I left Kathmandu two days ago and came to the city of Chitwan were I will be working at the teaching hospital for the next 2 months. I came with the other 2 French nurses. We slept lots in our 5 hours drive, and we eat somosas at the bus stop. Turns out the somosas were not a good idea since we all got sick with a bad stomach flu (that is why I haven't written anything these days). So, we are resting, having lots of fluids and eating only light food.
I went to work at the hospital before the onset of my stomach flu. I was shadowing the nurses at the ER. The hospital is really poor but they have the basics. They have a several vital signs monitors, we can measure Oxygen saturation, we have one defibrillator and we can do electrocardiograms. we do not have IV pumps ( we use the drip rate)
Things are very different here in comparison to Canada. What stroke me the most is that doctors and nurses rarely use gloves. They keep their hands from touching the blood by being very careful. The needles don't have any security caps, and they have to walk a long way before they reach the nearest sharp's container ( which is not really a sharp container, but a buckle without a lid). They also don't have many stock medications. They only keep a small amount of crash car medicines like adrenaline, which are only used in case someone needs to be resuscitated. They don't keep much of anything else. not even hand sanitizer :( ( I bought my own).
When a patient comes, the family has to go to the pharmacy and buy a bag of medical supplies for the doctor to use. The bag has gloves and needles and catheters ( all the basic stuff that I just take from the hospital shelves in Canada. Things that I normally take for granted). Because this bag has only so many gloves, doctors prefer to use them only when they need them the most.
Also, in Canada we use a lot of disposable catheters kits and dressing kits. Here in Nepal most of the stuff is metallic and can be autoclaved for sterilization. So, you can re-use it safely.
I also find that the family has lots of responsibilities. Each time the a blood test is needed, the doctor sends the family to the lab with the blood and the requisition form. Also, each time the doctors needs a new medicine or IV fluid, the family has to go and buy it from the pharmacy and bring it to the doctor. I find this is extremely inefficient and detrimental to the patient. The family does not know the hospital and they get lost. Therefore, it takes a lot of time to diagnose a patient's condition and to administer the right treatment.
Pain medications are a luxury here. I have not seen any doctor giving pain meds, even if I ask them. Even I asked the doctors if they would give pain meds to a patient who had a stroke, was hypertensive and was susceptible myocardial infarction. I understand that decreasing the pain helps to decrease the demand of the body for oxygen, so there is more blood that goes to the heart, and the chances of heart attack are less. The doctor told me that the patient had no pain and needed no medication (the patient was sweating and moving a lot, and his face gestures seemed like the pain was unbearable) . There was another lady with cholecistitis- stones in the gallbladder- who was also in a lot of pain. She would have gotten opioids for pain in Canada, but she got nothing here in Nepal (I also asked the Doctor if he was going to give her something and he said no). I guess pain management is not part of the protocol, since pain does not kill by itself (In normal circumstances). Here the resources are so scarce that pain becomes a secondary thing. Something that is not life or death.
A good thing of Nepal is that there are a lot of doctors. At the ER we have always a surgical intern, a pediatrician, two emergency inters, and a couple of interns from other units. These interns stay in the floor the whole time. Therefore, they share they expertise among each other and the doctor-nurse communication is really good. (In Canada, I don't even know the doctors who work at my unit. I just document everything in the computer and hope they see it. I only see them during their morning rounds but never really talk to them). The nurses and the interns are also very friendly and they like answering questions about the patient and their medical conditions. They taught me how to place the ECG leads and now I do it every time a patient comes:)
Also, the hospital is very clean! :) They have to ladies that clean it the WHOLE time, EVERYTHING!
