Monday, February 14, 2011

Local Health Care in Nepal

Yesterday I had my second brush with the local health care system in Nepal.

The first encounter, just after I arrived in Nepal, was hardly worth mentioning -- a visit at the CIWEC Clinic for my third and final Rabies vaccination and medicine for a lingering chest infection. With a roster of international doctors, CIWEC mainly provides care to travelers and permanent expats in Nepal, so its prices are higher than those of local hospitals but still far from the prices I am used to seeing on health insurance reports from the U.S. At $55 for a consultation, I find CIWEC amazingly affordable.

CIWEC, though, is located at the other side of town in Lazimpat, an embassy area in the north of Kathmandu, so it is not an ideal choice for emergency medicine when you are located in Patan. For Patan residents, the main choices are Norvic Hospital, which is located just across the Bagmati Bridge, and Patan Hospital. Then there is also Alka Hospital, which is located about a five minute drive from my home.

So why the review of hospitals, you ask? Well, it all started on Saturday evening, when I started to feel symptoms of either flu or food poisoning. In Nepal, you can usually count on it being the latter, but I had not had any strange foods that day, so I did not think much of it. (And oh, that hot buffalo's milk from Saturday's field visit? I knew better than to actually drink it. I have learned to accept such things graciously and, when necessary, dispose of them discreetly). Anyway, I went to bed early Saturday night and slept fitfully and feverishly.

I finally emerged from my bedroom about 12 hours later and went downstairs to get water. I felt a bit lightheaded, so I took a seat in a kitchen chair. Tia and my housemate were both in the kitchen, and my housemate asked me how I was doing and said that I did not look very well. The next thing I remember is waking up on the marble floor, where I had fallen, head first, from my chair, when I fainted. Apparently I was out for about half a minute. There was some momentary panic as Tia hopped on the phone to reach a doctor and Geeta sat behind me, holding me up. Dehydrated, sweaty, and a little sheepish, I gulped down water and juice and then allowed my kind housemates and stand-in caregivers to help me walk back up to my room. The doctor on the line had prescribed rest, fluids, and rehydration salts.

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Mixed with water, the salts taste pretty awful, especially when you are already battling nausea. (Mom: I don't know if your Merck colleagues in NJ have any power over Merck's production in India, but if you could make these a little tastier, that would be great. Thanks). I spent the rest of the day sleeping off and on but not improving significantly. At about 5 PM Tia decided I should see a doctor, so she drove me to the previously mentioned Alka Hospital.

The good: I was able to see an emergency room doctor immediately, and within five minutes I was resting on a hospital bed with an IV pumping rehydrating fluid into my veins. The doctors and nurses spoke great English, and they were very attentive and kind. My diagnosis was acute gastroenteritis, from either contaminated food or water. The total price, for the ER consultation, IV, lab work, and three prescriptions, was about $30.

The different (note: not saying bad): The hospital is organized around an open-air courtyard, and the Emergency Room was just that -- a single room which opened up to the outdoor courtyard. To get lab work, I had to walk outside and across the courtyard to the lab. Also, the staff seemed very resistant to keeping curtains down around the beds; as soon as Tia would let down a curtain to give me a bit of privacy, a nurse would immediately tie it up again. At least the open curtains kept me entertained with people watching during the IV administration.

Now, almost 24 hours later, I am feeling much better, thanks to rest, fluids, rehydration salts, $0.50 DVDs, the amazing care of my housemates, and a bit of perspective. Last night one of my fellow Kiva Fellows was also in the hospital, but across the world in Armenia, after a very serious car accident that left two people dead. Thankfully, my friend escaped with a dislocated hand, now in a cast, and some seriously shaken nerves. Her messages to us in the early morning shook us all. My thoughts and Kiva love go out to Armenia.

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