February 10, 2012 - Patan Hospital

After having written about lots of other adventures and travels during my first two weeks in Nepal, I figured I should mention about my primary purpose here – working at the hospital! During my time here, I will be working in the Pediatrics Department in Patan Hospital.

Patan Hospital was initially started in 1951 (although not in its current location) by a Christian missionary who visited Nepal and understood the incredible need for appropriate medical service for the Nepali people. Patan Hospital has since passed through multiple different hands, but is currently being run by the Patan Academy of Health Sciences. Patan Hospital offers many different services to its patients, including 24-hour emergency care, outpatient services, inpatient services, laboratory, CT services, pharmacy, and much, much more.

I have been working on the Pediatrics Ward for the past two weeks. The Inpatient Ward has 33 pediatric beds, most of which are usually occupied with various different types of patients.

Some of the patients are similar to those back in the US – pneumonia, bronchiolitis, gastroenteritis with dehydration, febrile seizures, and abscesses. Others are quite different from the US, including cerebral tuberculosis, brain abscesses, and enteric fever.

While the medical care is very different in the United States than in Nepal, it has been a very educational experience thus far. Very few patients in Nepal have medical insurance; therefore, they are required to pay for hospitalization (and every aspect of hospitalization) out-of-pocket. While the cost of hospitalization and other medical care needs may seem incredibly reasonable to those of us that are used to the exorbitant prices of medical care within the United States, many families in Nepal are unable to afford what we would consider “simple” therapies or work-up modalities in the US.

For example, a CT scan in Nepal costs approximately 2500 rupees (approximately $30 US), whereas it can cost upwards of $5000 in the states; however, we had a patient sitting in the hospital for over two weeks, despite the concern that an ear infection had caused a brain abscess, because his family could not afford a CT scan for further evaluation. Additionally, the family in Nepal is responsible for all care of the patient, including changing and washing the bed linens, providing food and water, and administering all medications (except IV) to the patient. The hospital is always full of family members, many of whom are cooking or washing laundry out on the balconies.

The day runs relatively similar to back at home. We have either morning report or a teaching session most mornings around 8:00am. This usually lasts a little over an hour, after which there is pre-rounding. I usually spend this time going through the patient charts to catch myself up on what happened with the patients overnight and who are the new admissions.

The Pediatric Ward is divided in to two teams, with each team having half of the beds. Interns and residents pre-round on the patients, and rounds usually begin around 10:00am or so. Each patient is discussed at length, with the family actively involved in the conversation. Most families only speak Nepali, and the team often reverts to speaking Nepali, as well, so it can make rounding a bit of a guessing game, but still educational.

After rounds are over, I usually head down to OPD, the Outpatient Department. Each day is a different clinic for pediatrics, with clinics such as High Risk Infant, Nephrology, Cardiology, and Acute care. I often work with either a resident or an attending, who is able to translate with the patients and families in Nepali.

The OPD is located in one large room, with many different patients being seen at different tables. It’s different than I’m used to in the US, but very efficient. Setting it up this way, the team of attendings and residents is often able to see up to ten patients at a time.

Despite, at times, many differences between the health care in Nepal and in the United States, one thing remains the same – the kids are all just so cute!