Yesterday was my first official morning at Kirtipur Hospital. It started with an 8am roll call with Dr Rai and his team of surgeons in the Burn/Plastic Surgery Unit, which included practice runs of two presentations that the team were working on. It turned out to be a great morning for me to learn more about the Burn Unit and its statistics since 2014.
Items that stood out most to me:
- Most of the patients who end up at Nepal Cleft Lip & Burn Center are NOT from Kathmandu Valley. This means they have had treatment elsewhere and were referred to Kirtipur Hospital because they either have no money (or run out of money) to pay for treatment or that their case has become too complicated for the local hospital. Their recovery is also compromised because of the delay of proper care.
- Many patients have developed some form of antibiotic resistance.
- Patient/community education about medical care is still very retarded eg when a patient it put on a ventilator, the family just assumes that they are about to die; and, the skin bank has only had 1 donation this year despite presentations to the local Lions and Rotary Clubs.
I had expected to be just in the physical therapy clinic/room but at 9am we started rounds at the Burn Unit. There were new patients who were admitted during the festival days and the doctors and physios had yet to assess them.
The patients I had an opportunity to work with:
- 16 year old girl with an open fracture on her pinkie on her right hand with part of the palm missing. She was walking along the road when she got her hand stuck in a tractor (scarily, not an unusual occurrence in Nepal). She had gone to another local hospital where they inserted a Kirschner wire (in the wrong direction, which limited her range of motion in the wrist) and had put the entire hand and forearm in a cast. The other hospital had told her they were planning on amputating her hand. Nonetheless, she was discharged and sent to Kirtipur Hospital because her family had no money for her treatment. There was no need to amputate as she had good sensation and movement around the fracture and open wound. The surgeons were also going to remove and replace the Kirschner wire correctly. Post-op the plan was to put her in a cast only from palm to forearm so that she could still move her finger to maintain mobility.
- 80-something year old man with a history of COPD & cardiac issues who was struck by lightning (again, not unusual in Nepal). He was on oxygen because he was having difficulty breathing. He also looked highly dehydrated, despite IV hydration. His family had said he was unable to keep down fluids but they did make up some ORS when requested. We discovered that he was highly agitated and was just petrified by the whole medical establishment. We changed his posture and worked on his breathing and over the course of 10 minutes, his oxygen saturation went from 84% to 98% and he was able to keep down his ORS.
- 20-something year old woman who was caught in a fire in her fabric shop with burns on her face, neck and hands. She was very responsive to receiving treatment and Mohan gave her hand mobility exercises.
- 39-year old male with electrical burns on his arms, legs, neck, throat & pec. Highly agitated, suspicious of care (was convinced that if he was touched or moved, he was going to come down with a fever) with antibiotic resistance. He had been at the hospital for nearly a month. Dr Rai has given his wife work helping with cleaning to help cover the cost of his continued care and medications.
Things to take into consideration for hospital care/stay in Nepal:
- At least 1 family member stays with the patient 24/7.
- The family is responsible for food and basic necessities.
- Especially at a hospital where the patient/family is far from home, the economic impact is devastating, despite having the ability to receive free surgery/treatment.
- Nepalis are extremely suspicious of Western medical care and are highly superstitious, so they usually arrive at the hospital in pain and petrified.
There was a man there in his 30s with major burns on his arms, legs, face, torso due to a cooking gas incident. The surgeons talked about getting skin grafts from his legs with the possibility of needing a living relative donor. I noticed that the surgeons kept using the term “male relative donor” and I asked if there was a cultural reason for only using a male relative. Yes, replied the surgeon; but not for the reasons I had imagined. I was reminded that females in Nepal are responsible for so much (cooking/cleaning/child care/paid labour) so it is impossible for them to be unable to complete their chores for 3 days post-op, so a male, who is not expected to do so much, is a better donor. Just when I think that Nepal had no more surprises for me, I still learn something new!