A former surgical colleague of mine (now an assistant professor at Tulane) attended the Global Missions Health Conference in Louisville, KY, in November 2009 and he learned of one organization that needed a surgeon in Nepal. I got in touch with the Nepali Christian NGO (Human Development and Community Services) headquartered in Kathmandu. They had a devoted French gynecologist, Dr. Bernard Geffe, going there twice a year for several years, and I phoned him about the hospital. He was anxious for me to come as the Chaurjahari hospital was staffed only by a very dedicated, competent Nepali physician, Dr. Caleb, who had just finished his internship four months earlier. When the committee at headquarters was not keen to have me, Dr. Geffe phoned and urged me to come anyway. When I got to the hospital, my first assignment was a C-section patient who had walked five days. “Please guide Dr. Caleb through the C-section.” After that, it was, “Please stay here and help us out.”
I later met some of the committee members and the reason for their (un)welcome was, “Why does this 80-year-old surgeon want to come here?” Needless to say, they were flabbergasted at my physical appearance when we met in person.
After medical school
After medical school at Northwestern, I interned at Cincinnati General and had a residency in general and thoracic (including vascular) surgery at the hospital of the University of Pennsylvania. Their surgical program was set up that way. I also had almost a year of pathology (Saginaw, MI) and went back to Burma where I did the first cardiac operations by a native son. The political situation changed and I retreated to the University of Pennsylvania for more general and cardio thoracic surgery and also a year of tuberculosis surgery in California – and was certified in surgery and thoracic surgery. I came out to California for a year and did not return to Philly, much to the disappointment of my former chief.
My MO all thru medical school and after was “learn all you can and do all you can.” A summer job as an extern in surgery was very useful and I learned a lot. I told the OB nurse to call me anytime there was a breech delivery because I wanted to learn. As it turned out, on my way back to Burma in ’59, I dropped into a small mission hospital in Eastern Malaysia and the nurse midwife had trouble with a breech delivery, so I helped her out.
Life in Nepal
The challenge in the poor areas, especially in rural Nepal: (1) language – they speak Nepali which has some resemblance to Hindi (which I used to speak very fluently as aÂ pre-teen in Burma and still remember some of it). In the past few years, I have been the only “American” working at that hospital. The other foreigners are French, German, and Japanese. Other nationalities come for a week or a few days and the native staff there gets understandably confused with pronunciations. We do have interpreters who try their best. The native Nepali physician who single-handedly runs the hospital speaks good English. As for the nurses, they all smile and nod “yes.” (2) Hindu customs carried down over the past 2000-plus years, (3) general chronic malnutrition, (4) the village medicine man.
Learn all you can and do all you can.
I am there 24/7 with the other physician(s). The village has no movies, land phones, TV, electricity, or running water. The hospital has a generator that takes over if we need it at night. Otherwise, we have a dim, solar-powered light. We turn the generator on at night if we need the OR, ultrasound, or X-ray. Some of the staff members play cricket and badminton.
The staple diet is lentils and rice one day and rice/lentils the next. To eat chicken, one buys the live animal, defeathers, cleans, and cooks it. Beef is not eaten for religious or cultural, reasons but water buffalo meat (called “buff”) is available occasionally. Sometimes there is goat meat, fish, and very seldom pork. There is no bazaar as such. Fish is available if the catch exceeds the fisherman’s need.
The outpatients number anywhere from 50 to 140 on any given day. Nobody is turned away. Because we know that the patients had to walk so far (up to 5 days), we feel it would be inhumane to tell them to return the next morning. The people are generally docile, but they don’t like complications. If there is one, their logic is “You are the doctor. You know everything, so why did you not prevent this?”
The hospital has no central heating, cooling, and no cafeteria. For ice packs, we raid the lab refrigerator. Patients have to buy their meals from the village people just across the fence. If you buy your meals there, they give you a place to sleep.
The nights are very peaceful except for medical emergencies (e.g., births, fractures, and the occasional appendicitis). The physician assistants, who do a good job, see the patients and consult us. The nurses deliver the babies and know when to call for a C-section.
My most recent trip in July and August was a surprise because the snakes were out.
My most recent trip in July and August was a surprise because the snakes were out. It was their monsoon season. It was also their planting season so most of the grandmothers (instead of the mothers who were working in the fields) brought the children for treatment. We had six snake bites and they all survived – thanks to the anti venom.
There is an anesthesia machine but there is nobody qualified to work it, so my surgery is limited to what can be done under spinal, regional, local or ketamine. There are thyroid, parotid tumors and some other neck lesions and abdominal cases that I cannot safely do under these circumstances.
It’s very disheartening when we have to refer a patient to a higher level of care in Kathmandu or Nepalgunj where there is a medical school and hospitals. The patient’s family says, “We will not go. We don’t have the money or cannot afford it. If you cannot treat us, we will return to our village and die there.” Examples are those that need dialysis, exchange transfusion, major abdominal surgery, etc. I can still see one woman who was carried in a bamboo basket on the back of a porter, only to return to her village without treatment.
I returned for my fourth visit in January and will continue to volunteer as long as I can. My feeling is that even with shortcomings in anesthesia, I can still do some procedures, but more importantly, I also teach the PAs and sometimes, they teach me!