Chronic illness management

Pangboche is a village at an altitude of 3985m.  A village very much like Phortse, where the staple farming is potato and buckwheat and most of the men are climbing sherpas.  Lower Pangboche is a village most commonly encountered by the trekkers enroute to base camp. I was residing in Upper Pangboche where the clinic and the Pangboche Monastery (Gompa) is.

Me with the health worker

I was at the clinic with Shiva, the health post worker. I ran the clinic together with him, teaching him along the way as well as conducting the health education sessions similar to the ones in Phortse.

Unlike Lhakpa, Shiva is not of Sherpa origin. He is from lower valley and speaks Nepalese. Hence he communicated with the patients in Nepalese, except for the older ones who only spoke Sherpa language.

Interestingly, as compared to Phortse, though the patient load was less, there has been a wider array of cases here (less of the URTI… perhaps it’s the weather). Of course, dyspepsia still dominates the clinical picture.

Faces of Pangboche

The villagers of Pangboche and Phortse are closely related. Many are in laws. I feel like I have come a full circle as now, many are becoming familiar faces. I had seen a lady a few weeks ago at Kunde, with a terrible wound. At Pangboche, I got to follow up on her wound healing, which is doing well.

Wound initially

Wound a week later

Management of chronic illness

I saw my first diabetic patient. According to her, she was found to be diabetic, started on medication and then stopped. She decided to just come by today for a ‘checkup’ (as what most of my patients have been telling me for the past few days) since she heard the doctor was in town. Her random capillary blood sugar was 29.1!!!!! My heart sank. Unfortunately we do not have any insulin or antidiabetic in the healthpost. Hence, we had to send her to Kunde Hospital to initiate treatment as soon as possible.

Managing chronic illness is a problem. People find it hard to grasp on the idea that if you have hypertension, diabetes or ischaemic heart disease you have to be on lifelong medications. It was easier in the Western world (while I was in the UK) as people understood they needed to be on lifelong medications and kept to one family doctor, which allowed good continuity of care.

However, in Nepal and even in Singapore, there are a couple of problems. Firstly, people think that if they have no symptoms, they don’t need to continue on medications. Which is totally wrong, especially in the case of diabetes…. Diabetes KILLS SLOWLY…. One may have no symptoms, yet over the years, it slowly damages your organs…. The eyes, kidney, heart, nerves, legs and eventually one suffers a slow painful death. It frustrates me when I see patients with sky high blood glucose and the reason is because they have ran out of medications for a week and hence have not been taking them.

Secondly, people doctor hop and hence either get prescribed different family of anti hypertensives, lose the continuity with their doctors and end up collecting all the various antihypertensives in their drug cupboard at home.

Clarifying medication doses

Here in the Khumbu region, many take medications from Kathmandu… but stop taking them once its finish and then randomly appear for a blood pressure check in the clinic. This is a very familiar problem we face in Singapore too…… but yet, we are a much smaller and developed country.

Right, I have totally strayed from my Pangboche experience and rambled on about challenges in chronic illness management.

Anyway, I do my best to emphasise to my diabetic and anti hypertensive patients about the importance of follow up in Kunde Hospital…. I hope I manage to get the message across. (Language is a great barrier for such purposes but hopefully my tone of voice and body language gives away the seriousness of the matter)

It was great to see my diabetic patient a week later. She had visited Kunde and was started on antidiabetic medication. We gave her diabetes counseling as well as the potential side effects of the medication. Her husband was with her, which was perfect for the counseling.

Shiva counselling our diabetic patient

Another patient was also found to by hypertensive on 4 occasions. She had initially been on medications from Kathmandu (4 yrs ago) but had stopped once  she ran out of it)  As as she had problems walking, she couldn’t make it to Kunde to have her BP checked and medications started. Thankfully we had some antihypertensives, which we started her on. The following week, she returned for her BP check and it has come down nicely.

It felt like a full circle indeed!!!