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The Going Global blog is an opportunity for emergency physicians to share their experiences practicing and teaching outside the United States. Submit an article about your experience to EMN at emn@lww.com. Be sure to include a brief biography and photographs of the authors. Photos taken during time spent abroad are also welcome, and should be 300 dpi and in jpg, tif, or gif format.

This blog was started by the emergency medicine residents of Palmetto Health Richland in Columbia, SC, who travel the globe on medical missions. The program is under the direction of Thomas Cook, MD, who oversees one of more than 40 academic departments of emergency medicine that sponsors Global International Emergency Medicine Fellowships.

Thursday, September 12, 2013
An Amazing Experience in Nepal
By Heather Brown, MD
 
 
I had an amazing opportunity to spend a month working in the ED at Scheer Memorial Hospital in Banepa, Nepal, during my second year of residency. Scheer is a missionary hospital 30 kilometers outside Kathmandu with a six-bed emergency room open 24 hours a day. The ED was staffed with a mix of seasoned western physicians and young Nepali house staff who were mostly recent medical school graduates. There were plenty of chances to make a serious impact, and I was ready to do just that!
 
Arriving in Nepal
I’ve been passionate about international medicine since I was in college, and I couldn’t wait to work in such remote part of the world. I arrived ready for adventure after a 16-hour flight, and Kathmandu did not disappoint. The airport was absolute chaos. I was immediately surrounded by cab drivers trying to overcharge me and vendors selling everything from water to snake oil. I was finally able to find a police officer who directed me to an honest cab driver who drove me to Banepa. We wove through dusty city streets with no lanes and up winding mountain roads next to crowded buses and swerving cyclists. I was sure that I was going to die in the back of that cab, but I somehow arrived at the hospital in one piece.
 
Dr. Brown in Nepal.
 
The Emergency Room
The patients at Scheer’s ED were not all that different from the patients I was used to in Columbia except the typical gastroenteritis patient in Nepal had typhoid, and the typical pneumonia patient had tuberculosis. I saw a lot of trauma patients (mostly motorbike crashes), many whom had serious injuries that the hospital was ill-equipped to handle. The nearest CT scanner was in Kathmandu, and because the hospital had no cervical collars, these patients were frequently forced to make an hour-long ambulance trip down a bumpy road with no C-spine precautions.
 
The Nepal ER.
 
A man came running through the front gate carrying his minimally responsive wife during my second week working in the Scheer ED. The patient was in her early 20s, and had been struggling with postpartum depression for just more than a month. No mental health system was available to her, and she attempted suicide by drinking a liter of organophosphate fertilizer. She continued to deteriorate after multiple vials of Ativan and pralidoxime. She was intubated and put on the hospital’s only ventilator from the ICU. The patient died later that day despite aggressive treatment with the appropriate drugs. I encountered three other suicide attempts by organophosphate poisoning during my month in Nepal. Unfortunately, psychiatric treatment is rare in Nepal and mostly reserved for the acutely psychotic.
 
 
Bisket Jatra (Nepali New Year)
That’s right! Nepal’s New Year is in April, and I had the opportunity to celebrate it in Bhaktapur with some visiting American medical students and Krishna, one of the young Nepali physicians who worked at Scheer. The festivities started just before sunset in the town square. A large chariot is constructed every year for the occasion, and is placed at the top of the hill in the center of the square. Several local children climbed on the chariot and slowly rocked back and forth. Krishna warned us not to stand too close because we could be run over. We decided to pick a safer spot near the bottom of the hill, but didn’t realize that we were still at risk for being crushed by the panicking mob running from the chariot, which had an unpredictable trajectory when it suddenly started rolling. The next day it became a makeshift temple where the people of Bhaktapur came in droves to sacrifice their best livestock. Fresh flowers and rice lined the streets where the citizens marched playing flutes and drums. It was definitely a unique cultural experience unlike anything I’ve experienced before.
 
The Bisket Jatra chariot.
 
My trip to Banepa gave me the opportunity to look at an emergency department in a developing country from a systems perspective as opposed to just direct patient care. I cannot express how thankful I am to have trained in a residency program and hospital that was supportive of my decision to make a career out of systems development in developing countries. It was an overall amazing experience.
 
Dr. Brown is a member of the 2011 graduating class in emergency medicine at Palmetto Health Richland. She is now an attending at Palmetto Health.
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