‘Only one per patient’Heidi Cutting
Flinders University GEMPIV Medical Student
As I meander along the rocky winding path, I am in awe of my surroundings. Mountain peaks as far as the eye can see, rivers and streams with crystal clear water, the warmth of the sun reflects off the green jungle around me and activates my Vitamin D, my lungs are filled with the freshest air they’ve ever drawn in. I’m trekking to the heart of the Kushudebu Public Health Mission (KPHM); the Medical Clinic, in Junbesi, Beni-5 of the Solukhumbu District, in the Sagarmartha Zone of Nepal.
After four hours and monsoon rains, I arrive in Junbesi. At this hour on a Saturday, a public holiday, the village is quiet. I pass the stupa and say a quiet prayer whilst turning its prayer wheels, then a few lodges and trekking shops, as tourism is the main source of income for this village. Pass the local school, the deserted monastery, cross a small wooden bridge and up the stony paths, to be greeted by the sweet site of the stupa which stands just before the clinic and staff quarters, my home for the next six weeks.
After settling into my own private room, thanks to the kindness of two staff members sharing a room, I meet my housemates and work colleagues. Krishna I’ve had the pleasure of trekking with, he is the Health Assistant, which is probably equivalent to a Nurse Practitioner, but I see him more as a junior doctor. Surendra is the resident laboratory technician, Tarshi and Bhagwati are the resident nurses, with Dohma as the cook and cleaner. Dohmas’ younger brother Passang also lives with us. It’s a young team, with an average age of 22 years, but with experience and knowledge of those well beyond their ages.
When it comes time to see the facilities of the KPHM, I am amazed and excited. An X-ray machine, of which Krishna is the Radiographer, film developer and Radiologist. A basic laboratory capable of performing 30 tests, from haematology and biochemistry to basic microscopy. A nurses station equipped with basic suturing and dressing supplies, a small three bed ward to keep patients overnight whilst awaiting transfer to higher centres, a small Family Planning room and the Outpatient Department; a single room with the feel of a General Practitioners consulting room.
Miss Heidi Cutting with Medical Center staff
It wasn’t until I stepped into the pharmacy that I realised just how great a service this clinic provides. A wall adorned with shelves full of medications supplied by the government, but mostly supplied by KPHM. The shelves were lined with boxes of a variety of antibiotics, intravenous fluids, medications for blood pressure, gastrointestinal conditions, pain relief, even multivitamins, and all either free or only forty percent of the full price. I couldn’t believe my eyes; I honestly expected there to be less.
After a couple of days in the clinic, I became torn between elation and frustration. At times I was completely amazed at the facility. In a country with so little, this health service provides so much to its district, and it’s all due to the hard work and commitment of Mr. Ang Tshering Sherpa, the staff and the committee of the KPHM. But there are limitations, and I soon came to realise these when our first emergency case arrived; a young girl with abdominal pain.
She wasn’t too distressed, but given the nearest hospital was a four hour walk, she had to be treated aggressively in case she worsened and required transport to Phaplu. This required intravenous fluids. The first attempt at inserting a cannula failed. As a medical student I have managed to accidentally jab myself with clean needles, and thus have become very aware of safety with sharps. So when the cannula was placed on the bed, I quickly, but carefully, picked up the cannula and placed it in the sharps safety box, out of harm’s way. The staff then turned to me and asked, ‘why did you throw out the cannulaâ€¦only one per patient’.
But what would the people of Junbesi and Solukhumbu do without the KPHM? Like other, even more remote villages in Nepal, most people would suffer. As was explained to me, if you have appendicitis in these regions you either get better or die. Dying of appendicitis rarely happens in Australia, and when it does, it’s usually due to a complication of treatment. So although this health service has its limitations, I have no doubt it saves, or at the very least, prolongs the lives of the people of Solukhumbu, daily!
Patients come from far and wide to access the KPHM. Two women walked five hours just to be seen at the clinic, because the hospital in their village was currently without a doctor; there are many understaffed health posts across Nepal. They left after a thorough examination, reassurance and vital medication, only to trek the five hours back to their home village. Given Junbesi is on one of the main trekking routes, it is a popular resting point for weary trekkers from around the world. Weary trekkers with blisters, diarrhoea, altitude sickness, even a common cold.
Miss Heidi Cutting during her work at Medical Center
Some patients, arrive at the clinic in baskets, and as a rule, these are generally the very unwell. Laphuti, the 80 year old woman from the monastery one hour up the path, arrived late in the afternoon on a Tuesday, in a basket, suspended from her sons head. Laphuti had suffered a stroke two days earlier, and was now paralysed down the left side of her body. As with many complex cases, she spent a night in the three bed ward, only to be carried an additional four hours the next day, in the same basket, to eventually be transferred to Kathmandu. Even if a case is too complex for KPHM, the basic healthcare it provides, stabilises those patients so they can receive further treatment.
Traditional Tibetan Medicine still plays a role, particularly in the monasteries. Up the path from the KPHM is the Thupten Choeling Monastery, a Tibetan monastery of more than 400 Llamas and Monks. Occasionally patients are seen who have undergone a trial of traditional medicine, often without any improvement. This means they present late to the clinic. But even an extensive bilateral external and internal ear infection can be treated and cured at KPHM, without the need for referral to higher centre or intravenous antibiotics. Patience, antibiotics, regular dressings and time is often all that is needed.
The clinic is also busy during the day, providing routine check-ups and treatment for many common conditions; hypertension, gastritis, diarrhea, tonsillitis, typhoid fever, scabies, skin and wound infections, even post-natal care to mothers and babies. I didn’t see a sick newborn, and I’m certain the healthcare provided by KPHM prevents more serious events in the future for the young and old. I can’t bear to imagine the health of the people of Solukhumbu without the KPHM.
But the experiences which affected me the most, was living in a village filled with such warm, humble, kind and very generous people. The people of KPHM, the people of Junbesi and the people of Nepal have opened my mind to another world, and it has made me appreciate not just healthcare in Australia, but all the little things in life, that I take for granted.
I’ve sat in temples of monasteries during important ceremonies, I’ve watched the sunrise over Mount Everest, I’ve visited local schools providing education to the future of Nepal, I’ve seen breathtaking views of waterfalls and mountain ranges, just minutes from the clinic, and I’ve tasted, I’m sure what is the best Momo and Apple Pie in Nepal! I’ve been welcomed into the lives of the people of Junbesi and what I have come to love most about Nepali people, is despite all their challenges, even through times of serious illness, they are always smiling, always laughing.
* [Miss Heidi Cutting from Australia had spent six week (from 14th September 2012 to 29th October 2012) in Kushudebu. During her stay she had provided health services to the local people at Medical Center. We would like to thank for her effortless support and valuable help.]
Miss Heidi Cutting during her work at Medical Center