Ultrasound anaesthesia course starts at Kirtipur hospital

James Paget University Hospital's General Surgeon Dr Kamal Aryal and Dr Andreas Brodbeck, Consultant in Anaesthesia, Intensive Care and Pain Medicine, launched the Health Exchange Nepal comprehensive ultrasound regional anaesthesia course jointly with PHECT hospital Kirtipur on Tuesday 15 November. 

Overview to follow.

Supporting the Parents Care Home in Nepal

Health Exchange Nepal is delighted to approve a fund to support the operation and management of Parents Care Home in Kathmandu.

The Parents Care Home is a non-governmental organisation that has provided a home for 10-15 vulnerable elderly and disabled people for the last five years.

The fund of £2500.00 will be used for day to day operation of the care home including the provision of food, clothes, health care and other general activities.

To find out more about Parents Care Home, visit the Facebook page. 

Anaesthesia Pain and Critical Care Medicine (CURRENT 2016) Refresher Course in Kathmandu

Health Exchange Nepal (UK) organised a refresher course in Tribhuvan University Teaching Hospital (TUTH) on 26 August 2016 in Kathmandu, Nepal.

Dr Shambhu Acharya took the responsibility of forming an international faculty and the rest of the faculty members were from TUTH for this meeting. It was an opportunity as well as a challenge to find the experts in the relevant fields who were willing to go to Nepal during a holiday season on a voluntary basis.

Three consultant anaesthetists from Aintree (Dr Shambhu Acharya, Dr Raj Nagaraja and Dr Shetty) and Dr Jagadish Agrawal from Wirral Hospitals and one paediatrician Dr Sujay from United Arab Emirates kindly agreed to be the faculty members to go to Nepal.

A range of topics were included in the course. The international faculty covered the following topics:

  • Anaphylaxis: Dr Shambhu Acharya
  • Complications of regional anaesthesia: Dr Ravish Shetty
  • Pregnancy induced hypertension: Dr Jagadish Agrawal
  • Neonatal resuscitation: Dr N Sujay
  • Critical appraisal of scientific papers: Dr Raj Nagaraja
  • Fluid management in trauma patients: Dr Raj Nagaraja

There were many challenges for our faculty as Nepal lacks many resources and some drugs are not available there and some alternatives were to be found that could be used in Nepal. 

Photo (Left to Right):
Dr Gentle Shrestha, Dr Diptesh Aryal (Co-ordinator for the course in Nepal), Dr Nagaraja, Prof Bimal Kumar Sinha (Acting Dean, Institute of Medicine), Dr Acharya, Prof Marhatta (HoD of Anaesthesia, TUTH), Dr Anil Shrestha

Sandesh and Bhagteshwar's ABC Challenge - Days Three & Four

Day 3 - Chhomrong to Dovan

Day 3 started decidedly colder than the other days. The altitude meant that the ambient temperature was colder. This day was easily the hardest of the trek starting with a decent of approximately 300m then a big ascent of approximately 400m towards Sinwa followed by a slow ascent to Dovan.

We faced a warm morning, a very hot midday, a rainy afternoon and heavy hail when we finally arrived at Dovan 8 hours after leaving Chomrong. I was really feeling the heavy pack at this point and made the difficult decision to leave a few things at Dovan before continuing up towards ABC.

I had found days 2 and 3 so difficult that I was concerned I would not be able to make ABC as the air gets thinner. Leaving clothes, some spare batteries and my sleeping bag, I managed to lighten my bag by about 3kg and decided that I would use the blankets provided by the lodges further up the trail.

Although our net gain for the day was less than 500m, due to the many ups and downs my Garmin watch estimated that he climbed about 1150m overall, higher than the height of Snowdon.

Distance: 12.7km, Net ascent: 430m

Day 4 - Chhomrong to MBC

Since I was small I had known the name of Machapuchre, meaning fish tail. However I never full understood why it was referred to as a fish tail as every photo I had seen showed the mountain from Pokhara where it always looked like a triangle or pyramid.

However Day 4 started with a view of Machapuchre that made me finally understand where it got its name. While the net ascent for the day was a lot more than for the previous day the lighter bag and steady ascent rather than big ascents and decents from the previous days meant the day went a lot smoother.

We went through a hazardous avalanche area. We realised the danger of this not just from the avalanche sign but also by our guide, Kumar’s change in demeanor, he was visibly more tense than he had been on the previous days. We also went past an area where we saw lots of small rock piles. Kumar told us that these were for good luck and added to by travellers on their way up to ABC. Only on the way back 2 days later when we passed the same spot did Kumar tell us that these were remembrance shrines to those that had lost their lives to avalanches in this area!

As we neared Machapuchre Base Camp (MBC) we encountered snow for the first time. The weather closed in as we arrived in MBC and we managed to get in and warm just before a storm that brought with it winds and snow.

Distance: 12.4 km, Net ascent: 1100m


Sandesh and Bhagteshwar take on the ABC Challenge - Pre Trek

On 12 March 2016, HExN committee member Sandesh Acharya and his friend Bhagteshwar reached Annapurna Base Camp (4130m), raising a fantastic amount of money for the charity in the process.

Not only did they take on the challenge of carrying the backpack (about 13-15 kg) themselves without a porter, but they also completed the trek in nine days; a feat normally achieved in twelve days with a porter!

Sandesh documented his progress every day of the trek and we are delighted that he has shared his experiences with us in this series of inspiring blog posts.

And so the story begins...

Following four months of training at various peaks in the UK, it was finally time to embark on the trek to Annapurna Base Camp.

Prior to leaving the UK, I did a final check of my kit and decided to weigh what I would be carrying for nine days of trekking in the Himalayas. The total weight of 16.2 kg (18.2 kg including two litres of water) was a few kilos more than what I was hoping to take (and what I had trained with), but I decided that everything was absolutely necessary. Being a medic, I probably did take more first aid and medications than I needed!

After arriving in Kathmandu with my friend Bhagteshwar Singh at 6pm, we met our guide Kumar, and left for Pokhara the following morning at 5am. Needless to say, our body clocks were a bit frazzled. After a seven hour bus ride, we arrived in Pokhara and opted for an early night… but only after a final pre trek meal of momo.

Hoorah for Harry in the Himalayas

It takes a lot for TV crews and photographer to return to a past disaster once it has slipped from the front pages.

       IMAGE BY: European Pressphoto Agency

So with the anniversary of the devastating earthquakes, which killed thousands of people and changed many more lives forever with long-term injuries approaching, it was perfect timing for the UK’s Prince Harry to undertake an awareness raising trip to the country. His visit was to both mark 200 years of formal diplomatic relations between the UK and Nepal, and also to highlight the progress in recovering from the earthquakes.

Like many of our HExN teams, Prince Harry spent time in both Kathmandu and remote villages, reminding millions of people internationally about how widespread the impact was.

Nepali hospitality shines through

The Kensington Palace media team have an international reputation, and the photo-opportunities were superb, from Prince Harry sleeping in local houses, to being named honorary head of a village, daubed in red paint as part of celebrations for Holi and playing volleyball, a sport very popular in village areas where clear, level ground is often at a premium.

The hospitality, generosity and remarkable fortitude of Nepal’s people shone through in every photo, and clearly impacted on the prince, who had served alongside Gurkhas when he was deployed in Afghanistan.

Prince Harry’s message, covered by UK and international media, was clear:

“I pay my respects to those who perished and hope to do what I can to shine a spotlight on the resilience of the Nepali people."

Tourism is key to Nepal's recovery

However, Prince Harry’s trip was not purely about reflecting the impact of the earthquakes, and the country’s work to recover.

Patan Durbar Square after the earthquakes

He sent out a strong message about the value and role of tourism, visiting artisans and apprentices working to restore the royal palace at Patan Durbar Square, which was heavily damaged by the quake. The prince held talks with Nepal's first female president, Bidya Devi Bhandari, when both recovery and tourism were on the agenda.

Talking to tourists during one of his walkabouts, Prince Harry said to one family:

“Well done, it's so, so important to encourage people to come back. Why wouldn't you come back here? It's beautiful."

The Prince’s words have a resonance to all of us who are privileged to have visited Nepal. Like Prince Harry, the country has found a place in our hearts. And we are not alone.

The UK has been one of the largest bilateral donors to Nepal, with a total commitment of £70 million in earthquake relief, according to figures released by the Department for International Development.

The warmth which the British hold for Nepal was seen by the amazing response to HExN’s own #NoSocksRocks appeal, which raised £100,000 against an initial target of just £10,000.

The prince’s visit painted a picture of a country recovering from a natural disaster of almost unimaginable scale. With trekking once again beginning to pick up in Nepal and work on the rebuilding of the historic buildings continuing, the role which visitors can play in assisting the nation to progress was perfectly illustrated by this very special Royal visit.

Guest Blog: Dr Andreas Brodbeck

Dr Andreas Brodbeck, Consultant in Anaesthesia, Intensive Care and Pain Medicine at James Paget University Hospital visited Nepal twice in 2015. He shares his story:

"One week after the April 2015 earthquake, a team of four doctors from James Paget University Hospital arrived in Kathmandu. We had been sent to provide medical help to Kirtipur Hospital which had dedicated its theatres for the overwhelming need for orthopaedic surgery.

Not knowing exactly where and how our team would be working, I had the opportunity to take an ultrasound (US) machine to perform regional nerve blocks, which proved to be a very helpful technique for the patients with upper and lower limb injuries.

The hospital’s anaesthetic team - already well trained in regional anaesthesia – learned how to work the ultrasound very quickly. Sadly I had to return back to the UK with the ultrasound scanner, but we agreed that I should return to provide a US guided regional anaesthesia workshop later in the year.

One of my Nepalese colleagues at James Paget University Hospital, Dr Kamal Aryal, had run a successful laparoscopic surgery course in Nepal for many years, supported by Health Exchange Nepal (HExN), and this organisation was quickly prepared to support my ultrasound workshop.  HExN even funded a new ultrasound machine which we were able to present to the Kirtipur Hospital anaesthetic team when I returned to run the workshop in December 2015.

The one day workshop was successful and the feedback from attendees was excellent. We want to consider a two-day course in the future that would include clinical work and exposure in theatres with patients."