Doing much with less

Nepal – a peaceful, small country lying amidst the Himalayas – was struck by an enormous 7.8-magnitude earthquake on April 25, 2015. Over 8,000 people lost their lives; tens of thousands were injured. The earthquake launched an avalanche on Mt. Everest, killing at least 19, with many more reported missing. The villages were wiped away. The capital, Kathmandu, famous for its brick-and-timber attached houses, was in rubble.

I was born and raised in Nepal, and I earned my medical degree there before I moved to the United States for further studies. I was in Nepal weeks before the earthquake, and it was heart wrenching to later see all those familiar places turned into debris. The first few hours of this news were terrifying, as I struggled to track down my family members from afar. When I learned everyone was safe, I didn’t know if I should be thankful or feel unfortunate that I wasn’t there with them. Within hours, Nepal was all over the news, and the world responded. The next few days were worse, with continuous aftershocks. My family members, along with the rest of Nepal, spent days and nights in open tents, cold and soaked in heavy rains.

Weeks before the earthquake I was there – visiting hospitals, teaching medical students, and analyzing the health care scenario. In Nepal, the family treatment budget is limited, and the physician decides which test/procedure will provide maximum information for management. Health care facilities, sanitation, and hygiene are very poor and are beyond the means of most Nepalese people. Mortality for those under 5 years of age is 51 per 1,000, and the chances of dying while giving birth are 1 in 80.

I revisited “clinical decision making” as obtaining labs and imaging was out of reach, and I realized how many unnecessary medical tests and procedures are done in the United States. I learned how to make a continuous positive airway pressure (CPAP) machine with a bottle of water, a piece of tubing, oxygen, and medical tape. In my 14-day trip, I witnessed purulent fluid being drained from spinal taps, constant seizures that refused to go away in spite of antiseizure medications, and children left to die as the family could not afford to pay for medical treatment.

In the days after the earthquake, I kept in constant touch with my family and friends from the medical community. Nepalese doctors worked endlessly, operating in paddy fields under the open sky with minimal medical supplies. People dug with bare hands to get trapped neighbors out. Time has elapsed since then, but life will not be the same again for these people. The strength and perseverance that the medical community showed was commendable. They showed the world, with so little, so much can be done. If only we here in the United States could embrace this.

Dr. Rajbhandari is a fellow in hospital medicine at Cleveland Clinic Children’s Hospital. Email her at [email protected].

Nepal – a peaceful, small country lying amidst the Himalayas – was struck by an enormous 7.8-magnitude earthquake on April 25, 2015. Over 8,000 people lost their lives; tens of thousands were injured. The earthquake launched an avalanche on Mt. Everest, killing at least 19, with many more reported missing. The villages were wiped away. The capital, Kathmandu, famous for its brick-and-timber attached houses, was in rubble.

I was born and raised in Nepal, and I earned my medical degree there before I moved to the United States for further studies. I was in Nepal weeks before the earthquake, and it was heart wrenching to later see all those familiar places turned into debris. The first few hours of this news were terrifying, as I struggled to track down my family members from afar. When I learned everyone was safe, I didn’t know if I should be thankful or feel unfortunate that I wasn’t there with them. Within hours, Nepal was all over the news, and the world responded. The next few days were worse, with continuous aftershocks. My family members, along with the rest of Nepal, spent days and nights in open tents, cold and soaked in heavy rains.

Weeks before the earthquake I was there – visiting hospitals, teaching medical students, and analyzing the health care scenario. In Nepal, the family treatment budget is limited, and the physician decides which test/procedure will provide maximum information for management. Health care facilities, sanitation, and hygiene are very poor and are beyond the means of most Nepalese people. Mortality for those under 5 years of age is 51 per 1,000, and the chances of dying while giving birth are 1 in 80.

I revisited “clinical decision making” as obtaining labs and imaging was out of reach, and I realized how many unnecessary medical tests and procedures are done in the United States. I learned how to make a continuous positive airway pressure (CPAP) machine with a bottle of water, a piece of tubing, oxygen, and medical tape. In my 14-day trip, I witnessed purulent fluid being drained from spinal taps, constant seizures that refused to go away in spite of antiseizure medications, and children left to die as the family could not afford to pay for medical treatment.

In the days after the earthquake, I kept in constant touch with my family and friends from the medical community. Nepalese doctors worked endlessly, operating in paddy fields under the open sky with minimal medical supplies. People dug with bare hands to get trapped neighbors out. Time has elapsed since then, but life will not be the same again for these people. The strength and perseverance that the medical community showed was commendable. They showed the world, with so little, so much can be done. If only we here in the United States could embrace this.

Dr. Rajbhandari is a fellow in hospital medicine at Cleveland Clinic Children’s Hospital. Email her at [email protected].

Nepal – a peaceful, small country lying amidst the Himalayas – was struck by an enormous 7.8-magnitude earthquake on April 25, 2015. Over 8,000 people lost their lives; tens of thousands were injured. The earthquake launched an avalanche on Mt. Everest, killing at least 19, with many more reported missing. The villages were wiped away. The capital, Kathmandu, famous for its brick-and-timber attached houses, was in rubble.

I was born and raised in Nepal, and I earned my medical degree there before I moved to the United States for further studies. I was in Nepal weeks before the earthquake, and it was heart wrenching to later see all those familiar places turned into debris. The first few hours of this news were terrifying, as I struggled to track down my family members from afar. When I learned everyone was safe, I didn’t know if I should be thankful or feel unfortunate that I wasn’t there with them. Within hours, Nepal was all over the news, and the world responded. The next few days were worse, with continuous aftershocks. My family members, along with the rest of Nepal, spent days and nights in open tents, cold and soaked in heavy rains.

Weeks before the earthquake I was there – visiting hospitals, teaching medical students, and analyzing the health care scenario. In Nepal, the family treatment budget is limited, and the physician decides which test/procedure will provide maximum information for management. Health care facilities, sanitation, and hygiene are very poor and are beyond the means of most Nepalese people. Mortality for those under 5 years of age is 51 per 1,000, and the chances of dying while giving birth are 1 in 80.

I revisited “clinical decision making” as obtaining labs and imaging was out of reach, and I realized how many unnecessary medical tests and procedures are done in the United States. I learned how to make a continuous positive airway pressure (CPAP) machine with a bottle of water, a piece of tubing, oxygen, and medical tape. In my 14-day trip, I witnessed purulent fluid being drained from spinal taps, constant seizures that refused to go away in spite of antiseizure medications, and children left to die as the family could not afford to pay for medical treatment.

In the days after the earthquake, I kept in constant touch with my family and friends from the medical community. Nepalese doctors worked endlessly, operating in paddy fields under the open sky with minimal medical supplies. People dug with bare hands to get trapped neighbors out. Time has elapsed since then, but life will not be the same again for these people. The strength and perseverance that the medical community showed was commendable. They showed the world, with so little, so much can be done. If only we here in the United States could embrace this.

Dr. Rajbhandari is a fellow in hospital medicine at Cleveland Clinic Children’s Hospital. Email her at [email protected].