Leave Approved

When we first arrived in Gundu, no-one seemed to know who we were and why we were there apart from our small welcoming party. Word of mouth works quickly there, though – a reasonably sized crowd had assembled within ten minutes of a few villagers getting wind of the doctor at the health post. They have never had a doctor here before, so everyone seemed to come in with a lifetime of health complaints.

I saw 181 patients in ten days. It may not seem like a huge number, but it took  time for the history to be translated from Nepali to English and then advice and instructions from English to Nepali again! Plus each patient had an average of four health complaints. The opening line was usually something like “She has back pain, dizziness, a vision problem and burning pain in the stomach”.

My very first patient had some unusual tingling in the back of the right arm (which I soon discovered was an extremely common complaint in Gundu) and, trying to be a good doctor, I tried to examine his arm thoroughly, causing a small riot in the waiting room because I was taking far too long! (Villagers burst in, demanding to know when they would be seen, as they had to return to the fields to work!)

So, I had to proceed with great speed and efficiency, but without abandoning good medicine. The expectations of the villagers are for a quick fix - “a pill for every ill” would be an accurate description. My ideals of preventive medicine and health advice were torn to shreds – gentle advice on stopping smoking simply fell on deaf ears. Patients wanted to walk out the door with magic pills in their hands, and these pills better work straight away! (A few came back after two days of being on iron tablets, wanting to know why they still felt tired). At times I did feel like a medical vending machine, but I think my greatest impact (hopefully) were the times when I was assertive in giving health advice – prescribing exercise for overweight diabetics, for example!

The most common ailments were a “burning pain in the heart” (meaning the stomach region), most probably caused by the Nepali habit of eating a spicy meal twice a day, with twelve hours in between meals, and going to bed soon after dinner. The first medicines to run out was Omeprazole which treats gastritis and similar problems! Respiratory problems were also common, most probably related to the high rates of smoking here. But the most common complaint of all must have been “back pain and knee pain”, which is not surprising when you know how hard the women work here. Almost every patient walked out with a strip of Paracetamol tablets for this. Diarrhoea wasn’t as common as I though it would be, and I didn’t see much that was exotic – it was usually run-of-the-mill stuff that I might have seen in Melbourne in a normal GP practice (but with different causes!) Most patients had had their problem for many years, and many had never consulted a doctor about them, although a proportion of them could afford seeing doctors (or received free treatment at the nearby Army Hospital, if they were eligible) and came in for a second opinion, or because of curiosity, or because they heard that free medication was available. Sometimes I felt as though they were hoping for a magic new cure from Australia – they were usually sent away disappointed!