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Report March, April 2013

Dr. Alice Markl, Dr. Michael Kuenstle, Claudia Lama (März, April 2013 in Simikot)


General Remarks


We found the hospital in a good and clean condition. The healthworkers are autoclaving, the NAPO helpers clean the rooms every day, if necessary many times. Urgen, a NAPO helper is responsible for the sheets, blankets and the pillows for the patients. He cleans them by himself, also using the washing machine.


The equipment is working and well maintained.


There is a new lab assistant, he runs the lab by himself, lab is open every day.


At the moment there are two new doctors at the hospital. Both are very friendly, helpful, interested and skilled. They take care of the in and outdoor patients. Especially one of them is working in the OPD every day. In the last years OPD was run almost exclusivelyby the health workers.


Children OPD


We installed an OPD for children while Michael was in Humla (3 weeks). Michael and Claudia examined all of the children. They got very good support by Batri, a health worker. He translated everything and he knows also a little bit German. Batri was veryhelpful, interested and skilled.


Most of the medication was offered by us.


During that period about 330 children were examined. The leading diagnoses are upper respiratory infections and malnutrition and most of the children were under the age of 5.


Some remarkable cases


>  Boy, 4 years with a heart vitium

The child was sent to NGJ for further examination (echocardiography). After confirming the diagnosis the child went to KTM for surgery.



> Girl, 16 years with a heart vitium

The girl had also a heart vitium. Unfortunately the parents do not believe the diagnosis. In Citta Hospital she was diagnosed (by a healthworker) with anorexia and chest infection. Together with Tsepal we tried to explain the situation to the parents many times, but they do not want to send their daughter for further examinations.


> Boy, 6 weeks, severe malnutrition

The boy had severe malnutrition, actual weight 2300 g. Breast feeding was not really possible due to a nipple problem. The mother fed her baby only once a day with a bottle. We instructed her, how and how often she should feed the baby and told her alsoabout the hygienic issues. The child could gain weight soon, after one week the weight was 2800 g.



Other work at the hospital


Alice and later, after Michael has left, Claudia worked together with the health workers in the dressing room. We could treat lots of wounds (cut injuries, burn injuries) some septic wounds, they all recovered very well. For some we offered sedation with propofole and ketamine. Furthermore we treated some indoor patients, together with the Nepali doctor, we took the decisions together.


We performed many ultra sound examinations, not only pregnant patients but also other indications. Sarita and Karmu are conducting the ANC by themselves. Karmu has recently finished her ultrasound training in Pokhara and IUD training in NGJ. We did some ultrasounds together, she is sincere and skilled.


During our time in Simikot an orthopaedic camp was conducted by the government (4 days). There was one orthopaedic surgeon from Belgium who has worked in Nepal for ten years. Now he is retired and conducts 6 orthopaedic camps a year in throughoutNepal. The other staff members were from different places in Nepal. They used our OT, autoclave room and dressing room. The Nepali staff was very nice, friendly and cooperative. Only the surgeon was not interested in talking to us.


During that time there was a woman with a huge abscess at the pubic region. For the incision the Nepali anaesthetist (from Beri Zonal Hospital in NGJ) administered generalanaesthesia for us, also for the first dressing. She was very helpful, and the staff of the camp prepared and autoclaved the surgical set for us.





We got some money from our friends and private donors. With that money we paid for the medication, purchased a baby scale, an otoscope, blades, sutures and disinfectantsolutions. Furthermore we supported two patients (as listed below, further details see annex)


> Boy, 4 years with a heart vitium
> Man, 50 years with an irreponible epigastric hernia



Plans and ideas for the future


> new floor and painting for the indoor room
> analyser for the lab, for the Avia are no more chemicals available
> establishing a dental OPD and dental camp with the aim to teach the healthworkers how to conduct small dental treatment (autumn 2013? the details can be discussed in Austria )
> concerning the new maternity building Alfred is the responsible person
> government will bring a new x-ray, 300 mA, isolation with lead is necessary for the plywood wall, 0.5 mm is enough



Annual report of the District Hospital, Fiscal year 2068/69 (July 11 till July 12)


> OPD: 20 202
> Emergency: 2642
> Total: 22 844
> Indoor patients: 1022
> Laboratory tests: 2619
> Death at hospital: 15
> Referred Patients: 35
> Deliveries: 120


Concluding remarks


We had a very good time in Simikot. Everybody was very helpful and friendly and interested in working together. Also Tsepal did and does a good job, without him it would not be possible to work here. We are hoping for a good future together withrespectful treatment of everybody involved.


Thank you for the great time!

Michael Kuenstle, Claudia Lama, Alice Markl



Emergency Fund support 1



report march april 2013 01
Personal Introduction


1. Name: Suraj Bohora
2. Father’s name: Kala Bohora
3. Age: 4 yrs
4. Sex: Male
5. Profession:
6. Address: Thehe-2


Medical profile


1. Diagnosis: Heart vitium


Referred to


1. Hospital: Beri Zonal Hospital and to Kathmandu
2. Place: Nepalgunj


Amount and kind of support


1. Cash Amount: NPR 17 095
flight costs to NGJ, bus to KTM, accommodation


Medical decision by: Dr. Michael Kuenstle, Dr. Alice Markl and Claudia Lama


Agreement by: Tsepal Dorje Lama


Comment: suspected diagnosis was confirmed in NGJ and the child was sent to KTM




Emergency Fund support 2



report march april 2013 02
Personal Introduction

1. Name: Dane Rokaya
2. Father’s name:
3. Age: 50 yrs
4. Sex: Male
5. Profession: Farmer
6. Address: Simikot-4


Medical profile


Diagnosis: irreponible Hernia epigastrica


Referred to


Hospital: Beri Zonal Hospital
Place: Nepalgunj




Amount and kind of support


Cash Amount: NPR 11 370
Flight costs to NGJ for 2 persons


Medical decision by: Dr. Alice Markl, Dr. Michael Kuenstle and Claudia Lama


Agreement by: Tsepal Dorje Lama


Comment: suspected diagnosis was confirmed in NGJ, but they did not conduct surgery due to comorbitity. The patient must go to KTM for further treatment.