From NZ to Nepal
05 Jan 10
Patients preferred to recover outdoors
Ian Bissett, Chairman of INF New Zealand, writes about his experiences in INF's recent general surgical camp in Nepal's Bajura District:
It was a privilege to be able to travel from New Zealand to Nepal and work with INF's medical camps programme in the country's Far Western Region.
It took journeys of seven, eleven and three hours on consecutive days by Land Rover to reach the place from which we flew by helicopter for 35 minutes to reach the health post where the camp was carried out.
A multi-national team
The team consisted of: INF's Nepali camps staff [administrator and pharmacist Eka Dev, engineer Rabi, Indra, Anandi, Robin, theatre nurses Regina and Dilu, and patient manager Ganga]; Ellen Findlay from Scotland; surgeons Colin, Bhoj Raj Neupane and myself; anæsthetists Neroli and Steve; GPs Wolfgang and Ian; nurses Hillary, David and Diana; ultrasonographer Alan; and my wife Jo as interpreter and patient history-taker.
Countries represented in the team were: Nepal [9 members]; New Zealand ; the UK ; Germany ; and Australia .
Publicity via radio
Patients heard about the camp via national radio and began arriving the first night we were there. Each day about 200 numbers were distributed to those who queued and were seen the following day by the GP doctors. Patients walked in from five different districts, travelling up to five days on foot. The local population have little or no access to surgical services. We saw patients with rectal prolapse of 20 years' duration, many hernias and cases of children with malnutrition and advanced medical conditions. Patients were assessed and treated by the GPs and referred to the surgeons if there was a possible surgical condition. The operations were performed in one of the health post rooms that was usually used for delivery of babies. We were able to set up three operating tables in this space and these were either attended by anæsthetists or operations were performed under local anæsthetic. Post-operative patients were managed on mattresses in the foyer of the health post for the first day and then transferred to a post-operative tent.
During the eight days of the camp 1,086 patients were seen, assessed and treated, 245 had an ultrasound, 144 operations were performed and 29 patients had hæmorrhoids banded. On the last day of the camp those who had been operated on were called back and 93 returned and were assessed. Many others had been discharged the previous day so that they could return to distant homes. There were no wound infections, only two wound hæmatomas that did not require treatment and one chest infection that had settled by the time the team left.
Poor but robust
Patients are robust despite their poverty. Most preferred lying outdoors in the sun to remaining in the post-operative tent. Major procedures performed included: 10 pyelothitomomies; 9 cholecystectomies; 5 abdominal rectopexies; 3 cystolithotomies; a huge ventral hernia repair; and a large ovarian cystectomy. About 55 hernia repairs were performed, half of them in children.
The team referred many patients for care at other centres, and arranged payment for those who could not afford it. Five patients were sent to Kathmandu for expert urological treatment [a bladder tumour patient, one with recurrent urethral stricture and three with a single kidney and stones], three were sent to Pokhara for prostatectomy and two for plastic surgery. It is hard to describe the emotions associated with contributing to these camps, as there are times when you feel helpless when faced with advanced pathology that is beyond treatment, and exhaustion after working non-stop for days, but there is a huge sense of fulfilment on the final day as dozens of patients return for checks prior to discharge. I hope to return each year in future to take part in INF's camps.
Photos by Dr Ian Ferrer, GP from the UK:
1. Woman with a large probable skin cancer
2. Team members in the operating theatre
3. Patients preferred to recover outdoors in the warm sun
4. Patient outdoors with drip