My name is Ros Vaughan. I am an Australian doctor who has recently completed 4 weeks working as a volunteer in the Kushudebu Public Health Mission clinic.
Back in Australia I work as a clinic doctor in rural & remote Aboriginal Medical Services. In 2007 I took part in a World Expeditions trek in the Annapurna Region of Nepal.We were lucky enough to have Ang Tsering Sherpa as our trek leader .I soon discovered that Ang was President of the Kushudebu Public Health Mission(KPHM).I was very interested to learn how the work of a doctor in an isolated village in Nepal compared with my experiences in remote Aboriginal communities in Australia. I offered to volunteer to work at KPHM as I thought I may have something to contribute & would learn lots.
Medical staff,Tibetan Nurse with Dr Ros
The clinic staff gave me a very warm welcome & great support throughout my stay.In & out of clinic hours Ang Gelu & Bimala Rai were always looking after my needs, providing great company & arranging interesting excursions in & around Junbesi.
In the clinic I worked closely with Kumar Shrestha a graduate in General Medicine. Kumar interpreted for me ,we discussed the patients presenting problems,findings & planned treatment together. We were ably assisted in our work by Bimala Rai Staff Nurse ,Rabi Dahal Laboratory Technician & 2 volunteer Auxiliary Nurse Midwives Ngima Sherpa & Kamali Bishwokarma. We also had the support of Sarbe Lal Chaudhary the Health Worker in charge of Junbesi Health Post & his assistant Pasang Sherpa.
Kumar Shrestha(GM) and Dr Ros
I was surprised that the most common reason for patients to present for treatment were gastrointestinal problems. Adults had symptoms of gastritis ,peptic ulcer disease & reflux oesophagitis . Children had diarrhoea. Other common presentations were arthritis,hypertension ,respiratory & skin infections.
One day the KPHM clinic staff provided a free Health check for the Nuns & Monks of the Thupten Choling Gumpa .A large Tibetan refugee monastery about 1 hours walk away fro the clinic. Our staff ,with great assistance from Tensing the Gumpa Health Worker saw 131 people. It was a challenging but extremely rewarding day.
I was enormously impressed by the facilities of the KPHM clinic which had been achieved in the last few years through donations,voluntary work of the World Expeditions Community Project members & the voluntary work of the local Management Committee.
Kumar,Dr Ros looking at the x-ray
The new staff quarters when completed will not only provide much more suitable housing for the clinic staff who now live in the clinic building but also free up much needed room in the clinic building for more consulting space. It is planned to have overnight facilities for patients who must travel up to 3 days to reach the clinic.
The donations are so important for ongoing costs & improvements to the clinic. The local community really appreciates that KPHM is an exceptional clinic & they are proud of it .
However more is still needed to improve patient care including a telephone service to enable communication with medical staff at Phaplu hospital 3 hours away & Kathmandu hospitals for specialist advice . A Medical Record system to provide permanent paper patient records at the clinic is essential for good patient care. Other needed equipment is a good quality auroscope & ophthalmoscope,an ear syringe & Doppler machine for detecting foetal heart rates.
I wish to thank the Kushudebu Public health Mission Management Committee,Ang Tsering Sherpa,Ang Gelu Sherpa ,Bimila Rai, all the clinic staff & the people of Junbesi for allowing me to be part of your community for a short time & experience your kindness ,amazing hospitality & culture.
In grateful appreciation.
REPORT OF VISIT & VOLUNTARY WORK BY DR ROS VAUGHAN FROM AUSTRALIA TO KUSHUDEBU PUBLIC HEALTH MISSION 30/3/09 TO 24 /4/ 2009
My qualifications are MB.BS. (Batchelor of Medicine, Batchelor of Surgery) University of Sydney& Diploma of Child Health.
I have worked in Australia for 35 years as a General Practitioner (Family, community doctor). For the last 12 years I have worked as Clinic Doctor in rural & remote Aboriginal Health Clinics.
I was invited to do voluntary work by Ang Tsering Sherpa. He arranged my itinerary, accommodation & clinic role.
My role at Kushudebu Public Health Mission (KPHM) was to assist the Health Assistant Kumar Shrestha & staff Nurse Bimala Rai in the management of patients coming to the Clinic with health problems or for health advice.
The Clinic opened from 10am to 2pm Sunday to Thursday & 10am to 1pm Friday. Restricted hours were due to power being available only during those hours. patients appeared to be well aware of opening times .Occasionally patients would arrive out of hours for emergency care or if they had walked many hours to the clinic. The Health Assistant Kumar was usually available to see these people as he lives in the Health Clinic building.
Dr. Ros from Australia with the staff of medical center
Staff of the Clinic at the time of my stay were.
Kumar Shrestha Health Assistant, a graduate in General Medicine of the Health Science School Chitwan. His qualifications & experience enabled him to very well manage the problems that patients presented with.
Bimala Rai Staff Nurse who started work at the clinic only 2 weeks before I arrived & whose role had not yet been fully developed. She is an extremely capable nurse & I am sure will be of great assistance to the clinic.
Rabi Bairagi Dahal Laboratory Assistant who is a very enthusiastic & capable worker who assists the other staff when needed.
2 Volunteer Auxiliary Nurse Midwives Ngima Sherpa & Kamali Bishwokarma were doing a 6 week placement following their graduation from Solu Kumbu Technical School Phaplu. Their assistance was very helpful to the clinic staff.
Soma Bishwokarma worked doing an excellent job as a cleaner & general assistant.
The staff of the Junbesi Health Post were.
Sarbe Lal Chaudhary Community Health Worker in charge of Junbesi Health Post.
Pasang Sherpa office assistant.
The Junbesi Health Post staff carry out the Public Health work in the villages they are responsible for in the surrounding area .They organize immunizations, maternal & child health & education programs.
The staff of Kushudebu Public Health Mission & Junbesi Health Post appears to have a good working relationship, they share the same buildings, both access free public medicines & have meetings to ensure both teams are aware of planned clinic & outreach activities.
The Clinic functions very well overall. Patients are seen within reasonable waiting time, usually no more than 1 hour & usually much less. Staff work well as a team & flow through clinic is usually smooth. Most patients are able to get appropriate treatment in the clinic whether that be advice, medication either free government medicines or pay for donated medicines (40% of cost price), X ray & Laboratory tests if needed. Occasionally situations arise where people need emergency hospital or specialist treatment. In these situations transport, cost, lack of telephone & lack of power to use the facilities at KPHM present difficulties for staff, patients & families.
Facilities at KPHM are excellent for a clinic in a small rural village in such an isolated region. The main gap in facilities at the Clinic at present is a permanent Medical Record system. Each patient needs a personal ID (identity number) & a permanent paper record held at KPHM clinic. At present only patients with a diagnosis hypertension have a paper file left at the clinic with all the written notes from their previous visits record At present all other patients who have consultations are given a sheet of paper with the Health Assistant’s notes from that visit to take away with them. Patients are asked to bring their paper record with then if they return for further clinic visits. I observed that this was usually not done ,so patients were given a new Clinic number, information about the past visits was gathered from the patient’s & Health Assistant’s memory.
It is essential for good medical practice to have a permanent paper or computer record for each patient stored at the clinic caring for the patient A Health Summary for each patient needs to be developed .This is usually on the first page of each person’s record .Included on this summary page is any allergies, significant past history of illnesses, current health problems, immunizations & current medication. Without the information contained in the summary page & patient’s notes managing the presenting problem relies on patient & staff memories & takes extra time during consultation in the attempt to get all necessary information for best treatment.
Until a permanent Medical Record system is developed it will not be possible to collect accurate statistics about client numbers, number of individuals presenting with a particular disease or setting up recall systems for patient follow up such as immunization overdue, Depo injections due & perhaps in later years recall for review of specific medical problems such as chronic diseases.
Cost for setting up such a system would not be very expensive only requiring a secure storage area usually filing cabinets or shelving & manila folders & paper for notes for each person who comes to the clinic.
Equipment needed for clinic
Good quality auroscope, ophthalmosope set.
Doppler machine for foetal heart rate.
Laboratory equipment-culture facilities to test for urinary, skin & other infections & to enable correct antibiotic to be used for treatment.
Testing strips for Glucometer- Medisense precision xtra manufactures by Abbott Laboratories.1 bottle of these, machine is in clinic but can’t be used at present without strips.
A suggestion by some of the World Expedition Community Volunteer group was that a list of what is currently needed in the clinic (equipment & disposable items) be written by the KPHM staff & sent by World Expeditions to the participants coming to do voluntary work so that they may be able to help out by bringing some items on the list with them to the clinic.
The voluntary work I did at the clinic during my stay at Junbesi was very worthwhile & meaningful to me .I leant much about the practice of medicine in an isolated community where staff have to consider the difficulty of transport to hospitals & specialist health services, lack of accommodation for patients from distant villages, cost of medicines & treatment by specialist services in Katmandu as well as cultural considerations.
To the management committee I wish to thank you from the bottom of my heart. Your welcome & assistance during my stay was really appreciated by me. I wish to thank Nag Put & Nag Dome for their warm welcome, comfortable room & delicious meals that Nag Put provided, Nag Gel & Bemata for all their support & being such fun to be with, Mr.Chumba & his family for their friendly support, all the clinic staff for accepting me as part of their team & Ang Tsering for all the time & energy he put in arranging my stay & work in Junbesi.
I will never forget your Sharpe hospitality .I hope I was able to contribute something to enable your clinic to grow & continue to provide excellent health care to the people of Junes & surrounding villages