A week in the life of clinic.

I just completed 7 days in clinic and it feels like I’ve been here a month. We were open for 7 days straight and I saw 61 patients. Off to a slow start for clinic standards, it should pick up after the holidays. Still sorting out exactly how I fit in with the team. We are all meant to be primary care and refer out as appropriate to the health post or the hospital in a larger city. Since it’s been slow everyone has had acupuncture first and then those with musculoskeletal pain are sent next door to me. So many people have musculoskeletal pain so I’m not lacking referrals. I would say one third of my patients this far have cervical or low back pain and most with radiculpathy, another third have knee pain and then a mix of carpal tunnel, plantar fasciitis, shoulder injuries, SI, old fractures, and pain of unclear origin. Everyone seems to have numbness and tingling as well. Posture is generally terrible and much of the pain is expected from heavy labor in the fields and the methods of carrying crazy heavy loads (mostly on their heads). Patients come in with labs, X-rays, MRI’s and CT scans and little information on the possible diagnosis. Many people have been told they have ‘bone degeneration’ and there is nothing that can be done. I feel very lucky to have our diverse team three TCM acupuncturists one who was an ICU RN for 10 years and one was a chiropractor plus myself. So between us we have been able to work through most patients concerns. Blood pressures and blood sugars are so much higher here, 160/100 isn’t that unusual. We have to strongly advocate for people to go to the health post or hospital, and at some point decide to deny treatment until it is addressed.
I have done so much education, other practitioners, our interpreters, as well as patients. And imagine that will be a main theme the entire time. Patients will ask for needles and herbs and I explain I heal through movement. Specific movements to restore balance in the body and decrease pain. Some people are very excited and other skeptical. I have been able to significantly decrease reports of pain and show objective increases in ROM/function with just a few treatments. I have an amply supply of kinesiotape and have used it for edema reduction, scar management and posture. Our interpreters are used to the language of acupuncturists and new to my type of assessment and treatment, I am cautious with interpretation and often ask a question three to four different ways… Sometimes getting three to four different answers. This adds a whole different level of difficulty to taking a patients history. There is so much I want to do and help with, but constantly reminding myself to start slow and simple. Everyone gets assessed, a brief treatment if needed, a good dose of education, one or maybe two exercises and is encouraged to return. The clinic is free so many people can easily can and will come three times a week. Others walk one to five hours to come to clinic and do not have the luxury of frequent visits.
A sampling of patients;
45 year old male chronic low back pain x 2-3 years radiating down one leg in recent months painful and limited range of motion
25 year old female sudden onset quadraparesis and neuro symptoms x 2 months, one week in hospital and diagnosed with MS in chart in English and never told or did not fully understand. Suspect CVA or congenital concern and highly encouraging MRI
56 year old female chronic knee pain, extensive OA, hurts even to look at her X-rays
24 year old female 4 months pregnant with pulsating mass in abdomen, I directed the case to Jacq as she has ten years experience in ICU and most recently cardiac. We suspected an dissecting aneurysm and in the US she would have been sent into surgery immediately. The health post was closed, none of the ambulances we called would answer. The pt was monitored until her husband arrived and the ambulance was finally on its way. Once the ambulance arrived the pt was missing, we found them and continued to impress the severity of the situation to the family. They agreed to take the ambulance 3-4 hours to Kathmandu and the practitioners paid for the $60 ambulance ride. The surgery will cost $2000 and they require payment prior. Last we heard the government was going to forgive 50% of the cost, she was transferred to another hospital and is just coming out of surgery. Clearly well beyond the scope of our abilities, we educate and advocate to the best of our abilities.
Aa a team we have to figure out what we can treat and when we need to advocate for pts and refer them out. Pretty wild to think what we worked through in just one week. There are so many people we can and will help and then some we simply can’t. I’m certain I’ve chosen the right program to volunteer with. Being here in Nepal and going to know Good Health Nepal (the NGO partner with) has been wonderful. Everyone’s hearts are in the right place and there is a strong desire and a goal to develope a sustainable program here. I continue to be so grateful for everyone who helped male this possible for me.