First week at Green Pastures Hospital

When starting a new job anywhere, it is often hard to know what to do in your first few days, and how you fit into things. It was even more true starting work in Nepal. My week got off to a slow start - Tuesday was a holiday so many people took Monday off too. In addition, some of the Nepali staff work 6 days a week, 10-4, so things are fairly quiet until 10am, even for those of us who work 9-5, 5 days a week.

At 10:30am on Monday there were ward rounds, which was a good introduction to the range of patients at Green Pastures. There are about 70 patients in the hospital, around 40 leprosy affected, 20 with spinal cord injury (SCI), and the remaining others are various rehab patients. I wasn't able to follow the Nepali spoken in rounds, but occasionally someone explained to me a particular patient's diagnosis or treatment, and it was quite interesting all the same.

I found out on Monday that there was a course (in English) about leprosy care and treatment going on all this week at the training centre nearby, so I was able to go to that and learn more about a disease I knew little about before coming to Nepal. That has been really interesting this week – although it did mean I missed my holiday on Tuesday. On Tuesday there was a session on the nerves that are affected by leprosy, and what that means to the patient that I was glad to be able to go to. I have learned a lot this week, and it has been a good introduction to working at a leprosy hospital!

Wednesday felt like a better day, with more people around, and the course to go to. I also met a prosthetist from the International Committee for the Red Cross who is doing training here for the next couple of weeks. He was interested to discover that I was here to work with wheelchairs, as their organization also works with them. They are proposing to fund a wheelchair training track/obstacle course to be built at the hospital. We had a very good meeting today (Friday), to talk about how we might do that, and potentially it will happen while I'm here, which would be great. Wed. I also found out where my office would be – situated in the room that makes up the Occupational Therapy department. That will be a very good place, I think, although a space for me to sit is still being sorted out. It was not until Thursday that I was formally taken around to meet everyone at the hospital, and it helped to have had that happen! I'm starting to know my way around, and feeling more settled about working here, although I still don't know for sure what shape that work will take.

So far I have found seeing the patients the most interesting part, and learning about their impairments, and how they are being treated. I've learned a lot about leprosy this week. I had known about the nerve damage, and how it causes loss of sensation and motor function in the hand, feet and face. The loss of motor function causes weaknesses, foot drop, eye damage, and clawing in the fingers and toes. The loss of sensation can result in unknowingly injuring the extremities, that without care, can result in amputation. I did not realize that when patients are put on the drug to kill the leprosy bacteria (curing them of the disease, but not the existing disability), their bodies attack the dead bacteria in their nerves, resulting in painful auto-immune reactions. The drugs used to treat these reactions, as well as to try to reduce some of the nerve damage, are also very strong, and cause other unpleasant side effects like mood swings and serious osteoporosis. All of this to stop the progression of the disease – and then the existing deformities might need to be treated, and the patient instructed on how to care for a protect their extremities that lack sensation – something they will have to do for the rest of their life.

At the hospital, there are patients with a huge range of stages of the leprosy. Some who were caught early, and have almost no impairment due to the disease, and are simply being treated and taught how to care for their feet and hands. Others arrive late in the disease, already missing toes and fingers, and with open ulcers that need to be surgically treated (or even limbs amputated). Sara, the reconstructive surgeon can do wonders with other surgical procedures too, providing some function back to a paralyzed hand, or improving blinking to save an eye that would otherwise go blind. There are patients as young as 10 or 12 with leprosy, all the way up to those who are quite old.

I will likely be working even more with the spinal cord injured and other rehab patients. Many of the SCI patients are being treated for pressure sores, resulting from sitting or lying too long in one position. Others are being trained to use wheelchairs by the Occupational Therapy department. There is a cheerful young girl (who likely has mild cerebral palsy) who came to the hospital unable to sit up because of muscle contractures. Since coming, she is up and about in a wheelchair, and even starting to walk with braces. Imagine walking for the first time at age 10 – she was very excited the first day she was up and walking! There is a woman with severely deformed club feet, and she has got around all her life by walking on her ankles, or by pulling herself around while seated. She'll either be treated surgically, or will be given special 'shoes' by the prosthetics department, to allow her to walk more effectively. It's difficult when I see the level to which some disabilities get before they are treated here in Nepal, but amazing to see what can be done for many of them once they do come.

Tonight I had dinner with the Canadian doctors and rehab therapists from Toronto who will be doing training at Green Pastures next week. They arrived this afternoon, and I look forward to having them around. On Monday we will be going to visit the home of a wheelchair user here in Nepal, which will be great. Tomorrow, the plan is to go paragliding, if the weather is good.