Bhaktipur and the Gyno

On Saturday, Joyce, Erin, Maddison and I went to Bhaktipur. Kathmandu used to be divided up into three different kingdoms: Kathmandu, Bhaktipur, and Patan. All three of them had city centers where the main palaces and temples are located, known as Durbar Square. When Joyce and I arrived, we rushed past the men at the front, trying to convince them we didn't need a guide. And then we proceeded to get very lost in the actual town of Bhaktipur.

Eventually, we made our way to Durbar Square and met up with Maddison and Erin, who, coincidentally, had a tour guide showing them around. After many pictures of large temples and pagodas, we ate lunch and headed back home to Marhajgunj.

Three of the interns, Anne, Kelda, and Allison were leaving on Sunday, so we celebrated their time here by going out to a great dinner at La Dolce Vita, and then getting cocktails at a restaurant called OR2K (both in Thamel.)

The next day, the three girls left and were immediately replaced with two new girls, Megan and Carly. Megan, from Arizona, would be working in Helping Hands with most of the other interns, while Carly, from Juneau, Alaska, would be working in a clinic in Pokhara, Nepal (about 6 hours away from Kathmandu.) Both girls are really charismatic and fun, and both have the same love for the mountains and the outdoors as me. Unfortunately, Carly had to leave for Pokhara in two days, so Monday night we, once again, celebrated her time here by visiting OR2k.

Megan began her rotations with Joyce and me, and this week we started in the Gynae (Gynocology) Ward. The gynecologist here is very good, and she is the only female doctor in the hospital. She discusses every case with us, and lets us look on during every physical examination. So far, we've seen a prolapsed vagina, cervicitis, vaginitis (yeast infection) and today, an abortion.

The abortion was done via sucking the 6-8 week fetus out of the uterus with something that looked like an overlarge syringe. Surprisingly, this was one of the more sanitary procedures that we've sat in one, despite the fact that the gyno was wearing re-used latex gloves that had sat in an open container of bleach for a week. Throughout the entire procedure, the patient was crying and was holding tightly onto the hand of the nurse. The gynecologist talked the patient quietly through the procedure and after about 15 minutes of a disgusting squelching noise, the abortion was done.

The gynecologist told us after the procedure that the woman's husband was paralyzed on his right side, and getting pregnant was very difficult for the couple. The woman had desperately wanted the child, but after 8 weeks with no heartbeat and a lot of bleeding, the woman had decided to abort it.

It was good to see the doctor talking the patient through, and letting the patient display her emotions. It's fairly uncommon to see Nepali people talk about their feelings, which often results in conversion disorder (something the interns and I see frequently in the ER.) Conversion disorder is when the patient is stressed or upset, and has no way to get it out. Instead of discussing their feelings, the feelings present themselves physically in the patient. For instance, one patient in the ER became totally unresponsive when stressed. And the atmosphere of the hospital doesn't help matters.

Helping Hands Hospital is the cheapest private hospital in all of Kathmandu. The doctors that work there are not paid--the time they spend there is purely voluntary. Because of this, and the way Nepali culture is structured, patients come in and out as fast as possible. Spending more than 15 minutes with a patient is a rare thing, and if admitted, the patient literally becomes a number (even the interns refer to the patients in the ward by their bed number.)

Being in the ER and the OPD, you lose touch with the sensitive nature of medicine. Dr. Gupta, at OPD, will see 3 different patients at one time in a room that wouldn't even fit one person back in the States. There is no such thing as privacy in the Ward; no such thing as patience in the ER. But the Gynae area gives a nice balance between the hypersensitivity of the US and the lack of privacy of Nepal.