Deadly D and V

D and V (diarrhoea and vomiting) is what this post will mainly be about because that has unfortunately ruled my life the past couple of days. Luckily there are no photos included in this post πŸ˜‰

I had a surprising wake up call at 6am on Sunday, I put this down to having lived mostly on boiled eggs and dry bread the previous few days. I ignored the fact that several of the volunteer group had been struck down with a terrible stomach bug recently whilst I ate my breakfast.

I was due to be going to a rural pharmacy for the day, where villagers present with a wide range of ailments, which would be an awesome experience. However, traveling 45mins to get to a rural village (with probably only one very basic toilet) and finding out then that I was in fact very sick, would not be an awesome experience at all! I decided to stay at the hotel on my own, and this was a very wise decision.

Whilst my roomies were out working I suffered a bit of an upset stomach, but nothing I couldn’t handle. When they came back excited and telling me about their day watching tooth extractions and diagnosing patients with fractured hips, I took a turn for the worse. Lynda went for a refreshing shower and I rudely interrupted with the first of many violent vomiting episodes. This certainly helped breakdown some boundaries between me and my room mates, who share just a small bedroom and bathroom with me 😳

And so the afternoon continued, with me apologising as I stumbled to and from the bathroom every few minutes. The perks of sharing a room with student nurses is they know how to be compassionate πŸ˜‰ luckily I don’t take life too seriously and I enjoyed a bit of gentle bullying from them too. They devised a new song,

“Nicola, she has the Ebola”, it is quite repetitive and catchy (very like my stomach bug).

After a few hours and many litres of water, I was still no better, there was no end in sight for this horror. I was dizzy, my heart was racing, my hands and feet were cold and tingly. My blood pressure was obviously low because I was rapidly becoming dehydrated. I couldn’t believe how quickly I had deteriorated.

I started having terrifying thoughts of being admitted as a patient to the local very unhygienic hospital we had been working in. They would probably poke me with all kinds of horrible needles, I would have to lay on the dirty floor next to patients suffering TB, who would cough in my face….my dehydration may have been getting the better of me at this point.

My roomies were awesome and gave me some anti sickness tablets to take, but I couldn’t hold them down. Then they took it in turns sitting with me whilst the other had dinner. Then they went to go get more meds from the local pharmacy, on the back of another volunteers motorbike.

Millie turned up with some intravenous ondansetron and a couple of medical students who were ready and willing to administer it. Cleverly Lynda had packed a lot of sterile needles, syringes and gauze in her suitcase, which were greatly appreciated. I’m the kind of person who doesn’t even usually take paracetamol for a headache, and I am certainly not a fan of needles. On this occasion though I was quite happy to offer up my arm.

They used a headband as a tourniquet and wrestled with the vial of medication to get it open. I was a bit nervous the med student might have to stick me with the needle several times to get a vein as I’ve been tricky for people before taking blood etc.

I didn’t express this though, I was just so grateful there were people able and willing to do this for me. I needn’t have worried anyway, turns out he is awesome at giving IV meds and hit the jackpot first time! They wished me well and said they were happy to come back if I needed cannulating and fluids putting up. Which was super kind of them! And I’m sure they enjoy every opportunity they get to practice their skills πŸ˜‰

Half an hour later and I hadn’t vomited, not even once! It was a beautiful miracle! I gradually tried to rehydrate. I spent the rest of the next day stuck in my room, not eating and suffering abdo pains, but I could drink, and I was gradually improving.

Since coming to Nepal I have learnt a lot about health, just in a very different way to how I had planned. Hopefully my luck changes soon

X

Advertisements

The Come Down

After a sleepless night sharing a cold school room with 15 people. I finally arose to a spectacular view over the hills, which I enjoyed whilst chowing down on some more boiled eggs and dry bread, yum.

Then we set to work organising the local people into groups of men and women to talk about specific health issues. With a translator we spoke to about 50 women, to learn what they understood about sexual health and advise them on safe practices. The volunteer group also tried to promote good hygiene practices. Then we spoke about symptoms of UTIs and asked the women with suspected UTIs to queue up and we distributed oral medication and creams and gave advice on how to use them.

I believe the men’s group also spoke about sexual health and had a handcrafted piece of wood to demonstrate the application of condoms. Haha!

Then it was time for lunch, more spicy vegetables and rice. I just had a small amount of rice it was too hot in the middle of the day for eating a lot. Then it was time to descend back down the mountain. A lot of us were feeling pretty apprehensive about going down the steep slopes in case we slipped and fell to our deaths 😳

I hung out near the back of the group on the way down and sure enough fell on my bum. Some of my fellow volunteers rushed to help me and ask if I was ok, I was fine, my dignity was just a bit bruised πŸ˜”

The rest of the walk down went without any problems and it was so much more enjoyable than going up! We even had a little dog who joined us and followed us all the way down! ☺️

We got on the bus for our long journey home, and had a slightly less considerate driver than on the way there. We hit ever lump and bump in the road which would literally send us flying out of our seats. We were sat on the back row of the bus, which was a new experience. You get all of the dust from under the bus come and sweep over you constantly. My hair looked grey my bumbag was very dusty and I couldn’t wait to get in and have a wash.

I used a baby wipe on my face whilst I waited for the shower to become free

IMG_1291.JPG

My face was so mucky! Like a little dirty pig 😊 it was so good having a wash and settling down for a good sleep. Little did I know what would happen next…….

X

“Hill” Walk

It was an early start, we were up even earlier than the ridiculous cockerel that we hear every day! But I was super excited! We were going on an hour bus journey up to the base of a hill, where we would then walk for about 3-4hours to get to a village.

We had a cup of tea and got on the bus, it is an open sided bus so it was a bit of a fresh journey. We went past some elephants and plenty of mustard seed fields. We got gradually more remote and could see rice fields and huge mountains that were cultivated on even the steepest slopes. Our bus went on some windy roads through some rivers and eventually stopped in a village at the base of some huge hills (I would definitely call them mountains). We used the last toilet we would see for many hours, a stinky hole in the ground, I tried not to get pee on my trousers, I think I was mainly successful. Then we hung out with some baby goats.

One of the Australian girls Sierra snapped a good 40 pictures of herself hugging the baby goats, the locals just watched, probably very confused about out behaviours. But those were some cute goats!!!

Then we started our hike in our sandals (which Australians funnily refer to as “thongs” haha!). We would be crossing a river 20+ times so sandals were the most appropriate footwear? I hadn’t been that keen on the idea, but they did the job.

IMG_1259.JPG

After about 40minutes walking gradually uphill we stopped for breakfast, boiled eggs and bread. I slapped on some factor 50, hoping not to burn myself anymore. The view was amazing and a little house was pointed out to us high up on a hill side. Apparently an elderly man had been loving on a cave and when Keshab found out some of the locals worked together to provide him with this house. Now he lives more comfortably.

Then we carried on with out hike, which involved a lot of stepping up big boulders and trying not to break your ankles on loose stones. The local porters blazed ahead of us carrying massive suitcases and bags full of medications and bedding and clothes to be donated. They made it look so easy….but it wasn’t. Towards the last half hour of walking the route got really steep and narrow with one side dropping down into the valley. We were all sweating buckets and stopping for photos as an excuse for a breather.

IMG_1271-0.JPG

IMG_1274-0.JPG

Coming over the final edge into the village we were greeted by a few villagers, confused as to why we were so sweaty and out of breath. We were all very pleased with ourselves and compared sweaty back patches, we were all winners! Then we got our work stations set up again, hand washing and first aid. More and more people arrived from the hills, I heard some had walked for a couple of hours to be seen here.

A lot of the injuries and health issues were closely related to issues with hygiene. A lot of wound were infected and slow healing due to the amount of dust and dirt cakes into them. It is understandable though as they have to work very hard and this environment is very dusty. I washed and covered a lot of minor wounds. One poor little baby boy must have had about 4 or 5 oozing wounds. They appeared to be from bites that had been itchy and become infected. Another major issue here seemed to be dry, infected or irritated eyes, again from all of the dust. People were having their eyes irrigated and being given eye drops.

IMG_1279-1.JPG

IMG_1281-1.JPG

In the afternoon we chilled out and had some lunch, curried vegetables and rice. Then we set up our bedroom for the night. The buildings they use as a school. We had foam on the floor and a few blankets and pillows, it was quite cosy looking.

IMG_1283.JPG

Unlike the toilets 😳

IMG_1284.JPG

We spent the evening around a fire, having magic coke (coke with any form of alcohol πŸ˜‰) and some barbecue. Then we tried to settle down for a restful night.

Trying to Catch Up

I’ve been without wifi for several days now, so I’m having to catch up with my blog. I’ve got plenty of time today because now to top off my sunburn, cold and scabies I’ve got a bit of jelly-belly…..anyway, more about that later.

Keshab works with the volunteer programme I’m with, SVPI. He is a local community leader, over the past couple of decades he has worked with several rural communities to help make them more self sufficient. He helps promote education and provided essential resources like access to clean water and has bought goats for the villages.

On Thursday we went to look at one of the villages he has been supporting. There was a blind lady living here and he had encouraged the villagers to support each other and this lady where possible. Whilst we looked around several villagers carefully followed us, intrigued by the sudden prevalence of foreign people. It was a really beautiful and remote village, with chickens, goats and cows living harmoniously with the people. There were vegetables growing everywhere even on the roof tops!! I loved these coke bottles that had been used as plant pots ☺️

IMG_1223.JPG

After this we hopped back on the bus and went to where the local day centre is for small children and a school for slightly older kids too. Keshab explained how important these facilities are as many of the men go into other local towns to labour and women will look after the crops and animals or also go and labour. Obviously having a day centre and school provides a decent environment for the children to be in whilst there parents are busy. When we arrived they all greeted us with little flowers.

I went into the day centre where the SVPI group were donating some toys and balloons. I am a bit unfamiliar with children and felt pretty awkward but they were super cute, especially once they got in to playing with balloons.

IMG_1227.JPG

IMG_1236.JPG

After hanging out with the kids we prepared the work stations in the garden area between the school and day centre. We had a tooth brushing station, hand washing station and a first aid station. Student nurses and doctors worked at the first aid station to assess small wounds, injuries and health issues and treat them when possible or refer on if necessary to the hospital. I cleaned a few wounds and patched them up as best as I could, feeling grateful for my previous experience in community nursing, which was mainly wound dressings. I also spotted a bad case of scabies now that I’m an expert in it πŸ˜‰. A lot of children had very sore ears too, it seems they don’t get them washed often or thoroughly and this would lead to infected areas of skin. One of the medical students showed us how to create a draining instrument for ears filled with wax, using just tissues.

IMG_1244.JPG

IMG_1240.JPG

Some volunteers helped distribute tooth brushes and encouraged the children to have a good scrub around their mouths. Other volunteers worked at the hand wash station using bars of soap and jugs of water to clean the children’s hands. And plenty of people had fun playing with the children outside on their break. I believe some volunteers who are teachers worked in the classroom reading books about dinosaurs too!

It was a very varied day. When we were finished we waved goodbye and hopped on a bus to a stream where we had a picnic in the jungle. I had rice and spicy vegetables sat on my rucksack whilst people squealed with grasshoppers hopping all over them.

Friday and Saturday were going to be days of hiking up a hill to a very remote village to set up a health camp and provide educational discussions about women’s and men’s health. When we got back we had to dash into town to buy some essentials (for me this was an attractive new pair of sandals πŸ˜” ). Then it was time to pack our bags and have an early night. This is when I saw my hearty sunburn on my neck, let’s just hope it burnt any scabies bugs if there were any remaining πŸ˜‰

X

Avatar or Smurf?

So having scabies is as rubbish as I had imagined. I’ve spent the last day looking for decent creams to treat it. Meanwhile all our Australian group members have joined and of course I have been doing my best to avoid getting too close to people. I don’t want to spread the scabies but it does make you appear a bit unfriendly when you awkwardly avoid hand shakes.

We used some cream yesterday which made me a bit anxious, I read it had been banned in some countries because it can be toxic if overused. But I really want to be 100% again so we rubbed loads on. (Also having scabies helps make very close friends when you need your treatment cream rubbing into your back where you can’t reach πŸ˜‰ always look for the silver lining.)

So today we managed to get our itchy hands onto some cream that comes with a much better recommendation. We were pretty excited to give it a whirl. When we opened the bottle it revealed a bright, thick, blue cream. My friend did hers first, her darker skin seems to hide the blue hue quite well.

Then it was my turn. Well! It doesn’t seem to fade away great on my pasty white skin. I look like I have a touch of cyanosis, although I have been trying to tell myself that Avatars were blue, and they seemed pretty cool.

IMG_1220.JPG

The truth is I’m not cool like an Avatar. I’m short and funny-looking like a Smurf.

I hope this washes off well in the morning, I think I am making a terrible first impression with the rest of the group and being blue at breakfast tomorrow won’t help my case!

Smurfette X

Stay away

Today I found out I have scabies, it’s not what I hoped to encounter on my holiday

IMG_1189.JPG

So that took the shine off my day a bit. I got some cream though which will hopefully do the job, then I bought some snacks and saw an elephant chilling out in the road.

IMG_1195.JPG

X

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.

IMG_1178.JPG

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! ☺️

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.

IMG_1053.JPG

IMG_1055.JPG

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.

IMG_1083.JPG

IMG_1084.JPG

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.

IMG_1114.JPG

IMG_1173.JPG

(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