April 23 & 24
We took a bus ride through Kathmandu to visit my practice placement. Bus rides are a particularly thrilling adventure; drivers merge with traffic with seemingly little regard to other vehicles. Due to the sheer volume of traffic, this appears the necessary norm. People also drive recklessly fast, quite an adventure. After the bus ride we have a daredevil walk up a narrow busy street. One really must be aware of their surroundings and what the traffic is doing when moving from place to place here. At the nutrition centre, we met with our field guide who told us a great deal about the organization, The Friends of Needy Children (FNC) Nutritional Rehabilitation Home (NRH). The children are either referred from the hospital or from one one of the outreach endeavours that the organization performs, or people come in right off the street or upon recommendation from friends or acquaintances. The children come and stay with a caregiver, usually their mother. They are then put on a World Health Organization (WHO) specified diet to promote weight gain and full nutrition. This is incorporated with education for family that includes how full nutrition can be achieved with the foods that are locally available and affordable to them. I am told that many people are unaware that children need more than just milk and rice, so a little knowledge goes a long way. Once the children reach a specified weight percentile, they are discharged to home. After, follow up visits are made at 1, 3 and 6 months (if I recall correctly) to ensure that the children continue to thrive. Follow up is very important as this identifies a relapse situation prior to extreme malnourishment, and children can be readmitted. The relapse rate is approximately 15%, which is remarkable. When children are admitted they are usually quite listless and unhappy and obviously severely malnourished, but when they leave they are laughing and interactive. I am still unsure as to what my role will be there, but am excited to participate in whatever way I can.
The following day we went to the other students placements, the first an HIV/AIDS centre for children. There we had a blast taking pictures with the kids and they absolutely loved using the cameras themselves, we had difficulty convincing them to put them off so they could eat lunch. The centre is also an FNC organization, and is run in much the same way, except they lack the resources for follow up service. After we visited Hospice Nepal, the remaining two students placement. I understand that it is the first of its kind here in Nepal. They are implementing comprehensive palliative care measures similar to what we do back home, which incorporates the concept of 'the good death' and support and care for family as well. Family members participate in caring for dying relatives. One aspect of note that a physician who works there explained to us is that often family members will request to not inform loved ones of their diagnosis. Interestingly, the ailing member could be taken to hospitals and clinics that have 'cancer' written across the signage, undergo surgery and chemotherapy, amongst other treatments, and still request that you do not tell them they have cancer, as they do not know. As such, people entering palliative care might think that they are still undergoing treatment and still have a chance at cure and recovery. Perhaps this is part of the reason palliative care is not altogether popular here in Nepal. That's all for now, Nameste everyone.