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Patan Hospital

Posted 12:47 AM, March 28, 2012, by Elizabeth Huffman

Thanks to the generous Mary Duke Biddle Scholarship fund, I was able to spend six weeks in February and March in Patan, Nepal, working at Patan Hospital. Patan Hospital was initially started in 1951 (although not in its current location) by a Christian missionary who visited Nepal and understood the incredible need for appropriate medical service for the Nepali people. Patan Hospital has since passed through multiple different hands, but is currently being run by the Patan Academy of Health Sciences. Patan Hospital offers many different services to its patients, including 24-hour emergency care, outpatient services, inpatient services, laboratory, CT services, pharmacy, and much, much more.

During my six weeks at Patan Hospital, I spent variable amounts of time on the Pediatric Ward, in the NICU, PICU, and newborn nurseries. The Inpatient Ward has 33 pediatric beds, almost all of which are usually occupied with various different types of patients (with excess patients frequently spilling in to the already crowded hallways). Some of the patients are similar to those back in the US – pneumonia, bronchiolitis, gastroenteritis with dehydration, febrile seizures, and abscesses. Others are quite different from the US, including cerebral tuberculosis, brain abscesses, and enteric fever.

While the medical care is very different in the United States than in Nepal, it was a very educational experience. Very few patients in Nepal have medical insurance; therefore, they are required to pay for hospitalization (and every aspect of hospitalization) out-of-pocket. While the cost of hospitalization and other medical care needs may seem incredibly reasonable to those of us that are used to the exorbitant prices of medical care within the United States, many families in Nepal are unable to afford what we would consider “simple” therapies or work-up modalities in the US. For example, a CT scan in Nepal costs approximately 2500 rupees (approximately $30 US), whereas it can cost upwards of $5000 in the states; however, we had a patient sitting in the hospital for over two weeks, despite the concern that an ear infection had caused a brain abscess, because his family could not afford a CT scan for further evaluation. Additionally, the family in Nepal is responsible for all care of the patient, including changing and washing the bed linens, providing food and water, and administering all medications (except IV) to the patient. The hospital is always full of family members, many of whom are cooking or washing laundry out on the balconies.

The day runs relatively similar to back at home. We have either morning report or a teaching session most mornings around 8:00am. This usually lasts a little over an hour, after which there is pre-rounding. I usually spend this time going through the patient charts to catch myself up on what happened with the patients overnight and who are the new admissions. The Pediatric Ward is divided in to two teams, with each team having half of the beds. Interns and residents pre-round on the patients, and rounds usually begin around 10:00am or so. Each patient is discussed at length, with the family actively involved in the conversation. Most families only speak Nepali, and the team often reverts to speaking Nepali, as well, so it can make rounding a bit of a guessing game, but still educational.

After rounds are over, I usually head down to OPD, the Outpatient Department. Each day is a different clinic for pediatrics, with clinics such as High Risk Infant, Nephrology, Cardiology, and Acute care. I often work with either a resident or an attending, who is able to translate with the patients and families in Nepali. The OPD is located in one large room, with many different patients being seen at different tables. It’s different than I’m used to in the US, but very efficient. Setting it up this way, the team of attendings and residents is often able to see up to ten patients at a time.

The days in the NICU, PICU, and newborn nursery run very similarly, although the patients in the NICU and PICU are, obviously, a bit more complicated. I was quite impressed by the resources that were available at the hospital in the intensive care setting, including ventilators, inotropes, and many different types of antibiotics. Additionally, almost any service is available for consultation.

My time spent at Patan Hospital was incredibly valuable, in more ways than just the medical experience. While there is a lot to gain by seeing and learning about new pathology, there is also a great deal to gain by immersing oneself in a new setting and soaking up the culture and the new experiences. It provides a wonderful opportunity for growth.

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Comment by: jevisOmondi at April 2, 2012 5:06 PM

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