Poop and Other Problems

Some things are the same everywhere. When it comes to ex-pats working in developing countries, a frequent topic of conversation is, invariably, one's bowel activity. Between this and my having the medical maturity level of a five-year old, I could talk about poop forever. But I'll spare you.

The CIWEC Clinic, where I'm working this month, has been in Nepal for approximately 30 years. It originated from a Canadian and international water & electricity collaboration (hence the acronym, CIWEC) whose ex-pat workers needed medical attention during their time in Kathmandu. The concept of a travel clinic for foreigners blossomed from this arrangement, and the clinic now sees (and occasionally admits as inpatient) anyone including evacuated Everest climbers, ill and injured tourists, ex-pats, and even some locals. Many of the physicians here trained in the UK, India, South Africa or the US; the clinic also employs Nepali ancillary staff.

Most complaints are acute, which makes things similar to the ER, though thankfully minus the drug-seekers and non-specific chronic complaints with psychiatric undertones. CIWEC has rudimentary ICU, X-ray, laboratory and ultrasound capabilities. CTs and MRIs are obtainable at a nearby facility, and intensivists and orthopedic specialists from the nearby teaching hospital are available as consultants. While the vast majority of patients are stable, there has been the occasional inpatient death- STEMI and a massive PE more recently (no cath lab, no tPA. There is one cath lab in town at the international hospital, but pt wasn't stable enough for transfer).

CIWEC has been instrumental in research regarding travelers' diarrhea- they were the first to attribute cyclospora as one of the causes of diarrhea outbreaks here throughout the years. 80% of other diarrhea cases in Nepal are bacterial, requiring treatment with either cipro or azithromycin. Giardia is also occasionally seen, and the lab here can test for all these relatively quickly. 

This week alone, I've seen cases of abject frostbite, dog bites requiring rabies prophylaxis, fractures, minor primary care complaints from resident ex-pats, and, of course, diarrhea. We also are one of the handful of Kathmandu hospitals that receive evacuated patients from Everest Base Camp and surrounding trekking routes, so distinguishing HAPE from a bad respiratory tract infection and HACE from AMS is a clinical skill I actually get to finally put into practice instead of just read about! It also doubles as a great local geography lesson- there are so many routes, town names and elevations to learn besides the more well-known ones like Namche Bazaar, Pheriche, etc. Taking a detailed ascent and descent history is paramount to teasing out what's really going on clinically. 

Between meeting patients from all over the world and learning to practice a bit of travel & altitude medicine, I'm grateful to CIWEC for the opportunity to be here and to be able to mix some of my favorite personal & professional interests.