I wanted to write this entry quite some time ago but things cropped up along the way. It is nearly the end of my medical stint here in Phortse. 3 weeks as flown by so fast since my arrival in Nepal. I am really enjoying myself here and feel that locals are benefitting from me as much as I’m benefitting from them.
The past 2 weeks has become a routine for me. Waking up at 8.00am, having breakfast at 8.30am, leaving the lodge at 9.40am, taking the 10mins uphill slog covering a vertical distance of 60m from the lodge to the clinic, starting to see patients at 10am and closing the clinic at about 3pm. Usually the clouds will start pouring into the village by 3pm making everything really cold and thus no one would come by the clinic. That would be the signal for me to close and get back to the cozy comforts of my lodge. Just walking up and down from the lodge to the clinic everyday has been excellent acclimatization for me.
When I first talked to the healthcare worker of Phortse when I was down in Nov last year, she told me that the max no of patients she had seen in a day was 12 and the number can plunge as low as 0 during the free days. Somehow I have never seen fewer than 10 patients in a day since I started the clinic. My busiest day was 32. I’m not complaining as I’m really enjoying the experience of running a rural clinic. I don’t know how the locals came to hear about my arrival in the clinic so quickly. The news has travelled like wildfire in the region. Villagers, even take a day’s walk from other villages to come to see me. It amazing I’ve seen over 150 patients so far when Phortse’s population is only around 400+.
Most of the villagers don’t have acute problems. They come to the clinic to complain about problems that they have had for years on end. At this juncture, I’m convinced that almost the whole village is plagued by knee/back pain and gastritis. ¾ of the patients walking into the clinic complain solely of musculoskeletal or gastric pains. The older they are the more chronic problems they have. Some of them come into the clinic, have a seat, and start by telling me that they can’t see for 5 years, can’t hear for 3 years, can’t eat properly for the past 10 years due to gastric pains and can’t walk properly for 20 years due to knee pain and would request something that would remedy all these problems all at once. I’ll start by telling them that I’m not god, and that I’ve only limited medications here and that I’ll see what I can do. Just by looking into their ears with an autoscope, they’ll miraculously be able to hear better. Just by giving them eye cleansing drops, they’d be able to see better. I feel that it’s an exaggerated placebo effect there being a doctor in the village and him giving out medications when no one else ever did. What ever the case may be, I still take each one of their complaints seriously as I don’t think there is a need to malinger over here and there’s definitely a problem when an 80 year lady takes a half hour uphill walk to see me.
One thing that I’ve noticed is that whatever I can or cannot do, the locals are still extremely grateful and thankful at the end of the consult. I have felt more appreciated working here for 2 weeks than working back at home for more than a year. I have felt more job satisfaction here even through I have been volunteering without any pay. No one complains about the waiting time and you can see each patient thoroughly without being pressured by the next patient waiting to be seen for a long time, there is no need to take down extra micro detailed case notes or do unnecessary investigations in a fear of litigation, you don’t have to order particular medications or perform certain procedures/tests just because the patients or their families demand you to do so, your clinical acumen is brushed up a million times as you don’t have blood tests/X-rays/MRI scans at the snap of a finger, there are no patients who think they know their own case better than you just because they have googled and read a few lines about their disease, there are no overnight calls, there aren’t that many emergencies and most of all, all the patients here appreciate what you’re doing for them because they know you are trying your best regardless of the outcome. It has been an excellent working environment if you don’t consider the freezing cold, the accessibility to shower only about once a week and the lack of any form of entertainment post office hours. After saying all this, if ones asks me to stay here, I’d have to decline as I still dearly miss family and friends back at home.
Below are some memorable moments from the clinic.
When I was in Phortse the last time, I had received a request for a proper light weight stretcher to facilitate the transportation of any seriously ill individuals to Kunde hospital which is a day’s walk away. Their reason for this request was due to their current stretcher facility comprising of 2 heavy bamboo poles tied together with a piece of cloth. They were very appreciative when they saw the new stretcher I had brought over (courtesy of Dr Donald Foo who went through great means to acquire the stretcher for me).
There was this lady who came to the clinic complaining that her eye sight was getting worse ever since she got her new pair of glasses from Kathmandu 2 years ago. She said her vision was so bad now, she could see clearer without her glasses than with their aid. This was rather peculiar. When I took a look at the glasses, it was smeared with dirt and grime and the lady confessed that she wiped her glasses with her fingers (which were super filthy) as she did not have any piece of clean clothing on her. I took sterile gauze, wet it with some soapy water and cleaned her glasses for about 5 mins to a new shine. She was so thankful she could see perfectly upon wearing her new cleaned glasses. I gave her the pack of sterile gauze so that she could continue to have perfect eyesight.
There was this other case of a man saying he had gotten progressively death in both ears over the span of 6 years. (I was wondering how he could still have a verbal conversation with us then.). I was thinking that it must have been an old untreated ear infection, just like the other villagers, which might have caused his deafness. When I proceeded to take a look into his ear, I could not insert the autoscope even halfway into his ear canal. It was full of wax, or so I thought. I went onto syringing the ear (using high pressure water to flush the ear of debris) but little came out. So I went onto using tweezers to manually pick the wax out. I was totally grossed out when this 1x1cm huge dirt ball with hairs sticking out came out of his ear. Even the patient was shocked. I had just removed 6 years of dirt, debris and wax and just like that, his hearing was restored! It felt weird but really good at the same time to have restored hearing in the patient with a simple act like that.
The biggest drama that happened over the 2 weeks here had me trekking out from Phortse for 3 days to see a sick patient. A man rushed into my clinic and said he needed pain killers for his father who lived in a village a day’s walk from Phortse. When I questioned more about the condition of his father, the son could say little other than that his 70 year old father had woken up one day with extreme pain in his knee and could not walk (previously able to do so unassisted). Since there was no mobile phone reception or any land lines in this village and since his condition was deteriorating, the patient’s wife had to walk about 3 hours to a nearby village to use their land line to call their son in Phortse. Nothing much was communicated other than the above info. I bombarded the son with a whole array of questions but he was as clueless as me as he had heard the info form his mother. I decided to give the son (who would be visiting the dad the next day) some generic painkillers and a list of questions for him to ask and find out from his father.
2 days later, the son shows up in my clinic and said that the analgesia made the pain better but the father still was only able to limp around the house with a stick. He then told me that the pain was not in his knee but his left hip. All the questions that I had requested the son to ask the dad were somewhat redundant after the source of the pain had shifted away from the knee. One thing that the son told me (that I had asked him to enquire as well) was worrying. The father had been running a low grade fever. Pain in the hip, inability to weight bear in a short period, restricted range of movement due to pain and FEVER! Alarm bells started ringing and I thought of septic arthritis (infection of a joint space which could potentially destroy the joint if not treated early) which is quite dangerous. I requested the father to be brought to Kunde hospital for further investigations and treatment but the son said that would be extremely difficult as Kunde was 2 day’s walk away and with the father not being able to walk and no one being to help him out, it would be out of the question. I had to see the father personally myself to provide a sound diagnosis and management plan.
Since his father’s village (Charchung) was 2 day’s walk from Phortse (to and fro) and along the Gokyo trek (a beautiful trekking path just adjacent to the more popular Everest Base Camp trek) and since I had not done this trek before, I decided to use this opportunity as an acclimatization hike and add an extra day to complete the whole Gokyo trek – Chola pass trail and return to Phortse after which. Normally the Gokyo trek – Chola pass combi would take an unacclimatized person, 5 days to complete but it took us 3 days since I had already been spending 2 weeks at high altitude.
The trek was simply magnificently beautiful. All the lakes and waterfalls were still frozen has winter had only slowly started easing out. No regrets adding a day and completing the whole trail. On day 2 of the trek, we took a detour to complete our main objective – to see the father. We trekked down to this isolated yak housing village which I later found had only a population of 3 during the winter months. I was going to visit 2/3 of the whole village (the father and the mother).
It was a modest shed. I and Dawa were cordially invited for numerous cups of tea as a gesture of kindness for us to have come all the way there to see the patient. There was no bed or place that the father could lie down, so the mother took a mat (that they usually use for covering leaks on the roof) and placed it on the ground of the cowshed, and there instantly, the dung filled dark cowshed had transformed into my examination room. The moment, the patient undressed, the problem was obvious. It was Shingles along the Lumbar 5 nerve root distribution. The son never mentioned anything about a rash (even though I had asked him to find out about that). The father was experiencing pain along the whole nerve root distribution and that accounted for the pain in his hip, knee, calf and ankle (which was reported truncated). It all made sense the moment I saw the lesions but I hadn’t brought any acyclovir (medication for treatment of Shingles). I had just brought augmentin and cefalexin to cover for any intra articular sepsis. In a way, I was relieved it wasn’t septic arthritis or anything very serious. The father would eventually recover with or without medications (though the acyclovir would speed up recovery with less pain) but I gave him the augmentin anyway for what its worth since I had already brought it with me (to cover for secondary skin infections form the burst lesion perhaps?).
I will be running the clinic for another 2 more days and will then proceed back to Lukla. There I shall be fetch Dr Gayathri and Dr Shuwei who will be bringing along resupplies. We will be visiting Dr Kami at Kunde hospital to discuss about further medical voluntarism in the Khumbu region and will then be proceeding to Phortse to deposit the new medical supplies. The 2 of them will be following me to bid farewell at Everest Base Camp. Dr Gayathri will then travel back down to Phortse to continue with the medical work there.
For myself, there at Everest Base Camp, I will start the next phase and the main part of my adventure – my Everest Expedition.