Pre Monsoon (Spring) 2008 Report

by Dr Cheryl Tallon (03/04/2008 – 05/05/2008)

Lauren Newcombe and Angus Mitchell were present during my stay (both final year medical students from the UK)

Overview

I had a great experience at the post, Chhewang and Kancha making me feel welcome when I arrived. The porter shelter rescue post is in a beautiful, setting enclosed in a valley with breathtaking views of surrounding mountains. Most mornings are calm with beautiful blue skies, a great time to drink Kancha’s milk tea in the garden.

 I soon began to familiarise myself with the post and was greatly assisted by medical student Lauren who had been there for a number of weeks. Kristen, the doctor who opened the post at the beginning for the season left for a trip to Gokyo and EBC after my arrival.

Patients presented with problems ranging from pyelonephritis, haematemesis, dog bites, and the usual gastroenteritis and altitude related problems.

The post seemed fairly quiet, particularly to the end of the season. Chhewang thought it was an exceptionally quiet season, probably due to the election and the controversy regarding the Chinese/Tibet issue.

Trek to the clinic

I spent one night in Lukla and visited both the Porter’s Progress clothing bank and the Lhamu Niquille hospital. The porter’s progress was closed when I arrived; however, after trying to speak to a number of shop owners in the street, I was led to the shop which had been opened especially for me! I also spent some time looking around the hospital which is in such a unique setting just outside of the main part of Lukla. It is a superbly clean and well equipped Hospital.

I spent the next day trekking to Namche Bazaar, where I stayed at the Panorama for 2 nights. (This should normally be done in 2 days). The panorama is situated at the top of the horse shoe of Namche. It has a great atmosphere, and I was made very welcome there. I visited Dr Kami whilst I was close to the hospital at Kunde. The hospital is incredibly well respected and used by the local community, and is well worth a visit on your trek up. Dr Kami even got out a few X-rays for my perusal!

I then carried on to Dole, where I spent a night at the Yeti Inn. The owner Urken is extremely well read and we walked up to the post together the next day.

Running the Post

The post is a large L shaped building with the living area and clinic on one side and the porter shelter on the other. The sun room was where I gave the lectures and usually stayed warm until the mid afternoon and the fire was lit around 6pm to keep us all warm during dinner.

Patients would mostly present early or mid morning, which tended to be on waking or on arrival at Machermo. Chhewang was a great help in translating and helping us to learn Nepali. The data from each patient was kept on a hand written sheet, and also on an excel spreadsheet I created. For some reason I was unable to save the data on to the palm. Luckily I had brought my laptop, which worked at high altitude. It was great to have as I was also able to make a computerised record of the drug inventory. There was no issue with having to duplicate the patient information.

The satellite phone was great for making contact with friends and family, and mostly had a great reception. It was also good for sending text messages. Chhewang would keep the phone topped up, and we could pay him per call.

Chhewang organising all the porter stays and educational videos, which seemed to be well received.

The fees of 20 Nep.Rupees introduced last season for the local residents worked to stop people presenting with minor non-urgent ailments, (encouraging them to visit Khunde instead).  There was no problem for trekkers to pay the fees for their treatment.

We raise money to help run the post by selling lots of T-shirts, badges and a few first aid books. Trekkers were keen to have their oxygen saturations checked for 100 rupees after the talks, and would often let us ‘keep the change’ as a donation.

The bedrooms were ample size, however didn’t ever get above freezing (even during the day!), so I was glad to bring my 4 season sleeping bag. Kancha would warm water during dinner to fill our hot water bottles!

Drugs

I felt we did not have enough drugs for the season, infact we had run out of Co-Amoxiclav by my arrival!! It seemed to be difficult to arrange for any drugs to be sent up. There were virtually no donations to the clinic from trekkers, as most people continue on to the Cho La pass and EBC, and understandably need their meds. I do not know the reasons for the low stocks, especially since it had been a quiet season. It was possible to contact the Panorama at Namche Bazaar, who would arrange for a porter to bring medications up with them. I am aware that Co-Amoxiclav is a relatively expensive drug in Nepal, and not sold in Namche.

Food

Kancha’s food was incredibly inventive considering what he has to work with. He cooks from a single stove on the kitchen floor. Breakfasts consisted of  pancakes, omelettes, porridge, rice pudding, eggs on toast! Lunch was normally potatoes/cheese/pasta type of dish. Supper would be soup with popcorn/ prawn crackers, then a main course. Overall, the food was a delight. I never went hungry and always looked forward to meal times.

Medical Experience

I had a varied experience during my time at the post, seeing a total of 60 patients during 4 weeks. During the whole season 105 patients were seen, approximately half (52) were Nepali. 34% of patients had an altitude related illness; a further 19% had symptoms of gastroenteritis. The other half consisted of a combination of viral/ bacterial respiratory chest infections, soft tissue injuries, corneal abrasions, and various others.

I had only 2 overnight patients during my stay. One patient had been brought from Gokyo on a horse at 8pm with a massive haematemesis; the other patient had severe HACE/HAPE. The patient with haematemesis was managed with warmed saline and antiemetics, and was evacuated the next morning. He made a full recovery I was pleased to hear.

There were 5 helicopter evacuations during the season; amazingly we even managed to evacuate a patient on the day of the Nepali elections which was a triumph in itself!! All the evacuations run smoothly and there were always people around to help.

The afternoon lectures were advertised in the teahouses in the village, although sometimes in a corner, and not very obvious for trekkers to read. We went around the tea houses in the afternoon which increased the numbers coming for the talks. It also gave me  an opportunity to make the acquaintance of the local teahouse owners and workers.

Porter Protection

I do not have the final number of porter nights for the post, but it was certainly well used.

During each talk we emphasized the porter protection issues, and overall there seemed to be little awareness of the issues porters were facing. There were very few independent trekkers, most were with large companies. I would always make a point of asking if the trekkers knew where their porters knew where they had slept the night before, and how much wages they earned per day. Most of the trekkers from the commercial groups did not know.

There were still porters sleeping in the cave by the river. One trekker actually stated ‘I think they prefer to sleep out, under the stars’!!

There still appears to be no enforcement of the load weight that is carried, and there appeared to be general acceptance to carrying a ‘double load’ for double pay.

Recommendations

There should be a post lap top, (to be carried in and out by Chhewang, the doctor can then access it on arrival in Nepal).  Then information could be carried home and up and down on memory sticks etc. All of the patient and drug info could be put on there, along with the handbook and even volunteers’ pictures.

I have made a list of suggestions for the additional clinical items that may be useful in the clinic at the bottom of the drug spreadsheet.

There could be some better posters made for the teahouses advertising the post/ lectures, or even with some altitude sickness information.

Summary

I had an unforgettable experience in Nepal. Not only did I get some practical experience of my interest in mountain medicine, but I also got to meet and make lasting friendships with some of the most amazing people, in such a unique setting.

I believe the post is making a positive impact in the Khumbu, not only with the trekkers, but more importantly for  the porters who get the benefit of education, shelter and healthcare.

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