Our accommodation in Nalma village was provided by a local family ‘the Gurung’s’.
We worked in the local health outpost which is normally staffed by a local with very little medical training. It was very basic. Those that were not treatable at the health post had to walk 3 hours to the nearest hospital.
25 medications are provided free by the government. All other medications were bought by the individual from private ‘pharmacists’.
The cases we saw in the health post were mainly those we would see in a GP practice in the UK. There was also an abundance of pelvic inflammatory disease and alcohol abuse.
The government has introduced immunisation programmes throughout Nepal. The BCG is given soon after birth. When a child is 1.5 months old they are given a diphtheria vaccine and a polio vaccine in drop form. After 9 months children receive a measles vaccination. Mothers are provided with immunisation records. If a mother fails to attend then the health volunteers who administer the vaccines quite literally go and hunt the child down.
I have noted down a few patient cases below as they highlight the lack of education, lack of resources and problems rural Nepali's face when obtaining adequate healthcare.
Patient case 8 – GUM
34 year old female with white vaginal discharge. Treated successfully before but it came back. Her husband is a heavy drinker and refused to take treatment.
We asked her to see if he would come and see us the next day, which he did. We explained to him the need for him to be treated as well. He said that as we were westerners he would listen to our advice.
In Nepal white discharge with pelvic pain is treated by a combination of Metronidazole, Ciprofloxacin and Doxycyclin. Without diagnostic tests they use drugs that cover all the causative organisms.
Doxycyclin is not free; it costs 3 RPs/tablet (£0.03)
Patient case 9 – Paediatrics
A 6 week old child who had not passed urine for 24 hours.
O/E massively distended abdomen, rigid and causing discomfort to touch. We recommended that her mother take her immediately to the local hospital 3 hours walk away
Patient case 10 – Trauma
60 year old female who had fallen on a branch 3 weeks ago resulting in a penetrating wound to the buttock. It was dressed once at the health centre but she thought it wasn’t healing quick enough and so did not return to have it dressed again.
Instead she visited an Ayurvedic practitioner who ground up herbs and packed them into the wound!!!
Again, because we were westerners she listened to us. We advised her to have the wound cleaned out and dress at the health post every few days.
The above report was taken from the elective report of Warwickshire student Craig Hinksman.