Health Education in Phortse

While at Pangboche for the past 2 weeks, I have not been able to have good internet access. My minimal access has only allowed me to check and send 1 mail a day, let alone update my blog.

Now tracing back my steps and days… I last stopped at my ramble about climbing Mt Everest. Lets divert from the mountains and move back to the medical work….

After Kunde Hospital, I returned to Phortse to continue running the clinic as well as start with the health education sessions that I had been planning for months prior to the trip.

My tools for the job- powerpoint and posters printed and laminated in Singapore

Combining forces with the Phortse healthcare worker!!

Lhakpa Yangjee the designated health worker returned after her much prolonged maternity leave. She returned with a very healthy, pretty baby girl, called Pasang Doma, after having an emergency caesarean section in Kathmandu.

Lhakpa and her daughter, who accompanied us in the clinc

It was great to have her back in the village as now we can proceed with the main plan, which was to work together with the health worker to educate the villagers as well as see patients together and help train them be more confident with prescribing medications.

These health posts were set up to oversee the villagers’ healthcare needs, health education and family planning. They are part of the Kunde Hospital. Inadvertently, these health posts become the general practice or polyclinic for the villagers. However, chronic illnesses such as hypertension or diabetes mellitus are still managed in Kunde hospital as the patient’s records are stored there.  This can have disadvantages though, as some old patients have too severe knee osteoarthritis to walk to Kunde. (average of 3 hrs from most villages)

The health workers are trained for 18 months in Kathmandu and can see to basic healthcare needs.

Our Role in Phortse

From our side, we had stocked the clinic up with an array of medications dressing sets, a stretcher, wooden splints, medications, blood glucose machine, oxygen saturation machine and blood pressure machine. (I still remember trying to load 90kg worth of medical supplies on board the domestic flight from Kathmandu to Lukla. Thanks to our Nepalese contacts, they came on separate flights on the same day)

When we 1st arrived, it was snowing in Phortse. Kumaran had the honours of lugging the bag of medications up the hill to the clinic. He had to stop to catch his breath!

While seeing patients with Lhakpa, we discussed the management of various ailments, the prescription of antibiotics, symptomatic treatments for URTI (as usually only paracetamol is prescribed), as well as learn about the different aspects of chronic disease management (besides drug prescription, there is the counseling and compliance aspect). I also gave her the blood glucose machine, such that now, the villagers can have their blood sugars tested rather than travel 4 hours to Kunde.

Shuwei and I counting our stocks and arranging them in the clinic. A big problem was the lack of running water in the clinic. Hence every morning, we have to lug a bucket of water up. We have flagged it up to the people in charge.

Naturally, a larger number of villagers visited the clinic as there were new ‘goodies’ as well as a foreign doctor.

One of my favorite visitor to the clinic!!

Women’s Health Education

The most interesting area was the health education aspect. As I had mentioned before, 50% of deliveries take place at home. Usually the lady’s mother and husband help to deliver the baby. Antenatally, they will visit Kunde hospital, where they will be scanned for presentation as well as triaged for potential delivery complications (usually about 4-5 visits). If complications are expected, they are advised to head to Kathmandu for delivery. They are given a sterile set to help cut the cord too. Then… when the water bag bursts, if the mother can’t make it on time to Kunde, the action takes place at home. (The mother ‘pops’ and the family ‘catches’) Even breech deliveries (foot presentation) takes place at home.

Coming from Singapore, where all deliveries are doctor led as well as being trained in the UK, where a large proportion of deliveries are mid wife led, this was not all too surprising to me. However, what was surprising was the lack of knowledge most had regarding the potential complications during childbirth itself. Hence I showed them pictures as well as a power point presentation on delivery, potential complications and how to best manage them.

One of the many pictures I use

Good ole technology and powerpoint presentations. Teaching was mainly outside the clinic, in the sunshine

The turnout and response was great. Most of the ladies from the village turned up with their children. As well as a teaching session, it turned out to be an opportunity for the ladies to socialize between their household chores. Lhakpa was great in helping me translate, even with her crying baby in the basket. The posters I had were mainly pictures with Nepalese writings. Hence, they helped to reinforce the information.

Nepalese text

Lhakpa translating education on antenatal care and delivery complications. The basket hanging from her head contains the baby.

It was an engaging crowd, where questions were asked as well as experiences shared. There were women of all age group. Hence the older ladies shared their delivery stories with the rest.

Other ladies also came with their babies

It was a great opportunity to reinforce the importance of antenatal care, postnatal problems (including depression), family planning and vaccination.

I must say I am impressed with the depot uptake rate here. In Singapore, I remember counseling patients after a termination of pregnancy on contraceptive methods and people being resistant to it for various reasons. (Common being the avoidance of chemicals in their body)

Children’s health

Children’s health education then seemed to be the natural follow up to the teachings on maternal health. I touched on children’s nutrition and hygiene, importance of breastfeeding, and early recognition of a sick baby.

Another one of my posters

The children audience were captivated by the new addition to the village

Teenagers

For the younger women crowd, we talked about problems faced during puberty, especially acne as well as menstruation related problems. Being an all lady crowd definitely helped approach this topic.

Despite the all ladies group, there were many giggles when squeamish topics were approached

Basic first aid and wound care

Lhakpa had her CPR training a few years ago. Hence we refreshed her knowledge on it. We then went on to teach the villagers some basic skills- such as how to save a choking person, wound care (from lacerations, bites, burns) and the importance of tetanus vaccination.

Showing them pictures on my laptop on wound care and tetany

Don't be alarmed- we were standing on a slope!

Following my sessions in Phortse, I then headed up to Pangboche with some of our medical supplies, to meet the health worker based there. It was also a chance to catch up with Kumaran who was at that time on his break from his Everest rotations. (he is now on his summit push)