My two weeks rotating in the Dhulikhel hospital emergency room (ER ) so far have been a powerful and eye-opening experience. Many patients come in transported by their families, with some in critical condition. By my observation, the five most common concerns are trauma secondary to motorcycle or farming accidents, COPD, heart disease, alcoholic liver disease, or infections like pneumonia or appendicitis. I have been most struck by the dedication, expertise, and resourcefulness of the medical staff. They work very long hours with minimal pay scaled by both living costs and work difficulty, are extremely efficient with their time and display a wide knowledge base, and make excellent use of their relatively limited resources to diagnose and treat high patient volumes. The ER has 26 beds (with two in the shock room for critically ill patients), one ultrasound machine and portable X-ray, and one dedicated room for minor procedures. I was also surprised to find that the hospital has a CT scanner and MRI of which it makes good use. Along with a well-stocked pharmacy and a suite of specialty services, the Dhulikhel ER is able to treat a variety of diseases and many patients are referred to Dhulikhel to receive specialized treatment.
I have noticed several similarities and differences between the Dhulikhel ER compared to the hospitals in which I have trained in the USA. In terms of similarities, Dhulikhel physicians follow many of the same guidelines and prescribe the same medicines (albeit with different trade names). In terms of differences, I was surprised to see that the ER treats both adult and pediatrics patients and that the patient’s families often participate in their care (e.g., by purchasing medicines from the pharmacy, feeding patients with food bought from the canteen or home, and providing blankets and pillows. I was unsurprised to see that most notes and orders are handwritten or that the ER was very crowded, with patients having minimal privacy. However, I was impressed by how fast turnover is in the ER, with some patients being admitted or discharged and many leaving against medical advice (AMA).
While my role has mostly been limited to observation and shadowing, I have been able to participate in caring for some patients. For instance, I have had the opportunity to perform physical exam maneuvers on patients, place IVs, do arterial sticks for arterial blood gases (ABGs), and perform extended focused assessment with sonography in trauma (eFAST) exams on trauma patients. I unfortunately also participated in my first code for a patient with decompensated liver disease who died from hemorrhagic shock secondary to bleeding esophageal varices as I was taking turns performing chest compressions on him. Throughout these memorable experiences, I have felt consistently supported by my Nepali colleagues who, despite being extremely busy, have tried their best to make sure I understand what is happening and that I feel included. Many have treated me out to tea or meals in the canteen and have been very welcoming and expressed interest in learning more about me and how things are done in the USA. Overall, this has been a wonderful experience and I am so glad I decided to do my GHAC global health rotation at Dhulikhel Hospital.
