It is now nearing the end of my third week in Nepal and it seems to have gone very fast! I have settled into the pace of life at the clinic and, as well as seeing (the still few!) patients that come to Chisang we have also been visiting places around Bhaunne. Some patients are more memorable than others as, like at home, there are always certain conditions that will be more common than others.
One patient that has particularly stuck in my mind is a 13 day old baby that came in with jaundice. Jaundice is not uncommon in newborns and is normally nothing to worry about. However, it is less common for a baby to present with new onset jaundice at 13 days old.
This may still be a physiological response as babies who are breast fed, which almost all are here, are more likely to develop jaundice. At home this case would probably be referred on for paediatric review, just to be on the safe side. However, in the clinic, we are not able to do this. This is one of the cases where we have to rely on our own clinical judgement but also have to adapt to what resources the clinic has. At home we would probably run more blood tests to rule out more serious causes but, at the clinic, this is not possible.
In cases of jaundice the levels of bilirubin are monitored as they can become high and if the levels become too high then it can damage the baby's brain. This is made more complicated as the units they use for bilirubin here are different to the ones we use at home and therefore we were unsure what level of bilirubin is considered dangerous. The test was run and the results came back showing the bilirubin levels where raised, but Yamina assured us that they were not significantly high. As going to hospital is a very serious decision here that is not taken lightly this baby was not sent on for further testing and the parents were advised to come back and have the bilirubin checked in a few days time.
It is cases like this that highlight the real differences between the two healthcare systems. A trip to the hospital is free and generally easy in England and therefore people are sent there much more freely. We also live in a culture where everyone is scared of being sued and therefore doctors are likely to be more cautious rather than less. As we have been trained in this environment it did make me feel a little uneasy that we were doing nothing for him, especially as this would definitely be a case that I would ask someone more senior about at home. However, I think this is an important part of going on elective, to learn to trust more in your own clinical judgement in a situation that you have to adapt to. You are very much forced to work beyond your comfort zone, even if it isn't 9 to 5 work!
One patient that has particularly stuck in my mind is a 13 day old baby that came in with jaundice. Jaundice is not uncommon in newborns and is normally nothing to worry about. However, it is less common for a baby to present with new onset jaundice at 13 days old.
This may still be a physiological response as babies who are breast fed, which almost all are here, are more likely to develop jaundice. At home this case would probably be referred on for paediatric review, just to be on the safe side. However, in the clinic, we are not able to do this. This is one of the cases where we have to rely on our own clinical judgement but also have to adapt to what resources the clinic has. At home we would probably run more blood tests to rule out more serious causes but, at the clinic, this is not possible.
In cases of jaundice the levels of bilirubin are monitored as they can become high and if the levels become too high then it can damage the baby's brain. This is made more complicated as the units they use for bilirubin here are different to the ones we use at home and therefore we were unsure what level of bilirubin is considered dangerous. The test was run and the results came back showing the bilirubin levels where raised, but Yamina assured us that they were not significantly high. As going to hospital is a very serious decision here that is not taken lightly this baby was not sent on for further testing and the parents were advised to come back and have the bilirubin checked in a few days time.
It is cases like this that highlight the real differences between the two healthcare systems. A trip to the hospital is free and generally easy in England and therefore people are sent there much more freely. We also live in a culture where everyone is scared of being sued and therefore doctors are likely to be more cautious rather than less. As we have been trained in this environment it did make me feel a little uneasy that we were doing nothing for him, especially as this would definitely be a case that I would ask someone more senior about at home. However, I think this is an important part of going on elective, to learn to trust more in your own clinical judgement in a situation that you have to adapt to. You are very much forced to work beyond your comfort zone, even if it isn't 9 to 5 work!
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