Anand Kasbekar / ENT Registrar
Last year, Liverpool-based ENT Registrar Anand Kasbekar let curiosity get the better of him and, leaving his home comforts behind, set off to a remote region in Nepal to an ear surgery camp. Two weeks, 598 patient consultations and 118 surgeries later, here is his story.
I’ve just had a hot shower, unpacked my backpack and switched on the kettle for a cup of tea. I had, until two weeks ago, taken running water, central heating and electricity for granted. I have just returned from a two-week “Ear Camp” in Nepal with the International Nepal Fellowship (INF), an organisation that undertakes surgical, dental, gynaecological, ear and other types of medical camps in the poorest and often remotest parts of Nepal.
I was part of a group of 22 consisting of ENT surgeons, anaesthetists, dentists, nurses, helpers and organisers who headed out to Chainpur, a small village in the far north-western mountainous Bhajang region close to the border with India and Tibet. The small population is spread out into little settlements all over the mountainous region and narrow treacherous paths are the only means of getting to the main village of Chainpur. Chainpur itself has very recently acquired a road which allows vehicles to reach it from the larger town Nepalgunj, which has a small airport.
Arranging the trip
Two years ago whilst I was working as an ENT junior registrar, I met Mr Mike Smith, an extraordinary ENT consultant surgeon. Through Mike I learnt about the Nepal Ear Camps that he leads twice a year since he started it in 1993. Mike usually takes out and supervises one senior ENT trainee per camp. I had never undertaken work like this before, but at the time thought it would be a good opportunity to work in one of the poorest regions in the world and also enhance my surgical experience. The element of adventure involved in travelling to a remote part of the world was also very exciting. I put myself forward, and a few months later was chosen to attend the April 2013 camp.
INF arrange pretty much everything from flights, transfers, accommodation, food and Nepalese Medical Council registration, so preparation was relatively straight forward. Interested team members could add on a trekking holiday at the end of the Camp if they wished.
Getting to the camp
Arriving into Kathmandu is an interesting experience with the melee of people, vehicles, sounds and smells that this part of the world brings. The temperature felt perfect, akin to a very warm summer’s day in the UK. The next day we were due to fly out to Nepalgunj in the mid-west of the country but the unpredictable nature of Nepal meant that due to a strike, the new medical members of the group were unable to get Nepalese Medical Council registration. We therefore spent an extra night in Kathmandu before flying out to Nepalgunj on a small 30-seater plane to eventually join the rest of the camp members.
At the crack of dawn the following morning, we started out on the jeep ride to the remote village of Chainpur. Two punctures, a jeep change, stunning scenery and 16 hours later, we arrived at our destination.
The Ear Camp
Our accommodation was in a local hotel which was very basic but did have running water and intermittent electricity. The day started with a very cold shower followed by an omelette breakfast on the rooftop under the glorious sunshine. A 10 minute walk to the nearby hospital involved crossing the Seti river over a very long suspension bridge and navigating the rocky footpath used also by mule trains, sheep and goats. The basic local hospital which serves a population of over 150,000 was usually staffed by a lone doctor who single-handedly dealt with all emergencies including all emergency surgery. At this time there were also two GP trainees from Kathmandu. Part of this hospital was quickly turned into a theatre suite with 3 operating tables side by side, an ENT clinic room, an audiology room, a small dispensing pharmacy and a dental treatment room.
A crowd of patients were waiting every morning at 9am outside the hospital entrance, some having walked for days to get to us. The degree of poverty in the region was clear to see and the everyday hardship these people endured was painfully apparent. The INF administrators and nurses acted as translators but learning a few simple words and phrases pertinent to ear problems soon speeded up the outpatient consultations! Mike, having lived in Nepal for 10 years previously, was fluent in Nepali. As we saw patients in one room we were able to hear each other’s consultations and ask for advice. This was particularly important for me as a trainee and I felt appropriately supervised both in the clinic and in theatre. Each operating table had an operating monitor mounted on the wall so that we could share in each other’s experiences. A portable generator in the background ensured continued electricity. The simpler cases such as myringoplasties (grafting of an ear drum perforation) were assigned to me, but as I soon found out, none of the cases were simple given the chronic diseased state of the ears in rural Nepal.
Operations and outpatients took place simultaneously and we moved between the two areas as needed. As operations were carried out under local anaesthetic and sedation, the turnaround time was extremely quick, allowing us to see roughly 595 patients in the 8 day camp and operate on 118 of them, an extremely high rate of conversion. This was probably due to the high level of ear disease prevalent in the area which had mainly gone untreated. A further 460 patients were seen by the dentists and another 254 by the audiologists who provided hearing tests and 75 hearing aids during the camp. Patients comprised adults and children, but surgery was restricted to children above the age of 5 due to the unavailability of general anaesthesia.
The days were long and demanding but as a surgical trainee being exposed to a vast amount of ear disease and operating on difficult chronic ear problems was something I relished and which more than made up for any fatigue. Perhaps the most rewarding experience of all was the utmost gratitude of the patients that were treated and the feeling that perhaps one aspect of their health and life would improve after attending the Ear Camp.
The Nepali people were incredibly friendly, welcoming and hospitable. The locals were extremely grateful for the Ear Camp, and the children raised in these areas showed remarkable resilience that only their tough upbringing could have shaped. Children aged as young as seven were quietly compliant with all our procedures including the insertion of cannulae and injections such that they would not even flinch. I could not imagine children in the UK not putting up a fight when I tried to insert a cannula.
The eight day camp ended with a postoperative clinic when all postoperative patients were reviewed, head bandages replaced and postoperative care reiterated. The two weeks flew by and left me with a feeling of achievement that I had undertaken something really worthwhile. I have also made long lasting friends in the process. The experience is one that I will cherish and will definitely return to once I have completed my training. I cannot recommend this camp highly enough to those of you considering such work whether you are a doctor, nurse or dentist.
Work has already begun building Ear hospitals in Pokhara and Nepalgunj, both of which will deliver high quality training to local Nepali doctors and also high quality care to Nepali people.
INF Nepal is based in Pokhara. The two members of staff critical to the smooth running of the camp were Ellen Findlay (firstname.lastname@example.org) and Eka Dev Dakota (email@example.com) who will be able to provide you with information on becoming part of a future medical camp.