Through the eyes of an Anaesthetist

It is Day 5 on our mission to alleviate Nepal from its scourge of pelvic prolapse. I find myself puffing up a dusty hill halfway between our hotel in Dhulikeil and the Scheer Memorial Hospital in Banepa. It is 6.45am but already the Nepal countryside is awake and active. Elderly women carrying heavy pails up rocky paths, children tripping down mountain roads in an assortment of school uniforms, men repairing tattered roofs on buildings bent and broken. Everywhere the bleating, barking, yelping, cooing of resident creatures, tame and wild.

I summit the hill and descend to the town. In the streets there is dust and smoke and noise and litter and colour and life. A heaving melee of bicycles, scooters, children playing in ditches, dogs sampling yesterday’s rejected meals, old men pulling food wagons where anything sells. A woman throws her turbid washing water into the streets. A dog runs away. A truck with colourful medallions hoots a jingle as it swerves to avoid a man pushing a cart burdened with fruit. A tailor using a sewing machine with a foot pedal plies his trade oblivious to passers-by. The sweet smell of incense. A temple bell. Everywhere the dust and fumes of a town choking on its own waste.

The welcoming gates of the hospital appear unexpectedly through the haze. The crowd before the registration clerk parts to let me through. In the open courtyard patients and their early visitors mingle and talk in hushed tones. An Orderly mopsthe stone theatre floor with disinfectant. In the theatre annex I meet my first patient: D.S.: an older woman, skin creased and folded like the Himalayan foothills. A lifetime of physical exertion imprinted on her face. Small hands and feet. Average height and weight- 146cms, 41 kg. I am 186cms in my theatre clogs. (picture below: Gulliver in the land of Lilliput). A student nurse is my stand-in interpreter. “Namaste Amah” -my greeting. I learn that the patient is 61 (she looks 80), has had 12 pregnancies, 7 children still living. “What happened to the children who died?” The patient responds that they died from disease. She couldn’t get them to the clinic to immunise them. Does she smoke? No – Gave up 3 years ago. I soon learn that the answer to this question is irrelevant. Passive smoking affects everyone here and cooking is done indoors over open fires. Never been to hospital before; denies diabetes or hypertension (quite prevalent); takes no medication. I don’t ask about herbal remedies. I don’t know enough about them.

We proceed to the tiny theatre. Plaster cracking off walls. An antique voltmeter sits in the corner to regulate the theatre lights. The strong smell ofLysolis overpowering. OurUlco-Campbellanaesthetic machines are vintage Australian, made obsolete by new technology. The ventilators don’t work. An enormous oxygen cylinder dominates the workspace. The pressure valves on the cylinder are broken, a low whistle from the fail-safe valve on the machine our only warning of impending gas failure. I check the batteries in the flashlight- essential backup in a country where electricity fails four or five times a day. My attention turns to the anaesthetic drugs and equipment. I review the syringes and needles we brought with us which are adequate for the simple anaesthetic required: spinal anaesthesia with light sedation. In older patients who have endured a lifetime of hard work spinal anaesthesia can be challenging. Small intervertebral spaces, degenerative spine disease, calcified interspinous ligaments. Variations in technique are required but are ultimately successful. The patients lie quietly during the surgery. I have to ask them frequently whether everything is OK. Stoicism and forbearance is the norm. Acceptance makes life tolerable.

It is only when I get to see my patients the next day that the real person emerges. The surgical ward is filled with relatives bearing small gifts or just good wishes. The patients lie quietly on stretchers stacked six abreast within the whitewashed walls. I recognise my patient from yesterday. A woollen blanket, so large it makes a mockery of her diminutive frame, smothers her. She sits up and offers me a gapped-tooth smile. Presses her hands together and offers a diffident nod of the head. Her lips crease to allow a smile through. “Dunyabad’ (thank -you). Namaste!

I head back to the theatre for a teaching session with the students before my afternoon list. I feel conflicted. On an individual level this is rewarding but the problem is too great, the work immense. What to do, where to start? Are we making a difference? I am reminded of the proverb: ‘Charity sees the need not the cause’. For Mrs D.S. a short visit by a group of inspired volunteers from Australia has changed the world.