Week one: Medical Ward

Our first week at Kanti was spent in the Medical wards. Days in the Medical Wards went something like this: arrive around 9:30am for the daily hospital meetings where the docs reported the number of admissions, and occasionally deaths, from the night before. This takes up about 20 minutes. Then we leave the Conference Room and head for the Paying ward. The Medical Department is split into Paying vs. Nonpaying patients. Paying patients afford their own medication and a small fee for their bed, whereas nonpaying patients are completely government-funded.

I was warned that my experience at Kanti would be very much observational; however, I was also told that doctors spoke English and rounds are conducted in English. As we began doing rounds on the Medical Unit we quickly realized that this would not be the case. Rounds are done with 1 staff physician, medical officers (somewhat similar to our residents), lots of Nepali medical students, and a few badeshis (foreigners) – totaling anywhere from 10-15 people depending on the day. Since the contingent of people is mainly Nepali, rounds end up being conducted in Nepali – so for most of the day we’re both mute and dumb. Every once in a while, either by our questioning or their own volition, someone may explain what’s happening to us. But we mainly try to figure things out by peeking at the charts – which is in English – or piecing things together by the English medical terms we pick up.

During our second day in the Medical Unit, we befriended two of the Nepali medical students (Udip and Amit) who enlightened us to the fact that we’re not missing much. Apparently most of the Nepali that we’re hearing is students chatting amongst themselves. The staff physician does very little – if at all – teaching, so the Nepali students are as bored as we are. On the one hand it’s great to know that we’re not missing much, but on the other it’s even more discouraging knowing that doing rounds is really just a means to pass time.

From what I’ve been able to gather, most of the cases that we’ve come across are gastrointestinal related. Lots of gastroenteritis cases caused by a variety of bacteria and parasites. There are also lots of cases of tuberculosis, with the strangest case being TB isolated in the abdomen. This young boy presented with massive stomach distention, which was complicated by malnutrition. We watched the docs drain some of the fluids from this abdomen for lab analysis, and it was one of the crudest operations I’ve seen performed. I had an interesting conversation with Amit at one point about the skill level of Nepal-trained physicians. Many medical students here aim to leave Nepal for the United States – “the land of opportunities” – so they must write the USMLE to apply for residency spots. For most students the theory aspect of the USMLE is a breeze, but the stumbling block in this process is the practical examination. As Amit admits, because of the lack of equipment available the clinical skills training are limited – and this really showed as I watched these doctors fumble their way to drain some of the fluid from this young boy.

I still have no idea how I can contribute to Kanti. We’ve noticed that there really isn’t any sinks around for the patients OR staff to wash hands. Handwashing may be a great project to undertake, but if there aren’t even useable sinks in the hospital, how practical would such a project be?