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Dharan, Nepal

Dharan, Nepal

Dharan is on the Eastern side of Nepal. It is a relatively small city, home to 5 public colleges and a University. I traveled there as a medical student to work at B.P. Koirala Institute of Health Sciences - a tertiary level hospital and the training ground for Nepalese Medical students. BP Koirala was originally the site for the Brigade of Gurkhas - Nepalese soldiers who served with the British military.

 The magnificent Annapurna circuit

The magnificent Annapurna circuit

 Carrying stones the Nepalese way

Carrying stones the Nepalese way


 

From the institute, we traveled by road to remote villages and stayed with local medical students while they learned about the state of the rural health system. This broadened my understanding of the challenges of working in a low resource environment.

 

 

 

 

Medical care in remote Nepal

 One of many pharmacies in town 

One of many pharmacies in town 

The most confronting exposure I had was meeting a 21 year old girl who was mauled by a bear. She lost her nose - the lower border of her eye sockets collapsed so that her eyes fell behind her cheeks. One eye remained relatively functional and the surgeons were able to reset the position and conduct a corneal transplant (replace the skin on the surface of the eye). Unfortunately reconstructing her face required much more technology that wasn't available. Being 22 years old myself at the time, it was heartbreaking to imagine what her future held.

The government health infrastructure in remote Nepal consists of low level hospitals, to health centres to health posts. Hospitals are often over-crowded and limited in their consumable items such as catheters, dressings and food. Consequently, patients usually need to supply their own - a big challenge for people who have little income. Health centres and health posts are similarly dependent on tenuous supply chains, varying quality of staff and not infrequently found un-manned. 

 A rural hospital in one of the town centres that had doctors, an outpatient clinic, a few inpatient beds and an Xray machine.

A rural hospital in one of the town centres that had doctors, an outpatient clinic, a few inpatient beds and an Xray machine.

 Rural health clinic is considered the middle level rural health provider, usually with a permanent community health worker, basic medicines and immunisations.

Rural health clinic is considered the middle level rural health provider, usually with a permanent community health worker, basic medicines and immunisations.

 Health posts were the most rudimentary level of health provision and often found un-manned, but intended for basic wound care and immunisations. 

Health posts were the most rudimentary level of health provision and often found un-manned, but intended for basic wound care and immunisations. 

 A hospital ward

A hospital ward

Health problems in Nepal - vaccine preventable disease

Common ailments I encountered were communicable (infectious) diseases like Tuberculosis, Malaria and Typhoid. It was common to see people with disability secondary to Polio moving through the streets. Incomplete childhood vaccination means that rates of vaccine preventable diseases remain high in low-income countries like Nepal. The Nepalese government has shown some commitment to universal immunisation coverage, but has struggled with implementation, presumably as a result of a multitude of factors including distribution and quality management of thousands of extremely remote communities. Interestingly though, children living in high density urban slums are at greater risk of incomplete immunisation. It is also interesting to note, that during the Maoist insurgency of 1996-2006, immunisation rates seemed to improve. 

 Public health posters

Public health posters

 Safe sex promotion

Safe sex promotion

 Recognising the symptoms of Tuberculosis

Recognising the symptoms of Tuberculosis

Recent statistics show that rates for BCG (Tuberculosis) immunisation have successfully reached 99% and Nepal was certified as Polio-free in 2014. Ancillary programs such as the electronic immunisation register and mobile phone sms reminders to parents, are currently being rolled-out by WHO and Nepal child health department. These will help immensely with encouraging appropriate timing of immunisations, a critical concern for multi-dose vaccines.

Burrumbuttock Hay Runners, Longreach

Burrumbuttock Hay Runners, Longreach

The people of Christmas Island

The people of Christmas Island