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………….

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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………

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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’.

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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??????