A night on call here in Tansen can be very restful, or it can bring interesting and sometimes painful encounters.
Last week I was called to the ER as the intern and resident also on call were having trouble getting a history for a recent arrival. Now – most of the time we can get a medical history by talking either to the patient or to the family members who accompany him or her. We sometimes do have language issues – most people speak Nepali, but about 20 % speak Hindi only. And some of the villagers speak only a tribal language, but they usually come with a family member to translate to Nepali for them. However, this patient lost consciousness at the small hotel outside the hospital where he was staying for the night and was brought in to the emergency room. He had no family members with him, and the hotel owners who brought him in knew nothing about his medical history. They only knew he had purchased a ticket for the next day to be seen in the clinics. Fortunately this patient was breathing fast and had a fruity smell to his breath, which helped us suspect a diabetic coma, which we were able to treat successfully. We learned later that he had run out of his medication, and traveled to the hospital to get more.
That same night, a 13 year old girl was brought in suffering from fever, cough and having had shortness of breath for a couple of days. We suspected pneumonia, but her oxygen saturation was very low, and her chest X-ray showed a diffuse clouding. She did not respond to the antibiotics and steroids we gave her, and she became too tired to keep on breathing and in a few hours she died. The father had a younger daughter who had been taken to another hospital with similar but milder symptoms a few days earlier, and she had recovered. But the family didn’t suspect a serious illness in this daughter until it was too late. We think they both had ARDS, a lung injury that can be triggered by an infection.
Sometimes, just as in the U.S., friends ask the doctor for a little “free” advice…. Debbie and I arrived home for lunch one day and found one of the ER staff waiting for us. He had come to ask me to see his 85 year old mother, who had had a stroke at home. She had smoked heavily for the past 65 years, until she suddenly become paralyzed in her left side. She could not speak or swallow. Her son had already taken her for a CT scan, which showed no bleed, and he had put in a feeding tube. His mother is not on the hospital insurance plan, which is only for immediate family members, and he felt like he couldn’t afford a long admission for rehabilitation. Even though we have a charity fund, people who have money in the bank are asked to contribute towards the bill, and some people, like this man, choose to save the money for his children’s education and for building a house. He was doing an excellent job exercising her limbs and feeding her through the tube. Other family members were also helping, and she is now able to walk some with assistance. I had very little else to suggest for her care, and prayed with them for her continued recovery before I left.
The son commented that his mother’s chronic cough was already better, since she couldn’t go buy her cigarettes! There was a timely article in the Nepali Times this week about the high prevalence of smoking in Nepal. At 48% for men and 18% for women, it is the highest in the region. Cigarette sales, advertisement, and production is still totally unregulated in Nepal. Two years ago a bill was passed requiring warning labels on cigarette packages and restrictions on advertising, but lawsuits by the tobacco companies have kept enforcement in limbo. In the villages we see even children of the working class uneducated families smoking and drinking. It is noticeable that strokes and heart attacks are now quite common, because more people have money for a heavier smoking habit, access to higher fat foods, and are doing less physical labor. I once asked a woman who had come into the clinic about her smoking habit. I was trying to encourage her to stop, but her response was, “The men all drink for fun, and the women are only allowed to smoke.” Knowing that life for village women in Nepal is extremely hard, and that pleasures are few, it was difficult to argue with this statement.
As we enter into the hot, dry season, the hospital continues to get busier. The political situation continues to “heat up” along with the temperatures, with more strikes being called and new elections due in the next few months. Thanks for your continued prayers for Nepal and for the hospital. God Bless!