Nepal remains one of the poorest countries in the world and has been plagued with political unrest and military conflict for the past decade. In 2015, a pair of major earthquakes devastated this small and fragile country.
Since 2008, the Acupuncture Relief Project has provided over 300,000 treatments to patients living in rural villages outside of Kathmandu Nepal. Our efforts include the treatment of patients living without access to modern medical care as well as people suffering from extreme poverty, substance abuse and social disfranchisement.
Common conditions include musculoskeletal pain, digestive pain, hypertension, diabetes, stroke rehabilitation, uterine prolapse, asthma, and recovery from tuberculosis treatment, typhoid fever, and surgery.
35-year-old female presents with multiple bilateral joint pain beginning 18 months previously and had received a diagnosis of…
20-year-old male patient presents with decreased mental capacity, which his mother states has been present since birth. He…
60-year-old female presents with spinal trauma sequela consisting of constant mid- to high grade pain and restricted flexion…
80-year-old male presents with vomiting 20 minutes after each meal for 2 years. At the time of initial…
In the aftermath of the 2015 Gorkha Earthquake, this episode explores the challenges of providing basic medical access for people living in rural areas.
Acupuncture Relief Project tackles complicated medical cases through accurate assessment and the cooperation of both governmental and non-governmental agencies.
Cooperation with the local government yields a unique opportunities to establish a new integrated medicine outpost in Bajra Barahi, Makawanpur, Nepal.
Complicated medical cases require extraordinary effort. This episode follows 4-year-old Sushmita in her battle with tuberculosis.
Drug and alcohol abuse is a constant issue in both rural and urban areas of Nepal. Local customs and few treatment facilities prove difficult obstacles.
Interpreters help make a critical connection between patients and practitioners. This episode explores the people that make our medicine possible and what it takes to do the job.
This episode looks at the people and the process of creating a new generation of Nepali rural health providers.
In this 2011, documentary, Film-maker Tristan Stoch successfully illustrates many of the complexities of providing primary medical care in a third world environment.
In my first week with Acupuncture Relief Project, a grandmother came to the clinic complaining of abdominal pain. She had eaten some bad buffalo meat and was now suffering from diarrhea and cramping. Despite her discomfort, she had a face that seemed made for smiling. As we discussed her pain, her face broke into a huge goofy grin, perhaps made goofier by the mere four teeth that comprised it. Her eyes twinkled and searched my face as she spoke. I took her vitals, felt her abdomen, gave her advice and treatment. The next time I saw her, she said her diarrhea had ceased and she had returned with a new complaint. As I evaluated her for this new pain, she looked at me and smiled her big goofy smile. She said “You really Love me. You Love me like my mother Loves me.” I was a little bit blown a way and admittedly, tears came to my eyes. My first thought: has no one loved you since your mother? Surely if someone had, you would have referenced that Love, being that you are so far in time from your mother’s Love. My second thought was no, “Love” is too strong a word; I “care” for you as any good practitioner would.
“Easy! Easy!” My motorbike’s rear tire spins out to the left as it loses traction on the rain soaked, stony... road? path?. It’s a cold wet Saturday morning and I’m wondering how good of an idea it was to come this way. Saturday is usually our day off, but today we are on a mission: three motorbikes slowly winding up through the misty hills near our clinic in Tistung. Mercifully the precarious drop-offs are obscured by low clouds meandering their way through the eerie landscape, giving us the illusion of navigating a precipice surrounded by an endless abyss.
The river is a lot deeper than I expected, soaking my boots. Now climbing the steep muddy bank, I grab a little too much throttle, finding myself slipping somewhat sideways with my bike bouncing ungracefully over the loose stones attempting to gain purchase.
Yesterday at our clinic, a volunteer practitioner, Emma Ellsworth and I managed a rather gory draining of a large skin abscess (carbuncle) on a thirteen year old boy. It was about a one inch, very painful lesion located between his left temple and the root of the ear. The procedure seemed easy enough as we numbed the area with lidocaine, sterilized his skin with povidone-iodine and prepared our tools. After making a small incision using a three-edged needle, copious amounts of turbid yellow puss were drained from the skin. (That was the easy part.) Then, using a sterile stick swab soaked in an antibiotic solution, I inserted the swab several centimeters into the pocket to clean its margins. Thankfully my assistant held steady as we worked quickly to finish the procedure. We dressed the wound, gave our brave young patient some medication for pain and infection, and sent him on his way.
Today we are following up with a house call.
Recently while working in the Bajrabarahi clinic I had the opportunity to help someone with an infected wound. A middle aged woman came into the clinic with a swollen, painful finger and a flesh wound that was clearly infected. Apparently she had placed her hand on the ground to help her stand up and she felt something prick her finger. After 6 days her finger began to hurt and after 10 days she was in our clinic asking for help. Her finger was swollen with parts of her skin that seemed to be shiny and lacked the texture of normal skin. The wound was open, roughly .5 inches in diameter, exposing pink flesh underneath with scabbed blood and dead skin covering half of the wound.
Having never dealt with something like this before, I wanted the clinic director, Andrew Schlabach, to come take a look. After giving a brief description I said, “I wonder if it is MRSA”, in which he responded with a good chuckle.
After coming to take a look, he told me I would have to clean it well with soap and water and get clean borders. So I brought her to the sink, scrubbed her finger for about 15 minutes with soapy water trying my best to clean out the blood and pus without hurting her. For a more deep clean, I used a long cotton swab to get under her dead skin and removed the pus that was hiding. Now that the finger was clean it was time to get clean borders. I was handed a sterile, surgical scissors and was told to find good light. So the patient and I sat on a bench in front of the clinic while I started to cut away her dead skin. Remember the skin that I said looked a little odd around her wound? Well, turns out it wasn’t attached to her flesh any longer. I couldn’t believe how much of her skin had been detached due to infection and would end up being removed.
After the removal of the dead skin, we made a poultice with Neosporin and some antibiotic herbs to put over the wound before wrapping it up and sending her home.
I look forward to seeing how she is doing when she comes in for a follow up. --Dean McNash