NICU in Manipal and Slum Outreach Clinic

I had a shift today in the neonatal ICU in Manipal. There are 22 beds, which currently are all full. Diagnoses include: preterm birth, low birth weight, neonatal jaundice, neonatal sepsis, respiratory distress syndrome, and perinatal aspiration. They use UV lights, IVs w microdrip tubing, NG tubes and other similar things as we do in the states. Unlike us, they use re-usable cloth diapers which they machine wash in a washer located in the unit.

One of the pts in the unit was on positive pressure ventilation for respiratory support due to hypoxia, with a primary diagnosis of premature w low birth weight. The non invasive positive pressure vent basically looked like a high flow nasal cannula that was taped to the infant's face. Unfortunately, I don't know many more details of the case and the morning rounds are all in Nepalese which I do not understand. There were only 5 people on the rounding team (attending, 2 residents, 2 interns), and they do not spend much time after rounds on the unit bc it is so freaking hot. Needless to say, there wasn't a good opportunity to ask questions about their procedures/processes. And the nurses were all very busy.

They were more strict on this unit about infection control than any other unit Ive seen yet (haven't been to the OR or OB GYN yet). Every person who enters the unit must change their shoes, remove their white coat, put on a green gown, and wear a face mask. When mothers visit, the nurses take the infants to them in special side rooms so they can breast feed and spend time w them without entering the main unit. I was not allowed to take pictures of the pts on the unit so the only picture I could take was of my friends (4th yr med students from the UK) at the nursing station.

NICU Nursing Station

In the afternoon, I went to a community outreach clinic in the slums with the UK students and a general community doctor from Manipal. There are usually morning and afternoon community outreach clinics that go to various places across the city. This program is not associated with Manipal accept that some of the doctors work at the clinics. These clinics are sponsored by South Korea and are run by a group of Catholic Nuns from Korea. They visit each place once every 15 days and see 5 to 30 patients for general care complaints. Most pts came to get their HTN and diabetes meds refilled, or had complaints of chronic back or joint pain. The Korean government supplements a collection of about 30 meds or so that these clinics are allowed to prescribe. The pts talk to the doctor for free then pay 10-30 Rupees (US 10-30 cents) for a 2 week supply of meds. Several times the doctor will recommend further testing, or tell the patients to record their blood sugars at home, or refer them to a hospital like Manipal; but the pts never go to the hospital or follow the advice usually bc they can't afford it.

There are many slums in the city and several of these, clinics but the doctor was not able to tell us if this program was only in Pokhara or in other cities or if there were other programs for other areas. Their equipment is limited to a BP cuff, a scale, and a first aid box in addition to the pile of nearly expired Korean meds they had out.

View of the slum street

The ally leading to the outreach clinic. Permission given by people in photo. 

Inside the Outreach Clinic. On the right we were gathered around listening to the doctor speak to the pts in Nepalese, and the pts would stop by the pharmacy table on the left on the way out. 

View from the other side of the outreach clinic room.

Korean Sister bandaging a man's foot sore. Permission from pt and Sister.

This is the "pharmacy" table with the Korean meds. The doctor told us that she would write a script as "antifungal" and the pharmacist above would pick from the limited meds since she was familiar with the Korean meds and the physician was not. 

Another random tidbit: Below is a picture of what the money looks like. You cannot exchange Nepalese money outside of the country, bc I think they want the money to stay inside the country. It isn't illegal to take out of the country, you just cannot exchange it. 

Nepalese Rupees. Front of bills on left, back of bills on right.