After spending some time at the National Institute of Neurological and Allied Sciences in Nepal, I was hooked on humanitarian and relief medicine. Surgery in Nepal is vastly different from the kind of things we do in the UK. Patients often present with advanced disease due to a number of factors, including the costs of healthcare. Patients delay presentation either because they can not afford to see a doctor, they are too far away or they are simply unaware and uneducated about declining health. As a clinician you have the ability to make a huge impact on people’s lives who otherwise would not survive or be burdened by their disease.
For me this was a learning curve. When counselling patients in the UK, doctors make it a priority to educate patients so that they can make an informed decision. This often involves weighing up the risks and benefits. The risks are of course greatly reduced due to the quality of our healthcare system; sterile surgical theatres, preoperative optimisation and highly trained staff. In Nepal, the decision is left entirely up to the clinician. Patients are not deemed able to understand the options before them. Often, even if it is evident efforts will be futile, family members will sell all their possessions to pay for treatment that will inevitably not work.
My time doing surgery in Nepal allowed me to see a part of healthcare I had never before experienced. The people we treated were often desperate, with no alternative to the risky surgical environment we could provide. Despite there being no follow up after procedures, leaving patients at risk of postoperative haemorrhage or infections; those risks normally outweighed the risks of doing nothing.
My ethical decision making was challenged and I was often pushed to tears encountering difficult situations.
You can read more about the experience over at the adventure medic
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