Days 3 & 4
So the last two days have been incredible, in both bad ways and good. The hospital is amazing; it’s huge and beautiful and well equipped, considering this is such a poor country. There are however three glaring differences to the UK in patient care: Infection Control, Confidentiality and Radiation Protection.
In the UK (and most developed countries, I imagine) infection control is a massive deal. Handwashing is one of the most effective methods of preventing infection and maintaining health amongst patients, staff, and the public. I’ll admit right off the bat that from what I’ve seen in the UK we can be pretty bad at it. I’ve seen plenty of healthcare workers go from patient to patient without washing their hands, but at least they aren’t visibly dirty, and the environment tends to be clean. In Nepal this is not the case; the rooms are dirty, flooring is damaged, surfaces are stained and there is a permanent smell. Soap seems impossible to find and there are no towels, so handwashing and even basic personal hygiene is nearly impossible.
While I’m in the hospital I have been making do with the alcohol gel I brought with me, but the biggest problem I have is that I can’t effectively communicate with the patients and have to manhandle them in order to get them into position. This means I’m contributing to the problem. I couldn’t physically wash my hands in between patients even if there was soap, because the sink is in the fluoro room which is usually in use and the next nearest one is in the next department. Yesterday there was an HSG in the morning, and in the afternoon there was still contrast media on the table. Also, there is one gown in the room which is worn by all the patients who are required to get changed.
Another thing which is strictly enforced back home is confidentiality. What happens between you and your healthcare provider remains between you and is only ever breached in extreme circumstances. When an x-ray, for example, is being performed, the doors are shut and locked and the only thing the other people in the waiting room know about you is your name and anything you choose to tell them yourself. The most humiliating thing you’ll have to do is get changed in a private cubicle and sit in the waiting room in a gown. This afternoon, however, I observed a fistulogram on a 13 year old boy- this basically involved lying him on the table with his bottom half uncovered while a tube was inserted and a contrast medium was injected into his rectum. The entire time the door to the hallway was wide open, and patients frequently came into the room to have an ogle at what was going on, or to talk to the doctor about their x-ray. The poor boy was on display to anyone who wanted a look, and after the first image I went to follow the radiologist so I could see the processed image, but the boy called out to me and asked me to stay with him. I felt so utterly devastated for him; he didn’t speak much English and my Nepali is atrocious so I just showed him some photos from home on my iPhone (he particularly liked the Southsea dinosaur) and held his hand and stroked his hair while he was in pain.
So the third issue is radiation protection but this also has an element of confidentiality too. The x-ray room doors (in the UK) aren’t just locked to keep noses out, it’s also to eliminate the possibility of irradiating a lost patient or a nurse who doesn’t know how to knock. We’re quite anally retentive in the UK about rad protection and rightly so. Our life expectancy is so great that we need to worry about things like cancer caused by radiation exposure and therefore radiographers owe it to their colleagues and patients to ensure that no one is irradiated unnecessarily; we take this so far that we won’t even x-ray a patient if we don’t think the doctor has given a good enough reason for it, and any relatives who accompany a patient will be provided with lead protection or brought behind the lead screen. In contrast, here the door to the x ray room is open all the time, unless it gets really crowded in which case it’ll be pushed shut. Whilst patient A is being positioned, patient B is in the corner of the room getting changed in full view of everyone, and patients C, D and E are either sat on the bench in the other corner or assisting with immobilising the patient!
Another thing I've noticed is the lackadaisical attitude to administering x-rays. It’s a big deal for anyone to come to hospital at all, so if they do, all investigations will be performed as the patient may not return otherwise. I assisted with a barium enema investigation on a one month old boy; he had constipation, nothing more. The doctors knew it was related to his mother’s diet and it did not require radiological investigation but they obviously thought that she wouldn’t bring him back for follow ups so they attempted everything possible right then and there.
I know that the points above sound as if they could be negative, but it is just the differences with the UK. I’m enjoying being here and I think I’m learning a lot. I doubt I’ll get the chance to make any kind of changes to how things are done, as the staff here know about aseptic techniques they just can’t afford to implement them, as the patients can barely afford the treatments they currently receive so any extra cost would just make it impossible for them to be treated at all. As you can imagine, the use of antibiotics here is very widespread.
Another problem with money is that there are no ambulances here; if you get hurt and you’re nowhere near a hospital you have to get a taxi or a bus, assuming you can afford that as well as the hospital bills, this is why a lot of patients aren’t seen until their symptoms are chronic or their wounds are gangrenous.
So I will end today’s blog with one quick message: I bloody love the NHS. It had better be undamaged when I return!