Nepal Team 2 – Spring 2017

Nepal Team 2 – Spring 2017

Photos by Jason Houston

 

Day 1: Arrival in Nepal

Saturday, June 3rd, 2017    

Despite the mayhem accompanying rounding up fifteen volunteers from locations scattered across the United States and flying them halfway across the world, somehow the entirety of the NYAGI Project’s Team 2 manages to arrive at roughly the same time to the airport in Kathmandu, Nepal.

Luggage piled high into the back of a pick up truck and secured by tarp while trusted watchman perch atop, we bump onto the streets of Kathmandu. Our destination is Dhulikhel, Nepal, roughly an hour and a half to the east on pitted, winding roads into the foothills of the Himalayas.

Traffic laws seem nonexistent. As we careen about the crowded streets, concentrated sound, colors and smells overwhelm our senses. The shouted warning to, “please keep your arms and legs inside the vehicle at all times!” seems great advice to heed, especially if you are in good standing with your appendages and would like to keep them.

Eventually we tumble out of the cars into the hotel, a colorful set of buildings painted in vibrant yellows and oranges complimented by flowers of every color with the stunning spine of the Himalayas as the backdrop.

Though our intrepid group is already exhausted, jet-lagged, and heavily-laden with donated iPads and portable ultrasound machines, our true journey is only just beginning:

Helping save lives in remote, resource-limited areas…together.

While filled with beauty, excitement, and adventure, Nepal is still firmly classified as a third-world country with a healthcare system that lacks access to the technology that the western world often takes for granted. Expectant mothers and their children are especially at risk due to many of the unforeseen complications that can develop during childbirth.

Jason Houston, the team photographer, aims to capture the zeitgeist of rural mothers in Nepal while the team teaches the ultrasound course. Indira Khatri, 23, had her second child four days ago. She lives is Thokarpa, Nepal, an hour walk – there are no roads – up the steep terraced hillside to the nearest clinic, and four to five hour drive, first on a rock strewn and mud slicked ‘road’ switchbacking down the valley, then the final stretch on mixed paved and dirt roads, to the nearest hospital. Her first child was born premature, but luckily she was in Kathmandu at the time where her husband sometimes works as a truck driver. They stayed in intensive care for about a week but had to go home early when the big earthquake hit in 2015. She was worried about her second child and went regularly to the local clinic for check ups but in these resource-limited remote villages, even the best care is severely lacking even basic diagnostic and preventative tools like ultrasound.

This is why we’re here for the next week. Indira’s story is similar to many other mothers in Nepal who would benefit from ultrasound technology, but whose remote location and the inaccessibility of roads in the event of rain make getting help for labor and delivery extremely difficult. NYAGI’s aim is to represent that pregnant woman in remote, resource-limited areas who may die from a complicated pregnancy and delivery. Ultimately, we all work for her.

 

The Challenge:

Our mission while here in Nepal is deceptively simple: teach the basics of obstetric (OB) ultrasound to a group of Nepali healthcare personnel in just five days, so they can then in turn use ultrasound technology for prenatal care in remote regions.  

Why ultrasound? Ultrasound is ideal for use in remote areas: it’s inexpensive and lightweight while providing dynamic imaging in real time via harmless sound waves. When used fully, ultrasound technology can act as a modern-day crystal ball, predicting future trouble in advance and thereby potentially preventing death.

It’s a wonderful feeling to be able to proactively save lives with the power of ultrasound.

To that end, we’ve brought thirty donated iPads preloaded with obNAV – an in-depth, interactive ultrasound training app that functions like a “pocket professor” so they can continue to learn from even after the team has left – in addition to portable, handheld ultrasound machines. 

Making sure they know how to use this technology – iPads, probes, and obNAV – is just as important as making sure that they know the position of the placenta and the amount of amniotic fluid, among other things. As a team, it is our job not just to make sure that our students know what to look for, but also how to look for it, realizing the full potential of ultrasound technology.

 

Before the teaching course at Dhulikhel Hospital officially begins, the team departs on a road trip to a remote clinic located in Melamchi, roughly a twenty mile trek from Dhulikhel. Despite the relatively short distance, the journey takes two hours on winding, pothole- and pedestrian-filled roads that would challenge most Western drivers. The Nepali drivers, however, navigate the road with skilled precision, calm even as two wide buses deftly slide past each other on a narrow road bounded by steep cliffs. While the ride is mildly frightening, the views along the journey are spectacular with vibrantly green, rolling hills and sharp mountains covered in a thin layer of fog.

Upon arrival at the clinic in Melamchi, we pull up at the same time as an ambulance carrying a nineteen-year-old woman, her three-day-old newborn baby, and her mother-in-law. After an arduous four-hour ride to the Melamchi Clinic, bleeding and suffering, the new mother is examined via ultrasound and then sent out again, this time to Dhulikhel Hospital, for more advanced medical care.

Stories like this are not unusual here. During a tour of the clinic, we learn that many patients must travel for hours – usually on foot – for diagnosis, treatment, and, in many cases, examination via ultrasound. Some have appointments, but most are walk-ins.

Many patients must travel for hours – usually on foot – for diagnosis, treatment, and examination via ultrasound.

There are a few buildings nearby providing temporary lodging for those who have come from the furthest away while they await medical attention. One Heart Worldwide, one of our partner charities on this trip, is responsible for developing the newest of these, a “maternity waiting home” designed to house those families and expectant mothers who must travel especially long distances for care.

Once we reach the ultrasound room it becomes clear that ultrasound is in high demand here: the room itself and hallway outside are stuffed with expectant mothers anxiously waiting to be scanned.

We are treated to a serendipitous greeting from an SBA participant from the NYAGI Team 1 Nepal trip in September of 2016. Welcoming us to the clinic with a big smile, she proudly demonstrates her ultrasound skills to the new team.

The team briefly peeks into the the labor and delivery room, emergency room, pharmacy before funneling into a small break room. There, the doctors briefly describe their work and answer our questions. Working three eight-hour shifts to provide round-the-clock care, seven days a week, the clinic is staffed by a team of just three doctors. They explain the challenges of maternal care in a remote clinic, how they deal with difficult births, and the value of ultrasound. Their hard work is paying off: a sheet on the wall boasts zero maternal deaths in almost three years.

After thanking the doctors for their time, the team piles back into the off-road vehicles for our hot, bumpy ride back to Dhulikhel. Our side trip to Melamchi has provided the team with a slight taste of rural Nepal and its medical challenges. It’s difficult to imagine just how exhausting a five to seven day journey from the rural mountains – during the third trimester with impending labor, no less – must be when it’s arduous enough as a two hour trip by air-conditioned SUV.

 

Course Day 1

Monday, June 5th, 2017  

Just a quick fifteen-minute walk away from the hotel, Dhulikhel Hospital is the location of the ultrasound course and where the team will finally be meeting the program’s thirty Nepali students. To our surprise, we are greeted at the entrance by a large banner announcing Dhulikhel Hospital’s Basic Ultrasound Course in OB for Skilled Birth Attendants, a joint partnership with NYAGI Project and One Heart Worldwide.

Our base of operations for the next five days of intensive training is the Women’s Health building, which has been an ongoing construction project for years. On the first NYAGI trip to Nepal, Team 1 learned that this is by no means uncommon in Nepal: buildings are frequently completed sporadically as the funds are available, so construction is often a lengthy, continuous process. Given that there is little waiting room inside, families sit outside on thin plastic mats, usually in the hot sun, while they wait for care or for news from the delivery room upstairs.

Once settled into the classroom, the team is introduced to the students, thirty wonderful SBAs – skilled birth attendants – who have traveled from regions all throughout Nepal to participate in the program. Some took five days to get here, making our journey from the States seem easy by comparison. Following a brief ceremonial greeting from representatives of the OB/GYN department and Dhulikhel Hospital, the course itself officially begins.

After a short lecture detailing the basics of setting up and taking a suitable ultrasound photo, we break into smaller groups. Each one is designed to be a cooperative, cohesive learning unit focused on a NYAGI team member’s demonstrations of ultrasound techniques and obNAV software instruction.

Students cluster tightly around each bed as the NYAGI sonographers begin walkthroughs of proper ultrasound scanning techniques. Outside the training rooms, a flock of colorfully clad pregnant women wait patiently to be scanned while within small, handheld wireless ultrasound machines and tablets are distributed between the two clinical teaching rooms.

Translators bounce rapidly from bed to bed.  Fueled by necessity and a shared desire to communicate, the team and the SBAs cobble together their own surprisingly effective language comprised of hand signals and broken English. Teaching can continue even in the absence of a translator.

Enthusiastic teamwork between the NYAGI team, the incredibly motivated SBA students, the Dhulikhel Hospital staff, and One Heart Worldwide assistants is what allows us to bridge the gap between cultures and languages.

The theme of the day appears to be adaptation and flexibility. Even a leaky water pipe flooding the hallway forcing a move further down the hall, delayed display of scanning images on the tablet computers from the probes, and iPads plagued by an overload of excess files aren’t enough to dim our smiles, NYAGI and Nepali alike.

 

Course Day 2

Tuesday, June 6th, 2017  

Beginning with a shower of much-anticipated rain, the second day marks the beginning of ultrasound obstetrics training via obNAV. The team lugs the thirty iPads – generously donated by large companies in both Colorado and California – which have been preloaded with the obNAV software.

Today the goal is to use the iPads not only to teach ultrasound but also to improve technology skills. As the day progresses – a whirlwind of activity scanning patients and attending two lectures – many of the students demonstrate increased confidence and comfort using the iPads, ultrasound probes, and obNAV software. Just like yesterday, there are hiccups for the team and SBA participants to adapt to, kinks to smooth out, and to motivation to muster to keep moving forward.  After all, there is still much to learn in the remaining three days!

Following initial patient scanning, the students further develop their ultrasound skills by practicing gynecological scans on themselves.

Determinedly seeking out anatomic structures, the students learn to distinguish ultrasound artifacts from useful diagnostic information, all the while further honing their ability to use and interpret the ultrasound technology itself.

The NYAGI tech and clinical support team run around providing help where needed during the hands-on scanning sessions. Sonographers teach and demonstrate ultrasound techniques tirelessly, while their SBA students zealously absorb the glut of information thrown their way. It’s thanks to the highly organized system developed by the patient coordination team that the day is able to pass so smoothly.

 

Course Day 3 – Day 4

Wednesday, June 7th, 2017  – Thursday, June 8th, 2017

For most of the students, the third and fourth days of the course prove to be the the transition from mild bewilderment to the beginnings of obstetric ultrasound mastery. The SBAs show repeated “lightbulb moments,” finding key anatomical structures, sliding the probe with ease, and dealing calmly with technological glitches.

One of the team’s goals was to have the participants memorize what came to be jokingly referred to as the “NYAGI Mantra.” This set of basic obstetric ultrasound steps are those most important concepts which the NYAGI team strives to drive as deeply as possible into their student’s learning centers so that, if nothing else, they remember them even after the team has gone.

It pays off. The Nepali SBAs are all able not only to remember and recite the mantra with ease, but also to actually apply that knowledge. Every student does an exceptional job, proudly identifying fetal heads, hearts, and placentas in ultrasound images, measuring the deepest pockets of amniotic fluid, moving the probes along the spine to identify major fetal anatomical structures, and using the probes to measure the femur to calculate the estimated delivery date.

Overall, the process goes very well. Patients flow from the Antenatal OB and Gyn clinic down the hall into pre-numbered holding chairs outside the scanning rooms. Scanning beds are rarely vacant for more than a few minutes before the next mother in line has gel and probe on her belly.

Fortunately, the rapid bonding and effective communication between the Dhulikhel Hospital team and NYAGI Team allows us to work together in a synchronized, streamlined fashion, which in turn makes patients and their families feel comfortable and confident in the quality of the care that they are receiving. Order arises out of the chaos of the first day.  Mothers are seeing their babies’ images for the first time, via ultrasound. Most importantly, SBAs are getting much needed and appreciated hands-on probe time, which is in truth the core of the NYAGI teaching system.

Along with many normals, the occasional abnormal and normal variants help the students develop more scanning confidence. Both the SBAs and the NYAGI team get excited each time a student experiences an “AH-HA” moment. One head…wait…two heads. Two hearts beating asynchronously.  It must be twins! One set with both heads down, another in “69” position as they called it – making the sonographer blush a bit at the participants’ description. 

Further examples include a blighted ovum from incomplete spontaneous miscarriage, simple ovarian cysts, a low-lying IUD, a placenta that appears older than expected for the dates that will need follow-up scanning. When appropriate, aberrancies are imaged and shared with the group.

Those who were skeptics of our rapid teaching system, students and teachers alike, become believers. Even the vice chancellor of Kathmandu University gets wind of our success and asks that we help bring more ultrasound training to other departments at Dhulikhel Hospital.

By the end of Thursday, the fourth day of the course, each and every one of the SBA’s without exception can demonstrate all but the final objective of the NYAGI curriculum. The sixth objective, biometry – measuring the babies size and estimating the date accurately – still challenges some, but it is recognized as a quite sophisticated skill even in the USA.

 

Course Day 5: Testing

Friday, June 9th, 2017 

Mission Accomplished!

As a team, we find that, just as we’d hoped, the fifth and final training day brings it all together. Sonographers fine-tune their students’ skills, while students teach students. Everyone scans with enthusiasm and with pride in their newly-acquired obstetric ultrasound skills.

While there may be a few who still need a bit more confidence in their skills, overall the majority of the students feel truly capable of performing basic obstetric ultrasound.

Smiles fill the room, while with grace and kindess the staff of Dhulikel Hospital and the One Heart World-Wide volunteers organize an emotional, pat-on-the-back closing ceremony. Students and teachers, Sonographers and SBAs, Nepali and Americans, all shed tears as expressions of gratitude pour out.

 

Our mission of taking ultrasound technology to remote regions was on point and achievable!  In five days, the participants learned the basics of OB ultrasound in addition to the skills needed to use technology: iPads, probes, and obNAV software.

We hope that we have managed to demonstrate on this trip how ultrasound truly can function like a crystal ball, allowing healthcare providers to discover potentially life-threatening conditions in advance. We have much to celebrate, but still a long way to go.

Our collective challenge: to bring ultrasound to all of Nepal and beyond.

In the end, we have bonded around the concept of NYAGI. NYAGI represents that pregnant woman in remote, resource-limited areas who may die from a complicated pregnancy and delivery. Ultimately, we all work for her.

Learn how YOU can get involved!

  • Doctors: Alicia Martin-Hirsel, Jeffrey Kerr-Layton, Cliff Gronseth
  • Sonographers: Arlana Franklin, Donna Sceusa
  • Support Staff: Ann Dixon, Emma Houston, Liana and Halea Kerr-Layton
  • Tech Support: Ariana Brand, Casey Brown, Will Dixon
  • Research Team: Rajani and Kabita Ghale, (Carol Cowley in absentia)
  • Photographer: Jason Houston

… and all the kind donors to the NYAGI Project!

 

One Heart World- Wide Team

Dhulikhel Hospital – Kathmandu University Team

7D Imaging Inc. obNAV Software

Konica Minolta Ultrasound

Title Nine

Nepal Team 1 – Fall 2016

Nepal Team 1 – Fall 2016

Written by Nancy Franzoso; Photos by Nico Toutenhoofd

Getting ready to leave for Nepal

Monday, September 26th, 2016

Our bags are packed and we’re ready to go… Thanks, John Denver.

 

Nepal Day 1

Tuesday, September 27th, 2016

NYAGI Nepal Team 1 is going! Travel across the Pacific and Asia went without event. Arriving in Kathmandu midnight Sunday, Dhulikhel Lodge at 2 AM, we slept four hours and then shuttled to hospital to teach. The team arrived at the Dhulikhel Hospital to find a room full of eager nurses and Skilled Birthing Attendants – SBAs – who arrived three hours ahead of schedule, ready to learn how to save lives using ultrasound.

Introductions and greetings were followed quickly by group orientation and instruction in the basics of using the equipment and obNAV program. After lunch, three clinic rooms were provided for patient contact; a hallway of volunteers filled the space, all waiting for the chance to help teach and see their babies live using ultrasound. On to day 2…

 

Nepal Day 2

Wednesday, September 28th, 2016

Day 2 of instruction was another great success. We arrived to a room full of eager, smiling students from multiple regions of Nepal. We learned that some SBAs traveled for three days to this regional hospital center to participate in the ultrasound training. The curriculum introduced them to concepts of basic ultrasound technology, training software and iPad usage. Then we moved to three separate examination rooms for small group ‘hands on’ learning with volunteer Nepali women in various stages of pregnancy, some with wide-eyed toddlers in tow.

Midday we sat with our gracious hosts for traditional very tasty Nepali food. The afternoon lecture provided significant clarification of terms; we found the use of a baby doll quite useful. At every lecture our hosts help interpret lecture material, as some of the participants have limited understanding of English. At the end of the day’s learning the thirty donated iPads were individually distributed and received with great excitement. All participants were given ‘homework’ for the evening, which included searching the obNAV software for specific information regarding stages of pregnancy and clinical findings.

Prior to walking back to the hotel, the team was given a comprehensive tour of the large Dhulikhel hospital campus, which has been twenty years in the making, from a single small house to now a large medical complex still in various levels of construction. We were familiarized with the staff routine and invited to the daily “doctor’s rounds” tomorrow morning before class begins. The team debriefed until the wee hours of the evening, and woke again to the sound of monkeys and roosters in the forest and nearby homes.

On Wednesday, we look forward to meeting with Dr. Sharma, the Nepali in-country One Heart World-Wide director, who was instrumental in arranging our itinerary. The students will continue with their accelerated education, learning how to measure key fetal biometric markers like estimated weight, amniotic fluid levels, and technical pearls of wisdom for scanning. They will also explore the iPads and software in more depth. We are all excited about the magic happening here!

 

Nepal Day 3 – Day 4

Thursday, September 29th –  Friday, September 30th, 2016

Morning didactic was followed by busy small group scanning sessions filled with pregnant moms anxious to get a scan. Every SBA had opportunity to use transducers and iPads, demonstrating new knowledge gained.  A majority of SBA’s exceeded expectations and excelled past beginners ultrasound skill set. We were all impressed.

During scan sessions, multiple abnormal findings altered the course of individual patients’ lives. The students found:

Breech presentations in late term pregnancy, breech twins, an ovarian tumor, a non-viable fetus with no heartbeat, a pending miscarriage, possible ectopic, and abnormal retained products after recent birth.  All diagnosed with ultrasound alone.

At the end of the clinic day, we were driven to Panouti, a nearby town untouched by last year’s earthquake considered a local heritage site of Nepali culture. The 4×4 bumpy 9 km ride was like a Disney ride in a foreign land, filled with bumps, sharp turns, with cows and dogs in the street and lines of wide busses squeezing past on what should be a one lane road.  The NYAGI Team quickly got a taste of the travel challenges for pregnant mothers, even a stone’s throw from main highways.

Nepal Day 5

Saturday, October 1st, 2016

Our planned teaching agenda was modified due to facility and One Heart World-Wide administrators’ very busy schedule; another reminder that planning and expectations  must always incorporate flexibility! Dhulikhel University arranged a beautiful conference room setting where all of the twenty eight SBA beginning ultrasound trainees could sit lining the room and each was called to front and center to receive their certificates of completion and iPad.

Drs. Cliff and Anjana shook hands with each program graduate and photos were taken, with much applause and gratitude. At the end of the ceremony one trainee blessed with the gift of song gave a beautiful spontaneous ‘thank you’ to the team in a haunting acapella performance which brought many of us to tears.

 

Nepal Day 6

Sunday, October 2nd, 2016

The team began our three-day excursion to the outskirts of the Dhulikhel-Kathmandu area. We boarded two 4×4 vehicles for the long winding, precarious journey on worn out, rutted roads no veteran of off-roading in Colorado would imagine. Dump trucks, jeeps, pedestrians and animals passed each other within a hair’s breadth of each other and the 500 foot precipice on the edge of the road.  We got to two different birthing centers in fairly remote areas. We asked many questions of the local staff, and learned that the centers are essentially ‘open’ 24/7 for pregnant mothers to arrive in labor. We were sobered to learn that a woman in labor in a nearby village brought to the birthing center via a stretcher carried by four volunteer family and neighbors who are available at a moment’s notice. They often trek several hours to the center. Some women attempt to begin their journey and don’t make it, delivering along the way. Women are dependent on males in the area to motivate to carry stretchers.  

Our One Heart guide for the trip, Bagawati, explained that most women in labor arrive to the clinic via stretcher carried by four men from the family, neighbors and friends. It is one thing to imagine and another to witness—as we prepared to load into our vehicles for departure we noticed some commotion down the hill. A group of men scrambling up the steep, muddy, washed out trail, carried a stretcher loaded with a woman in labor with twins from the village below. Few words can convey the emotion we all experienced during this moment.  A couple of us thought to search for a camera or cellphone to capture the moment; most of us stood motionless, captivated by the power of this humbling scene.  There were  mostly men in this group of locals. We were told the patient had been seen in the clinic in the prior weeks, so she was known to be carrying twins. We learned that due to the twin pregnancy she would likely be taken via “ambulance” (a 4×4 truck outfitted with stretcher in back) the long bumpy drive to either Duhlikel or Katmandu hospital, a three hour minimum drive. We also learned most women are reluctant to go the larger hospital, due to the separation from family and less intimate nature of the care received there. The overall message was that the local birthing centers were familiar and more likely to draw the patient in for care.

The Melamchi health center greatly impacted the team on an emotional level. The center was very busy, and we were delighted to see one of the SBAs on staff that participated in the ultrasound beginning training program. She had already performed thirty-two scans that day before we arrived and told us that this was a typical load. Back in the United States more than ten scans per day is considered to be a lot. The conditions were challenging; the facility was cramped, dark and filled with patients waiting to be seen.

As we entered the facility we walked over concrete hallway with trail of dripping blood from a patient who had just arrived after a two hour walk from her village. She had delivered her first baby alone at home. There were two men home at the time, no women to help, and the men assumed “she would know what to do”.  The baby did not survive and the placenta did not deliver, so she trekked – hiked – by herself, bleeding, to the birthing center two hours away. When we saw her she was lying on a stretcher, listless, receiving fluids via IV on a rusted pole.  She was not very responsive to conversation, when someone swatted a fly off her face she did not seem to notice.  We were unsure if she would stay or be sent home, or referred to another center for aftercare. It seemed they would attempt to deliver the placenta at the center and monitor her for a few hours afterward.  We learned that in a typical delivery the mother is monitored for six hours and then discharged to walk home.

The clinic manager informed us of most common issues which would cause them to call for ambulance to the University hospital hours away: prolonged labor, breech presentation, postpartum bleeding. The day was capped at 4:40 am, when some of us awoke to a small trembler. The hotel staff told us that aftershocks from the major quake a year ago are so common that the locals have stopped keeping track of them.

 

Nepal Day 7

Monday, October 3rd, 2016

We arrived back in the capital city after two full days touring the remote areas of the Sindhupalchowk district. Eighty percent of the population here lives in rural areas – districts in Nepal are much like large counties in the USA; each has its own government representation and management. We were fortunate to have two skilled local drivers and knowledgeable tour guide who accompanied us to each birthing center. Our guide was a local employee of One Heart World-Wide, who is tasked with monitoring the daily progress, conditions, functioning of the various birthing centers scattered throughout the region.  In this particular region we were told there were  70+ health posts,  twenty one of which are birthing centers.  All of the centers we visited were located atop large ridges or hilltops.

Most of the region is hilly and mountainous and the only open areas available for building are atop these steep inclines, meaning any patient must make the long climb to the center  in order to receive care.  A ‘health center’ is akin to our community health centers, and can address common health complaints such as pneumonia, diarrhea, traumatic injuries, etc. A birthing center has a designated area for labor/delivery, with SBAs.

 

We learned a great deal about the culture on our journeys.  A high incidence (20%) of uterine prolapse is felt to be multifactorial: “too many kids too close together too much work too fast post birth”. The official average age of marriage in women is 19, but in rural areas more toward 14-15yrs of age. Often marriages are arranged by family. Families desire a male child; so if a woman gives birth to a girl (or four to five girls) it is expected that she “keep trying” until a son is born. It is illegal in Nepal for a clinician to divulge the sex of the fetus if it is detected, due to likelihood of self-abortion if the fetus is female. The more children in a family, the less attention, food, general care they receive due to limited resources. Malnutrition and infection are common. The arrival of internet, cellphones, and web access has decreased the average age of marriage due to more awareness of outside world. Family approval for marriage is expected. Women are reluctant to speak their husband’s name aloud; it was explained that this is due to combination of superstition and old religious cultural beliefs.

After completing our tour of various health centers and birthing centers throughout Sindhupalchowk, the team felt it hard to emotionally overcome some of the scenarios witnessed. We were given a tour of the local district hospital, which was hit hard by the earthquake last year. The main building was unsafe to inhabit due to large gaping cracks in the supporting beams and other structural elements. The current operating hospital consists of a small collection of tents: emergency, male outpatient, female outpatient, inpatient ward, pharmacy. The doctor in charge of the collection of tents graduated from medical school just three months ago and this is her first government assignment. Typically medical doctors receive financial support from the government so upon graduation are assigned to various locations for two years. They have no say where they will be stationed or for how long.

Upon reflection of our tour, it was clear that the array of health care centers from the hospitals to the community centers and birthing centers each had their own unique challenges and needs, from staffing to basic supplies such as medications, medical waste disposal/management, to ultrasound equipment and technical training to use it once available. We were all drawn back to our experience at Melamchi, a most powerful exposure which made clear all of the above. In particular, we were inspired by the presence of one of our NYAGI-Nepal Team 1 SBAs, who was performing ultrasounds on pregnant women packed in the clinic halls. That day alone she performed thirty-two scans. We felt that the NYAGI training she received greatly helped her appreciate what she was viewing on screen.

On the last day of touring we visited a general health center with birthing facilities which was further north closer to the Chinese border. This facility had one of our more advanced SBA trainees on staff. We were impressed by her knowledge of the ultrasound machine, and the educational obNAV software. It was apparent that she had been already studying the material, teaching herself more information from the available learning software. We were able to watch her perform a thorough scan. She could identify necessary anatomy, take measurements and assess whether they were within normal range. She also displayed highly professional patient interaction- something that was emphasized during the ultrasound training sessions. The overall impression of the team was that the training had maximum effectiveness in this particular center; there was a large patient flow with good oversight/management and it was clear that the knowledge of ultrasound positively impacted patient care.

We learned that the Nepali government pays pregnant women a stipend to deliver her baby at a birthing center or hospital. This is meant to financially motivate women to receive some oversight during the birthing process, as many women might otherwise attempt to give birth at home alone.

In all there were many things that could not have happened smoothly without the help of One Heart support—guides, translators, and escort to help with the flow of the mission.  The trip itself, for the NYAGI team would not have been possible at all without very generous donations from local large medical device companies and especially private donations. The tour of Sindhupalchowk, for the NYAGI team, validated our feelings following the educational program that the fundamental goal of saving lives in remote areas was achieved and we are extremely grateful for all of the assistance that made this possible.

Dr. Nastu Sharma, the One Heart World-Wide director for Nepal, and Sibylle Kristensen, affectionately known as the” One Heart complaint deptartment,” were instrumental in assisting our efforts in this mission. The coordination of the daily/weekly schedule, assignment of local staff, drivers, guides, offered a measure of support which made our maximum efforts possible.

The team leaves late tonight (Wednesday, October 5th) to begin our journey home via Hong Kong. We have incredible images to share which help convey the reality of the conditions and challenges faced by all of those trying to improve the resources here in Nepal.

Learn how YOU can get involved!

 

  • Doctors: Nancy Franzoso, Cliff Gronseth
  • Sonographers: Pam Brower, Emily Downs, Philippa Tatge, Ashley Upton
  • Tech Support: Chris Paris
  • Photographer: NicoToutenhoofd

… and all the kind donors to the NYAGI Project!

 

One Heart World- Wide Team

Dhulikhel Hospital – Kathmandu University Team

7Dimaging Inc. – donated obNAV Software

OtterBox – donated iPad cases