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).