A Typical day in Nepal

Another patient we saw who needed surgery also had a very large thyroid gland that had never been investigated. She had traveled a long way to get to us. Our doctors wanted to do some thyroid function tests before they operated. Seems a simple thing to do – certainly wouldn’t cause me any stress at home!

But this is Nepal! So we started on Sunday by taking her to the pathology lab and requesting a TSH. We were told that the blood would be taken to Kathmandu on Monday and we should have the results in a couple of days. We postponed her surgery accordingly. All good so far …

Monday came and went in a blur. On Tuesday we were asked to add an urgent total abdominal hysterectomy to our already over full list so I thought I would see how we were traveling with the TSH result to see where we could squeeze the extra case in. After all, it had been 2 days since the blood was collected. I went to the laboratory only to be told that we couldn’t have the result because the boss was on leave and only he could phone the laboratory in Kathmandu for the results. Besides that, the results can take up to 3 weeks! After I took a few big breaths I said that if no one in the laboratory was able to phone for the results I would ask one of the hospital administrators to phone. Soon after that I was talking to the director of nursing asking for her help when one of the laboratory technicians came over and said that they did not have a blood sample for that patient. Few more big breaths… After showing them all the documentation that the test had been requested and paid for it was decided to collect the blood again and I was assured that the result would be available later in the day. All good…

Mid afternoon the surgeons thought they might do her operation as soon as the blood result was available. We contacted the lab for the result – and the blood was still sitting in the refrigerator because the courier had come earlier in the day before the blood had been collected (again). Few more big breaths … Back to the operating theatre I went to seek advice which was no surgery without the results. I went out to tell the patient that her surgery had been cancelled to be met by a laboratory technician who said he would try to get the results by 10am Wednedsay. Back to theatre again – big round table discussion between surgeons and anaesthetists. Final decision – no surgery as too risky without a diagnosis for the cause of her large thyroid gland. The risks of an her airway obstructing when sedated were to high.

Sadly, I had to return and break the news to the patient that her surgery was cancelled and we referred her to the hospital physician for follow up of her thyroid problem. She was very gracious and appreciative of our attempts to help her. Sure, just a typical day in Nepal really, but just highlights how good we have it at home!!!