Snake Bite

‘Snake bite’…‘electrocution…’ I read the board on the first day of my rotation in the Emergency Department (ED) at Dhulikhel Hospital in Dhulikhel, Nepal. During my time at Dhulikhel, I saw afflictions that I personally have not yet seen in America: epiglottitis, disseminated tinea corporis, prolapsed uterus with decubitus ulcers, many cases of pesticide poisoning, etc. Chief complaints I have never seen mixed with familiar ED presentations, but without the countless victims of gun violence that you see in American EDs (I did not see a single case in Nepal). Beyond learning about different pathologies, though, I learned about the practice of emergency medicine with resource limitations and the incredible model and vision of Dhulikhel Hospital.

Similar to the ED’s I have worked in in California, the Dhulikhel ED utilizes a triage system based on the acuity of a patient’s condition. The ED has 25 beds and is organized based on category of acuity, the “shock zone” being the highest. While the medicine is the same, I gained insight into the resourcefulness, strength, and adaptability of providers when dealing with resource constraints in the high acuity setting of the ED.

Providers typically interpret all their own imaging from printouts of scans that patients carry with them. They are savvy with point of care ultrasound, commonly diagnosing pulmonary pathologies before patients even get an X-ray. They are faced with difficult barriers, such as reagents for lab tests being unavailable or a power outage backing up the CT-scanner and then having to decide whether to transfer patients to another hospital for needed imaging. The ability the get immediate labs and imaging of choice in the ED is something I’ve often taken for granted in my previous ED experiences and such challenges certainly add a layer of complexity to clinical decision making.

During my orientation, I had the opportunity to learn more about the hospital itself. Dhulikhel Hospital is a community hospital located about 30 kilometers east of Nepal’s capital Kathmandu. It is an independent, not for profit, non-government institution that was conceived and supported by the Dhulikhel community to meet the needs of the people. It is guided by the mission to provide high quality health and education services to the country, working to provide health care services for the locals as well as rural communities through the creation of outreach sites. It is steadfast in the mission of increasing access to high quality care, through these outreach sites that provide primary care services as well as through the coordination of ambulances throughout Nepal. All the while, the hospital is committed to keeping costs of care low and accessible to patients.

I am so grateful for the opportunity to work with, learn from, and be inspired by the people of Dhulikhel Hospital. People were incredibly warm and welcoming, and this is an experience that I will carry with me throughout my career and life. Now that I finished my rotation and am saying what I hope is “see you later” to the people I met while at Dhulikhel, I’m headed to explore more of Nepal for a few weeks!

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