Introducing the Pediatrics Team

I thought you might enjoy meeting some of the doctors I work with.

Laxman (pictured on right below) is a general practice resident and junior staff doctor. He completed his medical school and internship in Nepal, then went to the U.S. to try to get into an internal medicine (adult medicine) residency program there. He had to take several very expensive exams, pay for his room and board, and work as a volunteer in a hospital before he could even apply. Unfortunately, the competition was pretty stiff, and he wasn't able to find a residency position in the US. Now he is trying to decide what to do next. There are a limited number of residency spots in Nepal, but it is very competitive – 20 to 30 spots for 2,000 to 3,000 applicants in internal medicine. So for the moment, he is working as a general practice doctor here at Tansen.

On the left is Kundan, so far my favorite Nepali intern. I have really enjoyed working with him – he is always happy, humble and willing to let me see patients and figure out how to manage them. He loves soccer and recently was injured during a hospital soccer game. The interns and residents play every day on the "tennis court," an enclosed cement (yes - cement for soccer...) surface. Poor Kundan hit the goal post, broke a couple of front teeth and bruised his lip and face. He made the goal, though! Unfortunately for me, Kundan is rotating to labor and delivery this week. I will miss him!

SIDE BAR: In Nepal (as in many other countries), students go to medical school right after high school and study for five years. The last year is an intern year, where they rotate through various departments and are responsible for patient care under the supervision of a higher level doctor. Unlike in the U.S., once they finish their intern year, they are able to practice medicine as general practitioners. Residency, or specialization (e.g., pediatrics, adult medicine, surgery), is optional, and though many desire to specialize, the opportunities are limited. Nepal has very few residency programs, so competition for spots is fierce. Those with financial resources can apply for residencies in other countries (India, U.S., etc.), but they must take a series of expensive exams and compete with other national and international candidates for residency spots. In many cases, foreign residents are not paid, making it even more difficult for those of limited means to specialize. Imagine working 80+ hours as a resident and not getting paid! In the U.S., at least we get paid as residents, however minimal the salary. One of the sad results of this system is the “brain drain” from poor countries like Nepal. The absence of specialty training and lack of opportunities for financially and personally rewarding practice causes many doctors to look for work outside Nepal. So I especially appreciate physicians like Rachel and her husband, Dipak, for their commitment to serve and work in areas where most Nepali doctors would rather not live.

Dr. Rachel (everyone uses their first names here), pictured with me above, is from India and completed medical school and pediatric residency there. She and her husband Dipak (an orthopedic surgeon) are Christians and have contracted to work at Tansen Hospital for a number of years. Dipak is from Nepal, but studied in India (where I assume he met Rachel). They have one daughter and are expecting another baby. Rachel speaks several languages, including English, Hindi and Nepali, which she taught herself upon arrival at Tansen. I really enjoy working with her; she is loves to teach, has a great sense of humor, and is warm and compassionate with patients. I hope to get to know her and her husband better over the next few weeks.

Pictured here from left to right are Laxman, Dalaki and Ashok. Ashok is another Nepali intern who attended medical school in the Phillipines and only started his intern year a month ago. He is very nice to work with also. Dalaki just started on pediatrics today, so I do not know her story very well. I look forward to getting to know her.

By the way, this photo was shot in the hospital canteen, where we all head after morning rounds for "chiyaa" (tea) and snacks (samosas and other sumptious treats). I eat lunch here most days. It's fun to go into the kitchen and point at things and say, "yo ke ho?" (what is this?). Everything I've tried so far has been mitho (delicious).

Just for kicks, here's a photo of another patient we saw in outpatient clinic who complained of fever and lymph node swelling. Can you see the big knot in his armpit? Definitely not normal. We sent him for a biopsy. Oh, and the little girl we thought had rheumatic heart disease actually turned out to have a congenital heart defect. She had a hole between the two atrium (smaller chambers of the heart), as well as a hole between the two ventricles (bigger chambers of the heart), causing blood to recirculate from the left side of the heart to the right side. This makes the pump much more inefficient, since much of what is supposed to go out to the body goes back to the lungs. The good news is that she now qualifies for a special Christian fund for congenital heart surgery, which would not have been the case if her heart were damaged from rheumatic fever. I got to watch Dr. Sunil do the ultrasound of her heart and see the reverse blood flow and holes in the heart walls - pretty cool!

This week, I witnessed my first pediatric death. A little boy was brought in with uncontrollable seizures. He had had a brain injury at birth from lack of oxygen, and the damaged areas of his brain caused him to have seizures from a very young age. Generally, his seizures were controlled with medications, but he had been hospitalized many times when the medications stopped working and had to be tweaked. This time, though, nothing seemed to help. He remained in a state of seizure for 30 hours!! Obviously, that wasn't good for his body or his brain. During seizures, the muscles, brain and other organs are deprived of oxygen. So had he survived, he would likely have had a very poor prognosis. Although he did eventually stop seizing, he never woke up. Finally, his poor body just gave out. The parents seemed to understand that the hospital staff and doctors did everything they could to keep him comfortable, and I hope their compassion and dedication were a powerful witness to the family and villagers of Christ's love. Again, please keep all of these folks in your prayers - and me as well.