Written Stories

Being a Doctor in Remote Place

14 Sep, 2016 By: Dr Surendra Basnet

"Namaste Doctor Saab" a low pitch voice stopped me as I was about to leave the hospital. It was about 4 pm of 2nd Asahd 2067.

"Namaste" I reluctantly replied. Another patient at the end of working hour? Oh god! That would be the last thing I needed. Why can't these patient come on time? I was thinking. Before I could utter any words the middle aged thin built man with unkempt hair n tired looking face caught my attention. The wrinkles on his forehead and reddened eyes made him appear way older then he actually was. He may not have washed his clothes for few weeks or more. My thoughts were broken when he started pleading "please doctor saab come with me to my home, I am in problem and you are the only hope … my wife … my wife …" No words came further, he broke into tears…. He was worried and restless.

"Please calm down. Tell me what's the matter, what happened to your wife?" Something is seriously wrong. I offered him a chair and encouraged him to elaborate.

"She is nine months pregnant, we were expecting a baby. She was having abdomen pain since yesterday night; I thought it wasn't very unusual. So today morning went to work, but when I returned home around 3 pm she was bleeding … she was there in pool of blood... She told me she has been bleeding heavily since 11 am today. Please come with the Dr Saab, please saver her"

"Okay I got you. But it would have been better if you had brought her here to the hospitals since are in better position to manage her".

"I thought about that too but there is not a single man around my house and I can't carry her up to hospital alone" he said sobbing unstoppably.

"Where is your house?"
"Talekhu. It will take about 30 min to reach there"
"Ok don't worry. We'll manage something"

In no time Dr Sudeep Khanal and Bhes Maya sister were ready to go with that man to his house with all the emergency medicine.

At 5.30 pm, Dr Sudeep called me "Hello Dr Surendra, she is pale still bleeding per vaginal and there is no fetal heart sound, please do the necessary arrangements in the labour room. We'll be in hospital within 15 min."

In 15 minutes Dr Sudeep, Santosh Lama (husband of the patient) and few other villagers who accompanied them on the way were carrying the lady on stretcher with IV line and IV fluid still running and Bhesmaya sister was holding the RL bottle.

6.00 pm Labour Room, District Hospital Manang.

BP – 90/60 mmhg
P – 120/min
Pale, restless,
FHS – nil
No uterine contraction.
LMP – 2066-7-12
EDD – 2067-4-19
Active PV bleeding with clots.

"She has already bleeding a lot. Sent blood for hb%, Grouping and open the venous line in both hands and start haemaccoel and RL."

I knew she need blood for blood, but we don't have blood bank in our district. How are we going to manage her? I was worried.

Dr Sudeep – "What do you think?"

"33 weeks 2 days pregnant was having rhythmic pain till today morning. After that she had no uterine contractions, started bleeding PV, no pain, it could be placenta previa or abruption placenta or worst of all ruptured uterus and the fetus is dead already"

Dr Sudeep added – "the problem is, PV examination is contraindicated in placenta previa, it could make things worse"

"She needs Caesarean Section"
"That too immediate"

We don't have any OT setup and no CEOC services in District Hospital Manang. So we have to refer her to nearly CEOC center that is either Lamjung or Pokhara. Even if we carry her in our shoulders and run it will take 2 days to reach there. And we know she doesn't have that much time. So the only option left is helicopter. But that is expensive, in fact too expensive Rs 137,000 to Kathmandu and 110,000 to Pokhara. The financial status of the family is that they hardly have Rs 10,000 cash with them.

Doctor her blood group is A+ve
Hemoglobin – 9gm%
Bp – 100/70 mm hg
p – 110/min

We had to tell the condition of the pt to the family and to make the necessary arrangements to rescue her to better place. "Her condition is serious. She had bled a lot and she is still bleeding. The fetus is already dead. She immediately requires blood transfusion and operation – Caesarean Section. Unfortunately we don't have any services here. So we have to refer her to better place. Lamjung or Pokhara or Kathmandu as soon as possible.

There are lots of difficulties, lacks, life is hard in remote places, but still people have hope and perhaps that is their strength. People are united. Active involvement in very events either it be feast, festivals or any difficulties is the culture here. Mother Group Chame came out of the crowd, they collected money from every government offices, peoples, hotels, shops and the family member of the lady also contributed little. In one night they collected the money sufficient to rescue her up to Kathmandu in helicopter.

We human beings can survive against all odds but who can fight against the nature? All of a sudden the climate got worse. It was raining whole night. Even in the morning the sky was covered with clouds and raining continuously. Our challenge was not over yet.

9.00 am District Hospital Manang

Hb – 7gm%
All we can do is maintain her vitals with RL, haemaccoel, complete bed rest and perhaps wait, wiat for the climate to get better and wait for the helicopter to come. Waiting is painful, it becomes more painful when you know that time is killing you slowly. We two doctors were by her side all the time trying to help her, but in fact we were helpless. I tell you, it is not easy to be a doctor in remote places. You know what to do, you have the knowledge but you can do nothing and we were at that situation.

The lady is Seema Lama, 30 yrs old. She had 4 children from her 1st husband and this was the 1st child from this husband.
The whole day passed, it was raining continuously. There was no sign of climate getting better. The pt party were anxious and we were even more. They want to take her on stretcher and carry her upto Lamjung. But we know without IV fluid her blood pressure is going to fall slowly and she can't survive till she reach Lamjiung and it's not easy to carry a lady in stretcher in that rainy days. All of us were just praying for the climate to get better.

6.00 pm
Hb – 5gm%
Bp – 100/70 mm hg
p – 120/min

Things were getting worse. I have never thought that a night can be that long. Perhaps that was the longest night of my life. It was like the second had, minute hand and hour hand of all the clocks were tired running and they were having rest that night.

We were having her vitals every 30 min, trying to maintain her blood pressure.

Miracles do happens. The climate got better. Rain stopped and by the early morning we could see some part of blue sky. We were so happy.

6.00 pm
Hb – 4gm%
Bp – 100/60 mm hg
p – 110/min

12.00 noon, 4th Asadh 2067, finally helicopter landed. Devaki Sister accompanied her and went with the pt. Now she was flying to Kathmandu. Still she had to wait another one hour. We had already called the blood bank in Pradashani Marg Kathmandu and arranged blood. Now we were feeling little relief.

3.00 pm
Devaki sister called me from Prasuti Griha Kathmandu "Dr. we are in emergency now. The doctors here think it may be placenta previa or ruptured uterus. They are making arranagement for emergency operation." Now we are much hopeful that at least the mother is coming home alive.

Later in the evening we knew that the operation was successful they saved the mothers life. That news brought an immense relief. Our effort didn't go on vain. I took a deep breath and thanked god. These are the moments in life-moments of satisfaction, nothing beats the immense sense of satisfaction these moments bring. Being part of effort to save a human life.

It was abruption placenta and fetus was dead. They did bilateral tubal ligation also.

11.00 am Bhadra 2067

"Doctor Saab Namaskar" a middle aged man was in OPD. I had no problem recognizing this same face that I saw two months back. He looked handsome on those clean clothes with neatly trimmed hair and most importantly the agony and anxiousness of his face was no more. A sense of gratitude was visible on his chinky eyes. He added "perhaps you forgot me Dr Saab, I am Santosh Lama husband of Seema Lama. We came back a week ago". Before I interrupt him, he finished in one breathe "She is OK now. We can have no more children now but still I am happy. At least she is with me alive. Had you not been there god knows what would have happened. Thank you for your efforts. Thank you for saving her life. I would never forget what you have done to me Dr Saab. Here are freshly plunked apples from our garden. My wife has sent it for you all".

He handed me the apples. I just managed to say thank you. I was speechless further. Before I could made any effort to say anything he was out of my sight. The fresh red apples were in my hands. I was thinking who said apples keep doctors away, come to Manang, Mustang, Jumla you will get lots of apples but can it ever replace the need of doctors?

Perhaps the peoples respect and gratitude are the only invaluable rewards for the doctors like me that make serving in the remote places of Nepal so worthwhile. And I feel proud of it.

Dr Surendra Basnet
District Hospital Manang

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