Download Devin Kato JMC `10 When planning my 4th year elective I had my

Devin Kato
JMC ‘10
When planning my 4th year elective I had my heart set on the Himalayas. I had
heard so many fascinating things about the area and knew that the medical need there was
great. So I started looking into programs on the internet. Although I had not yet decided
between Himalayan Healthcare Inc (http://www.himalayan-healthcare.org/) and
Himalayan Health Exchange (http://www.himalayanhealth.com) I applied for the
Foerderor Grant with details from both programs and my general objectives and plans. I
wouldn’t let the early application deadline discourage you from applying, even if the
specifics aren’t worked out. In the end, I felt that the Himalayan Healthcare Inc
medical/dental trek had a great itinerary and timing during my 4th year and they offered
the opportunity to volunteer for free in Ilam, Nepal. I felt like the balance between
village clinics and a more estabilished hospital would be ideal. The two settings would
provide varied learning opportunities and mentorship and provided a well-rounded
experience in the end. After committing to this program, I found out that it was the same
organization that Drs. Berg and Mangioni had volunteered with in the past and was able
to ask them a few quick questions about their experience. Mostly they confirmed that
was a reputable program and a great opportunity for learning, making a difference and
having an unforgettable life experience.
The program was very helpful in my preparations and was well-organized upon
arrival. They picked us all up from the airport despite varied arrival times and we felt
comforted and welcomed as we started our orientations and welcome dinner/tour. After a
couple of days to shake off the jetlag, see a few sights and orient ourselves to the group
and our mission we set off for our trek.
After a day of driving to the roads end on some windy mountain roads, we set our
first camp high in Langtang National park. We had an incredible trek. Snow-filled peaks
and hail storms held us back one night but we made it past the ridges and passes to
descend into the villages where we worked. We were at 2 villages for 2 clinic days each
and saw over 1000 patients in total. Three dentists did mostly extractions of infected teeth
and oral hygiene seminars. Our four nurses triaged and saw simple patients on their own,
including prescribing over-the-counter medications for GERD etc. The two pediatricians
and two internists and I saw the more complicated cases they passed on. The MDs were
very helpful mentors whenever I needed consultation. I saw an array of cases, usually
independently, often starting with the emergency cases (since I am pursuing Emergency
Medicine) during the morning seminars our group gave to the local health workers. They
were literally basket cases, carried in on family members backs in wicker porters baskets
with leg holes cut into them. Some were true emergencies (sepsis, upper GI bleed, COPD
exacerbation) while others were chronic and even irreversible conditions including poststroke hemiparalysis from up to 6 years back. It was great to be able to help some acute
patients and often hard to break the news to a partially paralyzed patient or advanced
cancer patient who had been holding out hope for years.
It was remarkable what we could do though. The lab tests and medicines available
were impressive and Himalayan Health Care also helps fund referrals through
connections with doctors in Kathmandu, donated funds, revenue from sale of their spiral
foundation crafts and other funding. So it was nice to be able to refer patients with
Devin Kato
JMC ‘10
debilitating cataracts, severe hernias or the cutest tiniest little 2y/o girl named Asmara
(angel in Nepali) who I diagnosed with a congenital heart condition (likely Tetralogy of
Fallot as confirmed by the pediatricians) and know that they would get the definitive
treatment they needed. We also had the benefit of intravenous fluids and even blood type
and cross-match so we were able to transfuse a few patients who were severely anemic.
There were some difficulties during the clinics. Sometimes the locals spoke
neither Nepali nor English and often 2 translators would be necessary to translate through
3 languages. Because of this, history taking could be difficult. The clinics themselves
were also sparse. We had to function with low light levels and in environments that were
hard to keep cleanly. The locals also have very poor understanding of their own health
and counseling was often frustrating. Also, it could be difficult to assess the severity of
some complaints because many patients came to the clinic without active issues. This
was understandable due to their lack of health care options and our visiting foreign
services.
Overall the trek was enjoyable and rewarding. We had a great group. Do to the
sheer size of our party (>100 in all) and the age and language range the 12 of us
foreigners often split into groups during the hiking days. Some of the younger Nepali
staff hung with us too. But there were definitely cohesive times as well around meal
times, swimming at the last camp and fireside dance parties to Nepali drumming and
freestyle lyrics. The agrarian landscapes, rustic culture and dress and especially these
fireside dances really gave the setting an indigenous feel. Many of the women wore large
nasal jewelry and bright but weathered clothing.
It would have been easy to romanticize their simple lives in this majestic setting if
it wasn’t for the reality we lived on the medical trek. We saw first-hand the poor
sanitation conditions and health repercussions of their lifestyle. Many diarrheal diseases,
vitamin deficiencies (A,D,K), chronic pulmonary disease due to indoor fire cooking and
heating and even basic hygiene (lice, scabies, worms) led to infections and illness.
Luckily we were able to serve an organization that is contributing on many levels.
Himalayan health care has projects to support schools, generate income for local women,
build latrines away from water sources and is starting a program to teach local builders to
build efficient stoves that will decrease deforestation and improve ventilation and
pulmonary health. Also, part of the reason that our trekking group was so large is that we
brought all of our own resources (medications, food) and even left some surplus in order
to avoid depleting the resources of the mountain villages. All in all this is an admirable
effort that we are joining here in Nepal and the leading family (Parajulis) has inspired us
and made us all feel at home here. I couldn’t imagine a better all-around organization
with whom to contribute your time and money.
Although others considered serving further time in Ilam, I am the only one who
has made the journey. I then worked in Eastern Nepal at a more established clinic. I
worked with MBBS (Batchelor of Medicine and Surgery) level providers, the equivalent
of 5 years post high school training. This includes 4 years of coursework plus 1 year of
internship. I fit right in and they taught me about tropical disease (filariasis, enteric fever,
Devin Kato
JMC ‘10
hepatitis A&C etc) and I am helped them learn our standards for diseases that we see and
treat commonly in the US. We also completed a rural village outreach clinic in this area
which was similar to the village clinics on the trek. It was a nice opportunity to continue
seeing the most disconnected patients and it was also nice to explore a bit of the tea hill
region of Eastern Nepal.
Everyone was really nice. I lived in the hospital quarters, eating extremely
affordable and delicious (though repetitive) food at the canteen (basically the neighbor’s
house which makes it feel like a homestay) and played ping pong and watched cricket
with the other young workers, read and walked through the village and nearby tea fields
in my free time. The work is good but it really made me appreciate the training and
resources in the states. Hopefully that sentiment and the inspiration from this trip will
help me through the tough residency path ahead. The resources here included translators,
nursing, physicians, labs, blood bank, xray, ambulance, dental/optho techs and other
limited support. There were outpatient clinics most every day and emergency services
were open 24/7. Doctors switch off call and you can see patients with whomever you
want. I often worked most days in the outpatient clinics and saw the emergency patients
some nights. In the mornings we wound round on our inpatients. We had a few small
wards, one for females, one for males and the emergency double ward doubled as an ICU
for our sickest patients. We did not have any surgical services and did not perform any
obstetrics while I was there. There was an ultrasound machine that was difficult to use
despite my limited training in emergency ultrasound. We did not have a CT scanner.
The nearest higher center with surgical services and CT scans etc was over 4 hours away,
so we needed to be as judicious as possible when deciding whom to refer.
Ilam is a very rural area in a misty hilly environment similar to Darjeeling, India.
If you come to this region, I would recommend getting a tourist Visa for India ahead of
time. Although you can get your Nepal visa upon arrival to the country, the Indian visa
needs to be prearranged and takes time and a must be done in Kathmandu while in Nepal.
I had some difficulties with my visas as I stayed longer than my initial 30 day visa and
due to this and my desire to visit India, I had to double back to Kathmandu. This was a
really long trip but again the Parajuli family helped me work out all the details. They
basically created a home away from home for me and were always attentive to my needs.
Nepal and this program were not only great for medical work, but also as a
traveler. I was able to get off the beaten track and see a side of Nepal that tourists often
don’t get to see. We fascinated many of the locals because they never see foreigners in
the mountain routes that we trekked. Some our group went on to see some of the more
touristy destinations in Nepal. Some did the Everest Base Camp Trek to see the mightiest
of the Himalayas. Some went to Pokhara to relax or do yoga retreats near the lake and
the Annapurna region. There are also great river rafting trips in the region. Because Ilam
was so close to India, I looped back through Northern India instead of making my way
back to Kathmandu domestically. As I mentioned, Darjeeling is quite close, and I saw
the Hindu holy city of Varanasi and the Taj Mahal in Agra before making my way back
to Delhi by land and then on to Kathmandu by plane. I did not encounter any problems
Devin Kato
JMC ‘10
with civil unrest in Nepal, but during my stopover back through I was advised not to
wander too much since there was a Maoist strike that day.
Many of my colleagues were able to arrange stopovers en route to Nepal. Some
flew on Cathay Pacific and got to stay in Hong Kong on the way. Others saw India since
flights into and out of Delhi are often an affordable way to get to Kathmandu. You can
get a transit visa (cheaper than the longer tourist visa) to India for 2 weeks if you go this
way. Though I enjoyed India, I think that you should keep in mind that it gets very hot as
summer approaches. I also thought that after working hard in Nepal I was a little
exhausted and looking forward to getting somewhere more relaxed. Though India is
energetic and a cultural standout it is certainly not relaxing. Luckily, I got a free stopover
in Bangkok with my frequent flyer ticket and got in some fun and relaxation in Thailand
and Indonesia before returning home for graduation.
The trip as a whole was quite expensive. I saved money by using frequent flyer
miles for the trip. Ilam was basically free to volunteer and I saved money during those
weeks. The trek is expensive ($2600 or so, over half my total budget for a 2 month trip)
but I felt like it was worth it and that the organization made a lot of impact and made sure
I had an incredible experience. Spending money while in Nepal and Asia in general is
quite cheap though so you can be quite frugal once you are there. Accommodation can
be grungy but safe and very affordable. Bargain where appropriate. Food is generally
fine, but bring some cipro just in case. I didn’t need acetazolamide as altitude sickness is
not an issue at medical trek elevations. Avoid taking too many flights if you are short on
cash because buses and trains are really cheap.
Overall, I had a fantastic trip that was well balanced in many ways. I always felt
supported by the organization. I got along well with the staff and other volunteers. I felt
that my contributions made a definite impact and that the organization was using their
resources well to make a sustainable impact. I met some great people, both Nepalis and
other foreign volunteers. I felt like I had autonomy and mentorship in the medical work,
which helped me both learn and gain confidence in my abilities as I approach residency.
Also, Asia is a great place to travel, have fun and relax after the challenges of medical
school and volunteering and refresh prior to starting residency (or 2nd year).
Nepal was an incredible place to volunteer and travel. The villages are exotic and
the educated people are helpful and friendly. The landscapes are breathtaking. The food
is healthy and tasty. Most importantly I felt that the choice of organizations was perfect.
It can be difficult to find groups that cater to both the needs of volunteers and the local
public as well as Himalayan Healthcare Inc does. I cannot commend them enough or
recommend them high enough for anyone considering health volunteering in the region.
Please feel free to contact me with any questions regarding your volunteering and
travel plans. I would be happy to help and thankful for the opportunity to live vicariously
through your travels. Thank you.
Devin Kato
Devin Kato
JMC ‘10
[email protected]
[email protected]
(714)330-6362