Namaste from Nepal! Today marks the one-week anniversary since I disembarked in Damak, Nepal rather tired and disheveled after 48 hours and 3 plane rides. Since my arrival, I have been overwhelmed by the hospitality and kindness of my hosts. The people here have gone out of their way to welcome me, from providing endless cups of tea to hosting dinner parties and even acting as weekend tour guides. Consequently, I am looking forward to an excellent and educational time over the next seven weeks.
My clinical experiences this week have alternated between spending time at Life Line Hospital and working with the local IOM. Life Line Hospital is the clinical site where I will be primarily based throughout my stay. The facility has an active outpatient department and a 100 bed hospital divided into medical, surgical, pediatric, and obstetric wards. The hospital has good diagnostic capabilities including a basic lab, ultrasound and x-ray departments, and even a CT scanner. It will soon expand to house a 9-bed ICU as well as a NICU. Next week, I will begin rounding with the medicine physicians here. I did have the opportunity to attend the annual board meeting of the shareholders, which gave me a chance to introduce the University of Minnesota as well as our global health program. The shareholders and physicians here are eager to continue collaborating with UMN and hope to develop a long-term partnership with our program.
While I did get a brief taste of Life Line Hospital, most of my time has been spent at the IOM, which is located about 1 block from the hospital. It has been interesting and informative to experience refugee health from this side of the globe. Unfortunately, given my limited time with the IOM, I am only able to spend about ½ of a day seeing each portion of the healthcare process. The first day was spent touring the facility and observing the vaccination program, the second day I observed TB screening facilities (including x-ray and the microbiology lab), and the third day was spent with the IOM physicians observing new medical and pre-departure exams. I plan to complete this week by learning about the TB treatment program, understanding mental health in the refugee camps, and hopefully visiting the camp itself.
Actually, the resettlement of the Bhutanese refugees here in Nepal is drawing to a close. Only two of the original seven camps still exist and only about 10,000 refugees need to be relocated. Consequently, many of those who remain in the camps are older and have more complex health conditions that precluded them from earlier travel. I had not previously appreciated the coordination it takes to stabilize these patients prior to travel. During the initial health screening, all medical conditions are evaluated and any necessary work-up or treatment is initiated. This can include subspecialty consultations, work-ups of malignancies, surgeries, and hospital admissions. Once the patients are medically stabilized, they are deemed safe for travel. When the time for departure is scheduled, the patients undergo a final health check with a physician and are sent to a central processing site in Kathmandu 10 days before leaving Nepal for further monitoring. About once per week, a flight is coordinated for the patients with complex medical conditions such as COPD, CHF, active psychosis or other mental health issues. Physicians are chosen to fly with the patients to ensure medical stability until arrival. Depending on the medical condition, subspecialists may be chosen to be among the physicians traveling (for example, a recent flight contained a patient with a complex cardiac history, so a cardiologist was one of the physicians included).
The physicians here are very worried about what happens with the patients’ healthcare after arrival in the US. Since the IOM physicians serve as primary care doctors from the time of initial health screening through departure, they are very concerned about appropriate follow-up to ensure that the patients will succeed in their destination country. Every physician I have encountered has asked repeatedly what can be done to better facilitate the medical transfer and to educate the patients about healthcare in the United States. I was able to reassure them that (at least in Minnesota) >95% of patients have a follow-up visit within the first few months of arrival. However, it is very telling that one of the universal concerns about patient health is how to best transfer medical information from one healthcare provider to another. Consequently, we are currently brainstorming ways in which physician-to-physician communication could be improved throughout the process.
On an exciting note, several of the healthcare providers at the IOM are planning to visit Minnesota later this spring to learn about refugee care in the US. I am hoping they will time their trip so I will be back in time to return some of the hospitality they have shown me. Until then, I plan to continue soaking up knowledge, eating plenty of momos (Try some! They are awesome!), and appreciating this beautiful country.
|My arrival at Life Line Hospital, where I was greeted by Dr. Surya and the staff|
|Annual board meeting at Life Line. I got a chance to speak and introduce my role in Nepal as well as the University of Minnesota|
|The TB isolation center for the IOM|
|Spending spare time sampling local foods with friends|