Dr Neil Pollock is an anæsthetist from New Zealand. In April this year Neil took part in an INF ear camp in Chainpur in western Nepal. He describes how the INF ear camp team treated 1,100 patients and performed 140 operations in just seven days.
No previous INF medical camps had been undertaken in this area and permits for trekking are apparently limited, so the local population had not met many foreigners and initially we were quite a curiosity.
Chainpur is located in the Bajhang district and the only way to get in was by helicopter, a one and three-quarter hour flight from Nepal’s capital Kathmandu to Surkhet, a night in Surkhet, then a further 45-minute flight to Chainpur.
We were greeted by a crowd of about 100 people, some of whom acted as porters carrying our bags to the accommodation which was a 25-minute walk from the airfield. It is amazing how even small Nepali people can carry heavy loads.
There was a 15-minute walk from our accommodation to the hospital. Mule trains regularly used this route, as well as sheep and occasional herds of goats. We had to cross the Seti River on an extensive swing bridge – it was quite an experience sharing the bridge with mules and goats coming from the opposite direction. Fortunately, nobody came to any harm!
Members of a team
There were four ear surgeons and three anæsthetists in the INF team, as well as several nurses and the ear camp organiser Ellen Findlay. INF’s Nepali medical camps staff work very hard and are essential to the smooth running of the camps. In all there were 18 staff, plus Eka Dev Devkota, the Nepali Camps Administrator.
About 140 operations were performed over seven days, and about 1,100 outpatients were seen. Insects in the ear were a common complaint. Medical services in the area were limited, and many people had chronic ear problems, particularly infection with consequent loss of hearing. We ‘cleaned up’ infected tissue, particularly in bony areas surrounding the ear, grafted in cartilage to take the place of small ‘hearing’ bones, and patched up holes in eardrums which had developed because of infection. Although hearing in a number of cases would not be restored to normal, a degree of improvement would have been achieved in the affected ear. Treatment for chronic infection benefited many patients.
Over 80% of procedures were done under local anæsthesia. This required a sharp learning curve at the beginning of the camp, but the three anæsthetists [one of whom had been to a previous INF ear camp] learned quickly and were able to provide good anæsthesia. Patient ages ranged from 6 to 50. The patients were given a sedative mixture and ketamine if necessary while nerve blocks were administered. The local anæsthesia was very effective – operations lasting several hours could be performed with the block still working well. Some of the children were quite amazing – they didn’t make a sound while the needles were injected around the ear for the local anæsthesia. Sedation did help with this, but many lay still for procedures lasting over an hour. More than 95% of anæsthesia was undertaken by this method. The remaining few required general anæsthesia.
One interesting practice was that all patients were given antibiotics. I don’t think the local bugs had met these powerful Western drugs before. Most infections which remained after the surgery disappeared rapidly. This antibiotic sensitivity also helped the team, as most of us had a bout of gastroenteritis at some stage. Two or three doses of ciprofloxacin cured this promptly.
Friendly people
The accommodation was fairly basic, as were the bathroom and sleeping facilities. Some of us were bitten quite badly by bedbugs, fleas or mosquitos, and we had disturbance at night from barking dogs.
We were located at about 1,000 metres above sea level, fairly close to the Indian border, but unfortunately didn’t have a good view of the mountains. After a couple of days, cloud came and settled in the valley and obscured the view, also causing problems for the helicopter. We were fortunate to get out of the area on the planned day for departure, flying out late in the afternoon after waiting all day. The hotel that night in Nepalgunj felt luxurious by comparison!
The Nepali people were so friendly. They put on a ceremonial dance to thank us at the end of the camp. Almost all of us took part. It was fun, but if we hadn’t asked them to stop it might have gone on all night!
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