The old lady and the kid

Today early in the morning I saw an old lady with small kid presented to ER in Okhaldhunga Community hospital. She had got burning epigastric pain.  While asking about members in family, she is living with that little kid; her husband is no more with her. The elder son, the kid’s father passed away many years back and the daughter in-law, the kid’s mother is far away in Kathmandu who comes once in a blue moon. Younger sons do not look after her. She had been having pain for 3 days and similar episodes in the past though.

While going through previous report, she found to have pancreatic cancer. While asking about socioeconomic status, there is virtually no one earning and supporting them. She has grandson, the kid who helps her make food and feed her.  They have some fields to grow foods. This time she came with Peptic ulcer disease (gastritis).

While asking kid, he had his eyes full of tears, burying his face with his hands, ‘I study in class 2. I go to school regularly but this time; I am not able to manage to go school because my grandmother succumbed to sick.’

 ‘Wont you go school now?’

‘How can I leave grandmother in this situation, sir?’

It just touched my heart. A nine year kid thinks that way and always there to serve his grandmother in every possible aspect. I was moved with his manner. 

मसंग थोरै पैसा छ ( I have less money)

Two middle aged couple with their somber faces came to Okhaldhunga Community hospital. They look like they are from lower class family. They have one small daughter aged 8 years who had some cloths wrapped around her right arm. They came from extreme part of Solukhumbu walking on foot for 5 days. I am very much surprised that people come on foot to this hospital very far from here.

This child has fall injury over her right arm and it was deformed. She underwent x-ray and found to have shaft of humerus fracture (bone of arm) which is partially displaced. She was planned for hanging cast.

Father said to us, ‘Ma sanga thorai paisa chha, chhori ko upachaarko lagi pudaina ki ? (I have less money, maybe it’s not enough for treating my daughter.)’

One of us asked, 'how much do you have?'

Reluctantly, he looked at us, ‘Just twenty thousands.’

'Twenty thousands…! One thousand is quite enough…!' Our paramedics said.

The Couple surprisingly looked at us and they could not smile for their happiness, maybe they were Super-HappY.

Introduction

National academy of Medical Sciences (NAMS) in Kathmandu conducts 6 mandatory training to its residents during their 3 years’ Postgraduate degree in different disciplines. One of them is Medical Education that is all about how to teach people especially patients and how to prepare class to the students or juniors and learning techniques. Others are Advanced Cardiac Life Support, Research Methodology, Basic Surgical Skill, Trauma Life Support and Palliative Care. This is the beauty of NAMS. We were privileged to get the 4 days’ training on Medical education getting it in brief way out of its vast contents. Some of them about teaching learning activities were knowingly unknowingly followed by us during our life and so many new things were revealed they were never been  in our mind.

Teaching is not one way but it is two way or multiple way and it should be dynamic not the static.

Lectures were given by the experts about medical education and they were worthy to take. One of the interesting parts of this training was introduction of participants. This was for how they can present them to audience.

Many funny things and interesting things were shared during introduction session about their professional life before entering postgraduate program.

Experience during professional life:

One OBGYN resident thought that Obstetrics and Gynecology will be funny and enjoyable but he found it actually was not.

A Male resident from same discipline mentioned, while he was is in district posting, a pregnant lady  in labor was crying in the middle of night and he requested her to not cry making loud sound hampering others’ sleep. She replied, ‘you will never go through the labor pain doc, and how will you realize what’s labor pain?’ That doc mumbled on his own, ‘padhe pachhi realize garaula ni’ He almost finished his II year residency in OBGYN and he said, ‘Still he yet to understand the labor pain.’

Some of them showed their patriotism. One of them mentioned almost half of country he has gone through during his professional life.

Answers about why they chose the particular program?

Some of them chose their program by their choice, some by their role model in that discipline, some by influence of people in rural area and some of them have no choice other than that.

One of residents from Psychiatry mentioned, he wanted to understand the complexity of brain of human being and he felt it’s extremely complex. One of the GP residents said, ‘General practice chose me, not I.’

Some of them were not determined what to do and still enjoying what they are doing.

Some of the Pediatrics and Orthopedics people mentioned, they did not need to go for further study like DM or MCh.

Query about Achievement:

Got the residency….got married….yet to get….found someone especial….single ready to mingle….!!!

This introductory program was done for how effectively a person can deliver his content in understandable and effective way. It’s quite a good strategy.

Man in Wheel Chair and Woman in Metal Stockings

While I was on line for my morning breakfast after hectic night duty in Patan hospital, I saw a man in wheel chair and I could see the happiness in his face. I asked him, 'How is your wife?'

He smiled me back, ‘Oh she is fine and I became a father, doc.’

And I formally said shaking his shoulder, ‘Congratulation, god bless you both and your child.’

‘Thank you, sir.’

I just casually asked him, ‘Where are you from?’

‘Kalikot’

Kalikot kaha?

‘Rupsa’

‘I have been there many times’

 He just paused and surprisingly asked me, Are you sure?’

‘Yeah I have been there many times’

…………………………………………………………………………………………………………

Yesterday one woman happened to me for regular check up in admission room of maternity ward at 6PM. She had shorter stature and had metal stockings on her leg for her club foot. She went through non stress test to estimate the health status of her baby inside her womb. It was turned out be reactive suggesting good status of baby.

I asked her, ‘Can you go through vaginal delivery?’

‘I dont know but I prefer to, doc.’

The mouth of her womb is opening and ripening. We put her on vaginal delivery trial and meanwhile we counseled her and her hubby that there is high chance of cesarean section for her.

Surprisingly she delivered her baby at midnight.

This lady was beautiful wife of this guy whom I met today morning while in line for my morning breakfast.

God bless them forever;  may their life be showered by world’s best possible happYness.

newborn of ABC

A newborn born earlier than he is supposed to and admitted in the nursery where he has crossed the 15 day of his life. He shows the sign that he can achieve the normal baby life after getting treatment here. He is still 1500gm and was born at 31weeeks of gestation. Once he has reached his feeding up to 15mL every 2 hourly but when started 20mL 2 hourly he could not tolerate it and stopped one feed tried to continue in 15mL and 10mL but he could not tolerate and became lethargic. So he was undergone full septic work up and antibiotics upgraded to meropenem and ofloxacin since high prevalence of enterobacter resistant to cefotaxime here. We kept him in intravenous fluid stopping oral fluid for 2 days and again started from 2mL every 2hourly and rest with intravenous fluid. Today he is able to tolerate 5mL every 2 hourly. It’s good sign he is trying to resume his healthy life and I am expecting to hand over him to his mother.

It’s good thing he is getting better for these 2 days but still he has challenges ahead.

His father, a lower class working man not being able to afford the drugs needed to treat his baby. Every time we sat for discussion about his baby, he comes with tears in his eyes says what he has done for that day to get money for his child. Mother is willing to undergo breast feeding but she is now in Sertraline and Haloperidol and those drugs come in category C for pregnancy and lactation according to US Food and Drug administration. Category C Drugs are to be used with caution if benefits outweigh risks. Animal studies show the risk and but human studies are not enough. Mother is so anxious to feed breast milk to her baby that she is ready to abandon the drugs she is taking. She is stable with the drugs and can communicate well. If she stops taking she may not be able to take care of baby.

When I meet them today to discuss about the baby’s condition, the baby’s father showed towards his wife pointing towards her ears. She was jewelries less. She used to come with heavy golden jewelries in her ears earlier now she appeared with bare ears. Those jewelries were gift from her husband on their first anniversary. They sold those jewelries for their premature precious baby. Haataka maila sunaaka thaila ke garnu dhanale…(money and gold are like the dirts of hand they can be washed away in no  time).

 I was moved with his gesture, I hardly cry. Nothing is superior than the life. Life is precious especially baby’s life. Their flawless, cuteness, lovely nature and their pure soul attract everyone. They cannot die and they should not die in this age. They have to grow and show the people how good they are indeed.

a new journey

It’s been long time that  I have not written the travelogue since I am not able to travel nowadays. After 6 years gap, I joined residency in NAMS in general practice. Well it ‘s really hard to cope with the rigorous duty in hospital and firing of questions in morning conference: it’s kind of different environment and experience I have been going through.  Having good job in a good post and abandoning it for the new start of educational journey looks somehow weird and encouraging. Getting yelling from young registrars looks unusual but still have to accept the truth. What I was and i am now…  comes in mind sometimes….hehe anyway it’s part of education.

Doing 36 hours duty covering night duty, next day being disoriented while getting questions in the morning conference is the unforgettable part of residency. Nothing comes in mind what I have done and what I am supposed to do and what’s my plan: it usually happens when you do not get rest in the night. Writing notes of the every patient enrolled and filling laboratory forms and drawing the blood and pricking the intervertebral space to take out the cerebro spial fluid and many of times being traumatic puts the resident in panic condition.

Moreover, alternate night duty is another horrible things in residency. Just being in residency, I am not able to think out of the hospital. Really I am not able to manage the time to hang out with dear and near ones.  Residency sucks sometimes comes out of my mouth but anyhow we have to continue this 3 years’ hectic journey. Hope it will give the new concept in life and help to move towards the service of people in medical field  in rural areas. Hope this will give the pleasure…!!!

Mugu Trip, post death escaping, part III

taking meal in Bhulbhule( A FCHV's house)

From the Bhulbhule, we moved ahead with full stomach having some confidence that we can reach Mugu that day. After few minutes we found some wide and open place. It is called Patan, a plain area for cattle grazing (it’s plateau terrain though). We started shouting in elation that we found such wonderful place in the lap of the mountain since we had crossed two deadly places before we found it. I made somersaulting over the grass ground and two of my friends cheered and started clapping hands. It was such a pleasant moment that we did not care what other might think about what we were doing. Passersby, shepherds, cottage hotel owners, sheep, horses, donkeys and other cattle we could see them lost in their own world.

Patan

We took some sips of cold but delicious water there. We felt as if we were taking the taste of amrit (a nectar of the god that makes them immortal) directly from god Shiva. We took some snaps there and video graph as well. As we came across the cool breeze directly from Himalayas, one of us uttered, ‘RUI, PHUI or DUI…’.we burst into a laugh in no time that refreshed our tired mind.

Patan

From Jumla to Mugu, road construction has been going on. Mugeli people are hoping to see their first motor before Dashain in this year but it seems impossible by this time. If construction goes smoothly, they may be able to see the motor by the end of this year. Finger cross to them. This road access to Mugu by motor is obviously good for Mugeli people; moreover, tourism will definitely come into bloom. Rara will be the best tourism destination for national as well as international tourist but foundation for tourism should already be planned by Mugeli People otherwise we may get lost what to do ahead.

Ghuchchiko lek, taking rest: throwing jokes and laugh

Crossing the plateau of Patan, we took rest on the top of the Ghuchchiko lek( Guchchi hill), the border between Jumla and Mugu wandering about 360 view. We discussed about life, journey, relation and destination there while taking rest. Somehow that moment make us sentimentalize. We were on the top of Ghuchchiko lek. it was one of most difficult part of trekking in Mugu. We moved down and down it made us tired but there was no signal of reaching the nearest village. Legs were aching, joints were burning and the whole body was tired; only taking rest did not make us regain the energy but there was no alternative.


Friends from Unicef and GTZ were left behind. Among them, there was one pregnant lady who dared to visit Mugu on foot. I really appreciated for her daredevil effort.

Ghuchchiko lek, taking rest

The Sun was sinking at the West, it was twilight and we could locate the road where it’s heading towards. With heavy mind and body, we stepped into the farm of a village called Pina of Mugu District. That day we stopped by there and rest our aching legs there in a cottage hotel.