Every once in a while we have the opportunity to be part of something much larger than ourselves. BMG Team Member Peter Robbert had that opportunity to do just that this summer, teaching prehospital emergency medicine in Nepal.
John: “A big welcome back Peter, tell us about your experience”.
Peter: “I was tasked to help lead a new EMS system training program in the Dhading District of Nepal. The new program, initiated by Medical Teams International, is educating local medical, and non-medical personnel in remote and rural emergency medicine tactics, much like a Wilderness First Responder. While I consider this my specialty, in the spirit of wilderness medicine ‘you use what you have’. In this case, they had lots of atypical items, like shoulder harnessed baskets to carry patients with. I learned a lot, it was great.
John: “What other types of things did you learn”?
Peter: “Well, learning how to modify a doko (a traditional bamboo basket) to carry a person when monsoonal rains wipe out the roads was cool. Like everywhere, there were specifics. Wasps that kill farmers, cobra and other elapid bites, high incidence of organophosphate poisonings, and lots of access issues. Some places are simply, islands, with no vehicle access during times of the year”.
John: “What surprised you about the health care in a remote village in Nepal”.
Peter: “MCI’s, MCI’s, and more MCI’s. The doctors shared that they will have an MCI every other month due to bus rollovers. We practiced triage, scene management, and introduced the ICS system. Since I returned, I’ve been notified of 2 bus crashes with 23 and 45 patients respectively arriving at the hospital where we taught; a hospital with 1 doctor and 2 nurses on duty”!
John: “Wow. What are their biggest challenges”?
Peter: “They are one of the poorest countries in the world. Nepal has a lot of hurdles to overcome to implement the new EMS system. I found the students to be very well educated on the medical side, but without the proper equipment. Of note, one thing that they are NOT-challenged by is making friends. Honestly, the friendliest people that I’ve ever met. Their kindness and generosity was mind blowing".
John: “What were your challenges”?
Peter: “Well, I quickly learned how to “Semper Gumby” - the instructor’s mantra for the week- ‘always flexible’ was the key to both the instruction and the learning. Daily power outages made PowerPoint presentations unreliable so lots of “Plan B’s”. It was so hot and humid, student’s had to be watched for heat exhaustion doing CPR for too long. And, as instructors, it’s easy to say treat cardiac chest pain with oxygen, aspirin, nitroglycerin, and morphine but what do you say when the students reply, "We don’t have oxygen, nitroglycerin, or morphine.” The RMR students had all the medical knowledge but they didn’t have any supplies. No EMT shears, oxygen, OPA’s, BVM’s, backboards, C-spine collars, epinephrine, diphenhydramine…nothing. I witnessed the hospital wheel in a suction unit the size of a mini fridge to suction the airway of a head injury patient. Needless to say, we focused on improvisation and, again, using what we had.”
John: What is their prehospital infrastructure like?
Peter: “Paramedics are sprinkled around villages and are able to perform minor surgeries and prescribe medications. Hospitals exist in the cites, some have advanced capabilities, and they do have ambulances. The outer villages do not have road access, and healthcare is sparse at best.
John: “When are you going back”?
Peter: “Hahaha, when I retire. No. But seriously, it was one of the most gratifying experiences of my life. So the short answer is- as soon as I can. I’m thinking to do a Continuing Ed Fundraiser or something this Winter to earn the funds to go back in February 2018 again".
John: “How much is it”
John: “Well there you go, I'll hold you to it"
Peter: "haha, I thought that you might say that"
And hold it to him we will! With a webpage in the works, we're going to send Peter back to Nepal for this important work in February. The idea is: Yes, you can strictly donate to his humanitarian fund, but, you can also see the skills in action this Winter at him home turf in Big Sur, CA. Details TBA .