Last days in Nepal

On our final morning in Dhangadhi, we had basically settled into our routine – wake up, eat breakfast, throw on scrubs and go to the hospital in a tuk tuk. After springing the idea of returning to the hospital at the last minute, four of us headed over to watch C-sections (and hopefully make it back in time for our 1:30 flight).

In Seti Zonal Hospital, two days of the week are dedicated to OB Gyn operations. All scheduled C-sections are performed on either Tuesdays or Thursdays, with women from far distances being referred to the hospitals to have C-sections on those days. The day typically starts at 10 a.m., with at least 2 C-sections being done simultaneously. There are only three doctors on staff who perform all the procedures, collectively up to 150 per month.

Since all four of us would be unable to watch C-sections at once, Ramji and I visited the labour room, while Kendall and Teja saw the C-section. Overall, we were all very impressed with the efficiency of the surgeons and the staff. In the labour room, there were six women waiting to give birth, each requiring preoperative care. A group of SBAs and students quickly moved from one to another, assembly line style -placing IV lines, giving medications, and measuring fetal and maternal heart rates. We heard from Kendall and Teja that the efficiency of the surgery was just as impressive, from the speed at which the incision was made to the final layer of sutures.

After we put on blue sterile gowns and cloth caps and masks, Ramji and I made our way into the operation theater. The surgeon was closing after a C-section, and explained the different layers of tissue that needed to be sutured separately. Though the turn-around time for each operation in Dhangadhi was very short, the technique for the entire procedure was almost identical to techniques used in the United States.

After staying in the operating theater until the last possible second and convincing Ramji that we had to leave for our flight we rushed in tuk tuks to the airport. Luckily, we caught our flight just in time and made it back to Kathmandu. That night, we had dinner with Sandhya and her family at her husband’s Chinese restaurant. We ate more delicious food than we could imagine and had great conversations. 

Friday morning, we had a chance to visit civil hospital in Kathmandu and tour the facilities with the matron. The most interesting part of the experience was comparing Civil Hospital to Seti Zonal Hospital. In Dhangadhi, we saw nurses handling very complicated cases, including suturing tears, performing vacuum deliveries, and basically all complications other than c sections. The nursing staff had to be incredibly experienced and well-practiced in order to meet the staffing and medical demands of Dhangadhi and the surrounding regions. The facilities at Civil Hospital were managed very well, staffed by very knowledgeable nurses. In relation to Seti Zonal Hospital, Civil Hospital, was staffed by many more doctors who could perform the more complicated deliveries.

From the hospital, we went to Jhpiego to meet Dr. Kusum and discuss our findings from our time in Dhangadhi. Our 45 minute scheduled time turned into a 2 hour conversation discussing each procedure and model we saw on our field visit and getting valuable feedback.  We're so grateful to have had a chance to meet with Dr. Kusum, Chandra Rai, and Sandhya and understand their perspective on the training needs we identified.

Since Teja had missed all our sightseeing last weekend, he replaced Ramji (who went home for the weekend) as our Hindi translator as we went around the city after the meeting. We made it back to the Pashupatinath temple, wandered around admiring the beautiful architecture, and watched a cremation on the Bagmati River.  We climbed the stairs behind the temple and wove our way through monkeys and cows until we reached the top of the hill. The view of the city from there was to die for.

From the temple, we made our way to Thamel for some quick last-minute shopping and dinner with Jenny. After wandering around for almost an hour, by some random chance, we ended up in the same store to buy pants for the third time that week. The store owner even asked us why Ramji didn’t come with us this time.

The next morning, after somehow managing to get each of our suitcases to weigh less than 20 kgs (which was actually a much bigger struggle than we thought it would be), we headed off to the airport to fly to Delhi. We had a fantastic time in Nepal, learned a ton in Dhangadhi, and had some great adventures we won’t forget! Team DoBA sends lots of love and thanks to everyone at Jhpiego Nepal and Seti Zonal Hospital who welcomed us for the week and made our time so memorable on such short notice!