Pharmacy and Hospital Adventures

19 10 2010

I’m getting to know Kathmandu hospitals very well because my mother-in-law has been in and out of them frequently in the last couple months since I’ve been here. I don’t mean to paint a negative picture, but let me just explain a couple aspects that are strange in comparison to American hospitals from my own experience.

Even in American hospitals, and especially in emergency rooms, it can be difficult to maintain complete privacy (those open-backed hospital gowns are a prime example) but people try, or at least I hope they try. Here, privacy is a different matter. We took my mother-in-law (“sasu” in Nepali) to the emergency room in the middle of the night recently. After she was stabilized, a young man was brought in by his family. Once the doctor finished examining him, the doctor chuckled and began telling my husband Suresh and I how this young man and our mother were admitted for the same problem but from different causes – and then he proceeded to tell us all about the other guy’s causes and symptoms. A similar incident occurred the last time she was admitted. We arrived in time to see the head doctor during his rounds. He explained sasu’s condition, very loudly, while approximately 10 people formed an eavesdropping huddle around us.

There are private hospital rooms but they’re more expensive and get snapped up quickly. Consequently, you’re forced to share a room with at least 3 other patients and sometimes, if you get stuck in the general ward, you might have 20 other patients beside you.

But the privacy thing isn’t as unfortunate (in my opinion) as the fact that patients are expected to have someone besides hospital staff attending them nearly 24 hours each day. And let me just say that this is strange from my perspective as an American with a background where the family unit is defined as immediate family (i.e. parent(s) and any offspring). The round-the-clock expectation works in Nepali society because the family unit includes extended family and unrelated people who are like family. In the United States, if the nurses or doctors think the patient needs a saline drip, they’ll bring the saline, hook it up and add the cost to the final bill. In Nepal, if the doctor or nurse decides that the patient needs saline, they’ll tell the family member or attendant and that person must go to the pharmacy next door and buy the saline before it can be administered. If the patient needs a shot, the family even has to buy the syringes/needles first.  The hospital staff gets really mad at the family if there’s no one there and they can actually refuse to admit a patient if no one is available to stay overnight and throughout the day. What do people do if they’re truly alone in the world? I have no idea. Now you understand why there were 10 people eavesdropping on our conversation with the doctor, because there were all these non-patients milling about and sleeping on room cots. This doesn’t make for a sterile environment, and I don’t see how patients can get any rest because most of the extended family and friends are talking on their cell phones the whole time or idly chatting with one another.

And maybe I’m sick for the second time in the last 2 weeks from being in these unsterile environments, but it’s abnormal to get a cold twice in a row that includes dizziness. I decided I had a minor sinus infection and, rather than seek the above hospital’s help (you can understand why), I took the self-diagnosis route and used the internet. It’s possible here in Nepal to buy just about anything without a prescription at any pharmacy, and that could be why so many people here suffer from liver and kidney disease. I haven’t tested the drug purchasing limits yet except for buying antibiotics to keep my late cat alive a little longer (may “Slipper” rest in peace). On the internet, I Googled “sinusitis remedies”, found a list of possible medicines to take, and sent Suresh to the above mentioned hospital pharmacy. He returned with an antibiotic and a nose spray to clear my congestion. But the nose spray chemical was unfamiliar so I read the instructions and used the trusty internet again to double-check it. Turns out, the nose spray is for treating chronic bed-wetting and prevents you from accidentally urinating at night! SO glad I looked that one up first, but we had a good laugh over it. What’s not funny is that I was able to quickly answer my drug questions but what about a Nepali citizen without home internet. I could easily read the English instructions, but what would a Nepali who doesn’t read English do?

In future, maybe I won’t complain so much about the American healthcare system. But I probably will anyway.

So that I’m not being completely negative or one-sided, let me just say that Nepali doctors and nurses, in my observation, don’t have to deal with the same sense of entitlement that some American patients (and Americans in general) angrily express. Maybe that will change as Nepal’s middle-class steadily grows. Given the available resources, the doctors and nurses do their jobs with humor and hope. The emergency room doctor in my first anecdote amused himself with the similarities between my sasu’s condition and that of the young man in the next bed. Perhaps he was trying to make both of them laugh at their predicaments. (Insert cliché here about laughter being the best medicine).

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11 responses

19 11 2010
Ben Kromminga

Hello Kathryn!

You mentioned that family members of some kind are always with the patient. In American hospitals there are lots of waiting rooms and lounge areas. Since there are so many family members present are there any designated areas for them so they don’t have to be constantly crammed in with the patients like what we have here?

18 11 2010
Lindsey

Kathryn,

As a nursing student, it was very interesting to see a new perspective of what it is like in a hospital!! Many students and nurses travel for internships or volunteer services. Do you think Nepal would be a good place for a nurse to visit to gain experience and insight from another culture?

Lindsey

18 11 2010
Kathryn Hagy

Hi Lindsey,

Nepal would be a good place, as would many places. There are many organizations in place already that you can volunteer with for 2+ weeks. When I was planning a travel course to Nepal a few years ago, I checked into having nursing students volunteer and it’s difficult as an individual without organizational affiliation. But as I said, there are many volunteer organizations and non-governmental organizations (NGOs) you can hook up with. Simply Googling “volunteer travel Nepal” will give you some results.

9 11 2010
Mallory Singbeil

I find this blog very interesting. I am a Nursing major at MMU and have made rounds a multiple hospitals in the area. The one thing I have noticed though is that privacy is consistence. I believe that American hospitals do a great job at keeping patients information confidential. Another thing i found interesting was how Nepal has to go out and purchase there medicine before the doctors can administers them. I guess i have never thought of drugs in the hospital that way but it does make sense. This proves that the family will fully pay the bill and the hospital wont loss money that way. Is the hospital your going to the only one in the area? If not are all hospitals in Nepal of the above description? Also can yo purchase whatever kind of medicine/drugs you want even without a doctors note?

9 11 2010
Kathryn Hagy

Hi Mallory,

Your observations are astute. Yes, the system does guarantee that people pay and this is probably necessary without an insurance system. There are many hospitals in Kathmandu alone. Some are public and some private. I can’t speak for all the hospitals, but in asking around, it seems that the payment system I mentioned is fairly typical. Payment s expected in full before the patient can be released. And it is possible to buy medicines/drugs (including narcotics) without a prescription. What keeps people from abusing this system more is the higher cost of drugs compared to other addictive substances.

26 10 2010
Amanda Walker

Kathryn,
WOW!! That is truly crazy, I work at St. Luke’s hospital in the Lab department and sometimes I have to draw blood in the Emergency Rooms. The situation that you described in the hospital where you had to take your mother-in-law would never do at any American hospital. I guess you and everyone else is right in saying that we shouldnt complain about what we have, and that we need to realize that no matter how bad things are, there are always people who would love the conditions that we think are so bad.
I am sorry that your mother-in-law had to go to the hospital and that you had a sinus infection!! Hope you both get well soon!

24 10 2010
william allen

The American medical system is hugely expensive for many different reasons. Because the family is forced to buy everything and the hospital can refuse treatment for various reasons, I would think the price of treatment may also drop, making stays at hospitals expensive but not prohibitally, like it is in the United States. Is this true?

27 10 2010
Kathryn Hagy

Hi William,

A night in the hospital where my mother-in-law stays is anywhere from $9-20/night but a “good” middle-class salary in Nepal is $100/month, so that gives you some idea of the cost comparisons. There is no insurance system in Nepal so that gives you some idea. However, because there isn’t an insurance system, the hospitals in Nepal haven’t reverted to the same cost-saving outpatient treatment system, so it is possible to stay for longer periods depending on patient’s health and family decisions. The type of ailment my mother-in-law suffers from would be easily treated at a local clinic (where medical tests were available) if she was in America.

20 10 2010
Michelle Fiester

Kathryn,
I have to say, I was shocked at reading your blog. My major is Health Services Administration and I just finished my internship at Mercy Hospital in Cedar Rapids. Americans do completely take for granted the healthcare system we have and I am right there complaining about it, too. In America, there is no way most people could have family in the hospital constantly. And you are so right, how do they keep things sterile? I feel for your mother in law and anyone that has to be in the hospital for an extended amount of time.
Regarding not needing prescriptions, does that apply for narcotics, too? Like pain medication? If so, that would be sad because I am sure many people would be addicted to them.

20 10 2010
Kathryn Hagy

Hi Michelle,

Sam pharmacy deal applies to narcotics, too. Although I’m sure there is abuse of this system, the higher costs of pharmaceuticals (compared to alcohol) is probably what keeps most people from addiction. But, that’s just my educated guess and not backed up by any sort of research or proof.

20 10 2010
Ndage

This is not different from where I am from, it’s the same problem (patients buy meds with no prescriptions, hospitals are packed with limited number of docters and nurses, no adequate treatement…). While americans are struggling with healthcare reform, most people around the world (in third countries) are desperate for medical care. Well, i guess you should not complain about American healthcare system, it still the best 🙂

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