“you are paid for this, doctor”
I knew I won’t be able to work my whole life in okhaldhunga. That was the reason I thought I should inspire other young doctors (GP residents who used to come to Okhaldhunga for 5 months for their rural postings) so that may be they will decide to work in rural regions at least for certain time in their career. I thought I was inspiring people, the way some people have inspired me in my early career………….
Inspiration has no limit. We might get inspired from any thing, from anyone and at anytime of our lives. This sounds funny, but I was once inspired by a character played by Shaharukh Khan (popular Bollywood actor) in a movie called ‘Swadesh’. It was definitely not the most successful movie he has acted but the character of a scientist working in NASA gets moved so much while he witnesses the plight of the villagers living in his abandoned country India, that he decides to return to India and work in the place where he has grown up (needless to mention, his new-found love in India also plays a role to hold him back to India). This sophisticated young aspiring scientist gets a jolt of his life when he has to leave his equipped wagon and has to travel in a passenger boat in the heat of the sun in a rural India. I suppose he gets to see ‘hungry’ people for the first time in his life and may be he understand the real meaning of hunger at that time when the poor farmer, exhibiting his bare body with just skin and ribs, requests him not to take the food out of his children’s tummy by asking to pay the debts.
I happened to read the book called ‘microsoft dekhi bahun danda samma’ (a nepali translation of Leaving Microsoft to change the world). It is really heart warming to know that people when gets determined can really change the world. It is actually very diffcult to bring any change in people’s life. In fact, I really don’t know how much change ‘Room to Read’ (organization formed by John Wood) brought in the lives of children in Nepal but it was definitely a good thought. The fact that an Aussie working in US has come to our country with loads of books just because our school in Bahun danda was lacking books in the library is, for me, a matter of shame to us. This book has really dared to capture an important moment in Wood’s life that really changed the whole course of many lives and he has well expressed the thoughts boiling in his heart. I wish I had written that book.
I had the similar feeling when I read another book called ‘Hospital at the end of the world’ written by a male nurse Joe who was volunteering at Tansen Hospital when I worked there. I was convinced that whatever little things we do in our lives if brings a better changes in other people’s lives we should go ahead with it.
_______________________________
I failed to be another John Wood and I apologized Okhlahdunga for that.
_______________________________
But one day…… in okhaldhunga hospital, some politically motivated bigwigs from okhaldhunga gathered to solve an issue in the hospital. We were trying our best to make them understand that we are also working there in a difficult situation and detrimental remark about the hospital actually lowers our moral. But a self-acclaimed ‘i-know-it-all’ type of teacher from Rumjatar School told us not to glorify what we were doing in the hospital. He further added all the things I did in Okhaldhunga is just because I was paid to do that…….
I thought I was inspiring people, I thought I was trying to make a small change towards a brighter future of my country. But the incident made me realize that I was actually paid to do whatever I was doing. And I should not do more than what I was asked to do. I failed to be another John Wood and I apologized Okhlahdunga for that. That day I told my wife that we should look for another places where they pay us more……..And there were plenty of them.
Sunday, November 14, 2010
Technology???
Technology???
…….after spending five years in rural Nepal ( three years as a resident and two years as a GP), it is difficult for me to decide whether I love or hate the technologies. In all these five years I have seen people being fixed purely by human efforts. Clinical judgment was the best available technology we had in those areas. After coming back to Kathmandu and in the course of my surgical training, it came as a frightening knowledge for me to see how people depended heavily on technologies. Clinical knowhow is placed at the backseat and major decisions are made solely depending on technologies like lab reports or CT Scans or sometime on Histopathology reports. All the hotshot doctors are seen boasting about the piece of surgical gazettes they possess or they had witnessed during their foreign tours. Three chip laparoscopic cameras, Harmonic scalpels and single hole laparoscopic instruments are marketed in the lavish auditorium of five star hotels followed by equally lavish cocktail dinners as if they are here to create a permanent solution to all the health problems of this country. Laser surgeries are advertised and congratulated in the papers in such a way that it looks like they have achieved the Millenium Development Goals. This is the unfortunate picture of all developing countries where solutions for the problems of the poor dying population of the country are searched in the comfort of the capital city amidst the so-called ‘cocktail dinners’.
One of my Australian friend in one of such program declared ‘this cannot be considered a developing country!’ He had just seen an elite jet-set local businessman rushing towards his health club and talking about holidays in one of the resorts in Pattaya over his cell phone in the hotel lobby. This Australian friend of mine, who worked as a doctor, in a rural Nepal for five years, when met some of the Nepalese doctors in a conference, was dead surprised to know how these urban doctors were divorced from the harsh reality of their surroundings and its health conditions. He had a good laugh when same people delivered lectures on making primary health care accessible to the rural population of Nepal. That is the sad picture of Nepal. How our policymakers are supposed to realize the agony of the people scrounging for food and clothing, lacking basics like safe drinking water or sanitation, for whom primary health care is an unknown luxury.
When we talk about transplants and bypass surgeries, I think about the woman who lost her life because there were noone to attend her obstructed labour. This discrepancy in health care is inevitable when we cannot prioritize our needs. On one hand, we know that our crying health needs are drinking water, sanitation, public health and preventive medicine and our prime problems are rampant malnutrition, malaria, tuberculosis and infections. On the other hand, there is so much enormous pressure from the healthcare industry of the developed countries to sell their products in the name of ‘development’, it is almost impossible to resist this temptation. Laparoscopic surgery and recently Laser surgeries are the end products of such pressures. Dr Udwadia, who introduced laparoscopic surgery in India, stated in one of his book that sadly but inevitably the true picture of the developing world is a varied tapestry of all these perceptions with every gradation of inequality and deprivation in between. In contrast, Dr PK Sen who pioneered cardiac surgery in India lambasted those regressive minds and said ‘there are sanctimonious do-gooders who never accomplish anything, who will fight any form of medical progress as an expression of sympathy for the poor.’ He added ‘if we were to wait till everyone had water and sanitation, it is very possible we will have neither drinking water nor surgical progress’. What he said in 1957 is worth thinking over today. What we need at this hour of transition is to strike a balance between technology and basic need of a typical developing country.
That is the reason why, at this stage I am not sure whether I should welcome technology or denounce it. These technologies should not make poor more poorer in the name of advancement. Laparoscopic surgery is of course ‘the’ example of technology with the potential ‘usefulness’ for the whole country, as far as, patient convenience is concerned and already there are few laparoscopic centres in rural Nepal. But single hole laparoscopy or natural orifice laparoscopy, for me, is total absurd. Following the principle of ‘Cutting edge advances should be made available to all people at all places’, we should look for technologies that might serve the rural population too. Telemedicine, CDMA phones, ropeways are few examples that might bring change to new Nepal. Mahabir pun type of information technology, Grameen Bank – a Bangladeshi bank of microfinance that won Nobel Prize to its founder, our own –aafno gaon aafai banaun type of campaign, government subsidy for the small hydropower projects are already few examples that had worked wonder to the rural development. Internet connection backed by solar power, DS Manandhar incubator – a Nepal made incubator to keep newborns, alternative power solutions like Gober (cow-dung) gases, ‘sudhariyako chulho – gasless stoves and maternal waiting homes –place where pregnant women are kept to avoid complications are all examples of our-soil-friendly technologies. There are other uncountable examples where technology has crossed lines with rural development. These technologies rarely catch our attention in such ‘cocktail dinners’. Rural friendly technologies, no matter whether they are locally made or imported, should be declared ‘creams’ and all other ‘craps’.
…….after spending five years in rural Nepal ( three years as a resident and two years as a GP), it is difficult for me to decide whether I love or hate the technologies. In all these five years I have seen people being fixed purely by human efforts. Clinical judgment was the best available technology we had in those areas. After coming back to Kathmandu and in the course of my surgical training, it came as a frightening knowledge for me to see how people depended heavily on technologies. Clinical knowhow is placed at the backseat and major decisions are made solely depending on technologies like lab reports or CT Scans or sometime on Histopathology reports. All the hotshot doctors are seen boasting about the piece of surgical gazettes they possess or they had witnessed during their foreign tours. Three chip laparoscopic cameras, Harmonic scalpels and single hole laparoscopic instruments are marketed in the lavish auditorium of five star hotels followed by equally lavish cocktail dinners as if they are here to create a permanent solution to all the health problems of this country. Laser surgeries are advertised and congratulated in the papers in such a way that it looks like they have achieved the Millenium Development Goals. This is the unfortunate picture of all developing countries where solutions for the problems of the poor dying population of the country are searched in the comfort of the capital city amidst the so-called ‘cocktail dinners’.
One of my Australian friend in one of such program declared ‘this cannot be considered a developing country!’ He had just seen an elite jet-set local businessman rushing towards his health club and talking about holidays in one of the resorts in Pattaya over his cell phone in the hotel lobby. This Australian friend of mine, who worked as a doctor, in a rural Nepal for five years, when met some of the Nepalese doctors in a conference, was dead surprised to know how these urban doctors were divorced from the harsh reality of their surroundings and its health conditions. He had a good laugh when same people delivered lectures on making primary health care accessible to the rural population of Nepal. That is the sad picture of Nepal. How our policymakers are supposed to realize the agony of the people scrounging for food and clothing, lacking basics like safe drinking water or sanitation, for whom primary health care is an unknown luxury.
When we talk about transplants and bypass surgeries, I think about the woman who lost her life because there were noone to attend her obstructed labour. This discrepancy in health care is inevitable when we cannot prioritize our needs. On one hand, we know that our crying health needs are drinking water, sanitation, public health and preventive medicine and our prime problems are rampant malnutrition, malaria, tuberculosis and infections. On the other hand, there is so much enormous pressure from the healthcare industry of the developed countries to sell their products in the name of ‘development’, it is almost impossible to resist this temptation. Laparoscopic surgery and recently Laser surgeries are the end products of such pressures. Dr Udwadia, who introduced laparoscopic surgery in India, stated in one of his book that sadly but inevitably the true picture of the developing world is a varied tapestry of all these perceptions with every gradation of inequality and deprivation in between. In contrast, Dr PK Sen who pioneered cardiac surgery in India lambasted those regressive minds and said ‘there are sanctimonious do-gooders who never accomplish anything, who will fight any form of medical progress as an expression of sympathy for the poor.’ He added ‘if we were to wait till everyone had water and sanitation, it is very possible we will have neither drinking water nor surgical progress’. What he said in 1957 is worth thinking over today. What we need at this hour of transition is to strike a balance between technology and basic need of a typical developing country.
That is the reason why, at this stage I am not sure whether I should welcome technology or denounce it. These technologies should not make poor more poorer in the name of advancement. Laparoscopic surgery is of course ‘the’ example of technology with the potential ‘usefulness’ for the whole country, as far as, patient convenience is concerned and already there are few laparoscopic centres in rural Nepal. But single hole laparoscopy or natural orifice laparoscopy, for me, is total absurd. Following the principle of ‘Cutting edge advances should be made available to all people at all places’, we should look for technologies that might serve the rural population too. Telemedicine, CDMA phones, ropeways are few examples that might bring change to new Nepal. Mahabir pun type of information technology, Grameen Bank – a Bangladeshi bank of microfinance that won Nobel Prize to its founder, our own –aafno gaon aafai banaun type of campaign, government subsidy for the small hydropower projects are already few examples that had worked wonder to the rural development. Internet connection backed by solar power, DS Manandhar incubator – a Nepal made incubator to keep newborns, alternative power solutions like Gober (cow-dung) gases, ‘sudhariyako chulho – gasless stoves and maternal waiting homes –place where pregnant women are kept to avoid complications are all examples of our-soil-friendly technologies. There are other uncountable examples where technology has crossed lines with rural development. These technologies rarely catch our attention in such ‘cocktail dinners’. Rural friendly technologies, no matter whether they are locally made or imported, should be declared ‘creams’ and all other ‘craps’.
Why........why..........why
Why…why…why…
This is, in fact, a million dollar question??? Why doctors do not come to places like Okhaldhunga? Why doctors always want to stay in big cities? Man is always accused of being hungry for facilities. They are ‘subidhabhogi’. But in none other profession, they are blamed for being ‘subidhabhogi’ as much as they do in medical profession. Doctors are, basically, seen as if they are supposed to be a social worker, a ‘sacrificer’, a ‘giver’, a noble human; in short doctors are supposed to be a ‘fool!’ (…….like me!).
One of my colleague rightly said about this issue of retention of doctors in remote places that there is always a ‘push’ factor and a ‘pull factor’. Let’s talk about the ‘pull’ factor of Okhaldhunga. Hmmmmm……I really can’t think about the real ‘pull’ factor of Okhaldhunga. When a learned man asked me why doctors don’t want to come to Okhaldhunga, I asked him back ‘what is there in Okhaldhunga that other places don’t have?’. He had no answer to that. Then I told him I can count hundred things that other places have that Okhaldhunga don’t have. Yes, money could be one of the real ‘pull’ factor for Okhaldhunga. People might come here for money. Money can do wonders but at the same time, money can not do everything. Yes, it is true money might recruit doctors here but, I am sure, it cannot retain them here. Sometime, accidentally if an exceptional doctor comes here to work here, with a zeal of doing something, he will definitely get an hernia trying to move the world. All his enthusiasm will bite the dust once he faces the stubborn ground realities about the life in remote places.
Now, I will list you the ‘push’ factors of Okhaldhunga that pushes the doctors away from this place. The attitude of the people tops the list. You save thousands of lives, people will take you as granted and they will say, it was your duty. They are right. It’s our duty. But suppose if you fail to save just a single life, they will say the patient died because of you, because of your inability and because of your carelessness. In the recent past, lots of such incidents have occurred in different regions of Nepal, accusing the doctors about their carelessness. Hospitals have paid thousands of rupees to sweep the issue inside the carpets. Careers of the aspiring doctors have received a tragic jolt because of such incidents. In my entire medical career, when my patients died, I had never been told by the patient party ‘Doctor! It’s ok. You tried your best’. I was once dragged by an agitated man in Okhaldhunga to bring back his just died father to life. (I know that is the usual first response of a bereaved family member and I am not sure, I might have done the same thing if that had happened to me). What I personally feel is that, doctors are actually entitled to care not cure. They are here to reduce the pain, to put you in ease and to minimize the misery you are in. And I can guarantee no doctor ever will do anything that will harm the patients. But in reverse, doctors are, in their view, entitled to do the magic, cure the disease and save lives. Such attitude pushes doctors away from this place.
This is, in fact, a million dollar question??? Why doctors do not come to places like Okhaldhunga? Why doctors always want to stay in big cities? Man is always accused of being hungry for facilities. They are ‘subidhabhogi’. But in none other profession, they are blamed for being ‘subidhabhogi’ as much as they do in medical profession. Doctors are, basically, seen as if they are supposed to be a social worker, a ‘sacrificer’, a ‘giver’, a noble human; in short doctors are supposed to be a ‘fool!’ (…….like me!).
One of my colleague rightly said about this issue of retention of doctors in remote places that there is always a ‘push’ factor and a ‘pull factor’. Let’s talk about the ‘pull’ factor of Okhaldhunga. Hmmmmm……I really can’t think about the real ‘pull’ factor of Okhaldhunga. When a learned man asked me why doctors don’t want to come to Okhaldhunga, I asked him back ‘what is there in Okhaldhunga that other places don’t have?’. He had no answer to that. Then I told him I can count hundred things that other places have that Okhaldhunga don’t have. Yes, money could be one of the real ‘pull’ factor for Okhaldhunga. People might come here for money. Money can do wonders but at the same time, money can not do everything. Yes, it is true money might recruit doctors here but, I am sure, it cannot retain them here. Sometime, accidentally if an exceptional doctor comes here to work here, with a zeal of doing something, he will definitely get an hernia trying to move the world. All his enthusiasm will bite the dust once he faces the stubborn ground realities about the life in remote places.
Now, I will list you the ‘push’ factors of Okhaldhunga that pushes the doctors away from this place. The attitude of the people tops the list. You save thousands of lives, people will take you as granted and they will say, it was your duty. They are right. It’s our duty. But suppose if you fail to save just a single life, they will say the patient died because of you, because of your inability and because of your carelessness. In the recent past, lots of such incidents have occurred in different regions of Nepal, accusing the doctors about their carelessness. Hospitals have paid thousands of rupees to sweep the issue inside the carpets. Careers of the aspiring doctors have received a tragic jolt because of such incidents. In my entire medical career, when my patients died, I had never been told by the patient party ‘Doctor! It’s ok. You tried your best’. I was once dragged by an agitated man in Okhaldhunga to bring back his just died father to life. (I know that is the usual first response of a bereaved family member and I am not sure, I might have done the same thing if that had happened to me). What I personally feel is that, doctors are actually entitled to care not cure. They are here to reduce the pain, to put you in ease and to minimize the misery you are in. And I can guarantee no doctor ever will do anything that will harm the patients. But in reverse, doctors are, in their view, entitled to do the magic, cure the disease and save lives. Such attitude pushes doctors away from this place.
Development in a developing state…..
Development in a developing state…..
The weather made me stay in Rumjatar for seven days. Whole world was making merry in the wake of Dashain season but I had no other choice that to look at the sky and pray for it to clear up. The news of helicopter crash including state minister along with high officials from WFP made days more gloomier. As passengers from flights of seven days accumulated in Rumjatar, fooding charges in the hotels there were hiked. As the days passed on, “dal” in those hotels got thinner and thinner, bed bugs got fatter and fatter, fleas had the party time, autocracy of Nepal Airlines manager rose, pit-hole toilets were filling up fast and both topic of conversation and stock of food were emptying.
Those dull days of stay in Rumjatar was made interesting by meeting with people from different fields. Myself being from the medical field was compelled to get amused in the company of a young geologist, a near-retiring road engineer, a group of sociologists, few district level political bigwigs, a group of patients and their relatives and few businessmen. The conversation was lively especially when we talked about politicians (that was the only common topic among the diverse group) and when we cursed the weather. A decision to form a society of office bearers in Okhaldhunga was tabled in the mean time. Plan to waste Saturdays with playing cards was formulated. It was decided to send a delegation to district CDO asking for a separate phone lines for the offices to make communication easier.
It was amazing to know from the outsiders that how every little happening in the hospital became the talk of the town. Who got what sort of disease, who broke which bone of which of his enemy, who was bitten by whose dog, who gave birth to how many babies, who died of what disease and whose prediction about his death came out to be true. Everything that happened in hospital was savored by people of Okhaldhunga with gusto. And it was equally amazing to know how version varied from people to people. Gossip mongers were at large at Okhaldhunga. I cleared few of the confusions people had about the way hospital was functioning. I tried my best to make people understand how difficult it is to practice medicine in Okhaldhunga but as expected, it was not well taken by the crowd. For the geologist, testing the soil of different variety found here was the most difficult job. For the engineer, convincing people to let them use their field for constructing a new road was the most difficult job. For the sociologists, using (or misusing) the donor fundings with quick and visible outcome was the major problem. Businessmen had all the problems because of the road link that was being planned as they were used to making more profit with the air-lifted goods. Politicians concluded all these problems are not dealt only because their parties and themselves were not in the power. In short, not only me, everybody was complaining and everybody was not satisfied. I thought that was Okhaldhunga for you…
I was not an expert in developmental studies. But what I felt was that development should go ahead in package. Co-ordination between the development agencies was so poor that it created some funny pictures in the name of development. I was told that on the way to Sunkoshi from Okhaldhunga, there is road link but no bridge and towards Solu, there was a bridge built but no roads connecting to it. In the name of infrastructure development aid, different INGOs has built buildings for the schools in different villages but as Education Ministry had no plans to expand the capacity of those schools, the newly-built houses are being used as goat-shelters. Wireless technologies in telecommunication were all available in cities but it was not there in places like Okhaldhunga where it needed the most.
Roads, Education, Health, Communication, Agriculture, Electricity and industries; all should come to the place like Okhaldhunga in a package. If one form comes before another, there will be a chaos. In Health Okhaldhunga had an ideal full fledged hospital but hospital itself is sick as there were no roads, no electricity and no communication. Same thing will happen to any industry if they plan to run in this place. Without industry or good agricultural potentials, there will be no employment opportunities and Okhaldhunga will just remain as a source of cheap manpower to the developed countries. Arun third (if gets completed) will be a wonder to Sankhuwasabha just like Kaligandaki has been to Syangja. But for Okhaldhunga no plans are on the pipeline on which people can stick their hopes. Here, tourism is dead, industries are impossible, agricultural products cant sustain its own people for whole year, education is non-existent and all its young generation are either in war or are outside the country. God knows what it takes for the flourishment of this place…..
I knew impatience is not a virtue. But as the days passed in Rumjatar, I could feel it in everybody’s face. The only functioning telephone in Rumjhatar also got dead as there was no sunlight for their batteries to get charged. That added more to our woes. Nobody had any idea about how to conquer the weather. All of us felt extorted by none other than the weather. Thanks to some of the passengers who knew how to infuse life to a dead situation and amused everybody around us with their gift of the gab and their acute sense of humor. It was because of them I felt if we had to celebrate Dashain in that place; it won’t be the worst Dashain I ever had.
……………………………………………………………………………
The weather made me stay in Rumjatar for seven days. Whole world was making merry in the wake of Dashain season but I had no other choice that to look at the sky and pray for it to clear up. The news of helicopter crash including state minister along with high officials from WFP made days more gloomier. As passengers from flights of seven days accumulated in Rumjatar, fooding charges in the hotels there were hiked. As the days passed on, “dal” in those hotels got thinner and thinner, bed bugs got fatter and fatter, fleas had the party time, autocracy of Nepal Airlines manager rose, pit-hole toilets were filling up fast and both topic of conversation and stock of food were emptying.
Those dull days of stay in Rumjatar was made interesting by meeting with people from different fields. Myself being from the medical field was compelled to get amused in the company of a young geologist, a near-retiring road engineer, a group of sociologists, few district level political bigwigs, a group of patients and their relatives and few businessmen. The conversation was lively especially when we talked about politicians (that was the only common topic among the diverse group) and when we cursed the weather. A decision to form a society of office bearers in Okhaldhunga was tabled in the mean time. Plan to waste Saturdays with playing cards was formulated. It was decided to send a delegation to district CDO asking for a separate phone lines for the offices to make communication easier.
It was amazing to know from the outsiders that how every little happening in the hospital became the talk of the town. Who got what sort of disease, who broke which bone of which of his enemy, who was bitten by whose dog, who gave birth to how many babies, who died of what disease and whose prediction about his death came out to be true. Everything that happened in hospital was savored by people of Okhaldhunga with gusto. And it was equally amazing to know how version varied from people to people. Gossip mongers were at large at Okhaldhunga. I cleared few of the confusions people had about the way hospital was functioning. I tried my best to make people understand how difficult it is to practice medicine in Okhaldhunga but as expected, it was not well taken by the crowd. For the geologist, testing the soil of different variety found here was the most difficult job. For the engineer, convincing people to let them use their field for constructing a new road was the most difficult job. For the sociologists, using (or misusing) the donor fundings with quick and visible outcome was the major problem. Businessmen had all the problems because of the road link that was being planned as they were used to making more profit with the air-lifted goods. Politicians concluded all these problems are not dealt only because their parties and themselves were not in the power. In short, not only me, everybody was complaining and everybody was not satisfied. I thought that was Okhaldhunga for you…
I was not an expert in developmental studies. But what I felt was that development should go ahead in package. Co-ordination between the development agencies was so poor that it created some funny pictures in the name of development. I was told that on the way to Sunkoshi from Okhaldhunga, there is road link but no bridge and towards Solu, there was a bridge built but no roads connecting to it. In the name of infrastructure development aid, different INGOs has built buildings for the schools in different villages but as Education Ministry had no plans to expand the capacity of those schools, the newly-built houses are being used as goat-shelters. Wireless technologies in telecommunication were all available in cities but it was not there in places like Okhaldhunga where it needed the most.
Roads, Education, Health, Communication, Agriculture, Electricity and industries; all should come to the place like Okhaldhunga in a package. If one form comes before another, there will be a chaos. In Health Okhaldhunga had an ideal full fledged hospital but hospital itself is sick as there were no roads, no electricity and no communication. Same thing will happen to any industry if they plan to run in this place. Without industry or good agricultural potentials, there will be no employment opportunities and Okhaldhunga will just remain as a source of cheap manpower to the developed countries. Arun third (if gets completed) will be a wonder to Sankhuwasabha just like Kaligandaki has been to Syangja. But for Okhaldhunga no plans are on the pipeline on which people can stick their hopes. Here, tourism is dead, industries are impossible, agricultural products cant sustain its own people for whole year, education is non-existent and all its young generation are either in war or are outside the country. God knows what it takes for the flourishment of this place…..
I knew impatience is not a virtue. But as the days passed in Rumjatar, I could feel it in everybody’s face. The only functioning telephone in Rumjhatar also got dead as there was no sunlight for their batteries to get charged. That added more to our woes. Nobody had any idea about how to conquer the weather. All of us felt extorted by none other than the weather. Thanks to some of the passengers who knew how to infuse life to a dead situation and amused everybody around us with their gift of the gab and their acute sense of humor. It was because of them I felt if we had to celebrate Dashain in that place; it won’t be the worst Dashain I ever had.
……………………………………………………………………………
They died because they were in Okhaldhunga…………
They died because they were in Okhaldhunga…………
Some people die because of the geography of the place they live. Sounds strange but the geography of okhaldhunga has killed few of its own people.
This young boy of 13 years was at the pink of his health. Climbing the trees and running over the hills were his daily routine. It was his way of having fun to climb the trees and eat the fruits on his way to home from school. On that unfortunate rainy day, he was, as usual, on the top of a ‘naspati’ tree and suddenly he lost his balance. He landed on a rock which was about 9 meters down from where he was, and then he rolled over to the mud. Because of the impact, he lost his consciousness for few minutes. When he woke up, he was being carried by his friends to his home. At that time, he noticed there was something wrong with his right arm. He saw the blood pouring out of the wound on that arm. The pain was unbearable.
It took whole one day for his farmer father to borrow the money from his neighbors to take his son to the nearest hospital, the mission hospital, which was 2 days walk from his home. Somebody tied the wound with the piece of cloth to check the blood flow. This man then asked few of his neighbors to carry the boy to the hospital on a locally made ‘stretcher’. The service was free but he had to feed those four men for next 4 days, so he had to carry few grains too with him to feed those men.
During my stay here in this hospital, I have noticed a special sigh of relief people give when they reach this hospital. This man again gave me the same expression, which made me uncomfortable for a long time. Deep inside I knew, his son is in trouble. I tried to explain it to him. The condition was called the ‘compound fracture’ and as the name suggests this was really a complex condition. I told his father that we will clean his dirty wound and try to strengthen his fractured bone but he still might get infection of the bone and might loose his limb. That did not trouble the father. He had been to this hospital many times for his ailing mother and he knew doctors sometime exaggerate the situation to prepare the patient party for the worst. But he did not know that this time I was damn honest.
There was lots of pus in his wound, which did not surprise us; we did a thorough cleaning of the wound till the wound looked good. At last, we were happy. So was his father. He thanked those who helped to carry his son to the hospital and bid good bye to them. He was taken to his bed, both father and son slept a good night’s sleep. Next two days were uneventful. The wound still looked ok. But on the third day, the nurse aid Gyan Bahadur ‘dai’ who was cleaning this boy’s wound noticed that the boy had an unusual jerk of this right hand which made him cry of pain. He explained the condition as an electric shock. That jerk stopped after the wound cleaning. But when we visited him on the next day, we noticed the continuous jerk, which I thought was ‘partial fits’ but my fellow colleague, Dr. Ashish, a CMC Vellore graduate was not convinced. It was a horrifying moment, when we reached on the conclusion that the boy has developed ‘tetanus’, a life threatening illness.
I had given tetanus toxoid prophylaxis to the boy when he first came to the hospital. But that takes time for tetanus toxoid to develop antibody on human body. We knew he needed tetanus immunoglobulin for the fast action. Our hospital does not keep such medicine, as it was so costly and we rarely use it. As we had telephone line fixed just few days back, we could now call our medicine supplier to send the medicine from Kathmandu as soon as possible. He understood the gravity of the situation and sent the medicines to the airlines counter on the same day (that’s the fastest (?) mode of transport to this place). I still think that we could have saved this boy if we had got the medicine on the same day or after a day or two. But the medicine arrived after one week, few hours after the boy died.
Thanks to the geography of this place. It took three days for this father to bring his son to the hospital. Thanks to the irregular flights. Thanks to the always-profit-seeking airlines. It took seven days for the medicine to come from Kathmandu to this place.
I still remember the expression on this father’s face when he first came to this hospital – a relieved father. And when he left this hospital, he gave me a never forgetting expression – expression of a confused father. As if, he was asking what his mistake was and what did he do wrong? If he had asked me, I would have matter-of-factly told him that his mistake was he was born in a remote place of Nepal called Okhaldhunga.
And I wish I could have taken his photograph to record the difference between the two expressions………….
___________________________________________________
Another 13 years (I wonder why all this happens to 13 years old) Sherpa boy was brought to this hospital in the afternoon after a multiple wasp bite all over his body. The incident happened in the jungle, a place which was very much familiar to them, where they grew up playing, where they went everyday to collect the firewood and where no bad incident had happened ever.
The boy was swollen from face to toes and was not in the condition to explain what had exactly happened. The swelling was not a problem for us. We knew if his kidneys are not affected, the swelling will subside in a day or two. But like they say, misfortune does not come alone; he stopped producing urine at all after the hospital admission. We tried some available medicines which was not effective. The only thing that could save this boy’s life was the dialysis, which was available only in Kathmandu. That boy’s father had never been out of Okhaldhunga in his entire life but when I asked him to make the arrangement to take the boy to Kathmandu, he quickly disappeared to get the money. He had lost his two other sons and his wife in the last year’s landslide. He was not in the position to take chance this time. That evening he came all prepared to take this boy to Kathmandu. He was hoping to get a ticket in tomorrow’s flight. There was only a slim chance of him getting the ticket as all the seats of the irregular flight will be already occupied by the so-called influential people of this district. Unfortunately, this poor man did not have to carry his son in the four hour journey to the airport and did not have to beg for the ticket with the ‘ruthless’ station manager or the Nepal Airlines there, as the boy succumbed to death in the night time. Both his kidneys were totally shut because of the extensive bites all over his body – condition medically termed as end stage renal failure secondary to myoglobinuria.
Most of the Sherpas have this expressionless face but the stunned look in this father’s face was not because of him being a Sherpa but maybe he was surprised by the kind of ‘fate’ he got. I didn’t offer him a good explanation nor I could explain to him about how we could have dealt with the situation in a better way. I was mute. This Sherpa father did not need much consolation from his friends too. He was quite used to this type of situation.
Ironically, few days later I got to read in the national daily that the number of dialysis machine was increased to 30 in the National Kidney Centre in Kathmandu – a news that did not please me at all. I would have been happier if they had worked to bring tertiary health care to the district level. That would have brought smiles in lots of faces………
________________________________________
Sometimes it’s the geography that distances people from the hospital and sometimes it’s the mindset of the people that keeps people far from where they should be. This 36 years old lady decided to run away from her village when she was pregnant with 30 weeks baby from her wealthy boyfriend – an unacceptable practice in the rural set-up. The whole plan to make that lady disappear from the village was architectured by the sister of the boyfriend with some monetary assistance from that man. The other man with whom she ran away was mourning the death of his wife’s death. He got this new wife as a consolation but he had to face severe opposition from the society. He was happy with this newly-wed pregnant wife of his that he did not bother about the pressure from the society. He had failed to procure a child after 10 years of marriage and that was the reason why he was happy to adopt a pregnant wife. He did not know he will be punished by the society when he needed it the most.
One fine morning, this lady passed water prematurely. Very soon, they noticed the leg of the premature baby hanging out. They knew it was not normal and she needs to be in the hospital. They lived in the next hill which looked quite close to the hospital – only one hour of walking distance to the hospital. When this man went to his neighbors to help him take his wife to the hospital, none of the villagers were ready to touch the ‘doomed’ lady. I came to know that he spent the whole morning and afternoon pleading the villagers to help him without any success. A little bit far from the village lived one of the hospital administrative staff, Ganesh ‘dai’. When he came to know about the lady, he was ready to help this poor man. He knew he might also get the same punishment in the future by the society. It was his greatness that he chose to help the needy person than to hold back fearing the society.
Finally when she reached the hospital the baby had almost come out and was dead. The head was stuck and the body looked macerated indicating that the baby was dead long time back, maybe she died at the time when her step father was pleading for the help with the society. We took out the unfortunate child, who was ‘literally’ killed by the society. Mother was fine but looked dejected. That was the price she had to pay for her marital problems. But that was not the reason why she had to stay in the hospital for one whole week waiting for someone to take her home. Her husband had now disappeared as his only hope of having an offspring had now crashed. Her boyfriend was obviously not in the scene and the woman who planned all this had already disappeard with all the money.
This incident convinced me that if we cannot change the geography, it’s the mindset of the people that needs to be changed to save more lives. Otherwise, having a big hospital and great doctors in this area is not going to help people. It’s the people, who need to be aware and willing to help to the needy. Man needs society the most in a place like this – a society made up of human not of ‘animals’.
____________________________________________
Again, there was a 15 months old boy suffering from pneumonia. When he was brought to the hospital, he was almost gasping for air. I knew it was too late for this boy. Still we gave him oxygen, bronchodialators and antibiotics. He recovered a bit but succumbed to death after four hours of struggling for life. Our national data says lots of children still die because of respiratory tract infection in our country. I must say, that is the half truth. Lots of children could have been saved if their parents had a proper mindset. This examples proves my point.
This boy had running nose 15 days back which quickly progressed to shortness of breath and associated high fever. He was taken to the local witchdoctor who was known as the ‘pnemonia specialist’ in that region. Foolishly, the ‘famous’ witchdoctor stripped him of all the clothes and began hitting him with a broom soaked in water. The small child was shaking with cold, which the witchdoctor said sign of evil trying to leave the body. Undergoing the same ritual for another three days, the boy now could not eat or drink. That frightened the parents and finally they decided to walk few hours to a local medicine shop where they were given some antibiotics and cough syrups. A long wait for another two days did not bring the child to consciousness so they decided to walk one whole day to the ‘mission’ hospital, where the child died after few hours.
Again the expression on this father’s face haunted me for few days. After few days, I had almost forgotten the incident but another patient from the same village came with similar problems. When I told them that the child needs oxygen, they refused it. The mystery was solved when one of our hospital staff took the detail history from the parents. The previous incident where the baby died after coming to this hospital gave our ‘famous’ witchdoctor enough evidences to prove his own utility. He claimed that his mode of treatment was working well but the parents foolishly took the baby to the hospital where the doctors made the boy smell the ‘bad air’, and that killed the boy. All other villagers then vowed not to take the ‘bad air’ (oxygen) in their lifetime. I never knew it will be so difficult to make these people believe that their belief is not believable. That’s why, I was convinced that it’s the mindset of people that’s killing other people. And no ‘great’ doctor can revert the printed conception of these people. If only they could realize that timely intervention in any disease can save lives and it’s the time which they wasted with the witchdoctor is actually to blame for the death of the child. I know its our medical system that is to blame. The only reason why people believe the witchdoctors is that they are available in the ‘next door’ unlike the doctors who stay in a big hospital one or two day walk from their home. If only we could make the health facility available to all and if only we could change the mindset of these people, we could have saved lots and lots of lives. I don’t know for how long people like this witchdoctor will keep on polluting the mind of the ignorant people around this area and wasting the precious lives of our own people.
And now, let me ask you, don’t you think all these people died because they were born in a place like Okhaldhunga??????
Some people die because of the geography of the place they live. Sounds strange but the geography of okhaldhunga has killed few of its own people.
This young boy of 13 years was at the pink of his health. Climbing the trees and running over the hills were his daily routine. It was his way of having fun to climb the trees and eat the fruits on his way to home from school. On that unfortunate rainy day, he was, as usual, on the top of a ‘naspati’ tree and suddenly he lost his balance. He landed on a rock which was about 9 meters down from where he was, and then he rolled over to the mud. Because of the impact, he lost his consciousness for few minutes. When he woke up, he was being carried by his friends to his home. At that time, he noticed there was something wrong with his right arm. He saw the blood pouring out of the wound on that arm. The pain was unbearable.
It took whole one day for his farmer father to borrow the money from his neighbors to take his son to the nearest hospital, the mission hospital, which was 2 days walk from his home. Somebody tied the wound with the piece of cloth to check the blood flow. This man then asked few of his neighbors to carry the boy to the hospital on a locally made ‘stretcher’. The service was free but he had to feed those four men for next 4 days, so he had to carry few grains too with him to feed those men.
During my stay here in this hospital, I have noticed a special sigh of relief people give when they reach this hospital. This man again gave me the same expression, which made me uncomfortable for a long time. Deep inside I knew, his son is in trouble. I tried to explain it to him. The condition was called the ‘compound fracture’ and as the name suggests this was really a complex condition. I told his father that we will clean his dirty wound and try to strengthen his fractured bone but he still might get infection of the bone and might loose his limb. That did not trouble the father. He had been to this hospital many times for his ailing mother and he knew doctors sometime exaggerate the situation to prepare the patient party for the worst. But he did not know that this time I was damn honest.
There was lots of pus in his wound, which did not surprise us; we did a thorough cleaning of the wound till the wound looked good. At last, we were happy. So was his father. He thanked those who helped to carry his son to the hospital and bid good bye to them. He was taken to his bed, both father and son slept a good night’s sleep. Next two days were uneventful. The wound still looked ok. But on the third day, the nurse aid Gyan Bahadur ‘dai’ who was cleaning this boy’s wound noticed that the boy had an unusual jerk of this right hand which made him cry of pain. He explained the condition as an electric shock. That jerk stopped after the wound cleaning. But when we visited him on the next day, we noticed the continuous jerk, which I thought was ‘partial fits’ but my fellow colleague, Dr. Ashish, a CMC Vellore graduate was not convinced. It was a horrifying moment, when we reached on the conclusion that the boy has developed ‘tetanus’, a life threatening illness.
I had given tetanus toxoid prophylaxis to the boy when he first came to the hospital. But that takes time for tetanus toxoid to develop antibody on human body. We knew he needed tetanus immunoglobulin for the fast action. Our hospital does not keep such medicine, as it was so costly and we rarely use it. As we had telephone line fixed just few days back, we could now call our medicine supplier to send the medicine from Kathmandu as soon as possible. He understood the gravity of the situation and sent the medicines to the airlines counter on the same day (that’s the fastest (?) mode of transport to this place). I still think that we could have saved this boy if we had got the medicine on the same day or after a day or two. But the medicine arrived after one week, few hours after the boy died.
Thanks to the geography of this place. It took three days for this father to bring his son to the hospital. Thanks to the irregular flights. Thanks to the always-profit-seeking airlines. It took seven days for the medicine to come from Kathmandu to this place.
I still remember the expression on this father’s face when he first came to this hospital – a relieved father. And when he left this hospital, he gave me a never forgetting expression – expression of a confused father. As if, he was asking what his mistake was and what did he do wrong? If he had asked me, I would have matter-of-factly told him that his mistake was he was born in a remote place of Nepal called Okhaldhunga.
And I wish I could have taken his photograph to record the difference between the two expressions………….
___________________________________________________
Another 13 years (I wonder why all this happens to 13 years old) Sherpa boy was brought to this hospital in the afternoon after a multiple wasp bite all over his body. The incident happened in the jungle, a place which was very much familiar to them, where they grew up playing, where they went everyday to collect the firewood and where no bad incident had happened ever.
The boy was swollen from face to toes and was not in the condition to explain what had exactly happened. The swelling was not a problem for us. We knew if his kidneys are not affected, the swelling will subside in a day or two. But like they say, misfortune does not come alone; he stopped producing urine at all after the hospital admission. We tried some available medicines which was not effective. The only thing that could save this boy’s life was the dialysis, which was available only in Kathmandu. That boy’s father had never been out of Okhaldhunga in his entire life but when I asked him to make the arrangement to take the boy to Kathmandu, he quickly disappeared to get the money. He had lost his two other sons and his wife in the last year’s landslide. He was not in the position to take chance this time. That evening he came all prepared to take this boy to Kathmandu. He was hoping to get a ticket in tomorrow’s flight. There was only a slim chance of him getting the ticket as all the seats of the irregular flight will be already occupied by the so-called influential people of this district. Unfortunately, this poor man did not have to carry his son in the four hour journey to the airport and did not have to beg for the ticket with the ‘ruthless’ station manager or the Nepal Airlines there, as the boy succumbed to death in the night time. Both his kidneys were totally shut because of the extensive bites all over his body – condition medically termed as end stage renal failure secondary to myoglobinuria.
Most of the Sherpas have this expressionless face but the stunned look in this father’s face was not because of him being a Sherpa but maybe he was surprised by the kind of ‘fate’ he got. I didn’t offer him a good explanation nor I could explain to him about how we could have dealt with the situation in a better way. I was mute. This Sherpa father did not need much consolation from his friends too. He was quite used to this type of situation.
Ironically, few days later I got to read in the national daily that the number of dialysis machine was increased to 30 in the National Kidney Centre in Kathmandu – a news that did not please me at all. I would have been happier if they had worked to bring tertiary health care to the district level. That would have brought smiles in lots of faces………
________________________________________
Sometimes it’s the geography that distances people from the hospital and sometimes it’s the mindset of the people that keeps people far from where they should be. This 36 years old lady decided to run away from her village when she was pregnant with 30 weeks baby from her wealthy boyfriend – an unacceptable practice in the rural set-up. The whole plan to make that lady disappear from the village was architectured by the sister of the boyfriend with some monetary assistance from that man. The other man with whom she ran away was mourning the death of his wife’s death. He got this new wife as a consolation but he had to face severe opposition from the society. He was happy with this newly-wed pregnant wife of his that he did not bother about the pressure from the society. He had failed to procure a child after 10 years of marriage and that was the reason why he was happy to adopt a pregnant wife. He did not know he will be punished by the society when he needed it the most.
One fine morning, this lady passed water prematurely. Very soon, they noticed the leg of the premature baby hanging out. They knew it was not normal and she needs to be in the hospital. They lived in the next hill which looked quite close to the hospital – only one hour of walking distance to the hospital. When this man went to his neighbors to help him take his wife to the hospital, none of the villagers were ready to touch the ‘doomed’ lady. I came to know that he spent the whole morning and afternoon pleading the villagers to help him without any success. A little bit far from the village lived one of the hospital administrative staff, Ganesh ‘dai’. When he came to know about the lady, he was ready to help this poor man. He knew he might also get the same punishment in the future by the society. It was his greatness that he chose to help the needy person than to hold back fearing the society.
Finally when she reached the hospital the baby had almost come out and was dead. The head was stuck and the body looked macerated indicating that the baby was dead long time back, maybe she died at the time when her step father was pleading for the help with the society. We took out the unfortunate child, who was ‘literally’ killed by the society. Mother was fine but looked dejected. That was the price she had to pay for her marital problems. But that was not the reason why she had to stay in the hospital for one whole week waiting for someone to take her home. Her husband had now disappeared as his only hope of having an offspring had now crashed. Her boyfriend was obviously not in the scene and the woman who planned all this had already disappeard with all the money.
This incident convinced me that if we cannot change the geography, it’s the mindset of the people that needs to be changed to save more lives. Otherwise, having a big hospital and great doctors in this area is not going to help people. It’s the people, who need to be aware and willing to help to the needy. Man needs society the most in a place like this – a society made up of human not of ‘animals’.
____________________________________________
Again, there was a 15 months old boy suffering from pneumonia. When he was brought to the hospital, he was almost gasping for air. I knew it was too late for this boy. Still we gave him oxygen, bronchodialators and antibiotics. He recovered a bit but succumbed to death after four hours of struggling for life. Our national data says lots of children still die because of respiratory tract infection in our country. I must say, that is the half truth. Lots of children could have been saved if their parents had a proper mindset. This examples proves my point.
This boy had running nose 15 days back which quickly progressed to shortness of breath and associated high fever. He was taken to the local witchdoctor who was known as the ‘pnemonia specialist’ in that region. Foolishly, the ‘famous’ witchdoctor stripped him of all the clothes and began hitting him with a broom soaked in water. The small child was shaking with cold, which the witchdoctor said sign of evil trying to leave the body. Undergoing the same ritual for another three days, the boy now could not eat or drink. That frightened the parents and finally they decided to walk few hours to a local medicine shop where they were given some antibiotics and cough syrups. A long wait for another two days did not bring the child to consciousness so they decided to walk one whole day to the ‘mission’ hospital, where the child died after few hours.
Again the expression on this father’s face haunted me for few days. After few days, I had almost forgotten the incident but another patient from the same village came with similar problems. When I told them that the child needs oxygen, they refused it. The mystery was solved when one of our hospital staff took the detail history from the parents. The previous incident where the baby died after coming to this hospital gave our ‘famous’ witchdoctor enough evidences to prove his own utility. He claimed that his mode of treatment was working well but the parents foolishly took the baby to the hospital where the doctors made the boy smell the ‘bad air’, and that killed the boy. All other villagers then vowed not to take the ‘bad air’ (oxygen) in their lifetime. I never knew it will be so difficult to make these people believe that their belief is not believable. That’s why, I was convinced that it’s the mindset of people that’s killing other people. And no ‘great’ doctor can revert the printed conception of these people. If only they could realize that timely intervention in any disease can save lives and it’s the time which they wasted with the witchdoctor is actually to blame for the death of the child. I know its our medical system that is to blame. The only reason why people believe the witchdoctors is that they are available in the ‘next door’ unlike the doctors who stay in a big hospital one or two day walk from their home. If only we could make the health facility available to all and if only we could change the mindset of these people, we could have saved lots and lots of lives. I don’t know for how long people like this witchdoctor will keep on polluting the mind of the ignorant people around this area and wasting the precious lives of our own people.
And now, let me ask you, don’t you think all these people died because they were born in a place like Okhaldhunga??????
Little things we did........in Okhaldhunga!
Little things we did……….in Okhaldhunga
After working in Okhaldhunga, lots of incidents convinced me that the Nepalese women have the umbilical link with the suffering.
Cholina Katel had successfully delivered one live children at home in the previous year. She was brought to this hospital on a rainy night by her villagers carrying her for about 10 hours because she could not deliver her second child at home and they saw the foot of the baby dropping out. This was the first time she had seeked medical service in her entire life, thanks to some of the old ladies in her village who knew baby’s foot dropping first is a problem and can threaten mother’s life.
She was first seen by Dr. Hemant, an enthusiastic young doctor who was assigned to work in this rural hospital for three months by a big urban tertiary care hospital in Kathmandu. As soon as he knew that the baby inside was still live he knew that this is a real emergency (a case medically termed as footlink breech) where a delay means a dead baby. He asked a hospital staff to fetch me from my home (we don’t have telephones in Okhaldhunga, an unimaginable situation for the urbanites), where I was preparing to make my one year old son sleep. The call made me and my wife Dr. Pankaj, who also happened to be a doctor, hand over my son to the babysitter and rush towards the hospital. Dr. Hemant was clever enough to start the intravenous line, give prophylactic antibiotic and insert a tube in the mother’s urethra as a preparation for the caesarean section. I quickly scrubbed my hands and slid into the OT gown and headed towards the OT where Dr. Pankaj, who happened to be relatively expert in anaesthesia amongst us, had sticked a needle on the mother’s back to make her lower half of body paralyzed and pain free. It didn’t take time for me to realize that the leg which was hanging outside had turned blue and might be useless if I make further delay in taking out the baby. I quickly ordered to arrange one pint of blood from our ever-reliable blood bank (neighbouring college students’ hostel) that provides fresh blood 24 hours 7 days a week. With Dr. Hemant assisting me in the operation, I opened her abdomen and pulled out the baby from the mother’s uterus in no time but to my surprise, the leg was not blue. That proved the baby who had the blue leg was still inside the uterus. Then I pulled the second baby out who definitely had the blue leg. Finally we handed over both the babies to Dr. Pankaj, who had to resuscitate both the babies with the help of an inexperienced nurse. She somehow managed to help both the babies to take first breath of their life and finally babies gave a weak cry – a relief to all of us. As we were closing the mother’s abdomen with the help of some not-very-good 25 years old instruments, Dr. Pankaj took the babies to an equally old incubator (which looked more like a wooden box). We transferred the mother to the ward and left to our respective homes thanking tits and bits of experiences which we gathered during our training as a GP, which helped us to save those three lives.
Both the babies were premature weighing two Kilograms each. That means they had to spend months in the incubator and had to feed with the help of a tube for next few days till they become able to suck their mother’s breast – a fact that added agony to their parents who had left their other child, buffalos and fields unsupervised at home. Till now they were not bothered about the hospital bills – which they could have never afforded even after selling their entire property if the Hospital Social Service Department had not come to their rescue. Their hospital bills were taken care of by the Social Service Department on the next day. But that was not the end; they had to arrange the artificial milk for the babies as their mother could not produce enough milk for two babies. Social Service department was kind enough to arrange two regular meals for the mother too.
They were discharged one month later when their happy father came to receive them. We unsuccessfully tried to convince the father to get vasectomy done as they now already had three live children but the fear of getting weak in future was imprinted in his mind so deeply that we failed to counsel him for vasectomy. We regretted our inexcusable failure to close the mother’s tubes while doing the caesarean section – at the operation, we were not sure whether their small and fragile looking babies had chances to live or not.
They promised to come in later dates for permanent sterilization (……just to make us happy). We knew that date will never come. She might come again next year with a new pregnancy and probably with another complication. No doubt, Nepalese mothers had umbilical link with the suffering.
_________________________________________
It was another busy hospital day. Our normal hospital days had always been busy after the truce. Its definitely not that people are getting more sicker after the truce but it showed how people used to confine their disease within themselves at the time of conflict. But this six years old boy had nothing to do with the conflict. He was playing with the friendly trees as usual but this time, one of the weak tree branches cannot hold this active boy. He fell down; in the process, a pointed branch pierced his abdomen. He cried in pain. That made the matters worse as the intestines from inside his abdomen came out of the wound, frightening the people around him.
They lived in Sindhuli district, an area close to the highway. The nearest hospital was the Sagarmatha zonal hospital in Rajbiraj, which was about 10 hours drive from their place. But the father of this boy chose to take the opposite way towards Okhaldhunga, where he had to walk almost 2 days. He had heard about this hospital in Okhaldhunga where white skinned doctors, who were very good in speaking the broken nepali language, used to treat the patients. He knew that the hospital won’t disappoint him. The only problem to him was to make his son alive till he reaches the hospital, which he successfully did. He looked relieved as he reached the hospital. We donot know how he felt seeing the Nepalli doctors attending his son.
We had almost wrapped up the days work when we were told about this boy who had all his intestines outside. We knew, we had to spend the whole evening in the operation theatre. So we hurriedly grabbed some food and headed for the OT. The boy was vomiting and looked dry. So we had to do vigorous resuscitation of the baby to make him fit for anaesthaesia. Afterall, none of us were quite good in anaesthetizing the children. When our drugs made him sleep, he became pain free for the first time in last three days.
Our operation revealed a sharp piece of tree branch still lodging inside the abdomen in between the intestines, piercing it at three different places and his abdomen contaminated with mud and leaves. Repairing of the injured part was done and the abdomen was washed (the same way as we wash our dirty cloth) to dilute the mud. We were still not sure whether those intestines which was outside for three days and looked blue as in the picture, will get better once we put it inside or will it be necrosed and cause more problems in the future. We closed his abdominal wound and he slowly gained consciousness after the operation.
_______________________________
.. what made this case special to us was the faith the father had shown towards this hospital.
_______________________________
He passed normal stool after three days - A rewarding sign for us. That proved the intestine is now working well and he repair was not disrupted. We finalized a date to send him home on the next week but on his discharge date, as we were taking out his stitches we encountered pus from his wound. It was partly because of the mud that was already inside the abdomen and partly because our operation theatre was not completely sterilized. Otherwise, each and every bacteria would have swept away with such a vigorous washing. Anyway, that extended the boy’s stay in the hospital. After that day, we had to clean his wound everyday and restitch his wound after few days. Thankfully, those bacterias were not strong enough to eat up all our sutures. If that had happened, all his intestines would have been out once again.
It was neither a big operation nor we try to glorify what we did. And any tertiary level hospital would have operated on this boy successfully. But what made this case special to us was the faith of that father towards this hospital. Every father in this world would have wanted the best possible treatment for his son in such a scenario. And this man chose Okhaldhunga Community Hospital. By God’s grace, we did not disappoint him. We thought, we carried on the legacy of those white doctors with broken nepali who laid the founding stones of this hospital, quite successfully. We did not disappoint them either.
(We would like to request all the readers to consider the term ‘we’ mentioned in this article as all the doctors and all the staffs working in this hospital)
After working in Okhaldhunga, lots of incidents convinced me that the Nepalese women have the umbilical link with the suffering.
Cholina Katel had successfully delivered one live children at home in the previous year. She was brought to this hospital on a rainy night by her villagers carrying her for about 10 hours because she could not deliver her second child at home and they saw the foot of the baby dropping out. This was the first time she had seeked medical service in her entire life, thanks to some of the old ladies in her village who knew baby’s foot dropping first is a problem and can threaten mother’s life.
She was first seen by Dr. Hemant, an enthusiastic young doctor who was assigned to work in this rural hospital for three months by a big urban tertiary care hospital in Kathmandu. As soon as he knew that the baby inside was still live he knew that this is a real emergency (a case medically termed as footlink breech) where a delay means a dead baby. He asked a hospital staff to fetch me from my home (we don’t have telephones in Okhaldhunga, an unimaginable situation for the urbanites), where I was preparing to make my one year old son sleep. The call made me and my wife Dr. Pankaj, who also happened to be a doctor, hand over my son to the babysitter and rush towards the hospital. Dr. Hemant was clever enough to start the intravenous line, give prophylactic antibiotic and insert a tube in the mother’s urethra as a preparation for the caesarean section. I quickly scrubbed my hands and slid into the OT gown and headed towards the OT where Dr. Pankaj, who happened to be relatively expert in anaesthesia amongst us, had sticked a needle on the mother’s back to make her lower half of body paralyzed and pain free. It didn’t take time for me to realize that the leg which was hanging outside had turned blue and might be useless if I make further delay in taking out the baby. I quickly ordered to arrange one pint of blood from our ever-reliable blood bank (neighbouring college students’ hostel) that provides fresh blood 24 hours 7 days a week. With Dr. Hemant assisting me in the operation, I opened her abdomen and pulled out the baby from the mother’s uterus in no time but to my surprise, the leg was not blue. That proved the baby who had the blue leg was still inside the uterus. Then I pulled the second baby out who definitely had the blue leg. Finally we handed over both the babies to Dr. Pankaj, who had to resuscitate both the babies with the help of an inexperienced nurse. She somehow managed to help both the babies to take first breath of their life and finally babies gave a weak cry – a relief to all of us. As we were closing the mother’s abdomen with the help of some not-very-good 25 years old instruments, Dr. Pankaj took the babies to an equally old incubator (which looked more like a wooden box). We transferred the mother to the ward and left to our respective homes thanking tits and bits of experiences which we gathered during our training as a GP, which helped us to save those three lives.
Both the babies were premature weighing two Kilograms each. That means they had to spend months in the incubator and had to feed with the help of a tube for next few days till they become able to suck their mother’s breast – a fact that added agony to their parents who had left their other child, buffalos and fields unsupervised at home. Till now they were not bothered about the hospital bills – which they could have never afforded even after selling their entire property if the Hospital Social Service Department had not come to their rescue. Their hospital bills were taken care of by the Social Service Department on the next day. But that was not the end; they had to arrange the artificial milk for the babies as their mother could not produce enough milk for two babies. Social Service department was kind enough to arrange two regular meals for the mother too.
They were discharged one month later when their happy father came to receive them. We unsuccessfully tried to convince the father to get vasectomy done as they now already had three live children but the fear of getting weak in future was imprinted in his mind so deeply that we failed to counsel him for vasectomy. We regretted our inexcusable failure to close the mother’s tubes while doing the caesarean section – at the operation, we were not sure whether their small and fragile looking babies had chances to live or not.
They promised to come in later dates for permanent sterilization (……just to make us happy). We knew that date will never come. She might come again next year with a new pregnancy and probably with another complication. No doubt, Nepalese mothers had umbilical link with the suffering.
_________________________________________
It was another busy hospital day. Our normal hospital days had always been busy after the truce. Its definitely not that people are getting more sicker after the truce but it showed how people used to confine their disease within themselves at the time of conflict. But this six years old boy had nothing to do with the conflict. He was playing with the friendly trees as usual but this time, one of the weak tree branches cannot hold this active boy. He fell down; in the process, a pointed branch pierced his abdomen. He cried in pain. That made the matters worse as the intestines from inside his abdomen came out of the wound, frightening the people around him.
They lived in Sindhuli district, an area close to the highway. The nearest hospital was the Sagarmatha zonal hospital in Rajbiraj, which was about 10 hours drive from their place. But the father of this boy chose to take the opposite way towards Okhaldhunga, where he had to walk almost 2 days. He had heard about this hospital in Okhaldhunga where white skinned doctors, who were very good in speaking the broken nepali language, used to treat the patients. He knew that the hospital won’t disappoint him. The only problem to him was to make his son alive till he reaches the hospital, which he successfully did. He looked relieved as he reached the hospital. We donot know how he felt seeing the Nepalli doctors attending his son.
We had almost wrapped up the days work when we were told about this boy who had all his intestines outside. We knew, we had to spend the whole evening in the operation theatre. So we hurriedly grabbed some food and headed for the OT. The boy was vomiting and looked dry. So we had to do vigorous resuscitation of the baby to make him fit for anaesthaesia. Afterall, none of us were quite good in anaesthetizing the children. When our drugs made him sleep, he became pain free for the first time in last three days.
Our operation revealed a sharp piece of tree branch still lodging inside the abdomen in between the intestines, piercing it at three different places and his abdomen contaminated with mud and leaves. Repairing of the injured part was done and the abdomen was washed (the same way as we wash our dirty cloth) to dilute the mud. We were still not sure whether those intestines which was outside for three days and looked blue as in the picture, will get better once we put it inside or will it be necrosed and cause more problems in the future. We closed his abdominal wound and he slowly gained consciousness after the operation.
_______________________________
.. what made this case special to us was the faith the father had shown towards this hospital.
_______________________________
He passed normal stool after three days - A rewarding sign for us. That proved the intestine is now working well and he repair was not disrupted. We finalized a date to send him home on the next week but on his discharge date, as we were taking out his stitches we encountered pus from his wound. It was partly because of the mud that was already inside the abdomen and partly because our operation theatre was not completely sterilized. Otherwise, each and every bacteria would have swept away with such a vigorous washing. Anyway, that extended the boy’s stay in the hospital. After that day, we had to clean his wound everyday and restitch his wound after few days. Thankfully, those bacterias were not strong enough to eat up all our sutures. If that had happened, all his intestines would have been out once again.
It was neither a big operation nor we try to glorify what we did. And any tertiary level hospital would have operated on this boy successfully. But what made this case special to us was the faith of that father towards this hospital. Every father in this world would have wanted the best possible treatment for his son in such a scenario. And this man chose Okhaldhunga Community Hospital. By God’s grace, we did not disappoint him. We thought, we carried on the legacy of those white doctors with broken nepali who laid the founding stones of this hospital, quite successfully. We did not disappoint them either.
(We would like to request all the readers to consider the term ‘we’ mentioned in this article as all the doctors and all the staffs working in this hospital)
A fool.............!
A fool…….!
I was declared a ‘fool’ in my friends circle to have chosen Okhaldhunga to practice medicine. In this age, where all the doctors are vying for the lucrative job offers in US or UK, I was definitely a ‘fool’ to drive my career in the back gear and land up in a place like Okhaldhunga. When my other colleagues were being dazzled by the colorful nights of Manhattan, I was fumbling under the darkness of the candlelight in this place. When my friends are flashing their newly introduced high tech palm with built in 3 megapixel digital camera with cellular phone with 3G technology, I had to walk half an hour to the nearby ‘bazaar’ to make a single phone call. When my friends are sick of having the fast foods from KFC or McDonalds, I was chewing the rubbery ‘rotis’ made of local millet. When my friends are in touch with the whole world by their fingertips with their broadband connected internet in their computers, I was listening to the news in the out of tune ‘Radio Nepal’. When my friends are shopping out in the sophisticated malls and paying checks with their latest Debit cards, I was waiting on the way for the villagers to come and sell their agricultural products. When my friends are spending their time in the huge studio flat in one of the skyscraper of the west London, I was living in this tin-shedded mud house. My friends must have doubted about my sanity when they knew how I am leading my life in this ‘mero pyaro Okhaldhunga’.
_______________________________
It was Okhaldhunga where people came to thank me with the biggest cucumber in their field.
_______________________________
But little did my friends know that it was Okhaldhunga where I experienced the total satisfaction of saving others’ lives. It was Okhaldhunga where I developed the guts to explore the abdomen of other people to sew the hole in their guts. It was Okhaldhunga where people came to thank me with the biggest cucumber in their field. It was Okhaldhunga where I could tell the toddlers crawling in the street dust ‘it was me who took you out of your mother’s womb’. It was Okhaldhunga where I spent the sleepless night when one of my favourite patients was breathing last breath of her life and watched death taking its toll in front of my own eyes . It was Okhaldhunga where I learnt how important communication is to man and mobile phones are just a luxury. It was Okhaldhunga where I realized that staying in the dark for few hours of ‘load-shedding’ is not a big deal as millions of people in my country have never seen the electric light in their whole life. It was Okhaldhunga where I sweated to take out lumps and bumps from their bodies so that they don’t have to fly to big cities for that cosmetic surgery which they thought could grow to become a cancer. It was Okhaldhunga where I grew up as a doctor and as a human, otherwise I would have been an ignorant brat for my whole life. Okhaldhunga has been my ‘guru’. I am proud to learn the basics of life and ground realities of living in this place.
At the same time, I feel sorry for people’s conception of measuring the success in terms of their time spent in a foreign land. Your foreign degree is considered as a feather in your cap and the very own degree earned in your own country is treated as the patch stitched to cover holes in your pants. We never try to think the problem in the broader term. The ‘big’ countries are in a way poaching the ‘cream’ brain of our country and we are happily clapping while they disappear in the oblivion of the foreign land. Government is happy with the revenues they earn from these foreign labors and financial bigwigs term it as a boost in the national economy. The so-called ‘brain-drain’ is seriously affecting the health sector at its most. If this trend continues we will be left behind with the doctors graduated with a mediocre degree from the commercial universities where certificates are exchanged with ‘vodkas’.
How long this place will keep on focusing only on primary care? How long Okhaldhunga will keep on referring patients to higher centres for specialist care? How long people in and around Okhaldhunga will have to wait to see a ‘colorectal surgeon’ to work in their local hospital? How long will it take for a neurosurgeon to come and work happily in Okhaldhunga? How long will it take to convert Okhaldhunga hospital into a multi-specialty hospital?........I can tell you definitely that it will take another two centuries for all these dreams to materialize. Thanks to the brain drain. Rajiv Gandhi once said ‘Brain drain is better than brain in drain – probably the most anti-nationalist statement delivered by the most nationalist hero of this region.
_______________________________
Government is happy with the revenues they earn from these foreign labors and financial bigwigs term it as a boost in the national economy.
_______________________________
I was not pleased at all reading the news of the second biggest trauma centre in the entire SAARC countries being construced in the premises of Bir Hospital in Kathmandu. Probably none of the trauma patients in Kathmandu have died because of lack of medical treatment. I would have been overjoyed if they had empowered the primary health centres located near the highways. I was not pleased to know about the big surgery and millions of dollars spent to separate the inseparable conjoint ‘Ganga’ and ‘Jamuna’ by the group of neurosurgeons in Singapore, that gave the surgeons fame in the medical fraternity and the parents two retarded children. I would have pleased if they had established the water treatment plants in villages to protect thousands of children dying from diarrhea. I was not impressed when the topmost neurosurgeon of the country flew to Pokhara to operate on an Israeli person and hogged the limelight. I would have respected him if he had done so to every Nepalese people who break their spines. Giving test tube baby to the infertile couples, who can afford, is a noble job. Our pioneer gynaecologists who claims to have done it ‘first time in Nepal’, must have earned millions of rupees by that but he would have earned millions of ‘thanks’ if he had done something to help the dying newborn babies who dies only because their mothers did not know its important to have someone skilled to work as birth attendant while they were born. I felt nauseated when I read that Nepal now introduced a new technology of studding a diamond in the teeth to make their smile glitter. I would have felt content if someone had distributed tooth brush to the children in villages, which would have made the millions of smiles brighter. I was not flattered when my friends called me a ‘fool’; I would have felt grateful if they had patted by back……..
I was declared a ‘fool’ in my friends circle to have chosen Okhaldhunga to practice medicine. In this age, where all the doctors are vying for the lucrative job offers in US or UK, I was definitely a ‘fool’ to drive my career in the back gear and land up in a place like Okhaldhunga. When my other colleagues were being dazzled by the colorful nights of Manhattan, I was fumbling under the darkness of the candlelight in this place. When my friends are flashing their newly introduced high tech palm with built in 3 megapixel digital camera with cellular phone with 3G technology, I had to walk half an hour to the nearby ‘bazaar’ to make a single phone call. When my friends are sick of having the fast foods from KFC or McDonalds, I was chewing the rubbery ‘rotis’ made of local millet. When my friends are in touch with the whole world by their fingertips with their broadband connected internet in their computers, I was listening to the news in the out of tune ‘Radio Nepal’. When my friends are shopping out in the sophisticated malls and paying checks with their latest Debit cards, I was waiting on the way for the villagers to come and sell their agricultural products. When my friends are spending their time in the huge studio flat in one of the skyscraper of the west London, I was living in this tin-shedded mud house. My friends must have doubted about my sanity when they knew how I am leading my life in this ‘mero pyaro Okhaldhunga’.
_______________________________
It was Okhaldhunga where people came to thank me with the biggest cucumber in their field.
_______________________________
But little did my friends know that it was Okhaldhunga where I experienced the total satisfaction of saving others’ lives. It was Okhaldhunga where I developed the guts to explore the abdomen of other people to sew the hole in their guts. It was Okhaldhunga where people came to thank me with the biggest cucumber in their field. It was Okhaldhunga where I could tell the toddlers crawling in the street dust ‘it was me who took you out of your mother’s womb’. It was Okhaldhunga where I spent the sleepless night when one of my favourite patients was breathing last breath of her life and watched death taking its toll in front of my own eyes . It was Okhaldhunga where I learnt how important communication is to man and mobile phones are just a luxury. It was Okhaldhunga where I realized that staying in the dark for few hours of ‘load-shedding’ is not a big deal as millions of people in my country have never seen the electric light in their whole life. It was Okhaldhunga where I sweated to take out lumps and bumps from their bodies so that they don’t have to fly to big cities for that cosmetic surgery which they thought could grow to become a cancer. It was Okhaldhunga where I grew up as a doctor and as a human, otherwise I would have been an ignorant brat for my whole life. Okhaldhunga has been my ‘guru’. I am proud to learn the basics of life and ground realities of living in this place.
At the same time, I feel sorry for people’s conception of measuring the success in terms of their time spent in a foreign land. Your foreign degree is considered as a feather in your cap and the very own degree earned in your own country is treated as the patch stitched to cover holes in your pants. We never try to think the problem in the broader term. The ‘big’ countries are in a way poaching the ‘cream’ brain of our country and we are happily clapping while they disappear in the oblivion of the foreign land. Government is happy with the revenues they earn from these foreign labors and financial bigwigs term it as a boost in the national economy. The so-called ‘brain-drain’ is seriously affecting the health sector at its most. If this trend continues we will be left behind with the doctors graduated with a mediocre degree from the commercial universities where certificates are exchanged with ‘vodkas’.
How long this place will keep on focusing only on primary care? How long Okhaldhunga will keep on referring patients to higher centres for specialist care? How long people in and around Okhaldhunga will have to wait to see a ‘colorectal surgeon’ to work in their local hospital? How long will it take for a neurosurgeon to come and work happily in Okhaldhunga? How long will it take to convert Okhaldhunga hospital into a multi-specialty hospital?........I can tell you definitely that it will take another two centuries for all these dreams to materialize. Thanks to the brain drain. Rajiv Gandhi once said ‘Brain drain is better than brain in drain – probably the most anti-nationalist statement delivered by the most nationalist hero of this region.
_______________________________
Government is happy with the revenues they earn from these foreign labors and financial bigwigs term it as a boost in the national economy.
_______________________________
I was not pleased at all reading the news of the second biggest trauma centre in the entire SAARC countries being construced in the premises of Bir Hospital in Kathmandu. Probably none of the trauma patients in Kathmandu have died because of lack of medical treatment. I would have been overjoyed if they had empowered the primary health centres located near the highways. I was not pleased to know about the big surgery and millions of dollars spent to separate the inseparable conjoint ‘Ganga’ and ‘Jamuna’ by the group of neurosurgeons in Singapore, that gave the surgeons fame in the medical fraternity and the parents two retarded children. I would have pleased if they had established the water treatment plants in villages to protect thousands of children dying from diarrhea. I was not impressed when the topmost neurosurgeon of the country flew to Pokhara to operate on an Israeli person and hogged the limelight. I would have respected him if he had done so to every Nepalese people who break their spines. Giving test tube baby to the infertile couples, who can afford, is a noble job. Our pioneer gynaecologists who claims to have done it ‘first time in Nepal’, must have earned millions of rupees by that but he would have earned millions of ‘thanks’ if he had done something to help the dying newborn babies who dies only because their mothers did not know its important to have someone skilled to work as birth attendant while they were born. I felt nauseated when I read that Nepal now introduced a new technology of studding a diamond in the teeth to make their smile glitter. I would have felt content if someone had distributed tooth brush to the children in villages, which would have made the millions of smiles brighter. I was not flattered when my friends called me a ‘fool’; I would have felt grateful if they had patted by back……..
Saturday, November 13, 2010
Beginning of an experience
Beginning of an experience…
This was my second time in Okhaldhunga as a doctor. I was quite sure from the very beginning that my stay in Okhaldhunga this time will be as adventurous as a movie or at least it will be more interesting than the never-ending boring Hindi tele-serials. Hospitals have always been a site where we can witness the human emotions at its closest. And as a doctor, we always come across situations where we feel overwhelmed with joy and at the same time depressed with sorrow.
I am writing this book based on my experience in Okhaldhunga Community Hospital, a hospital situated in a remote hilly region of eastern Nepal. This hospital, from my point of view, is an ideal place for a doctor like me to gain the experience of a lifetime, to see death from a point-blank range, to overcome the challenge on your own, to perceive the pain felt by the poor underprivileged people of my own country, to fill yourself with satisfaction when you save a life and at the same time, to tipple over the obstacles set by none other than your own people. I will always cherish the precious moments I had in this place. It has definitely helped me grow not only as a doctor but as a human. I feel grown up every time I come to Okhaldhunga. I am dead sure that everybody should have an experience felt by me once in their lifetime. And I feel everybody who come to a place like this to serve or thinking of going to place like this in their life, should read this book once and ……….feel the difference.
I don’t know what made me write. Honestly, I am not a writer. Nor can I narrate any story interestingly. Maybe I am writing this because I think when I grow old, I would love to look back on my life in Okhaldhunga through these writings. Maybe I can tell my son (who was one year old when I took him to Okhaldhunga) that when he stumbled while trying to take first few steps of his life, his father was also crawling in the initial years of his professional life. One thing is sure that I am writing this thing for myself and for noone else.
As I had expected, the adventure began right from the airport in Kathmandu. My flight to Rumjatar got cancelled for three times, adding to the agony of Dr. Erik, a Norwegian doctor waiting to depart from Okahaldhunga after my arrival there. I waited in the airport seeing flights taking place regularly to Pokhara and Lukla – the famous tourist destinations for the foreigners (private airlines earn dollars from the foreigners charging them double the fare than the Nepalese, making them more interested to fly to tourist destinations only – an unethical but commercially profitable move for the private airlines). For the first time in my life I was disadvantaged because of the colour of my skin. Little did I know that there were lots of other incidents waiting for me in Okhaldhunga when I will be let down because of the colour of my skin. My fellow colleague, another Norwegian Doctor, was preferred by the local people when we both used to stay in the Out Patient’s Department. I was amazed to see how people examined by me used to stay outside this white doctors room to get rechecked. So colour is good in every aspect except in the case of skin. I don’t blame the poor innocent people who preferred the white doctors. They were grown up being treated by the white doctors for last ‘astonishing’ forty years. These expatriate doctors were healing the pain of the Okhaldhunga people since that time when none of the Nepali doctors even thought of coming to this place. Still now, recruiting and retaining a Nepali doctor is a near impossible issue in this place. It’s a shame to the medical fraternity of Nepal that a ‘bideshi’ doctor is filling up the vaccum created by none other than our own Nepali doctors. We seek facilities, money and opportunities before coming to work in a place like this. Whereas on the other hand, these expatriate doctors sacrifice everything offered by their economically sound and politically safe country to work in the so-called third world country like ours. I salute these doctors no matter whatever the reason they have come here for……….
Finally on the third day, I was flown to Rumjatar. In these three days, I spent almost the same amount of money in taxi as the plane fare, to reach the airport. It was a scary bumpy ride in the air (pilots later blamed it on the eagles flying over a dead animal thrown at the river near the airport). Last time, when I was here, it was a time of declared emergency in my country. I never felt the difference of living in emergency period while I was in Kathmandu or in Tansen. I sensed it was a time of emergency by the tone of the army people who were safeguarding the Rumjatar airport. They spoke crudely to all and their glance was suspicious. A bottle of water on the outer packet of my bag was missing. But I didn’t dare to ask the armies about the bottle. Their look told me ‘don’t mess with me’. This time I started second inning of my Okhaldhunga stay right after the success of the janandolan – 2. So this time I did not feel the same arrogance in the faces of the security personnels in Rumjatar. They seemed relaxed and cool. Otherwise, I knew exactly how the mental status of the armies was at the time of war. I had the rare feat of spending a night in the army barrack when a gun-battle was going on the nearby village, when I was here last time. It was a cold evening of March 2005, some forty soldiers from the barrack, which was about one hour walk from the hospital, came to the hospital to fetch the doctors for reasons better known to them. They told one of their soldiers was sick and they said they were in no condition to bring the sick one to the hospital. We sensed pretty well there was something fishy and we knew there must have been some other grave reasons for their demand, which they had rarely made in the past. We never refused when they asked for a doctor in the daytime and we always attended all the emergency cases from the army barrack with utmost preference. This time they wanted us in the night time. We expressed our inability to go to the barrack citing the problem that there were other 30 patients admitted in the hospital at that moment who needed our constant care. The government doctor who was actually responsible to attend the calls in the barrack was enjoying his holidays in Kathmandu. Maybe that was the reason why they were in no mood to hear ‘no’ and at last forced us to go to their place at gunpoint. When I spent the night there in the barrack, for the first time in my life, I feared for my life. They feasted us with the best available food studded with best pieces of goat meat but in fact, that was the worst meal of my life. I know very little about the war but I knew perfectly well that night I was treated in an inhuman way. The other time when we felt death looming over our heads was when a Maoist leader came to our hospital and entered the operation theatre with hand grenade in his hand asking for money which they termed ‘tax’ for their government. I was lucky to have my hands gloved and soaked with blood in the middle of the operation. My fellow colleague Dr. Kishor who was standing nearby and observing the operation was grabbed on his collar and dragged outside. After one hour of their speech which we term as a ‘total threat’ we decided to give them a day of our salary as ‘tax’. That day we paid for our security, we paid for the air we were breathing and saved our lives. At the same time, we saved the hospital for millions of people who were going to get saved in the hospital.
___________________________
We are now more tolerant. We are now more patience. We now realize life is too short to repent.
___________________________
Thinking retrospectively, I feel no grunge towards both the incidents. That was the little price I had to pay for the instability in my country. I was working in Tansen when it got a massive attack by the Maoists armies. Me and my wife spent the sleepless night covering our one year old son in between us so that even if our house is bombed he will have the least injuries. Some of these incidents actually had positive impacts on me and my family. We are now more tolerant. We are now more patience. We now realize life is too short to repent. We now accept how important politics is in our lives. In every bad situation, we now say ‘this is not the worst scenario we had ever been. Nothing can be as bad as praying for our lives. These incidents definitely elevated our pain threshold.
I thought my second visit to Okhaldhunga will be safe as the peace process was going on and the Maoists were in the verge of entering the mainstream politics. But I was wrong. I was more unsafe this time. I was stopped on the way to the nearby ‘bazaar’ and was forced to attend their political rally. The hospital was nearly vandalized only because one of the hospital staff asked to deposit money to some ‘politically aware’ people while I was looking after their critically ill patient. Similar political people bypassed the line to out patient department because they were busy in making a ‘new Nepal’ and had no time to waste waiting for the doctors. Every death in the hospital was scrutinized by the political parties and many times I had to explain the political leaders that the death was inevitable. Every week we used to receive letters demanding financial support to organize some political gatherings. Doctors were expected to guarantee life of every patient who entered the hospital premises. Every inevitable complication during treatment was coined as ‘carelessness’ of the doctors. Market prices were hiked to two-three folds in the span of one year, whereas voices demanding free treatment even in non-govermental, non-profit making organization were raised. My explanation ‘free treatment means no treatment’ was overshadowed by theories of Marx and Lenin. My grudge about all this with the local people there was made even bitter when I was answered ‘that’s why you are paid for!’ Slowly and this time more concretely, I got my answer to this million dollar question ‘Why doctors don’t come to place like Okhaldhunga???’
So staying in Okhaldhunga as a doctor was an ‘adventure’ for me……. where every moment, I was stared at, by my own life.
This was my second time in Okhaldhunga as a doctor. I was quite sure from the very beginning that my stay in Okhaldhunga this time will be as adventurous as a movie or at least it will be more interesting than the never-ending boring Hindi tele-serials. Hospitals have always been a site where we can witness the human emotions at its closest. And as a doctor, we always come across situations where we feel overwhelmed with joy and at the same time depressed with sorrow.
I am writing this book based on my experience in Okhaldhunga Community Hospital, a hospital situated in a remote hilly region of eastern Nepal. This hospital, from my point of view, is an ideal place for a doctor like me to gain the experience of a lifetime, to see death from a point-blank range, to overcome the challenge on your own, to perceive the pain felt by the poor underprivileged people of my own country, to fill yourself with satisfaction when you save a life and at the same time, to tipple over the obstacles set by none other than your own people. I will always cherish the precious moments I had in this place. It has definitely helped me grow not only as a doctor but as a human. I feel grown up every time I come to Okhaldhunga. I am dead sure that everybody should have an experience felt by me once in their lifetime. And I feel everybody who come to a place like this to serve or thinking of going to place like this in their life, should read this book once and ……….feel the difference.
I don’t know what made me write. Honestly, I am not a writer. Nor can I narrate any story interestingly. Maybe I am writing this because I think when I grow old, I would love to look back on my life in Okhaldhunga through these writings. Maybe I can tell my son (who was one year old when I took him to Okhaldhunga) that when he stumbled while trying to take first few steps of his life, his father was also crawling in the initial years of his professional life. One thing is sure that I am writing this thing for myself and for noone else.
As I had expected, the adventure began right from the airport in Kathmandu. My flight to Rumjatar got cancelled for three times, adding to the agony of Dr. Erik, a Norwegian doctor waiting to depart from Okahaldhunga after my arrival there. I waited in the airport seeing flights taking place regularly to Pokhara and Lukla – the famous tourist destinations for the foreigners (private airlines earn dollars from the foreigners charging them double the fare than the Nepalese, making them more interested to fly to tourist destinations only – an unethical but commercially profitable move for the private airlines). For the first time in my life I was disadvantaged because of the colour of my skin. Little did I know that there were lots of other incidents waiting for me in Okhaldhunga when I will be let down because of the colour of my skin. My fellow colleague, another Norwegian Doctor, was preferred by the local people when we both used to stay in the Out Patient’s Department. I was amazed to see how people examined by me used to stay outside this white doctors room to get rechecked. So colour is good in every aspect except in the case of skin. I don’t blame the poor innocent people who preferred the white doctors. They were grown up being treated by the white doctors for last ‘astonishing’ forty years. These expatriate doctors were healing the pain of the Okhaldhunga people since that time when none of the Nepali doctors even thought of coming to this place. Still now, recruiting and retaining a Nepali doctor is a near impossible issue in this place. It’s a shame to the medical fraternity of Nepal that a ‘bideshi’ doctor is filling up the vaccum created by none other than our own Nepali doctors. We seek facilities, money and opportunities before coming to work in a place like this. Whereas on the other hand, these expatriate doctors sacrifice everything offered by their economically sound and politically safe country to work in the so-called third world country like ours. I salute these doctors no matter whatever the reason they have come here for……….
Finally on the third day, I was flown to Rumjatar. In these three days, I spent almost the same amount of money in taxi as the plane fare, to reach the airport. It was a scary bumpy ride in the air (pilots later blamed it on the eagles flying over a dead animal thrown at the river near the airport). Last time, when I was here, it was a time of declared emergency in my country. I never felt the difference of living in emergency period while I was in Kathmandu or in Tansen. I sensed it was a time of emergency by the tone of the army people who were safeguarding the Rumjatar airport. They spoke crudely to all and their glance was suspicious. A bottle of water on the outer packet of my bag was missing. But I didn’t dare to ask the armies about the bottle. Their look told me ‘don’t mess with me’. This time I started second inning of my Okhaldhunga stay right after the success of the janandolan – 2. So this time I did not feel the same arrogance in the faces of the security personnels in Rumjatar. They seemed relaxed and cool. Otherwise, I knew exactly how the mental status of the armies was at the time of war. I had the rare feat of spending a night in the army barrack when a gun-battle was going on the nearby village, when I was here last time. It was a cold evening of March 2005, some forty soldiers from the barrack, which was about one hour walk from the hospital, came to the hospital to fetch the doctors for reasons better known to them. They told one of their soldiers was sick and they said they were in no condition to bring the sick one to the hospital. We sensed pretty well there was something fishy and we knew there must have been some other grave reasons for their demand, which they had rarely made in the past. We never refused when they asked for a doctor in the daytime and we always attended all the emergency cases from the army barrack with utmost preference. This time they wanted us in the night time. We expressed our inability to go to the barrack citing the problem that there were other 30 patients admitted in the hospital at that moment who needed our constant care. The government doctor who was actually responsible to attend the calls in the barrack was enjoying his holidays in Kathmandu. Maybe that was the reason why they were in no mood to hear ‘no’ and at last forced us to go to their place at gunpoint. When I spent the night there in the barrack, for the first time in my life, I feared for my life. They feasted us with the best available food studded with best pieces of goat meat but in fact, that was the worst meal of my life. I know very little about the war but I knew perfectly well that night I was treated in an inhuman way. The other time when we felt death looming over our heads was when a Maoist leader came to our hospital and entered the operation theatre with hand grenade in his hand asking for money which they termed ‘tax’ for their government. I was lucky to have my hands gloved and soaked with blood in the middle of the operation. My fellow colleague Dr. Kishor who was standing nearby and observing the operation was grabbed on his collar and dragged outside. After one hour of their speech which we term as a ‘total threat’ we decided to give them a day of our salary as ‘tax’. That day we paid for our security, we paid for the air we were breathing and saved our lives. At the same time, we saved the hospital for millions of people who were going to get saved in the hospital.
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We are now more tolerant. We are now more patience. We now realize life is too short to repent.
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Thinking retrospectively, I feel no grunge towards both the incidents. That was the little price I had to pay for the instability in my country. I was working in Tansen when it got a massive attack by the Maoists armies. Me and my wife spent the sleepless night covering our one year old son in between us so that even if our house is bombed he will have the least injuries. Some of these incidents actually had positive impacts on me and my family. We are now more tolerant. We are now more patience. We now realize life is too short to repent. We now accept how important politics is in our lives. In every bad situation, we now say ‘this is not the worst scenario we had ever been. Nothing can be as bad as praying for our lives. These incidents definitely elevated our pain threshold.
I thought my second visit to Okhaldhunga will be safe as the peace process was going on and the Maoists were in the verge of entering the mainstream politics. But I was wrong. I was more unsafe this time. I was stopped on the way to the nearby ‘bazaar’ and was forced to attend their political rally. The hospital was nearly vandalized only because one of the hospital staff asked to deposit money to some ‘politically aware’ people while I was looking after their critically ill patient. Similar political people bypassed the line to out patient department because they were busy in making a ‘new Nepal’ and had no time to waste waiting for the doctors. Every death in the hospital was scrutinized by the political parties and many times I had to explain the political leaders that the death was inevitable. Every week we used to receive letters demanding financial support to organize some political gatherings. Doctors were expected to guarantee life of every patient who entered the hospital premises. Every inevitable complication during treatment was coined as ‘carelessness’ of the doctors. Market prices were hiked to two-three folds in the span of one year, whereas voices demanding free treatment even in non-govermental, non-profit making organization were raised. My explanation ‘free treatment means no treatment’ was overshadowed by theories of Marx and Lenin. My grudge about all this with the local people there was made even bitter when I was answered ‘that’s why you are paid for!’ Slowly and this time more concretely, I got my answer to this million dollar question ‘Why doctors don’t come to place like Okhaldhunga???’
So staying in Okhaldhunga as a doctor was an ‘adventure’ for me……. where every moment, I was stared at, by my own life.
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