Working in the Nepali health system

As many of you know, I (Jo) am working in the Nepali government health system. It is a user pays system although the prices at the government hospital are a lot cheaper than the thousands (it seems) of private hospitals around.

This is the enterance to the emergancy area. What you can't hear are the screams of a little child that is having a proceedure done with no anaesthetic as that costs money and isn't considered necessary.

When  the patients arrive at the hospital they go to the ticket counter and buy a ticket in order to see their respective specialist. It seems to be one place in Nepal where people form orderly lines.

 

Once they have got their ticket they see the respective specialist - medical on the left, surgical on the right and ortho at the end. There aren't many people yet as the hospital doesn't really start work until 10am and these photos are taken at about that time.

If medicines or plaster casts etc are needed they are bought at the pharmacy in the hospital by the relatives of the sick person.

The relatives have to do all the washing etc - here are clothes and bed clothes of some patients drying.

If the orthopaedic surgeon decides that physio is needed they are sent to the dept (room no 22). If they have a shoulder problem then range of movement exercises are given just like Rasoul is teaching this Aama at the moment. Even if the shoulder has full range and the problem is something else this is still given as it appears that the ortho surgeons and the physios don't have the same level of assessment skils that would be expected in New Zealand. The education system here is all rote learning - they struggle to analyse anything, and often to analyse assessment results is too difficult for the staff and isn't done.

Ultrasound treatment is given as if the power will go out tomorrow (which is may well do!). There is very little evidence for ultrasound especially the in areas at the doseages that they give but it is given none the less. Last week I solidly ultrasounded about 20 patients in 2 hours - enough to make anyone go mad!!

Some of the rooms in the hospital are filthy but then inside is really flash equipment such as this xray machine - only an expat can take the photos that I did!

The area outside the CT room- really nice machine and just to the left of this photo is very wet damp areas that I have frequently seen mice running around in.

This is the ortho ward - men and women are all in together - privacy is not considered important

One of the physios job is plastering fractures.

The physio dept - Rasoul teaching the prescribed exercises for a sore neck, another patient doing her exercises with a patient in the far right of the photo receiving ultra sound.

The surgical ward. Rasoul is giving therapy to a patient, the family of all the patients standing around, helping their sick relatives and providing linen and food.