostly just wide enough for one vehicle)!! Patients began to come as soon as we arrived. Pictures from the village closest to the building. Due to the steep hilly area, people live in small scattered villages – wherever flat space for a home or garden can be carved. Anandaban staff had come the week before to spread the word over a wide general area that a free medical camp was coming. Some people walked 2-3hrs to come.  The health post was a really nice building – but usually in harder to reach places like this, staff, supplies and ability are limited. Can you imagine having the nearest health facility 2-3hrs walk away (or even days walk away)? What if you broke a bone, had a relentless fever or needed a c-section? For contextual reasons, these places are often at the top of a steep hill on public land no one else has use for. Often a doctor may not be available (ie, “gone to KTM”), the meds needed may not be available, the goat paths are steep and narrow (meaning the patient must be carried up), and you had best not need anything remotely like surgical intervention. Nevertheless, it was a nice building and local staff and volunteers came to help sort the people.

Sad News

A few days ago, an elderly woman died in the wards. During the past year or so, she had been admitted more and more frequently – I think with the wounds and ongoing foot problems too commonly left from leprosy (see pic on blog update April 20, 2009: http://behindpalacewalls.blogspot.com/2009_04_01_archive.html ). The others called her Grandmother and her husband, Grandfather. Her husband was unique. So often spouses abandon or reject when someone is diagnosed with leprosy. But he did not. It was a common sight to see him walking uphill every day to be with her. I heard that she would not eat until he would come. Even when she was cranky and her wounds disturbing – he came. One of the guests took this picture of him about a month ago weaving one of his baskets.  A few nights ago, she died on her bed. He came. Someone told him not to cry – but he refused saying that he was the one to know what it felt like. Please pray for him. We may not get to see him now, since she is gone. He makes my heart hurt.