Les wrote this about 2 weeks ago – but then we got busy with work and helping Hannah get ready to move away from Nepal. (More on that later). Hope it is interesting still!
This is the busy season at Tansen hospital. Monsoon is not yet fully established, so there is no rice to plant. The roads are still mostly passable, before some of them get washed out with the rains again. The people from along the Indian border, who are used to warm weather, are no longer afraid to come up where the temps are now usually in the mid 80s. This is not bad for sitting at home in the breeze with a cold drink, but it makes the clinics very hot, with short tempered visitors all anxious to get seen quickly and get out of the building. Ceiling fans help a little, but we are all sweaty and grumpy in the heat of the day. (The only air conditioning is in the operating rooms.)
After a string of very busy hot days last week, I (Les) was told that we had set an all-time record for our outpatient department, seeing 510 clinic patients in one day. This inspired me to go look at the annual statistics on how work volume at the hospital has changed in the past decades. Some of this is showing the changes in the country of Nepal and the environment the hospital is working in. Some of the change is due to improved services that we are now able to provide.
Dates of stats 1990-91 2015-16
Total Admissions: 5663 12728
Bed Capacity: 102 169
Overall mortality rate: 5.65% 2.43%
Total deliveries: 536 2295
Caesarean Sections: 12.5% 14.2%
Outpatient visits: 100,218 98,338
Full time Nepali staff: 255 396
Expatriate Staff: 16 12
There has been some population increase in our area, but most of the increase in patient load is from the building of roads and increased access to vehicles to carry patients from the villages to Tansen. There is also more awareness that doctors can help with illness. I hear a lot less now days about visits to the witch doctor, or illness being causes by spirit possessions.
Another change these days is that a patient quite often presents with a condition which needs a consultation with a specialist. When the family has the means to pay for the trip into a medical college, we refer them from Tansen to Kathmandu or another city. However, there are also more services we can provide in Tansen: a High dependency Unit with ventilator support, many more lab tests (especially biochemistry), endoscopy, echo-cardiograms, and CPAP for babies. Most orthopedic cases are managed operatively rather than by prolonged admission and traction. Broken legs usually go home in less than a week. Laparoscopic surgery has been started on most types of cases, which also has a shorter recovery time.
I am not sure why the mortality rate has gone down. Maybe we are able to save more people, or maybe we are admitting some “less sick” people. And many of us believe that the continued prayers from around the world affect the work here as well.
Deliveries in this district are now happening in a hospital 90% of the time. This has caused an explosion of our maternity case load. (Just last night while on call I attended a breech delivery, a forceps delivery, and a complicated obstetrical tear that needed repair. All of the women and babies are doing well this morning.) Cesarean sections have not increased very much. Both of these are good statistics for pregnant women in this district, who now expect to survive the delivery and have a healthy baby. (I still have a very vivid recollection of a woman in labor during our first few years in Tansen. She cried through the first hour she was with us about how she was going to die. I thought she was just afraid of labor pains, until she finally looked at us and said, “Are you saying that I’m not going to die?!?”)
The most important statistic though, in my opinion, is the last one. We continue to move towards a facility fully run by Nepali staff. We are able to recruit more local people who have the basic qualifications we need (doctor, nurse, accountant, etc.), even if they do need some additional training after we get them. And we have a large group of interns and residents working to learn at our hospital, some of them Christian. I see a future where the missionaries come in fewer numbers to not just “be the doctors” at Tansen hospital – but to train and encourage the Nepali doctors and staff in their work. In the meantime, we continue to covet your prayers and gifts for the work at Tansen hospital.