Blog 3 from Nepal – The Magic of Ultrasound

Ill try and keep this post short and sweet.

One of the challenges we faced in Nepal was the provision of Ethical Care.
This is a country where individuals can claim to be doctors and ‘prescribe’ Ayurvedic therapies in place of actual treatment, or even use fuzzy television screens as pretend ultrasounds to diagnose “bad blood on the uterus” or “cold water”.

In response to this, the need for maximal transparency and robust ethical standards in healthcare was and is vital.

Its for this reason that I can’t begin to communicate the enlivening experience of working at the Chisang Clinic: a Truly Ethical clinic.

The Chisang Clinic

The Chisang Clinic

I have never, and I say this with utmost confidence, Never, volunteered or been associated with an organisation whose moral stance on everything from operative costs and patient care was so completely humane and compassionate.Hajur Ama - Grandmother One of many elderly women whose treatment is completely subsidized by the clinic.
And Dr Karki is to thank for this.

Medicines are sold at almost cost price; the poor, elderly and “untouchable” castes are offered reduced costs – if not free care. And there is complete transparency; with a governing committee made up of local, district and national shareholders in Nepal.

 

Hajur Ama – Grandmother
One of many elderly women whose treatment is completely subsidized by the clinic.

 

 

 

 

 

But my favourite part; ultrasound is provided for free along with antenatal care and advice.

Its only because of the generosity of our incredible donors as well as the support of Sonositeuss Australia that the Chisang Clinic is now performing ultrasound scanning in Rural Nepal- adding a new dimension to the level of care already being provided.

Here’s a highlight of what we achieved with ultrasound in just the 3 weeks that I was at the Clinic:

  • More than 20 obstetric ultrasounds
  • 2 women with possible life threatening placenta praevia’s referred to P1010129a district hospital for OBGYN review

 

  • 2 kidney stones clearly diagnosed and referred
  • 3 women confirmed and counselled about an unknown hysterectomy performed during P1010196C-Section.

 

 

 

  • 2 patients cleared of pneumothorax
  • 1 patient’s diuresis titrated based on IVC fluid status

 

 

 

  • 2 men referred to district centres for suspected benign prostatic hyperplasia
  • 1 Ultrasound guided diagnostic needle aspiration of an abscessP1010174
  • 1 Ultrasound guided IM injection of NSAIDs
  • More than 14 Kidney ultrasounds screening for nephrolithiasis and 3 diagnosed and referred cases of hydronephrosis.
  • P1010395
  • 3 cardiac Ultrasounds to screen for gross abnormalities, 1 resulting in LVH diagnosis and referral.
  • 1 US indicated referral for Polycystic ovary syndrome
P1010606

Alka and Yamunah beaming after a great day of OB Ultrasound

 

 

 

 

 

 

 

 

But what further sets the clinic apart from the rest, are the efforts that are taken to be transparent and educate patients – slowly but surely improving the local health literacy.

We created diagrams and charts to SHOW patients exactly what we were examining and why.

P1010077

Diagrams with Minimal text in Nepali to illustrate to patients which organs can and cannot be ultrasounded – both encouraging transparency, and educating patients so that they are less vulnerable to quackery and can make more informed decisions. Pictured above in the centre are diagrams explaining that generalised abdominal pain cannot be ‘seen’ as a physical manifestation on ultrasound – as many local quacks would have patients believe.

P1010189

A whole family from over 50km away who had travelled to the clinic for their young daughter’s OB ultrasounds but ended up bringing along other family members to have their ailments and illnesses ‘checked out’ while they were there.
A great way to encourage and improve health literacy!

And our efforts were rewarded with a surge in presentations from all over the district!

 

 

 

 

 

 

 

Watching on as a mother sees – with her own eyes- the flutterings of a tiny heart on a screen for the very first time is such a wonderful experience. Her eyes light up, a smile appears on her face, eyes wrinkling and a gasp of air escapes her lips in delight.
I only wish everyone who helped to make this possible could see it for themselves.

Yup! ultrasound Does save lives, and for me, the experience of being able to provide a new level of care and reassurance to my patients was pretty magical.

 

As always,
Dhanybad,

Aidan – the Little Medic.

 

 

 

 

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    • Cheers Tim!
      The best part was using a sonosite we were able to keep scanning for about an hour or so because of the battery even when the power went out (there are >3 hour power outs every day)
      and AC charged it the rest of the time. Also could take it to home visits and more remote locations.

      thanks to Sonosite and the donors the machine is now at the clinic permanently which is awesome! (sorry, probably didn’t explain it properly)

      what we really need now are experienced clinicians [such as yourself ;) ] to go out there and train the local staff up.

  1. My name is Tenzin Kalden , currently pursuing a career as a sonograher in newyork and this july I will be in my internship. My dream is to volunteer at Nepal in near ffuture, where I was born. Be able to confidently perform my scan for people who are in need. I am very pleased at your job performed out there in nepal , Aidan.
    I would love to have some feedback, how to be prepared and have this dream come true.
    Thank you
    Aidan

    • Namaskar tenzin!
      Thank you for the lovely comment and good on you for pursuing such an incredible career.
      That you want to return to help your society is truly an incredible notion and i admire you for it.
      I would say that you need to find a place where you agree with the values and ethics of the people running whichever clinic or hospital you are working at. Too many practices in Nepal are not administered as ethically as they could be so that is really the most crucial part. After that, I believe everything happens naturally.
      Feel free to email me to discuss further or for more specific details and some places you might want to have a look at.
      alittlemedic@gmail.com

  2. I’m a sonography student in the U.S. and loved this post! An instructor of mine had a trip planned to India to teach basic OB ultrasound on a mobile machine, unfortunately it fell through but I’m sure he’ll make it out there eventually. Several students in my program are interested in mission work/overseas volunteering- how did you end up in Nepal with a donated machine? Any info is appreciated
    thanks again!
    Agnes

    • HI Agnes!

      thanks for commenting :)
      the basic story is up on my blog in the previous few posts.
      I ended up fund-raising from friends and local businesses and then got a second hand machine partially donated from the company (Sonosite) itself.
      I found the clinic from a google search -- chisangclinic.org -- they are absolutely fantastic and if you are ever thinking of going anywhere i recomend this as the place to go and really make a huge impact! they desperately need sonographers.
      Please email me on alittlemedic@gmail.com if you want to chat about specifics and getting in touch with the clinic.
      Thanks & Dhanybad

      Aidan