Helping Hands Community Hospital

Ok, I have been putting off this blog post for far too long, I am very excited to finally relay to any followers some information about what I have been doing for the past three weeks.

The Center
Helping Hands Community Hospital is just that, a hospital that really caters to the needs of the community. It provides excellent care, at prices that the average Nepali citizen can afford; and if an individual can not pay, then hospital will provide all of it's services for free to those individuals. I have been fortunate to experience a lot of the healthcare system in the United States, and have spent some time in them so I am very excited to compare and contrast the two countries and there hospitals.

The Director
The director for HHCH (helping hands community hospital) is Doctor Gupta. Gupta started the hospital about 10 years ago with literally nothing. He will tell you if you ask; first bringing out a piece of paper and drawing a big 0 on it, then he will say "This is how much money I had to start this hospital!" He now runs a one acre plot of land that is intertwined with about 5 buildings ranging from 3 to 5 stories high all part of the hospital. Gupta is a 52 year old father of two, ( his son is 22 and daughter 20; both are living in the United States along with his wife)and his ambitions are higher than ever. He recently acquired a 52 acre plot of land about 10km away form the hospital; it was a free gift that he acquired through some government connections (He was the personal physician to the recently ex-prime minister and his family; we actually were able to help with an X-ray for the ex-prime ministers son one day). He has big plans for this land; he wants to open a free clinic, a hospice, and a nursing home,  as well as a Medical School. He says he will need about a billion dollars to complete his dream so it is definitely a long term goal in the process at the moment. He manages to do a lot with just about nothing, he is somehow able to get equipment donated and pay his amazing staff while still keeping up his facilities and even turning a profit every year. He told us that the rent for his hospital is about 10 thousand and about three thousand in utilities. All of this considered, he still manages to turn a pretty substantial PROFIT of about 12 thousand dollars, remember these figures all all in $US by month. As director he is in charge of all the departments of the hospital, so everyone reports to him. He works from 11am to 4pm everyday seeing about 100 patents as a general physician. It is amazing how efficient he is and how great he is at what he does. I have learned a lot from him, he loves to teach and is very nice. That is one of the main reasons why the hospital is so popular for medical students and pre-med students, the staff see's a lot of patients every day and the staff is trained to teach and advance their learning. Not only are there about 5 volunteers working at the hospital but there are about 70 med-dental students also working in various departments of the hospital. Hands on experience that they acquire at the hospital is 60% of their total grade. This provided a little bit of competition for us volunteers but it was all in good fun. They have been really nice and have been able to show us a lot that the doctors and nurses have not had time to show us.

Emergency Room
Ok, as I said before the hospital is divided into many different sections and one of the major ones that we got to experience was the Emergency Room. In the ER there are about 10 "beds" in a very small cramped area, then there are two more beds in a smaller room connected to the other beds. The ER experiences a lot of different kinds of cases each day. The most common kinds of cases are Gastritis or digestive tract problems, i.e. diarrhea and stomach pains related to infections in the digestive tract. This is caused mainly due to sanitation issues; so people not washing and cleaning food properly and or not washing there hands after using the restroom (and yes they usually use their hands instead of toilet paper...). So the ER will usually run urine and stool samples to check what is causing the infection, then they can treat with antibiotics for bacterial infections or other medication for other forms of pathogens in the digestive tract. They also experience a lot of respiratory problems due to the bad air quality and the prevalence of Tuberculosis in the region. Those cases are not always the most interesting but it is great to learn about them due to there frequency. The more interesting cases that we got to see in the ER included: a motorcycle accident where a women's heel was torn from one point of the ankle around the back to the other side only held on by the tendons in the heel,  a kid with a monkey bite on his arm where he had a chunk of his arm missing about an inch and a half in diameter, a toddler who had lost the tip of one of his toe cut clean off, a man with an infection in his leg that had to be drained and "exploded like a volcano of puss" as Lars so kindly put it, a lady with glass shards in her finger(never was able to get those out...), a man who had a rod go through his leg which looked a lot like a bullet wound( got our hopes up for a second haha (that sounds bad)), a man that had whole in his hand that they ended up stuffing with iodine soaked gauze to try to prevent infection, along with countless other stitching and dressings as well as re-dressings and re-castings. So some of the more crazy cases were seen here, we got to help where we could, sometimes getting to clean wounds (starting at the center of the wound and working your way out to prevent infection) as well as helping get them supplies and holding patients (anesthetic was not all too common).

Radiology
This was another hot spot section of the hospital that many of the volunteers decided to hang out. Lars and I made a very good friend here in the radiologist tech Bemal. In the radiology department they take all of the X-ray's. The room has two x-ray machines and a large table for the patients along with some chemicals that they sometimes inject the patients with so that certain things will show up on the X-rays with stronger contrast (specifically for kidney stones and the urinary track). Then in the other room where the computer, the printer/scanner and all of us sat; only separated by a 9in concrete wall and two led doors. They seem to take X-rays for just about everything from broken bones, stomach aces and even sinus problems. Apparently, they are not extremely worried about the effects of radiation. Bemal was a little more reassuring, he said that he was very aware of the effects radiation has on developing fetuses and sensitive areas such as the genitalia. He also informed us that the amount of radiation exposure is very minimal especially for patients who come in once or on a rare occasion. We got a full crash coarse on how the X-rays are processed including how they are labeled and how the contrast is adjusted to show soft tissue, and when they need to see just bone or even cartilage. We learned a lot about different positions that the patient must be placed in in order to get a proper x-ray that shows all the components that the doctor may need to see. For instance if an individual needs a chest x-ray They should roll their shoulders forward so that their shoulder blades don't block the view of the lungs. We were very fortunate that Bemal really took a liking to us, at some points we were working the computer and the X-ray equipment all by ourselves, a unique experience to say the least. Bemal was a fantastic wealth of information telling us all about the government of Nepal; the inter-workings of the hospital, learned all about kidney stones one day, local spots, how the funeral processions work for the Hindu religion in Nepal(one started at the hospital one day and we were able to observe the whole process). He even took us on a motorcycle trip outside of the city to a huge Hindu god statue (143ft tall) and kept Alan out of trouble when he got his motorcycle taken and didn't have a license. He is 20 and has been working at the hospital for about a year, he said Lars and I were the first volunteers to really talk to him and get to know him. He always reminds us how happy he is to be friends with us American boys and how he never thought in his wildest dreams he would have two new American friends. We really seem to have made a big impact on his life through our friendship and it will be hard to say good by to him soon.

Ultrasound
Due to a large lack of money the hospital is really only capable of running two types of body scans on patients and that is X-rays and Ultrasounds. The ultrasound tech is pretty amazing, he is able to find a persons liver, kidney's, gall bladder, and even their uterus before you can finish pronouncing the word ultrasound. I had never experienced an ultrasound before so it was a rather special experience getting to see a fetus moving inside of a patient and even being able to observe one sucking its thumb while still in the womb today. It was really amazing seeing how they check and measure the organs and the babies to check for abnormalities and ruptures or inflammation. I thought that one of the most amazing parts of ultrasound was seeing the development of the fetus as it changes during different ages. Seeing the heart beating at one point and bone development at another; and how one way to measure the fetuses development is by measuring the size of the cranium. I was also impressed when I got to see an ultrasound of an enlarged appendix and even an ultrasound of the trachea.

Surgery
For me this was one of the most highly anticipated areas of the hospital for me. I have found that it is very difficult to go and see surgery though... But, I did get in to see two surgeries. the First was an orthopedic surgery on an elbow where the ulna was sticking out of the elbow and they ended up drilling in some rods to the bone and "worked" it back into its original place before closing him up. I also got to see an emergency appendectomy for a 13 year old boy. It was a pretty quick surgery compared to the elbow that I saw only taking about 30min compared to almost an hour and a half for the elbow. It was very cool tough; they made a small incision and pulled it right out, cut it out and stitched him up. I know the appendix is supposed to be a fairly small organ but his was about the size of my palm which definitely indicates some significant swelling. I scrubed in with the scrubs that the surgeons gave me (pretty small) and they also dont where shoes during surgery but sandals... I also noticed that they don't like to cover there noses with their masks during surgery. This leads nicely into the hospitals sterilization techniques that I was able to observe on the roof of one of the buildings... they wash all of ther instruments by hand in soapy water in buckets on the roof and wrap them in in their drapes and cloths that have been also washed by hand in the same bucket of soapy water and then hung out to dry outside in the sun on the top of this roof.

Thoughts and Comparisons
Helping hands is absolutely an amazing; it has an extreme impact on the community, and is a revolutionary place in this crazy city. Obviously there are many differences between the hospitals in the United States and Helping Hands. First of all the facility is a makeshift collection of buildings crammed together, where a US hospital is usually a state of the art building with advanced equipment and the capability to handle more patents more efficiently. Obviously the US has more strict codes on sterile technique and much more advanced and up to date equipment and can do more than ultrasounds and X-ray tests (i.e. cat scans, MRI's ect.). The United States has a much more strict system where patients are seen by several doctors and reffered to certain departments; where at HHCH if you know you need an x-ray you just go buy an X-ray and then go see a doctor, same with ultrasounds or blood tests. In American hospitals the hospital will provide individuals with changes of cloths and food, where at HHCH the family members and friends of the sick or hurt individual pull together to provide there friend with a home cooked meal and a some fresh cloths as well as some company everyday as they are recovering. In American hospitals the doctor treats you and then bills you later, at HHCH the family buys everything at the hospital right down to the gauze and syringes being very involved in every step of the care knowing exactly what the patient needs as they need it. When an American does not have the money or insurance to pay for an operation or treatment, then they do not receive it, at HHCH the community pulls together to pay for an individuals treatment and if they can't, the hospital will provide all of the care for free... Helping Hands Community Hospital provides tretment and help to patients at a fraction of the costs of the nicer privately ownd hospitals in the city. Dr. Gupta told us that the largest portion of the patients are from outside the city in the country side and will travel up to 4 days to get help here. In some ways, I would say that Helping Hands is better than many American Hospitals. For instance they are much more efficient with all of there resources, they are able to do so much with so little. They do practice great stearal teqnique given what they have to work with and they are able to handle an immense quantity of patients with a small space and even tighter resources. I always wonder how much more they would be able to do with just a little bit more. They are forced to reuse gloves because they are trying to save money and reuse as much as possible so that they can use that money to either provide free services to patients or get more or newer equipment for the hospital. the hospital has grown from literally nothing into a project that is really changing the lives of hundreds of people a day. They primary concern for the hospital is the care of the patients not money... hmm kind of makes you think about what really matters to the Nepali people and what really matters to Americans... That is probably the biggest thing that I have taken form my trip here in Nepal so far; what really should matter and what motives are for different people. In a third world country like Nepal  the entire community works together to try to to do what is best for each-other. They care more about friendship than money or whatever else that they can get out of you. They are so nice, ready and willing to lend a hand without so much as a second thought. They don't often have much so they treasure everything that they have and make the most out of every situation. I really hope I am able to take all that I have learned here and really turn it into motivation not only to better myself in many ways; but also do everything I can to give back to everyone I can. Although I have been volunteering here for what will be about 4 weeks; I feel that that the Nepal has given me so much more than I have been able to give it. I feel that this trip has been eye opening and inspiring in more ways than I can even begin to articulate; and has had a greater impact on me than I could have ever imagined. I felt like ending this post with a quote that helps sum up all of the ideas that I have tried to convey from my experiences.

The difference between a helping hand and an outstretched palm is a twist of the wrist.  ~Laurence Leamer

LOVE KEVIN.