out. The temp outside our window this morning was 41 and inside 58. Since the hospital has no central heating it is similar, as the one patient I photographed this morning at 9 am. demonstrates. He was very pleased to have his
picture taken and at noon he was sitting in the courtyard of
the hospital with his wife enjoying the sunshine along with many others and asked if I would please take another picture of him with his wife. At this point the air temp has risen to almost 65 and in the direct sunlight it is quite pleasant.
The problem is in preserving the heat of the day for the night. The other photo shows our unsophisticated effort toward this end with the four 25 liter containers and reflector making hot water for an evening bath. How hot it gets depends partly on the time the morning fog lifts but mainly on the intensity of the sun. I cover the jugs at night so the temp won't drop so low; eight am temp in the jugs is usually about 65-70 if the previous day was good and by noon the temp of water is 85-95 and by 4 pm it should be above 100 on a good day, 115 on a really sunny day.
Back to patients. While we see many problems similar to what would be expected in the USA we also have some unusual, or I should say unfamiliar ones. Late last week a 14 yr girl was admitted with a collection of pus in the right chest (empyema); certainly unusual in my experience but rather common in Nepal. The staff tell me most of these are from TB. Of course this had to be drained with a chest tube and when I saw her this morning on rounds I learned more about her problems, probably unrelated to the empyema. In the last year she has been having "seizure" problems and at such times she often grasps her neck and appears to be trying to choke herself in addition to twitching of the eyes and epileptic like muscular contractions. The witch doctor (a relative of the family) didn't charge much but told her the problem was someone had put a curse on her. He proceeded with some incantations, applied some red paste to the forehead and the girl seemed to calm down and feel better. The family has taken her to the "doctor" six or seven times over the last year. Interestingly, no other members of the family have tried out the witch doctor. The junior doctors seemed amused by the story so I suggested they take the story seriously because at least I believed such forces existed. The girl will be with us at least another week so we will see what more we can learn from the family as to what they believe.
Another problem we see with disturbing regularity is suicide and attempted suicide. The favorite form is to take organo-phosphate used in farming. I think we see at least a case a week. This compound slowly shuts down the respiratory system and untreated of course they die. Medication is primarily injectable atropine and many high does must be given with the patient being observed in ICU. Most of these patients are young women, which is understandable considering they are destined largely to a life of hard labor and multiple child births after being first bartered off to a husband five to ten years older, the decision being made by her father and primarily based on economic considerations. If they are not working in their family's fields they may hire out to carry baskets on their backs loaded with dirt, rocks, bricks or any other commodity needing transport, each basket load being about 70 pounds or more and for this they get about $1.25 USD per day. Little wonder that one of the most common problems among these women is a prolapsed uterus.
Another significant distraction is the relative lack of law and order which leads to disorder. The most common form is the "Bandha", pronounced like "bond". This is usually instigated by a political faction in an effort to let the government know they are unhappy and about which the government seems to have little or no control. But a "Bondha" also may come at the decision of a power faction such as the petroleum companies. Once a "Bandha" is called, all public transport through out the country comes to a halt, stores and shops all close and on the bright side, the air becomes less polluted. Buses or trucks or even motorbikes move at risk of being accosted or stoned. If you were planning on leaving on a plane and are fortunate enough to be at a major hotel in Kathmandu a government convey may get you to the airport. But being stoned does not require a political action party. Last week a prominent hospital in Kathmandu was "attacked" by stone throwers because a patient died and the family blamed the doctors, insisting they were not being allowed to see the patient in the ICU. Our hospital has also had to deal with such threats but so far never actually carried out.
Well, that is enough for now, so here are the few pictures.
Carlyle and Lora
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