Tamang woman in her home

Even though the trek was over and two of the other three doctors were heading home, John and I would spend the next few days checking on the patients we had referred to several Kathmandu hospitals. In addition, I was looking forward to having a tour of three Kathmandu hospitals, one private, one public, and one religiously affiliated.

The first patient that we visited was one of the first patients that I had seen in Tipling, she being the 30-year-old emaciated Tamang woman we suspected of having TB. She had successfully been carried out of the mountains by her family and taken to The Kathmandu Medical Hospital, one of the private teaching hospitals in Kathmandu. We met with three of her doctors and their diagnosis at the time was abdominal TB. Cases like these, rare in the United States, are not that uncommon in areas like Nepal, where TB is very common. This patient's TB had caused so much inflammation in her abdominal region that it had obstructed her stomach and intestines from emptying properly. The result of this bowel obstruction was the vomiting, poor appetite, and weight loss that she had been experiencing. Over the two-year period of her disease, she had lost about forty pounds, one quarter of her body weight. Thankfully, her TB will most likely be treated successfully with the typical one year regiment of TB medications. If she has no complications, she should have a full recovery.

The second patient that we visited in Kathmandu was the severely malnourished eight-year-old Tamang boy that we had examined in Sertung. This child and his father had hiked out of the mountains with us and the child was admitted to The Nutrition Rehabilitation Center in Kathmandu. The center is a well-funded private clinic that admits malnourished children and their parents for treatment and education. The children and their parents get three to five nutritious meals each day, in addition the parents are also educated about proper nutrition and cooking techniques. A child will stay at this center until they reach a healthy target weight, an average of about three months. It was very encouraging to see this little Tamang child eating. In addition, the father of the child was to get help with his alcoholism. The young Tamang boy, once at a healthy weight, will be enrolled in a Kathmandu school, sponsored by HHC. It is heartening to see that a country with such poverty is able to provide important health care and education services.

The third hospital that we visited was the Christian-affiliated Patan Hospital. This hospital was of particular interest to me because it was the medical facility that accepted our two patients that had been evacuated by helicopter. The gentleman with the acute appendicitis had already had his appendectomy and been discharged, but the 18-year-old Tamang woman who had gone into septic shock was here and alive.

We had a chance to discuss her case with the head nurse and she related to us that the doctor's working diagnosis was indeed pelvic inflammatory disease. Her blood cultures had not grown any specific bacteria, which was not surprising since we had administer several antibiotics to her prior to her blood being drawn in the hospital. The doctors, as we had, were treating her with a series of broad-spectrum antibiotics. The nurse reported that her condition had improved, and that she was now taking food and even sitting up in bed. We had the good fortune of being able to visit her and her husband in her room.

Many language barriers existed between us American doctors and our patients during this trip. In Nepal there are thirty-seven different ethnic groups, with an equal number of distinct languages, not to mention Nepalese, the national language. There were several times during this trip, regardless of how accurate the translations were, when the language barrier between the patient and doctor slowed, or even misconstrued, the medical diagnosis and care. Today, however, when John and I entered the hospital room of our young Tamang woman we did not need a translator to help us understand each other. We stood there and were able to communicate across a room of silence just what the moment meant to each of us. Two doctors, early in training, one young Tamang woman, early in life, each having shared a critical and intimate time with the other, now in the same space, time, and thought, without words.