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Report from Nepal part 2

Subject: Day 3, Chitwan

It is 0600 on wed, our third day. Was to tired yesterday to write.
We are starting to get into a swing, and being accepted and trusted by the local doctors. Being our first time at this location, it takes some time. Yesterday I spent time in GYN clinic with two of their GYNs, they used me as a consulting attending, meaning they wanted to run cases by me for opinion, especially those for incontinence as well as prolapse. We currently have ten patients admitted in the hospital waiting for surgery , as their policy is to admit immediately and hold them upstairs room till there is time to operate. We have 5. Cases scheduled for today. There is a big push to teach laparoscopic ( minimally invasive) Hysterectomies. As none of them have done that. Unfortunately they have minimal equipment, and to date have not been able to show us the few mandatory items we need to proceed with these cases. I am encouraging them to start with basic cases and work up their skill set, but it will take some time to work on this.

Today we will focus on Incontinence as well as prolapse cases if possible, as well as several pelvic masses.

This morning will be telling, as we do not want to get into cases that we can not complete, yet they are desperate to learn these skills. The GYNs share one rack of laparoscopic equipment with the general surgeons, and according to our Surgeon who did a laparoscopic gallbladder yesterday, it is barely passable.

We have worked on numerous infection control issues with the OR staff so far. As well as some surgical techniques that could be improved. They have read the recent articles, but are reluctant to institute some changes.

Yesterday I did three c sections for them as they where so backed up. They seem to like our technique, wether they adopt any changes will have to wait to see. My last case was a know Dandy Walker abnormality of the fetus. That means the scalp bones do not close and the brain protrudes from the back of the head, covered by skin only. I will spare you the pictures, but this was a very severe example, and we suspect the child will have a very poor prognosis. :(

Our group have melded together like mission trips always do, everyone looking out for one another, pitching in and really just trying to help out and get work done. See OP Med face book for up dates as well as details about participants.

Prior to arriving at Chitwan we where able to have a half day of tours in Kathmandu. We took an early morning flight around Mt Everest as well as all the 20,000 foot Himalayas mountains. Breathtaking, Spectacular, does not begin to describe it, and pictures do not do it justice.
We followed that with a tour of the city as well as of temples and an open Crematorium.
Very spiritual and moving.

More later.

Jeff Segil
Dover Women's Health
Dover, NH

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