The one where they found a leach

28 April 2024

Good day readers, Ki here, sorry about the wait we have been busy bees. Since Brit's last post we spent one more day in Sotang to attend the clinic and learn from the nurses, midwives, community health workers, Dr. Pawan, and Dr. Shreshtha. We learned assessment and treatment plans and were able to compare to our system in Canada. For instance, I realized I have taken laboratory testing for granted. Occasionally we treat symptoms based on history and physical exam alone in sexual and reproductive health, urinary tract infections or yeast infections for example, although typically we still send a sample to confirm the diagnosis. Now, to be clear, the Sotang hospital has a laboratory, X-Ray, ultrasound, pharmacy, optometry, dentistry, surgical suites, blood transfusion capacity, a birthing room, and postpartum suites for mothers that live far away to rest before travelling home. This is a hospital with equipment and skilled providers. With this said, the available resources differ. Vaginal or cervical swabs were not available to send for testing if a person presents with irritation. Britney and I felt really grateful to our physical exam (PE) and testing and diagnostics instructors (thanks Anne for showing us so many PE pics in first year, Zoe for your thorough and easy to remember infections in pregnancy classes, and UBC CPD courses!). With consent of the patient and clinician, we were able to assist in narrowing the differential diagnosis and ask some additional history questions with the nurse/auxiliary nurse midwife (ANM). It is awesome to learn from Nepali providers alongside a classmate - brainstorming together in a shared clinical learning experience is surprisingly rare in midwifery school. This was a unique unanticipated benefit to the global placement.

When debriefing with our preceptor and course lead, Cathy, she encouraged us to further consider sexual and reproductive developments in a global context. For instance, how developments in cervical cancer screening might benefit these communities. I know the self-screening HPV swab has yet to reach more rural and remote areas of BC, Canada (as of the last time I spoke with a peer in northern BC on this). It made me think about the challenges that developing countries or isolated communities encounter when trying to unroll new technologies, despite these groups likely gaining a greater advantage from these developments.

Next, we hit the road leaving Sotang on our way to Gudel (2.5hr jeep ride with a short cut). Brit and I were really looking forward to Gudel so we could sleep in tents. Gudel is gorgeous, once we arrived Brit and took the afternoon off and did a little hike. Google maps or trail finder apps did not pick up great reception so we had to follow our hearts to find our way home (our hearts were wrong at first in choosing mild terrain - the way home was actually about 2km up stone stairs). Along the way, we found a river with stunning views. At first sight of a secluded, calm spot in the river Britney quickly diverted off path towards cooler aspirations. I am a passenger in this life, so without considering any alternative I followed with haste. We whipped our shoes off to dip our toes and began verbalizing our pro and con lists for swimming. There were some squirmy swimmers we struggled to confidently classify, either a leach or a tadpole we thought, relying heavily on hazy memories of grade 11 biology. These squirmies tipped the scale to favour the con list, so we gathered our things and returned to the path laughing at ourselves for being so neurotic that we overthought something as simple as swimming in a river...

The next day we met the kind staff of the Gudel Health Post and began a session about postpartum hemorrhage management and cervical tears. Holy goodness gracious did these nurses/ ANMs PERFORM. I have never, nor will I ever do an OSCE with the speed and detailed verbalization these clinicians did. We were so appreciative to have Pema's co-facilitation and translation as we got to know the staff, she keeps everyone on the same page while teaching staff and us students. Next Mickey, one of our leads on the trip that brings with him many years of family practice, emergency medicine, and photography experience, came in to debrief his day with us...

"We had an interesting case this afternoon, would you like to hear about it and maybe look a few things up?" He asked.

Britney and I already said yes before he finished speaking.

"A kid was rinsing their face in the river yesterday and presented today with a leach in their nose, we are having trouble getting it out it squirms away when you try to remove it."

I believe I can speak for the both of us when I say we have never felt more pleased with a decision than the one against swimming the day before. A quick search confirmed these leaches like to attach in noses, urethras, vaginal canals, etc. (we updated our swim con list accordingly), and eventually we found a few case reports and studies detailing strategies to remove it that we passed along to Mickey, who supported the staff at the health post with their plan on the case.

Our time in Gudel was busy, we woke up early to meet with Dhamis, psychological and spiritual health practitioners in the community, then walked to the Health post for education sessions or antenatal clinic visits. We spent each evening playing cards with Mickey and Pema, and someone other than Pema even won once or twice. The staff from Gudel stopped by our place the last night before leaving to say goodbye. It was a sad goodbye, we learned so much in Gudel and felt so welcomed by the Health Post staff. Maybe one day we will meet again!

The next travel day was on foot, a nice morning hike from Gudel to Bung. Once we arrived, we spent the afternoon washing up and hanging laundry. It was a nice productive afternoon.

That brings us all the way up to today. We packed up again and did a much faster walk to Sotang, which is where this blog post started! Today is a rest day (hence the playing catch up on blog posts). Today marks three weeks since Brit and I left Canada, and a little over two weeks of our global placement. In a lot of ways I feel like I have been here for much longer - we've met so many beautiful minds, facilitated many sessions in different regions with differing resources, struggled with language barriers, felt humbled, gotten to know our travelling team more, and started to feel comfortable with a routine of no routines. In other ways, it doesn't feel like we have been gone long at all, likely because we have a lot to look forward to in the coming weeks.

Thanks for reading, stay tuned for our next update!

A little extra on language...

As brit noted, my mother has stirred up quite the confusion here in naming me Kiley all those years ago. My name means "fourth daughter" in Nepali. Before learning this, a nurse came to me and asked to take a picture with me, stating that she, too, is Kiley. Later, I learned she was the fourth daughter, a few more nurses and community health workers were fourth daughters as well, so we all got a picture together. Luckily, in a brady bunch fashion, I am technically the fourth daughter (phewff). My current understanding is my name is silly to Nepali speakers, almost as if my mom named me "Four" but they all giggle and say it is a "very nice name," regardless. I will be having a word with my mother on this (mom feel free to apologize in the comment section below).

Feminine Nepali Birth Order Terms

First born daughter: jeṭhi (pronounced "Jeti")

Second born daughter: māhili (pronounced "Miley")

Third born daughter: sāhi~li (pronounced "Sigh-ly")

Fourth born daughter: kāhi~li (pronounced "Kiley")

Images will be added later! (We do not have the data for it today)