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.

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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.


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.. what made this case special to us was the faith the father had shown towards this hospital.
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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)