A leg handle

Today I went to theatre, it was a pretty great day. I met an orthopaedic surgeon and then got changed into my theatre uniform.

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The first case I saw was a man of about 60 years, who lived in a village. He had been climbing a tree and fallen out of it causing his right hip to dislocate, this happened 2 weeks ago! He had been walking as best as he could on it, but finally came to this main hospital for help. I guess maybe he didn’t have healthcare services available in his village, or maybe he would have been worried about the financial implications of getting help.

The surgeon told me they had tried to manipulate the bone back in to place the previous day under general anaesthetic with no luck. The patient was laid out on the operating table with spinal anaesthetic in place, I could see a big pin going through the lower part of his leg just under his knee. Everybody was busying themselves so I didn’t ask what it was for.

Whilst I stood watching this surgery another procedure was going on behind me, maybe 2 metres away, Caesarean sections. It was a really busy room.

You could see this guys hip was obviously dislocated, he was a thin man and the bone was clearly not where you would hope to see it. They cut through the layers of skin and muscle using incisions and heat. Then the surgeon and 2 small nurses would try and manipulate his leg into place. The piece of metal I had been wondering about came into play here. This was used as a handle to pull on and twist the leg! Oh it made my eyes water! The surgeon explained this was a very difficult procedure because of the length of time the patient had left between sustaining the injury and this surgery. The muscles had tightened around the joint making it hard to manoeuvre. After about an hour of pulling, twisting and sweating they got it in place. They drilled in some pins and put in a drain. The surgeon then sutured it and stapled it. It looked really neat, but I couldn’t help but wonder how much this guy would be aching the next day!

Immediately after this another guy came in for a procedure on his back. There wasn’t even 5 minutes between the procedures, I started to see how the room got so dirty looking. No time is given for really cleaning down equipment, tables and floors. They do sterilise equipment on site, which is wrapped in pieces of fabric. An aseptic technique is generally followed, it’s just very different due to the difference in resources and experience.

This second patient had previously had spinal surgery 11days ago to repair a fracture. The wound had not quite healed so the surgeon debrided it and resutured it. The patient was awake the whole time just with local anaesthetic, no one spoke to him through the procedure and he was wincing sometimes when the surgeon was suturing. The surgeon then exposed a sacral wound on this patient, he told me these are bed sores. When I asked how he got them I was told it’s because he’s now paralysed. Meaning this sore had developed within approximately 12days. It was such a shame to see work done to heal the spinal wound but there was clearly a lack of preventative measures in place to stop pressure ulcers forming.

The final patient I saw was an elderly man who had suffered an open fracture on his lower leg. I didn’t get a lot of explanation about his situation, but I could see a lot of external metalwork around his foot and lower leg. They said this was a procedure to debride the wound, apparently they had done this several times before, the patient was diabetic and the wound was struggling to heal. He had an open wound from his knee all the way down to his foot and around his heel. It had a lot of infected looking material in it, and his Achilles’ tendon was hanging out in a bad way. They used hydrogen peroxide in the wound, it stank, and it went all over the floor and on the surgeons feet. He was wearing flip flops with no socks on as most of the staff do, there were bits of tendon and flesh on the floor as well.

It was such an interesting day, I really enjoyed it. It’s made me really excited to see more of the village communities, where health issues are probably left to develop and worsen because of lack of health services. It was also interesting to see how many patients here are diabetic, so this evening I have been trying to read up on diabetes in Nepal, which has been challenging with our frequent power cuts!

Now I’m super tired and ready for a day sorting out stuff for village health camps tomorrow!

Sleep is good, goodnight! ☺️

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Pink Elephants

Today has been a day off! So we decided to venture out with the main aim of seeing the elephants!!!

We had a hearty breakfast, mine was a strange combination of poached egg, fruit and jam with toast. YUM. Then we went to go hire a bike for the day and had a good ride around the area. We saw lots of chicks and baby goats, a lot of local people waved and shouted “Namaste” ☺️ it was lovely. We came across a strange little museum which had a lot of pickled animals in, like an elephant fetus and a little tiger cub.

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Then we went and found a cafe by the riverside where we spent a couple of hours enjoying buy one get one free cocktails, reading and relaxing.

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Feeling a bit giddy from my rummy Elephant Special we hopped back on out bikes for a long cycle to the elephant breeding centre. We got there an paid 50 rupees entry and then strolled around admiring all the lovely elephants.

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(I’ve had the “pink elephants on parade” song in my head all day, love it!)

Life is good X

Big Yellow Ball

I worked in a maternity waiting room today. It was basically a room filled with sweaty, vomiting pregnant ladies. They occasionally cried because of contractions. This was definitely not my ‘thing’. I was also feeling quite unwell since the start of the day.

There were a lot of student midwives in this waiting room, and they seemed quite fascinated with me. They would stare at me, pull faces at me, and then poke me in the face and giggle….It was a long morning.

Not long after starting my day there a woman came in with a box of treats. Treats are usually something that put a smile on my face, HOWEVER, these were bright yellow massive balls of rice stuff. Not my usual treats. I knew they would offer me one, and I knew they wouldn’t let me politely decline.

I slowly ate it with them all staring at me, it was as awful as I had anticipated. It was all soft and crumbly and it coated my mouth in a weird yellow film.

Not to make you all think that the food is bad here, because it’s not. I’ve been happily stuffing my face like a little pig everyday. But everything about these yellow balls was wrong, and eating it in the dirty hospital environment with vomiting ladies a couple of steps away from me was not very enjoyable.

Life is good (but better with tasty treats!) 😊 x

Heart in Mouth Moment

Yesterday I decided to do a day in intensive care unit (ICU) as part of my experience here. I’d previously done a 7week placement in an ICU in England and absolutely loved it, I was really intrigued to see how differently things are done and what resources are available in An ICU in Nepal.

My friend Lynda was with me as well for the day, she is at the same level in the nursing degree as me but hadn’t done ICU before. We were pleased to be together to talk through the day…and we didn’t even know at this point how much we would need each other through the short shift.

Initially the nurses weren’t very interactive, they said they were busy and went about their day. We joined the ward round, the doctors were great and explained everything to is as we went. Some patients had sepsis, another had a fever they had ruled out dengue fever and meningitis and were waiting for results to determine whether it was encephalitis. Another patient had liver cirrhosis and slot of his other organs were failing too, the doctors said he had a very poor prognosis.

The set up of the ICU was quite similar we had to wear gowns, I think they were an infection control measure but they had blood stains on and I couldn’t really see how they would help reduce spread of infection. There were 9 beds with cardiac monitoring on all of the patients. They do observations every 2 hours, where we do them every hour.

One patient who had been admitted with sepsis was ventilated but completely alert. He was sat up in bed with his endotracheal tube taped to his mouth and a plastic airway taped in next to it, his hands were loosely strapped to the bed. This physical restraint was in place to try and prevent self extubation. When anyone walked past him he would gesture to all the bottles of water and juice sat on the table at the end of his bed. He was clearly very thirsty, the staff declined giving him a drink because it would go straight in to his airways and he would aspirate.

A couple of hours into our shift I saw the nurses run to this patient, he had extubated himself, they called the doctor as it was critical to open his airways and intimate him. I’d seen something similar back home in ICU and it had been a very smooth procedure. This was something else…..

The patient was completely alert and naturally resisting the doctor trying to stick a big metal laryngoscope down his throat. The doctor pushed his chin to try and force his jaw open and the nurses rubbed their knuckles on his sternum.

At this point I could barely watch, I felt so uncomfortable, it went against everything I knew. I tried to rationalise the situation, “this is what they do in Nepal, they don’t have the same access to sedation and monitoring we have”. But also “this is horrible I hope they don’t crack his teeth on that thing!!”

After an excruciating few minutes for the patient the team seemed happy he was intubated and connected to the ventilator. They packed up and went to the other side of the room to chat and look at paperwork. Me and Lynda stayed with the patient, in absolute disbelief at what we had just seen. Then we looked at the monitor, his heart rate was racing and they hadn’t attached the oxygen saturation monitor, I went and told a nurse. She ambled over and put the finger probe on, and walked off again before even waiting to check the reading! We waited and then saw it was 12% TWELVE PERCENT. I’ve never seen numbers that low, I ran and told the nurse, it took her a moment to understand me. Then the whole team came back again. They disconnected him from the ventilator and used a bag to ventilate him, which improved his saturation levels, but nowhere near where you would hope to see them. The doctor asked me to bag the patient whilst he was using suction. I did, but I had never done before so obviously I was a bit nervous, but this definitely seemed like an all hands on deck kind of situation. It didn’t take long to get into a good rhythm. Once the patient’s sats were up to 80% they decided to reconnect the ventilator.

Then they all left again. I looked at the ventilator and could see a leak of about 35% registering. Me and Lynda watched his sats on the monitor, they were dropping again. The doctor walked back and disconnected the ventilator and started bagging again. We took over the bag and took it in turn because it was making our hands ache after a while. Me and Lynda discussed his condition and the gurgling we could hear and the leak that was highlighted on the ventilator and we though a bigger ETT would be needed to prevent the leaking.

The doctor was talking to the patients relatives, and then three of the ladies came and crowded round the patient. They were all crying and holding his hands and feet, me and Lynda carried on with our job and tried not to get emotional. My eyes did get a bit wet though, it’s always that way for me when I see/hear a family crying.

A while later the relatives left the ICU and the doctor decided to use a bigger ETT with a bigger balloon/cuff. This meant extubating, taking out the current tube. And re-intubating, all with little or no sedation again. Me and Lynda stepped back and let the ICU team do their work. It seemed to take forever for them to get an airway and ETT back in. All the while there was no additional oxygen provided. His saturations dropped to 5% I was waiting for him to completely arrest. The doctor used the light on the laryngoscope to check the pupils reactions…..”just put it in!” I was thinking! FINALLY the doctor got the ETT back in. They used the bag to increase his oxygen levels, when they got to 80% they attached the ventilator and the saturations continued to rise to above 95%.

This all occurred over 2hours! We only had 15minutes left so we chatted with the doctor. He was happy with our performance and said he would be pleased if we came back to the ICU again because we had been a big help.

So it looks like we have a job lined up in a Nepali ICU if we should ever need it πŸ˜‰

We were really proud of ourselves for identifying the patients deteriorating condition and working with the team to help the patient. It was strange being in this kind of role, back home we would be supervised all of the time and probably even take a step back when something like this happened to allow the team, who are very specialised and efficient, to do their job. It felt great to have played such a vital role, but also super exhausting! We all had a big dinner and a well deserved lazy afternoon 😁😊

Life is good X

Bed time reading

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I’m so excited to finally have the time to read this book. I’ve been meaning to gets my mitts on it for ages but never found the time. Luckily I saw it in the airport before we flew from Heathrow and it made my day.

I’ve not gone too far into it yet because of our busy days but it’s been great so far. I love the way he writes, it reminds me so much of Louis Theroux’s style of documentary. Love it! Going to try and get through a few more pages seen as the local hotels drummers don’t want me to go to sleep just yet 😳

Life is good (and loud, and rhythmic!) X

Bharatpur Hospital

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After learning about the prevalence of TB yesterday, we decided to follow the local fashion trend and slip on a face mask for the day.

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I went to a medical ward as it looked quite busy. When we got there the doctors were doing ward round with loads of nurses and nursing students following them. The doctors and nurses all speak English and write in English which is obviously so helpful for us!

Some of the conditions people on the medical ward were suffering were: rheumatic heart disease, HIV, meningitis and poisoning.

We observed the ward round, patients being admitted and a blood transfusion.

The main difference I felt was the involvement of families in patient care. They would transfer their relatives from trolleys to beds, they get medications from the pharmacy and bring it to the ward, they bring in food and supply the patient with bed linen and clothing.

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Similarities were the admission which was very holistic taking into account a patient’s age, gender, religion and job. Vital signs are frequently measured and recorded, so there was a lot we could see and relate to as well.

Tomorrow I plan to see the ICU.

PS today I also saw a lizard 😊

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Life is good!!! X

Hospital welcome

We’ve just got back after looking around a couple of hospital where we will be working and learning on the placement.

We went to a government public hospital first. Honestly I was quite surprised it was clean, well organised and well staffed. I had originally been anticipating the worst case scenario from reading I had done before leaving.

There are big differences, such as the re-use of equipment, infrequent hand washing and poor hand hygiene facilities. But there are similarities in observation of patients and medical management of illness. We got to snoop around there store cupboard which was loaded up with familiar meds and equipment. They also had a lot of speedy HIV test kits and some snake anti-venom vials, which we are not used to seeing on out shelves back home.

We got to look around gynaecology ward, medical ward, surgical ward and a delivery suite where there was a lady with her legs parted and a large crowd surrounding her. It’s going to be difficult getting used to the different culture and the way people work here, just opening doors into rooms where people are receiving intimate care and treatment.

We noticed a lot of the paperwork is in English and the doctors and nurses speak plenty of English so that was a major relief!

We are sat at the riverside with the sun above us, making some notes and preparing for our next day where we will actually start working in the hospital……exciting stuff!

X

Monkeys and doggies and prayer flags

Woke up early this morning and had a massive breakfast. Fruit, cereal, omelette veg and bacon, a great start to the day.

Hopped on a bus and went to a sacred Hindu area. A river where they burn the bodies of their dead loved ones. They were decorated beautifully. We then went to a Buddhist temple area. It was beautiful and decorated in all of the prayer flags. We all bought some little prayer flags to take home, they are so beautiful and symbolic of Nepal.

After we headed to a monkey temple, I was so excited to see the monkeys. We’ve had a few scares though, after I encouraged Lynda to have her photograph taken near one, it tried to lash out and we ran! I also tried to take a photo of an adorable baby monkey sleeping next to it’s mother. The mother then grabbed it and ran dragging the baby, which we then realised was dead…. πŸ˜”

I’m currently sat high up on a floor of a cafe with a stunning view over Kathmandu. It’s about 20degress, there are monkeys strolling around and I’m waiting for my vegetable Momos drinking a papaya lassi.

Life is good x x

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I’m here

After a long 26hour journey me and the uk girls Lynda and Millie finally arrived in Kathmandu Nepal.

Our journey consisted of an 8hour, mainly sleepless, night flight from heathrow to Delhi. We were squashed in our seats with our rucksacks in the footwell. We sat next to a nice Indian guy who was going home for a family wedding. We had a great meal and then tried to get some sleep, but with someone’s light shining in our faces and then some turbulence, sleep was not on the cards. Apart from Millie who was sat at the back in the dark, snoring away πŸ˜‰

Delhi was a nice airport we freshened up and then decided to get some noodles, our first lesson on ordering mild food whenever possible if you want to be able to eat your meal. We bought some girly moisturisers and fragrance and chilled for the next few hours. Our next flight from Delhi to Kathmandu was smaller and only an hour and a half journey. I don’t even remember taking off, sleep took hold. Then I woke up to Lynda poking me saying more food was coming! Which was unexpected, but we made the most of more food, curry of course!

We got heat sensor checked for Ebola on our way in the country…we made it in with no problems and then got out visas and waited for our taxi.

The taxi journey was exciting, going through such busy streets. 4 people on a motorbike. The child sat at the front the dad sat behind with the guy being the only one in a helmet, constant horns and people wandering through the roads. All going on with the mountains on the horizon!

We made it to hotel luck star I’m sharing a room with an Australian girl Sierra whose so nice. We went out for a meal, we were all so tired and full of curry, I opted for spaghetti. We went back for some sleep. Obviously I has no issues with that 😁

A great first day an introduction to the next 6 weeks. I think we are all looking forward to exploring and learning more 😊

X

A bit of bedtime reading

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I really love this book, insight guides Nepal, I think it will be the perfect travel companion for me. I’ve just been reading little snippets in the evening at the moment.

I’ve also got another book, Little Princes.

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This is set in Nepal and so seemed like an appropriate book to take along on my trip.

I will have to make sure I leave space in my suitcase for them ☺️