Nepal emergency department - part 2

My two weeks within the emergency department has flown by. It has truly opened by eyes to what health care can be like in another country. I feel like I have painted the hospital in a negative light with some of the cases I have written about through facebook posts etc. But the fact is that the majority of the time the staff do an amazing job over here given the last of resources they have. Sneaking off to a surgical ward round didn’t feel much different from being on one within the UK; still got a grilling off the lead surgeons. The surroundings of the patient yes were different but the procedure they were treated with would have been the same within the UK.

The system as a whole has come as a major shock. Patients will present in the emergency department talk to a paramedic or a doctor and get given a token if they believe the problem warrants some investigations, this is purely based of a 2 minute chat. As well as a token they also issue a list of items that they believe will be needed, for example: IV cannula, syringe, blood bottle, pair of gloves and you can’t forget the buscopan (they love giving out buscopan here no matter what the complaint). The family members will take this to a counter in the main area of the hospital where they are then given a clerking sheet and the items on the list for a fee. As this is a government hospital, there are many within the city but most are private, the equipment is cheap, from my perspective anyway maybe not from a village families. For example a chest x-ray costs 350 Nepalese rupees (about £3). The doctor or paramedic will then clerk in the patient and investigations and treatment written down so they can purchase anything further. This whole process of ordering and purchasing the items makes you question how much equipment we waste in the UK, mainly gloves. If you have one pair of gloves per procedure per patient I’m sure staff would care a lot more about the amount of disposable gloves we get through in the UK. However there has also been many a time where I wish I could use a pair of gloves but none have been available. I have heard many a rumour about them reusing needles over here, however I have not personally seen that. Due to there only being one cannula per patient I have seen episodes where the vein has been missed so the cannula is taken out and reused on the same patient.

One patient that came in after a road traffic collision had multiple lacerations to his foot, ankle and head all of which needed suturing, apart from the foot which in my opinion the 5cm wide skin loss needed a plastics referral for a graft. This suggestion was found to be very humorous by the doctors and paramedics, turns out plastics at least wasn’t a speciality in this hospital, it was a pure suture job. There are various grafting types used within the UK, autologous, where the skin is taken from a different site on the patient, allogenic, where the skin is donated from another person, xenogeneic, where the donor is of a different species and prosthetic where the skin loss is replaced with synthetic material. In allogenic grafting a dermatome is used to slice off a thin layer of skin which contains the epidermis and only a portion of the dermis. The dermis that is left behind in the donor site contains the hair follicles and sebaceous glands. This thin graft is then surgically stitched or staples to the bare area.

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