This week I decided to do paediatrics with obstetrics and gynaecology in my spare time! We are lucky and have a German paediatric consultant (Eva) who specialising in neonatology who has joined the hospital for a few weeks as the usual paediatrician is away.

I have seen so many things this week from mumps, to measles, pneumonias, enteric/typhoid fever and one 4 month old baby with dextrocardia (heart on the right side of the body for all you non-medical people). It has been great for my medical experience to see many of the childhood illnesses that we just do not often have in New Zealand and which I have only learnt through textbooks. I hope having been able to see it for myself will aid me to make the diagnosis in the future.

This week has been the tough one. There is something about dealing with children that tugs on my heart strings. This week had been particular hard as we have had a number of premature babies that we are looking after. One was a survivor from a set of twins – born at we think around 31-33 weeks (dates are not exact over here!). The other twin was alive at birth but died at about 7 hours old.

Sad sad story really as with appropriate equipment could have been saved. We think she just needed ventilation and some surfactant for immature lungs. Frustratingly, the hospital 15mins down the road has this but was unable to take the baby as it was born in our hospital. Anyway her twin weighs 1.1kg but she fighting and is strong. I cant believe how small she is and spend so much time each day staring at her!

It has been great to have Eva here as she is very experienced in dealing with neonates. However, one of the most frustrating and tough things to deal with has been that the family is incredibly poor and it has been a challenge to care for the baby as we might in the western world. For example we wanted to order a bilirubin but the parents refused to allow the test to be done. As it was going to cost them to order the test, they refused to do it as “the baby is not yellow”.

It seemed so futile to care for the baby when your clinical decisions is not listened to/ignored. Although of course we have to understand that cost is a huge factor over here.  Furthermore, the family then informed us 2 days later that they were going to take the baby home (weighing 1.3kg) as they could no longer afford to keep it in the incubator. I found out that it costs about $15-20 per day to keep a baby in the NICU here which can be about 1/4 of their monthly wage here in Nepal.

Despite pleas by us to the hospital we could not lower this cost and we were forced to allow the baby home. I couldn’t help but to want to pay for a couple of days just to keep this little girl safe and warm. But obviously I/we can’t do this for every patient and it would only be setting a precedent and giving false hope to other families if I were to offer.

It has been tough. I would really like to see a fund set up within the hospital which can be accessed by those in dire poverty/special circumstances to help pay for medical treatment such as for this little baby.

But in fairness, there are just so many people in such a position it would be hard to manage this fairly. A difficult problem really with no easy solution. In the meantime, you just have to do what you can with what you and the patient has. It has been a tough case to be involved in but I just hope that this little girl is the tough one and makes it through the cold Nepali winter at home.

Another thing I must share with you has been my experience in the obstetric clinics! I have been lucky to be able to examine many patients and have even diagnosed my first breech by palpation (the midwives in Grey Base hospital would be proud!!).

It has been interesting to see that many of the western figures for working out gestational age via measuring the abdomen do not match what we see here in Nepal. The women tend to have smaller babies in general and using the ‘western’ measures is not compatible.

But the most interesting thing has been trying to work out how far along a women is in her pregnancy and when her due date is! While we have the normal pregnancy wheels, they are a bit hard to use when you are given a last menstrual period (LMP) date of 02/08/2068 (when it is december 2012)!! The Nepali calendar is very                 different to ours (we are told it follows the lunar calendar) and makes interpretation of timing a little harder!! It has been fun to work to all out!

Some more quotes for you!

- “She had a hot potato voice so I admitted her” – Any other history?!

- “Provisional diagnosis is Left Iliac fossa pain” – A diagnosis?!

This week also signals the end of my time here in Banepa at Scheer Memorial Hospital as next week I am going to travel to some remote rural health clinics in the Chitwan province. It has been a wonderful experience here at the hospital and I can not begin to explain how much I have learnt in such a short time.

I need to take a moment and thank all those who have made my time at Scheer Memorial Hospital such a success. I hope that you continue to strive to provide the best healthcare you can – I really admire the efforts you make.

Thanks to the generous support of The Pat Farry Trust, I was also able to buy some equipment to donate to the hospital such as an automatic blood pressure machine, blood glucose monitor and testing strips, thermometers, gloves and batteries. These have been donated to the Obstetric ward as I spent so much time here and they will be able to put this equipment to great use! In the photo you can see Dr Vidya is very grateful for the help!

Now, I am off to see what is available to people in the even more remote areas of Nepal, which is exciting! I’ll let you know how it all goes!