I step off the airstair and pause, just for a second, before my foot touches down. It has been more than four years since I left Nepal, after completing two years as a Peace Corps volunteer. Four years. How strangely the time has moved. When I left, Barack Obama was president. My parents lived in a different house. I did not know if I would be accepted to medical school, and had no real medical knowledge. And, though I still feel inadequate, I think about how much I have learned in that time. I think about how the world has changed. I think about the countless phone conversations with my Nepali host family and friends—"when will you come back? this year? It has been very long.” Now, I think, as my foot touches down. I see the red-brick façade of the Kathmandu airport terminal, zigzag through customs and immigration, and heartily embrace my dear friend Ramesh, who rode a public bus for two hours to come greet me. “It has not been very long,” he says. And this feels true.
I am spending the month at Patan Hospital for a global health elective. I'm supposed to write weekly blog posts, which I'll repost here. Rereading some of my old Peace Corps blog posts in anticipation of this trip, I’ve felt that some of them were tainted with undertones of frustration, condescension, and even contempt. I will strive to avoid that this time, while still sharing my thoughts and feelings about this experience. In medicine, we use a format called SOAP—subjective, objective, assessment, and plan—to document and communicate patient (his)stories. I will organize my blog posts using this framework, but will lead with objective observations, so that you can develop your own impressions, independent of my own.
It’s 2am of my first full day and I cannot fall back asleep, jittery with jetlag and anticipation. At around 7:30, the other visiting students awaken and we have our breakfast of a croissant and boiled egg. They escort me through the winding streets of Patan to the hospital and show me to the library, where I am to meet our supervisor. There, I am told that he is on vacation and will not be back until four days from now. One of the students offers me to tag along in the medical intensive care unit (MICU), and gives me a tour and orientation.
Patan Hospital is the major teaching hospital for the Patan Academy of Health Sciences, a not-for-profit medical school in Nepal’s capital. The hospital has 320,000 outpatients and 20,000 inpatients per year, according to its website. The MICU has seven regular beds in one room and one isolation bed in another room. It is staffed by four nurses, around eight medical officers (doctors in training who rotate through various specialties), one resident, and one attending. In certain ways, it resembles an ICU in the United States—patients on ventilators, vitals machines beeping with the occasional alarm, fluids suspended from poles dripping into IVs. But the charts are all paper, the x-rays and CT films are held up to the light to read, and everything is older than in American facilities.
On my first day, I follow along on rounds, which are conducted in a mixture of English and Nepali, in a somewhat different format than in the states. When rounds conclude, the other student and I go next door to watch a coronary angiogram. These first two days, we have a lot of down time, which we spend practicing ultrasound, reading articles, and discussing the “cases,” as they are called here.
On the afternoon of the second day, the cardiologists invite us into the echocardiography lab. In a room with waiting room chairs and an echo machine, the patients are called one by one to the bed where the cardiologist places the ultrasound probe on their chest and takes pictures of the heart, while an assistant types up the echo report with numbers taken from picture printouts and the cardiologist’s verbal interpretations. The cardiologists seem more than willing to teach, quizzing us on the locations and appearance of heart structures, pointing out certain findings and explaining their clinical relevance and correspondence to the ECG.
At one point, one of the cardiologists turns to us and asks “So what learning objectives do you have for your time in Nepal?” It’s a fair question. For one, Nepal is a special to me, and the opportunity to return to a place that showed me such hospitality, and to reconnect with the people with whom I lived and worked, was too good to pass up. In addition to cultivating this connection, I’ve been thinking about how best to put my knowledge, skills, and experiences to good use, and I’d like to help support Nepal’s health care system in a sustainable way. I’m applying to residency in internal medicine, with an interest in hospitalist care and several subspecialties, including infectious disease, rheumatology, and cardiology, along with medical education and process improvement. I have not yet forged these intellectual passions into a unified vision of my potential role in Nepal, but I mean to. I know it will require many of the skills I learned in the Peace Corps, including identifying grassroots needs, building local networks, identifying motivated changemakers, mobilizing local and international resources, and working with diligence and humility. I am hoping that this monthlong rotation will begin to reveal these opportunities. So that’s my plan. Keep reading to monitor my progress.
No comments:
Post a Comment