(WARNING LONG POST AHEAD...if you want to skip the medical gibberish, read the first two paragraphs and the last one :))
also not sure how to move the pictures, so they are at he beginning (I am a newbie at this whole blog thing; I will also try to be better at taking pictures of what I talke about in the blog, something to work on for next week
Here is an update as to how things are going here. I have been in Nepal over a week now. To say having to adjust would be an understatement as it has taken a while to adjust to life here. This first week was rough. Harder than any other week I have ever had but also the most satisfying and rewarding week of adventure, purpose, and friends. To start things off I landed in Kathmandu at 0900 Monday morning only to stand in line for customs for almost 2 hours. I finally arrived at the hotel I was staying at around 12:30pm. They asked if I wanted lunch and I politely declined and went to sleep until around 5pm. At 5pm another volunteer and I went to exchange money and buy a SIM card for my phone so I would have a Nepali phone while here. Then we went back to the hotel and I relaxed and journaled until dinner, which I did not eat. The first three days of being here I was anxious, nauseous, and couldn’t really eat food and the food I did eat I couldn’t keep down food. Tuesday morning I left with a projects abroad staff member, Shova, and two other volunteers, a high school volunteer from New York, and a nurse volunteer from South Korea, and 6 hours later we arrived in Chitwan, also very exhausted. We had an introduction meeting then we went to our host houses. I slept until dinner time, which I also did not eat, and the next morning I would start my journey as a nurse volunteer, and it was also the first day of a cold. So for the past few days I average 5hours of sleep a night, waking up from the hours of 1am-4am with very little appetite and basically no food in my system. Today (8/13) I found out I have an ear infection, more to come of this story later.
After a rough few days of adjusting and trying to fight an illness, I began to eat again and participate in nursing activities. I play the role between a medical intern and a nursing student. I cant give medications but I can observe medical interventions/surgeries as well as perform ADLs and take vitals. I am currently on the CCU unit and will rotate through units every two weeks, as most of you know the CCU holds my heart and will hopefully be my home as a nurse back in the states. A little about the CCU unit here, there are twenty beds, about 3-4 nurses (they work 7hr shifts, and they work everyday), and about 3-4 doctors or medical interns. The unit does not have individual rooms but each patient has an individual bed. The patients are separated by curtains, which are only drawn if the patient is getting a bath or using a bed pan. In the morning we perform ADLs and vitas before the doctor rounds, after the doctor rounds the patient’s family members come to visit and ask the doctor questions. The families are very involved in the patient’s care and often perform the ADLs instead of a nurse.
Some differences are there are no precautions ie. sepsis, MRSA, pneumonia. The nurses don’t take handoff report from one nurse, the nurses do rounds and get updates on every patient in the unit when they come on shift. Everything takes a lot longer here, from getting medication to receiving treatment. Treatment is based on the family’s economic status, if the patient cannot pay the procedure is not performed. There are no CRRT machines, there are no ventilators, and there are very few (1 or 2 patient in the whole hospital) central lines. The nurses and doctors wear hospital gowns over their scrubs/jeans and a T-shirt and they wear sandals. They also have very little health insurance here as many patients pay out of pocket for treatment, granted their treatment is very less expensive than American medical treatment, it is a lot of money to a Nepalese family. Another thing that is different is how their pharmacy works. There is no drug pharmacy for patients, in America we have something called a Pyxis, where you log in, click on your patient, click on their due drug, and receive their medications. Here the doctors write a prescription the prescription is given to the family, the family then leaves the hospital finds a pharmacy on the street (they are everywhere) and gets the medication. They return to the hospital and give the medication to the nurse to then deliver to the patient.
Similarities are all patients in CCU have IV access, and patients receiving inotropic drugs receive them IV, but peripherally. Some research has shown that if inotropic drugs are given peripherally it can cause necrosis distal to the insertion of the IV, that is why many US hospitals deliver inotropic drugs directly to he heart. Since they do not have central lines they have no way of monitoring numbers ie CVP, PAWP, or PA. They determine how to titrate the inotropic drugs through ejection fraction by an echocardiogram, a normal left ventricle ejections fraction is 55-70%, most patients I have seen have 20-40%.
One of the patients I really chose to focus on has been diagnosed with acute pulmonary edema, history of HTN, LVEF of 40%, chronic kidney disease, pneumonia, and ischemic hepatitis from LVEF of 40%. The patient has a history of a previous MI. Basically this patient is very very ill when I first saw him. Now almost a week later, he no longer as pneumonia, his AST and ALT (liver function tests) are decreasing in number, meaning his liver is starting to work better, and they are titrating his dobutamine and noradrenaline. They taper his drugs through monitoring intake, output, and blood pressure.
I have really enjoyed learning the cardiac unit, and I look forward to what is to come the rest of the week. I had my own experience of being a patient at the hospital, but as an outpatient. As I stated earlier I have an ear infection. I started to not feel good a few days ago and thought it would go away with medicine and rest, but this morning I was sleepless and in throbbing pain, so I decided maybe it would be a good idea to get my ear checked out. I went with my host father to turn in all the paper work and then you receive this booklet from the counter and go to the outpatient unit of speciality, mine being the ENT. I went to the ENT around 9:15 and they said come back at 10:30, so I returned at 10:30 after the doctors had made their rounds and was seen by the ENT who then wrote a prescription in my booklet, that I then took to a street pharmacy after my shift. All of this cost less than one US dollar. So now I am medicated, and soon to be on my way back to being happy, healthy, heather!
The title of this blog post is elephant rides, magic buses, ear infections, and momos. This weekend, if you follow my social media pages, you saw I went to the local national park. We went on a Jeep safari, a canoe ride, and an elephant ride, on an elephant we named Helen. It was a great weekend bonding with the other volunteers that I will being spending a lot of time with! Magic buses are the mini buses we take to and from our host family to work, they cost around 15 cents per ride. They stuff as many people as they can fit into the back of one which is around 10 people (I don’t think I have a picture, but I will try to take one and post one later). I have already discussed my experience as an outpatient and my ear infection, and lastly are the momos, the greatest Nepalese food. Momos are dumplings and they have chicken momos and veggie momos, this is what I have for lunch every day, when I am not eating a chicken basket (chicken tenders and French fries) from the coffee shop in the hospital. Sorry for such a long post, but a lot has happened since I have arrived, and I want this blog to be a place for me to be vulnerable and open about what is happening here and how I am doing.