At the foot of the Himalayas, among roads bustling with taxis, stray cattle and small motorized rickshaws, stands the building of the National Orthopedic Hospital (NOH). Located in the zone of Joparti within the Kathmandu valley region of Nepal, the hospital is largely staffed by English and Dutch medical school volunteers, and is one of the only facilities to provide charitable orthopedic treatment in all of Nepal.
It was there, in one of the most remote regions of the world, that fourth-year medical student Tran Ly learned firsthand about the reality of medical practice beyond the Western world.
In the midst of a spell of some serious career-based reservations, Ly made the decision to spend five weeks as an assistant at the NOH this summer through a program with Projects Abroad, a New York-based international organization that sends college students on work-experience and volunteer-based projects around the globe.
She saw the program as a once-in-a-lifetime opportunity, and said she would probably never have visited Nepal otherwise.
When she arrived at the hospital, Ly was put in charge of the emergency room. Lugging with her a Western background in medicine, she was overwhelmed, to say the least.
In the Western world, she said, people associate the term "emergency room" with a large twenty-bed unit, sufficiently staffed with physicians trained to treat a variety of cases. In Nepal, things were quite different.
"The ER [at the NOH] was a small room with three beds," she said.
Each week, on average, the emergency room would treat one or two cases of trauma. Ly recalls treating a man who had severed his finger with a saw and had come in without the missing fingertip.
"He had a clean cut to the second phalanx," she said. "I cleaned it, removing any remaining bone chips and damaged tissue, and then I sewed it back up."
Although local anesthetic was sufficient in such a case, Ly described agonizing cases where morphine was clearly needed but not prescribed due to its shortage in supply. She described how in comparison to the States, "where doctors have access to virtually any medical kit ever manufactured", the selection of medical supplies at the hospital was very limited.
Ly said her experience in Nepal touched her on a personal level as well. She recounted an incident when a 10-year-old Nepalese girl came to the hospital with a cut on her cheek.
The physician's attendant had decided it would be appropriate for him to treat the cut with stitches, but Ly was convinced that the wound was far too superficial for such treatment. She was also particularly sensitive to the dreadful possibility of leaving a permanent scar on a young girl's cheek.
When the physician's attendant disregarded Ly's take on the matter and proceeded to treat the crying patient, Ly insisted that he wait while she called the physician, who agreed with her and stopped the potentially damaging treatment. Following the physician's arrival, the lacerate was delicately treated with butterfly sutures.
"It is frustrating to see how if someone is not properly trained, bad decisions can be made," Ly said solemnly. She had witnessed first-hand the importance of education in her profession.
During her time in Nepal, Ly said she learned as much about herself as she did about medicine. Her decision to travel there, she said, came after taking a year off from her studies at Tufts School of Medicine.
Ly had been frustrated by the impersonal and almost cold nature of work as a doctor in the United States, and said she felt disillusioned about what a medical career really entails.
When comparing her perception of being a doctor in the States to her work in Nepal, she noted that the latter definitely involved more direct patient care.
"There is no chart, no paper-work, no billing or insurance responsibility, just a lot more direct care," she said.
In contrast, Ly said that a physician's job in the United States sometimes only extends as far as diagnosing a treatment by scribbling a prescription on a chart, whereas in Nepal, the job covers the entire treatment process.
But while she still believes medicine in the United States involves plenty of red tape, Ly no longer doubts that being a doctor is her calling. She tentatively plans to work at an American hospital upon finishing medical school, but said that in the end, her heart lies in Nepal. After completing her rotations this fall, Ly hopes to be in Nepal by springtime.
