Healthcare in Nepal is by most western standards, rudimentary. It also seems as though, at least in this village of Bhaunne, to be a fairly novel establiishment. The reason I say this, is that most of the patients we have seen think that there is a definite medicine for everything and that everything needs a medicine. Like in the U.S and I assume most parts of the world, some patients think they know exactly what they need and some defer completely to the physicians discretion. However, almost every time I suggest that no medicine is necessary, the patient becomes wary. They assume every cough require cough syrup and every fever requires antibiotics. Rarely is a patient happy to hear that they do not need anything. Interestingly, although they want to be overly medicated, many will then also refuse to do anything to a child that will make them cry. This includes checking their ears and making them drink the requested medicine.
Blood pressure is another touchy subject here. We have quite a few patients who daily check their pressures with an insignificant change casing elation or despair. A "good" blood pressure is equated by many to mean "good health". We have one frequent visitor, an elderly gentleman, who sees us and the local shaman about his blood pressure which is consistently alarmingly high. Ritually he visits the shaman who gives him cures such as "walking barefoot" and then immediately comes to us. If by the time he settles down to get checked, his reading is a couple points lower, he tries to convince us that the shaman's advice was valid. if the opposite occurs, he says that it needs more time to work and will come back later.
We see many different pathologies in Nepal than what I'm used to in the U.S. Although there hasn't been a malaria outbreak in this specific area in a few years, that remains a concern. Japanese Encephalitis is in a similar boat. What is seen quite often are different parasitic and helminthic infections. Every year children get "de-wormed". Every abdominal pain has liver parasites in the differential. The most over-self-diagnosed problem that I have seen is liver pathology evidenced by jaundice. It is a very common problem, so much so that any skin discoloration at all is rushed to us to have liver function tests done. LFT's are one of the few evaluative tests we have in our lab along with a microscope for stool, HIV, Syphillis, and glucose monitoring.
About a week ago, a young girl, 5 years old, presented with fever and lethargy. Suspecting viral heritage, We sent her home with tylenol and orders for rest and fluids. She returned after seven days, still the thermometer read 102 degrees Fahrenheit. Starting to get a little worried that this might be some tropical illness I was not prepared for, I decided to give it one more day. I told her to continue her current treatment and in a fervor, spent many hours that night consulting the few medical books laying around. Because Bhaunne is mostly isolated from a lot of outside interaction, there hasn't been much of a chance for HIV to enter the community. That quenched one thought that was still in the back of my mind. Luckily, because I had now more questions than answers, she arrived seemingly as healthy as ever the following morning. This had certainly put me on a bit more alert as to problems I might not know how to ideally deal with.
A few more tidbits I have noticed about the rural Nepali villagers:
There seem to be two primary concerns amongst most of the people. The first being who is marrying who. The second being any focus of religion. Whenever gossip is being spread, it always seems to come down to some social politics of marrriage. Who is good enough for who and what caste is taking a downgrade by an upcoming nuptual. Villagers would try to explain this to me through a thick language barrier, but I think I generally got the drift. These conversations would invariably somehow lead to questions about what religion I was. Being a white American, they assumed I would answer "Christian." Obviously I didn't and when i tried to explain that I wasn't really religious (not wanting to get into a debate about it) they would not comprehend the statement. They would give a blank stare and ask the question again until I succumbed in submission of "Jewish." I thought this would certainly bee enough of an answer until it became clear that this was just as flabbergasting. They simply didn't know what "Jewish" was or that it existed. When I tried different ways of saying it, they would just assume I meant Christian and was a poor conversaionalist. Life here is focused much more on the immediate surroundings and social structure than in the U.S. Taboos of family and religion hold a lot more weight and create a large impact of the village life.
