All in a Day's Work....

For this blog entry, Kim will be given a much-needed break, as she has been the one diligently writing all the blogs up to this point.  She has been a blessing to me in so many ways, and updating the blog is just one of the many responsibilities that she has taken on so graciously.   Which is a good thing since she’s a much better writer than I am….

In case you were wondering what it’s like to work as a physician here at the mission hospital, I thought I would give an example of a typical day at work.

First of all, I had to learn quickly that missionary docs in general are often asked to work outside of their comfort zone.  For me, that meant working primarily in the Pediatric department here.  Back home, I was seeing mostly adult patients in my practice.

I also learned quickly that a dependence on God and lots of prayer were crucial to making it through the challenges of each day.

7:45a- 8:00a  Morning report.   We start with a devotional given by one of the missionary doctors, then the interns (1 medical and 1 surgical) will present the patients that were admitted overnight.  Almost every day, the surgical intern would present someone falling from a height (usually a tree) and breaking an arm, leg, hip, or other bone.  This ranged from young kids to even an woman who was 70!

Why kids break bones out here.

8:00a- 10:30a Rounding on the wards.  Right now, the pediatric team is Dr. Joan Shu (a pediatrician who’s from the San Fernando Valley), Prakash (General Practice resident), two interns (Abhijit and Shreshal), and myself.   This being monsoon season, we’ve been seeing a high volume of meningitis and typhoid fever, plus the occasional snake bite.

We have a critical care room, a newborn nursery, and will see newborns in maternity.

Don’t mind the boy on the right peeing in a cup.  Thankfully his identity is protected….

Dr. Joan (we’re all called by our first name)

This 9 year-old girl was bitten by a neurotoxic venomous krait snake and needed intubation.  Thankfully the girl recovered fully.   

Example of a krait in the middle bottle.

10:30a-11:00a “Conference time”.  Actually this is when our team goes to the canteen for a chiya (Nepali tea) break.  My favorite part of the day.

11:00a-1:00p Children’s Outpatient Department (OPD).   The patients are first seen by CMA’s (Clinical Medical Assistants) who take a history, do a physical exam, and order relevant lab tests and X-rays before seeing the physicians. 

Outpatient waiting area

1:00p-2:00p Lunchtime.  I live about 200 feet from the hospital so I get to go home and eat with Kim, which is great since I don’t get to do that back home. 

2:00p-5:00p Children’s OPD again.   What kind of stuff comes in?  Here’s what I treated one recent afternoon:

-Giardia (intestinal protozoa infection)

-Ascariasis (intestinal worm infection)

-Dysentery (bacterial and amoebic)

-Pneumonia

-Acute hepatitis A infection (with jaundice)

-Rectal prolapse

-Follow up on a young child who developed aspiration pneumonia after ingesting kerosene

-Urinary tract infection

Ascaris worms from one unfortunate patient (he had enough to fill 3 bottles)

At any time during the day, we can get called to the operating room for C-sections and be available to do neonatal resuscitations.

I would say it’s taken me a good 3 months to really get the hang of the medical side of things here. The work has been challenging, frightening, exciting, and humbling, but I haven’t been put in any situation that was more than I could handle, and I thank God for that.  I’ve been required to do procedures (with a lot of anxiety) that I haven’t done in many years, like lumbar punctures.  There are some days that I feel completely lost and useless, but I’ve always been able to ask for help from the other physicians (which I still do a lot of the time). 

We may not be able to save every life, but we can touch the lives of every patient and sometimes their family members with our care.   We have a Pastoral Care team that shares the gospel with every admitted patient upon his or her discharge from the hospital; they are the heart and soul of the hospital….

Well, we’re down to just about 3 weeks to go here in Nepal, believe it or not.  We're looking forward to coming home.  Thank you all for your support and prayers!

Namaste, Tom