Nathasha in the Mountains part 2- ‘M’ is for ‘Mountain’, ‘N’ is for ‘Nepal’
‘Why not coconut?!’ One of the many amazingly random but wonderful phrases DB, our guide, recited at us. His mischievous chuckle still makes me smile. Why not indeed.
If you have made your way from ‘A Dream is a Wish Your Heart Makes’ <link to previous blog> to here, good effort for sticking with me! If you are a newbie to the blog world, get stuck in and see what inspires you. I promise it won’t disappoint.
My name is Nathasha and I’m a Paediatric trainee from the UK. In October 2016, as part of The Wild Medic Project, I had the extreme privilege of taking part in their Nepal expedition. Our team (Sam, Olivia, Jess, Steph and Lee), in addition to a local Nepali doctor Aban and his own volunteer, Jens took to the remote region of Chitre and more, providing primary care to local villagers.
Over the course of two weeks, we, Team Ashwin, set up 3 mobile medical camps in the Helambu region, assessed over 200 children in a school in Lapsephedi, inventoried and compiled hundreds of lists of medications and found out that Co-Amoxiclav is a very expensive drug!
Where do I even begin?
Sleeping quarters at Lapsephedi school
Picture the scene. Lapsephedi school grounds, a new building to replace the old earthquake broken one, open only 4-5 months. We (myself and our guides) are in an office. The power is out, a solitary candle by the window gives us our only flickering light source, shattered at times by the glare of our head torches. I know I intrude in their companionship, but the bench outside just didn’t cut it for me. The others are all otherwise occupied. Olivia and Sam are prepping for their First Aid teaching the next day. Jess and Steph are negotiating a wash by torch light with the water tanks in the corner of the playground. Lee is perfecting his bedsit, no hammocks tonight. Bondari, one of the outstanding cooks, is heating milk on a tiny gas stove for their post dhal bhat chai. Yuvraj, who summited Everest just a month before (wow by the way) is eagerly awaiting grub. Insects come at us from various angles. I switch my torch off, it will only draw them to my face. And then, DB starts to tell me of his home, his family and the money he hopes to raise for a school in the Solokhumbu region. These are some of the special moments I remember sharing with DB and the gang. These are the ones that no one tells you about. These are the ones that make Nepal special. Its people, its warmth, its willingness to let you in if you open your heart just a little.
DB, Bondari and Yuvraj messing around at the grocery store!
I always say, what we gain from volunteering far outweighs what we provide. It’s a warped kind of selfishness, but it’s addictive nonetheless. And if the side effect is providing a little help where it’s needed, I think my conscience can live with that.
Let me tell you about my favourites. Our first mobile clinic was in Dodin. It was a new destination, a new health post and we really didn’t know what to expect. With an estimate of 300 patients (though the final being 114, phew!) we set to work ensuring maximum efficiency to make our way through patient numbers. I had great fun in Dodin. My OCD bells singing in happiness. Medications - check, consultation stations - check, observation stations - check, registration - check, private examination room if needed - check, observation area to ensure no allergy to antibiotic - check, health volunteers and translators on stand by - check. We were set.
Clinic at Dodin with ‘Pharmacy’ – ready to go!
That day went by in a giant blur. Don’t they say ‘time flies when you’re having fun?!’ And my goodness, I hadn’t expected so many kiddies!! Wonderful. My favourite little girl was a wee 4 year old who came alone and sat shyly next to me. Jeevan was my translator at this point (a man of many talents I must add, I really don’t know how he does it all!). ‘What is the problem today?’ ‘No problem!’ she says, shrugging her shoulders and smiling sweetly at me. It made me laugh so much. Clearly she’d just come along for the ride, so sweet! I sounded her chest and gave her a bunch of multivitamins and sent her on her happy, skipping way. But not all patients were that easy. Some of the more complicated adult issues I deferred to my adult colleague - Aban. A lady with what sounded to me like early menopause, did she need referred? A gentleman with on-going gastritis who had already been scoped, what else, if anything, could we add?
Not all stories were as easy to digest. Our most heartbreaking patient was a lady who had previously had, what sounded like, a FOOSH injury. It had been casted and fixed, but hadn’t healed in the correct position. We don’t know, of course, whether there were other reasons for not taking her to theatre at the time or even if it had needed to be operated on, but her on-going concerns of pain and tingling and numbness were so heartbreaking. It was visibly deformed, even I could see that. I felt so helpless for her, what could we do? We plied her with every medication we could think of, pain relief, omeprazole, multivitamins, toothbrushes… Aban told us they probably wouldn’t operate on her in Kathmandu given her co-morbidities. I still think about her and wonder what else could be done. Suggestions on a postcard welcome
The team - waiting for patients at Chitre
The other little girl I still think about is a beautiful 9 year old who came to us at our camp site, half-limping half-carried by her father. She had a giant abscess in her left upper thigh/groin area which had tracked internally to her knee. Not good. Not only that, it was weeping from a single point at her knee. It looked like a fairly nasty Staph infection. It needed drained with aggressive antibiotic treatment, and an urgent orthopaedic opinion. This is not something that we could do. Thankfully for us, Aban had some links with the surgical unit at Kathmandu and was able to make a referral. This was invaluable for many patients, not just this little girl, and allowed some tertiary level care for patients who required it.
I did find myself wondering whether her family would actually take her all the way to Kathmandu or not. I watched with heavy heart as she hobbled her way down the mountain pass. No complaint, full of smiles, grateful. We hadn’t even done anything. Our Paediatric supply of Flucloxacillin had run out (hint, very commonly needed drug!) so all we could do was give her Paracetamol for pain relief and a topical cream Mupirocin.
But do not let my stories of doom and gloom dishearten you, for there were many positives also. Like the 250 children (and teachers!) we saw in ONE DAY picking up on staph skin infections, a possible murmur, an acutely vomiting child and identification of kids who require better dental hygiene and a careful watch of heights and weights. This is a giant plus. Or the kiddo with abdominal distension, diarrhoea, anaemia and lethargy who we treated for worms. Or the families who came and told you their stories, their investigations and treatment so far, who you supplemented with a few basic additions. Or the alcoholic with gastritis, whose wife came to us at the end of our clinic and thanked every one of us individually, hands held together as if in prayer. She really touched our hearts. She still touches mine. Or the 93 year (young) life veteran who came to us with a good going chest infection that we could actually do something for. What a living legend.
Photo credit: Olivia Fiddelaers
If, after all this, you are having any doubts over your ability, clinically or otherwise, to jump in and volunteer I can guarantee that you don’t have anything to worry about. Wild Medic will get you through, and with a little bit of thought and careful preparation, it can be done.
After all, in the words of my favourite namesake:
‘If I can learn to do it, you can learn to do it
Pull yourself together, there’s nothing to it!’
Go on! You know you want to!!
Note: All pictures reproduced with permission.