Scalpel's Edge

A surgeon's notes

Sunshine is coming

Nepal ele

One of the remarkable aspects of working in a charity-run hospital is the abundance of short term volunteers and visitors. October is one of the nicest times to visit Nepal – the mountains are more likely to be visible and free from cloud, the weather is mild and the monsoon is over.  Furthermore, the rice harvest is finishing, so (Hindu) Nepalis are caught up in festival season and visiting friends and families.

As a result, we have visitors – interesting people to meet, who dilute our small community, introduce us to different skills and give us an opportunity to look out at the world.

One of our visitors is an experienced paediatric surgeon form Australia.  He is someone I would probably never have a chance to work with at home, and even if I did it would be largely as colleagues, as I don’t normally operate on paediatric patients.  But here I can watch complex intestinal and perianal cases, and learn from his techniques.  As a group, we have the opportunity to discuss those cases we have seen over the last year who seemed confusing, frustrating and heart-breaking.  We can debrief and get absolution (“Those cases are simply hard and there’s not much more we would have done either), as well as get ideas and techniques for the next similar patient if they arrive in the next few weeks.

We also have the joy of having patients that we know well discharged after definitive surgery.  One of the patients being treated this week presented to us 12 months ago for his first operation, at just four days old.  He recovered well, thrived, and is now a healthy toddler. It is infectious to see his family’s excitement at having his final procedure performed, and exciting for us, too.

Another visiting surgeon has worked as both a general surgeon and a plastic surgeon. We regularly have patients that would benefit from fancy plastic surgical solutions, particularly.  Our alternate techniques require more time for healing and more obvious scars and deformities.  It’s very entertaining (as a surgeon) to see a racy solution to some of these problems.  And fun also to banter with a new surgeon who is familiar to Tansen, having been here before.

It is also the season to meet new people.  This last week we met a couple from Australia who worked here 16 years ago.  This time they came to visit with their children and our kids got hyper excited by Australian accents in their Sunday school class.  Plus as they bought vegemite, which we have not had for a month, we were predisposed to love them.  Next week we are excited to meet a new family who are considering volunteering to work here long term.  One of the great parts of working with such a diverse group of people is the variety – some mission heroes have been here for decades, some for a month or two, some are still considering, and some are returning.  It’s like joining a huge family reunion in a cacophony of languages.

At the moment, our expat, and even Nepali hospital staff numbers are pretty limited.  We have few GP’s to run the medical and maternity side, and we are running on a skeleton crew of surgeons.  Some of our senior staff are on leave, which accounts for some of the difficulties.  When a large proportion of staff are expatriate, then their holidays periodically involve travelling home for longer periods.  We also have reduced numbers of long term volunteers, possibly indirectly due to the earthquake last year.  Our regular periodic visitors all came last year to help, and our potential candidates maybe decided to serve in a different country.  As a result, we are feeling a bit “small”.  Everyone is working more, and serious patients who need round the clock monitoring (like intubated patients) add extra strain.

In the midst of that we get bursts of sunshine – visitors to lift our spirits.  Visiting surgeons to offer expert procedures, and advice.  New surgeons to share their excitement.  Newly qualified Nepali doctors who step into higher levels of responsibility and remind us that medical training is the bomb. And friends to debrief with, who bring vegemite and Tim Tams.  Sometimes God brings the sunshine just at the right time.

Image credit: Nepal Tourism

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