Cynthia and I met for breakfast and found David McGee there as well. We then saw Richard, just arriving from the airport, and all got ready to leave for the hospital.
Many parts of Kathmandu that we passed seemed unchanged, although occasional piles of rubble gave away the truth.
We arrived at the hospital, and to my delight, since my visit almost 2 years ago, many details and areas of the hospital are now complete and one can get a better grasp of the vision Shankar has for his hospital and patient care in Nepal. There is a pharmacy, entry lobby, dedicated physical therapy space, teaching rooms, and endoscopy suite in addition to patient wards, surgery suite, and recovery room.
The surgery suite was filled to the max with many very complicated patients with long roads to recovery. But for each patient this surgeon has a dream and will not bow to obstacles. Yet when it is put to him that a patient is really beyond his or anyone's help, he is able to respectfully agree and move on, with a plan to speak with the family and try to resolve the situation together. You can see that he is universally trusted, adored, and respected by his patients. With good reason.
These photos lovingly obtained with patient permission, so please do not share or abuse.
This patient was trapped in rubble for 3 hours with her toddler grandson, who survived without major injuries. She is missing part of her tibia bone, and the orthopedic doctors have put on an external fixation device to provide the leg a chance to be stable. She will get a flap of skin and muscle, moved from another location, and placed over the wound. Bone that is not covered does not heal and often leads to serious chronic infections, so closing the wound is a priority. Whe will then get more treatments to provide the bone a chance to heel.
Lots more work to be done on this patient; the xray shows many loose fragments, a floating patella, and a collapsed joint space.
There are several patients with devices I had never seen before - the Iliazarov apparatice, meant to bring bone together that has not healed or has a gap to bridge. These devices cost a fraction of what they would in the west, but at $400 they exceed the $250 that is paid by the state for each patient's care. The fact that these patients are getting such care in this small and energetic place is quite amazing. This gentleman was tending his animals when the quake hit, and his leg was damaged by falling stones and debris.
Another creative orthopedic repair - a clean wound but still bone exposed with nowhere to attach. They are talking of placing methyl methacrylate as a kind of spacer while the wound is covered and treated, then a bone graft or other treatment can be done in the future.
Team talking about issues. Shankar shared with us that many people in this country use healers who talk to the gods. They don't send people to other specialist healers for certain gods and keep others. This makes it hard to get patients to understand the concept of referral, and they start to believe a doctor is not good if he cannot do everything. This pressures every facilitate to try to treat all things, even if there is a better location. Then there are the financial aspects - some hospitals pay the ambulance for each patient it brings them, and then inflates the cost of care enough to cover the ambulance incentive. This inflates the cost for the patient.
I love the new tricks I learn each time about how to reuse and save opening new paper packs at every turn. This patient, about to be prepped for a debridement, has his leg over the glove and supply wrappers to catch drips during the process.
Dr. McGee at work, cleaning an old wound with new colleagues.
Literally a "window box"; viewing complicated xrays by the light of the sun.
A bone disaster, with Kathmandu in the background, also broken in many places.
We have an expensive device we use in the US which is like a power washer with batteries, fluid, and suction. The wound can be cleaned and suctioned at the same time. Each time the device is discarded. Here Shankar and team are using a 60 ml syringe, bowl of water, and metal tray to catch the water to be suctioned away. Almost the same thing, at a great savings. There are so many gadgets we have that we would love to share, but then the hospital and staff become addicted to the disposables and possibly a machine that may break and cause them more problems than help. We have to be careful where we interfere with new products, because the team is often on its own better path.
Shankar debriding a hand with severe burns that will need skin grafting, if the patient survives. He may lose one or both legs, but getting him clean of the infected and dead skin is his only hope at survival.
Dr. McGee and Dr. Shankar at work. I love the way Resurge doctors come together with that "let's do this" attitude. As educators, we are here to help, facilitate, and try to interject procedural changes where they are seen by all parties to be a helpful improvement.
Sometimes the plastic avoid or recycle activist in me squeals with delight at the signs of reuse and conservation that happen in an effort to squeeze every ounce of use out of an item. The hospital wins, and so does the environment.
Bad monkey scampering down the scaffolding, looking for a hand-out.
Ambulance - simplicity in most. Grab and go with bed and oxygen. The rest is speed.
Some of these tiny roads are barely wide enough to walk, and yet vans pass each other with stone walls and no forgiveness on either side. I was sure we were going to have to pull the rear-view mirrors in, but we made it!
There is a tram/trolley device that goes from outside the hospital up the mountain in one direction, and down to the valley in the other. It has not functioned for years, and the Nepalis cannot afford to take it down. So they built around it, and it can be seen piercing the walls of many structures as it meanders down.
More rubble, and a family at work.
Deck folded over. I hope no one was sitting there. Natural disasters strike without ample warning, and the consequences are severe.
To the rooftop at the hotel for some food and cheer, and then all off to bed. Much work to be done.
Many parts of Kathmandu that we passed seemed unchanged, although occasional piles of rubble gave away the truth.
We arrived at the hospital, and to my delight, since my visit almost 2 years ago, many details and areas of the hospital are now complete and one can get a better grasp of the vision Shankar has for his hospital and patient care in Nepal. There is a pharmacy, entry lobby, dedicated physical therapy space, teaching rooms, and endoscopy suite in addition to patient wards, surgery suite, and recovery room.
The surgery suite was filled to the max with many very complicated patients with long roads to recovery. But for each patient this surgeon has a dream and will not bow to obstacles. Yet when it is put to him that a patient is really beyond his or anyone's help, he is able to respectfully agree and move on, with a plan to speak with the family and try to resolve the situation together. You can see that he is universally trusted, adored, and respected by his patients. With good reason.
These photos lovingly obtained with patient permission, so please do not share or abuse.
This patient was trapped in rubble for 3 hours with her toddler grandson, who survived without major injuries. She is missing part of her tibia bone, and the orthopedic doctors have put on an external fixation device to provide the leg a chance to be stable. She will get a flap of skin and muscle, moved from another location, and placed over the wound. Bone that is not covered does not heal and often leads to serious chronic infections, so closing the wound is a priority. Whe will then get more treatments to provide the bone a chance to heel.
Lots more work to be done on this patient; the xray shows many loose fragments, a floating patella, and a collapsed joint space.
There are several patients with devices I had never seen before - the Iliazarov apparatice, meant to bring bone together that has not healed or has a gap to bridge. These devices cost a fraction of what they would in the west, but at $400 they exceed the $250 that is paid by the state for each patient's care. The fact that these patients are getting such care in this small and energetic place is quite amazing. This gentleman was tending his animals when the quake hit, and his leg was damaged by falling stones and debris.
Another creative orthopedic repair - a clean wound but still bone exposed with nowhere to attach. They are talking of placing methyl methacrylate as a kind of spacer while the wound is covered and treated, then a bone graft or other treatment can be done in the future.
Team talking about issues. Shankar shared with us that many people in this country use healers who talk to the gods. They don't send people to other specialist healers for certain gods and keep others. This makes it hard to get patients to understand the concept of referral, and they start to believe a doctor is not good if he cannot do everything. This pressures every facilitate to try to treat all things, even if there is a better location. Then there are the financial aspects - some hospitals pay the ambulance for each patient it brings them, and then inflates the cost of care enough to cover the ambulance incentive. This inflates the cost for the patient.
I love the new tricks I learn each time about how to reuse and save opening new paper packs at every turn. This patient, about to be prepped for a debridement, has his leg over the glove and supply wrappers to catch drips during the process.
Dr. McGee at work, cleaning an old wound with new colleagues.
Literally a "window box"; viewing complicated xrays by the light of the sun.
A bone disaster, with Kathmandu in the background, also broken in many places.
We have an expensive device we use in the US which is like a power washer with batteries, fluid, and suction. The wound can be cleaned and suctioned at the same time. Each time the device is discarded. Here Shankar and team are using a 60 ml syringe, bowl of water, and metal tray to catch the water to be suctioned away. Almost the same thing, at a great savings. There are so many gadgets we have that we would love to share, but then the hospital and staff become addicted to the disposables and possibly a machine that may break and cause them more problems than help. We have to be careful where we interfere with new products, because the team is often on its own better path.
Shankar debriding a hand with severe burns that will need skin grafting, if the patient survives. He may lose one or both legs, but getting him clean of the infected and dead skin is his only hope at survival.
Dr. McGee and Dr. Shankar at work. I love the way Resurge doctors come together with that "let's do this" attitude. As educators, we are here to help, facilitate, and try to interject procedural changes where they are seen by all parties to be a helpful improvement.
Sometimes the plastic avoid or recycle activist in me squeals with delight at the signs of reuse and conservation that happen in an effort to squeeze every ounce of use out of an item. The hospital wins, and so does the environment.
Bad monkey scampering down the scaffolding, looking for a hand-out.
Ambulance - simplicity in most. Grab and go with bed and oxygen. The rest is speed.
Some of these tiny roads are barely wide enough to walk, and yet vans pass each other with stone walls and no forgiveness on either side. I was sure we were going to have to pull the rear-view mirrors in, but we made it!
There is a tram/trolley device that goes from outside the hospital up the mountain in one direction, and down to the valley in the other. It has not functioned for years, and the Nepalis cannot afford to take it down. So they built around it, and it can be seen piercing the walls of many structures as it meanders down.
More rubble, and a family at work.
Deck folded over. I hope no one was sitting there. Natural disasters strike without ample warning, and the consequences are severe.
To the rooftop at the hotel for some food and cheer, and then all off to bed. Much work to be done.
