galem camp

tough, young men were chosen for the trip to the small village of galem in syangja, nepal.

tough and young because the journey was arduous, and men because the journey was arduous (this sexist bias was the department of community medicine's doing, not mine).

challenge #1 : getting up early in the morning, before the usual time, to leave the college by 7.30am.

challenge #2 : having a quick breakfast before leaving and packing something for the trip, which could last the whole day!

challenge #3 : surviving the winding roads up and down the hills. sitting all cramped up in the tiny back seats of mahindra for 2 hours with a bad bout of nausea.

challenge #4 : trekking up the path, extremely narrow at some parts for an hour plus.

prashanna standing for the picture at a turn on our trekking path to galem village, where a medical camp was organised.


a particularly picturesque spot on the way. a lot of pics were taken here.
we reached the village school all sweaty and sticky. but the pleasant welcome was quite unexpected.

dr. milan is in the picture, an MO from the ER.
all the children were lined up patiently waiting for our arrival. we had a team of 6 doctors from manipal (including 3 interns, and 3 doctors) and a group of people working for GONESA (which is an NGO) who arranged and sponsored the trip.

the garland welcome :)
maoist? :P
how cute is that ?! :) its been so long since i saw kids lining up like in kindergarten!!

an amazingly beautiful setting for the school but very inaccessible !

the path looked like this, a brilliant red colour.

overall, it seemed more of a formality than actually helping out the people. because half the guys who went were not interested, and were reluctant in the first place. i was disappointed because i couldnt take much part myself in the examining and clerking the patients as i was unable to express myself in the nepali language well enough to get through to the patients. so i simply joined team with another guy and watched him do the work, meanwhile trying to check a few kids myself.

the lunch we had was pretty good though. was worried that i ate too much and might have to go poop sometime on the way . lucky enough it didnt happen.

the main time spent was the journey! 3-4 hours one way! we reached home by 7.30pm! 12 hours out! and there was no telephone network!!

but it was lovely to see the villagers all happy and pleased to see us visit! we got nice tokens of appreciation (a hand woven bag) in the end.

the only thing i missed was my earphones, which due to the hurry i forgot to pack. if only i had those the journey would have been really enjoyable.

in the ER

started the community medicine ER shift. so basically i along with rashika, prashanna and anindita go to the ER in the morning and stay till the afternoon.
today i learned how to use that ECG machine they have at our hospital. sadly, these people dont keep any training sessions for new doctors, and neither can you find any instruction manuals anywhere. so its a chore to actually get yourself to learn anything new. but i did it and went around taking the ecgs of 3 patients in the ER today. :) so happy overall for learning something new today.

more babies from the OBG ward

from the nose you can guess this is dr.abhishek's son.
really cute one !



for nan and ma! :)
zat is it for tonite.

some more baby pictures :)

since the OBG ward is one of the best places to view newborns, i get a great opportunity to take pictures while i am posted here.

this is an old picture, been 2 months i guess since 'the crisis' . anindita conducting the delivery and i was assisting!

she's basically suturing the episiotomy wound there, the baby was out already.

these are latest pictures :

holding the mic! gonna be a singer?

urmila karki (didi from the deep canteen), gave birth recently by cesarean section, unfortunately the wound did not heal probably because of obesity. so today she went for a re-suturing!

same baby :) sleeping soundly

baby of anju kafle (a patient with ASD - heart disease) 

someone's kid, forgot whom :P

bye.

wards

i am in the ward duty since a week or more now, and it just seems so exhausting!
totally unlike OPD duty where it was like a 9-5 job, you left the office fresh to enjoy the evening. here in the wards, you have to report for rounds in the morning at 8.30am, although they hardly ever start on time, cause the consultants arrive around half to an hour late.

you gotta take notes of what to do with the patients that day (ie basically either send/collect reports of various investigations or monitor the vital signs or discharge or dressings etc)
plus, you are not under direct observation and guidance of the consultants unlike in the OPD , so you have further stress to be able to assess any sudden emergency case or deterioration in a patient's health. which adds to the stress of work. and i just have a 3 intern group, so its one short of expected, and thus more work on each pair of shoulders.

the long hours is just irritating. you have to stay overnight as well, but i dont, i come back for a late night snack around 2-3am and sleep in my room till 6am.
the next morning you have to do your rounds first to determine how each patient in the ward is doing, and later wait for the consultant on call to arrive for the official rounds.

after the rounds is over i can leave, while the next batch of interns take over! the worst thing is the mismanagement of meals, i usually end up missing them and have to take them outside, instead of at the mess, and at odd hours.

worse still, you are so exhausted by the next day that even though you are off, you cant enjoy the day, all you can do is sleep !!
today was such a day, i slept all day and now am awake at night! :S

annoying

so, vijay sir is going crazy over the duty rosters!

he has done it again! changed the schedules.

now he went an annoying extra step, and changed our groups too, so i dont have the people whom i want to work with now.

plus, my ward duty had to start on 23rd, he changed that and now its starting on 20th itself. so extra ward (which is the worst)!

so the opd duty, which i kinda liked is cut short now :S

anyway, it'll soon all be over and we will be in community medicine department after this.

oh i totally forgot about the Log Books we have to maintain!!

we have to write about interesting cases that we have seen ... time consuming work!

a day at the emergency room

yesterday was my ER duty along with sambhav, from 8 am to 8 pm.

totally unready for what to do and what are the expectations from interns in ER, we just left after having breakfast.

sambhav was there earlier, coz thats him, he likes to be present everywhere earlier than the others. so when i got there there were a few cases only, some old man with COPD on nebulisation and a lady with abdominal pain who was waiting for the surgical consultant to arrive.

we started chitchatting and introduced us to the nurses and the MO on call.

then some patients started to come.

what we realised by evening is that patients come in hoards, and when its empty its empty, you hardly have one or two patients ever, its either 6 or none! :P weird isnt it ?

and all we had to do is do the forms, follow instructions from the MO / consults.

we had to make calls to the dept.s to send consults. we had to collect lab reports. we had to take history and do general examination and fill up the file with relevant data.

we could help the nurses with procedures but we were new, so they let us watch first.

i did my first PR exam on this old guy with urinary retention (big prostate felt!!)

(PR = per rectal exam, basically shoving your finger up the anus)

tried to cannulate a patient but didnt get the vein, so the nurse took over. next time might get it right! :)

by the time it was 7.30pm a load of patients arrived! one guy with serious head injury and bleeding came in moribund condition. i checked his pulse, carotid pulse was palpable, i checked his pupils , non-reactive !!

rushed to fill his forms, ran with him to CT scan his head. he had a big fracture and hematoma.

his brainstem had bleeding so when the neurosurgeon arrived he said, this patient will not survive!

we had to leave coz our time was over, when we left we hadn't seen anyone die under us! thank god!

we heard that this patient didnt survive as expected.

there was another patient yesterday, she was suspected of heart attack / acute pancreatitis. she was shifted to ICU, heard today that she died too!

sad!

got to learn so much in emergency duty!

this woman came with 3 kids. the girl in pink held in the mother's arms had a greenstick fracture to her right forearm .

assisted in her plastering.

sanumaya sister from the OBG ward. time passing down here with us early in the morning when the load was less.

she is a very nice fun lady. very helpful, very knowledgeable, knows who are keen and who arent and helps those who are to learn a lot.

sambhav was really good in handling the phone calls and taking the history and all.

didnt expect so much, impressed me to some level.

we might be able to do more and do better in our next ER duty i hope.