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| Stories From Nepal |
| Amp Pipal Hospital |
 I’d last seen my two porters as we crossed the old airfield beside the river. After meeting me off the truck in Turture, they’d somehow lashed my various and awkwardly shaped travel bags into units and were carrying them on their backs. It was hot and they intended to travel slow and easy. After the first 10 minutes of walking, they asked to stop for food. I was hoping to beat the approaching darkness up the hill, so I pushed ahead towards where they indicated the Amp Pipal Hospital was.
After about an hour of gentle climbing through banana trees and past stone houses with thatched roofs, the first rain bounced off the guitar case I was carrying. I wondered where my other porous pieces of luggage were. April is not monsoon, I reasoned, but the rain continued. The light dimmed in the forest. The trail turned upwards.
I overtook the three Nepali nurses who were also walking to the hospital. At first I thought to go ahead, but as steep became steeper, I came to appreciate their steady pace. They knew when to stop and rest, and when to be refreshed by tea. And they had a light, while mine was with my porters, wherever they were. In the cool, steady drizzle, we picked our way among the shadows of half-seen rocks and tree roots. I thought about the shower and hot food that must be waiting for me up above.
The forest thickened. There were no lights, no electricity, and people were not out walking on such a night. Lightening flashes briefly illuminated the path. The walking seemed to go on for hours.
As we came around the hill, I was startled by lights a mile or so ahead. The hospital, the nurses said. As we drew nearer, the hospital generator sounded like the props of an airplane readying for take-off. Glowing in this steep forest, it seemed like a spaceship that had strayed into a primitive land. As the trail brought us closer, the image dipped in and out of the woods. The compound lay in the lap of a mountain whose head loomed over my right shoulder. The nurses brought me around to several houses, murmuring into half-lit doors, before depositing me on the doorstep of Ken and Jill Anderson. Inside a hot shower and their Scottish brogue over bowls of hot soup restored me.
The small boy was wailing as his father brought him into my exam area. He clung to the man. The man’s hands were heavily callused and the creases appeared permanently stained by the earth; these were hands that held heavy tools or grabbed barn animals. Now he cradled the smooth, glistening child and looked to me for help.
With much effort, we turned the child in my direction. He cried more loudly. His gaze darted about the strange faces in front of him. Was he afraid of the treatment or was it the thought of what was inside him? It had happened when the boy was slurping water at the village tap that morning. We had to take the father’s word for it. We tried to look up, but the creature had nestled up too far to be seen.
A small group of assorted hospital staff gathered. All of them – except me – knew the appropriate treatment. Hem Raj, the muscular X-ray technician, carefully handed me a full basin of water. “Hold it near his nose, Doctor. His father will force the boy down close.” We did as he said. The boy hollered louder still. Suddenly, as if on cue, a shiny black frond shot from his nose, reaching for the cool water. Hem Raj’s tweezers appeared and clamped down. He pulled the thing loose and held the wriggling 2-inch creature up in front of the boy. He immediately stopped crying. He left in his father’s arms. Hem Raj dropped it into a bottle of formalin where staff kept a small collection of water leeches.
Two sturdy lads with the high cheekbones and almond eyes of mountain people, wearing thick wool caps, placed the old man down on the concrete floor outside the nurses’ station. He lay in a blanket, the four corners of which hung suspended from a thick wooden pole: the hill ambulance. They told me that their walk from the northeast had taken them four days. They were a bit dusty and had a weariness about them, but I guessed that they could have gone another four days without much trouble.
The man’s face looked as if it had endured many monsoons and many cold winters. He had a stubble beard. His battered expression looked like he doubted whether he’d return home. He offered little help as the young men moved his limp body onto the exam table.
He said he’d been sick for 4 months, and pointed to the problem. From across the room, I’d already seen the great bulge coming from under the right side of his rib cage. A question or two, and a gentle press on the soft, tender mass made me fairly certain that he had an amebic liver abscess. He’d unknowingly taken the parasites in food some months before. They invaded his intestine, migrated up to the liver, then slowly and steadily multiplying, they’d carved out a cavity the size of a football. It was filled with dying liver tissue and blood. The man and his family, who lived far from a doctor, tried to ignore the pain in the hope that it would just go away.
If you have to come in half-dead to the hospital, this is the disease to have. There is prompt treatment. I put a fat, 4-inch needle directly into his bulge and out came the characteristic pus of ameba. Medical students are taught to call amebic pus “anchovy sauce”, though most don’t know what that food item looks like; usually the pus is like a reddish chocolate sauce. I emptied 31 syringes full of pus – nearly 2 liters had built up in his liver. Although he still needed 10 days of antibiotics, he looked a new man, sitting up on the side of his bed smiling when I saw him on rounds the next day. He would walk home beside his sons.
Each morning at 10 I walk out of the hospital to get some tea. A steep rock stairway descends to the entranceway. On the far side of the stairs, the hill drops away. On the stairway, sitting and standing, smoking and talking, are the dark hill folk. They are just visitors to this Western institution. They pass the waiting time out here on the steps, silhouetted against the hills beyond. Their outlines seem to float against the passing velvety white clouds. The green valley lies below the clouds. Two miles away the other side of the valley rises up. Some smile, some stare as I walk past towards the tea shop.
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