Fillers A memorable call

A house call in Nepal's Himalayas

BMJ 2004; 328 doi: (Published 01 April 2004) Cite this as: BMJ 2004;328:806
  1. Puncho Gurung, volunteer physician
  1. Himalayan Rescue Association, Nepal

    The young man came into the Himalayan Rescue Association aid post in Manang at midday. He asked me to go and see a man in a nearby village who had been sick since the day before and was unable to move. I stuffed my medical gear into a backpack and followed the man to the horse that he had brought along, and, after a two hour ride, we finally arrived at his village.

    We walked through the narrow alleys to the patient's house, where a cow greeted us on the ground floor, and climbed the wooden staircase to the terrace to find a middle aged man lying still on a mattress. Though in agony, he tried to smile on seeing me. The history of his ailment and subsequent physical examination made me think that he had either acute cholecystitis or liver abscess. He looked pretty sick, so I started treatment with intravenous fluids and antibiotics, followed by pethidine, which made him doze off for a while.

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    He needed an abdominal scan, and the nearest place where it was available was four days' walk away. Helicopter evacuation seemed unfeasible as this is too expensive for most Nepalese. The only viable option was to fly him out from the local seasonal airfield, which was two hours' walk away. After telephone calls to the city, we found out there was a plane flying in tomorrow. This was our best bet. By now it was apparent that my patient needed medical supervision until he could be flown out to the city hospital, and I sent the young man back to the aid post to get extra drug supplies.

    Strong winds started in the evening, and it snowed late into the night. This had stopped by the morning, but the whole valley was now covered with thick fog, and it seemed unlikely that the flight would come in. After a few hours, however, the fog started to clear, so we put the patient in a large basket, his legs dangling from two holes in its side, and started carrying him to the airport. The flight came in when we were halfway along the trail. Two of us rushed ahead to ask the pilots to wait, and the party finally made it just as the pilots, impatient to leave, were preparing to take off. To save a few precious minutes, the sick man was lifted over the perimeter fence of the airfield.

    A few days later, I got the news that my patient had had liver abscess and was recuperating in a hospital in Kathmandu.


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