IN THE SPOTLIGHT
AN ACG GOVERNOR’S
OUTREACH TO NEPAL
By James C. Reynolds, MD, FACG, Professor of Clinical Medicine,
University of Pennsylvania and ACG Governor, Eastern Pennsylvania
Imagine waking at dawn on a brisk,
windswept mountainous hillside to the
smell of freshly brewed coffee and the chatter
of cooks preparing your breakfast. As you
step out further, you see one of the most
amazing sites on our planet: clear blue skies
surrounding the awesome, snow-capped
mountains of the Himalayas. At more than
29,000 feet, strong winds are constantly
blowing the snow, giving the impression of
white flags flying from the peaks of three or
four of the tallest mountains on earth. The
bellows of a water buffalo pulling his wooden
plow through the mud in a nearby rice paddy
interrupts this awe-inspiring moment. A
farmer and his family are planting rice on
one of thousands of terraces that cover every
hillside. He skillfully guides the massive
creature as he has year after year, carefully
avoiding roots of the few trees that hold the
hillside together. In the next terrace stands a
peach tree bursting with pink blossoms. In the
distance, bright yellow flowers of a new crop
of mustard greens cover the hill. Suddenly,
the farmer pulls the buffalo to an abrupt stop
and reaches into his traditional Nepali skirtpants that are typical of this region, and pulls
out a cell phone. It’s a poignant reminder of
how rapidly this culture is changing.
I turn to attend to efforts to maintain hygiene
by heading down a path to find water, only
to be greeted by the cutest little girl you have
ever seen. She stops her skillful hopping
down the treacherous hill, bouncing up
to the side of the path as she does daily,
being careful to avoid falling into the mud
of the flooded rice patties. Her journey’s
interruption is just long enough to ponder the
strange white man in her village and to say a
hasty “Namaste” before she leaps down and
skips off to get ready for school.
My short walk gives me other opportunities
to share the heart-filled traditional Namaste
greeting with each of the Nepali people I
encounter. I soon reach my destination—an
16 ACG Update | June/July 2016
incredibly beautiful, crystal clear river
rushing down the mountainside. To my
right, a young boy fishes a throw net to
catch his family’s dinner, and perhaps
enough to sell at the local market. Up
river, younger boys take a few minutes
before school to jump in and out of the
river, ‘au naturel,’ as if they don’t have a
care in the world.
Less than an hour later, I will have
inhaled the delicious breakfast
prepared for my co-workers and me
before heading to the local school. Its
mud-floored rooms have become the
medical clinics, the ultrasound suite,
a physical therapist training area and
a free pharmacy. This is the site of the
most excitement this village has seen
in years, as four to five hundred of its
residents begin to stream down from
the mountains to get free care. If they
are one of the fortunate ones, a lab test
will become a treasure, or if they are
pregnant, they will leave with memories of
the “video ultrasound” of their next family
member.
We have no running water, but many bottles
of alcohol disinfectant are available for use
between patients. The patients are seen by
several physician-nurse teams who provide a
variety of care: internal medicine, pediatrics,
orthopedics, obstetric and gynecology, or
physical therapy for their aches or injuries.
The days are long and the work hard. But
breaks include intermittent opportunities
to step into the school playground and peer
up to the majestic peaks long enough to
remember that I am there at the pleasure of
the Creator of these incredible vistas. That
makes it all very much worth whatever it
takes to be a blessing to them.
It’s an experience I have seen repeated more
than 40 times in six trips to Nepal over the
past 11 years. Many thousands of patients
have been treated and blessed; mostly with
gi.org
IN THE SPOTLIGHT
doses of multivitamins, acetaminophen and
antihelminths. While I don’t get to use my
scopes, the most common diagnoses I see
are gastrointestinal disorders. Many patients
have infestations by parasites and dyspeptic
symptoms that come from the stress of even
the most simple lifestyle. And of course
there are no malpractice concerns, no bills to
submit, no EMR, and no ‘meaningful use’ to
document. What more could you ask for?
Unfortunately, the truth is, that is only half
of the story. My sleeping arrangements
are a mat and sleeping bag on the concrete
floor of a church my colleagues had built.
The toilet accommodation is a recently
constructed outhouse with a hole in the
ground (squatty potty style). Breakfast is
the same as every other meal we eat while
in the villages—white rice and dhal.
Many of the people we treat have rarely, if
ever, benefited from substantive medical
care. Two-thirds suffer from avoidable
disorders that often begin with malnutrition
and the use of unclean water. Even the most
beautiful rivers are polluted with coliforms
and breed malaria carrying mosquitoes
in monsoon season. Few have received
information that could improve prenatal
care, nutrition and cancer rates. All too
many suffer from traumatic injuries that
could have been easily repaired if attended
to more promptly. Others have advanced
tuberculosis that goes untreated. Many
feel trapped by a caste system that persists
despite being outlawed by the government.
Devastating earthquakes that ravaged
Katmandu in April of 2015 had their
epicenter in the Lamjung District,
which is where we most commonly
work. Unfortunately, there is little sign
of governmental aid to the victims of
the earthquakes. In fact, the tons of
supplies brought in by the organization
I work with, Pennsylvania United
Medical Association, was the major
source of support for many villages
in Lamjung. One year after this
devastating event, there have been few
improvements despite the $4 billion in
aid given to the government by people
around the world.
Photos courtesy of David Alexander by permission.
gi.org
So as long as their needs persist,
colleagues of mine will be returning every
two to three months until I can do my
rotation again. Between visitors from the
States, the indigenous Clinical Medical
Assistants we employ will provide basic
care and medications.
“While I don’t get to use
my scopes, the most
common diagnoses I see are
gastrointestinal disorders.
Many patients have
infestations by parasites and
dyspeptic symptoms that
come from the stress of even
the most simple lifestyle.”
For incredible photographs and a picture of a
baby we delivered during this latest trip, go
to our website: www.PUMA2000.org. There
are many places like this that need the help
of those who are able. Many members of the
ACG give up their time and skills to do so all
around the world. I encourage you to think
about getting involved. It just might help you
remember the passions and desires that led
you to go to medical school in the first place.
AC G
ACG RESOURCES on
International Physician Volunteerism
The College developed a Resource Guide
to help its members who have an interest
in volunteering their skill and training to
underserved areas of the world. In this online
guide, you will find links to humanitarian and
faith-based groups, resources to help you in
preparing to volunteer internationally, and
inspiring stories from colleagues who have
participated in medical missions abroad.
LEARN AND SHARE
Want to learn more,
or have a story to share?
Visit gi.org/volunteerism
June/July 2016 | ACG Update 17