Grandma and grandson at Tipling Clinic

As I sit and write up this report over these four days I am struck by how much I have learned from this medical experience. Foremost, I have gained fresh insight into the dire need for health care providers in rural, especially mountainous, areas. It is also clear from this expedition the absolute necessity of having competent, well-trained medical staff available to serve all communities in Nepal, as well as the world, regardless of the community's geographic isolation. The two villages that we visited in Nepal are very fortunate to have their regular health care needs met by many very dedicated local health care givers and HHC staff. Needless to say, there are numerous areas in Nepal, and the world, where no health care is available. Bringing health care to these areas needs to be a priority amongst health care providers, philanthropic organizations, and government.

The other aspect of rural health care that was highly edifying was the incredible logistics that it takes to deliver health care into rural areas. Our HHC trekking group was no less than a small army. Forty-one porters, six cooks and ten medical staff transporting one and one-half tons of medical supplies, tents, food, and living supplies that enabled us to stay in the mountains for two weeks and treat over nine hundred patients! It is mind-boggling to say the least.

This awareness of the complexity of health care delivery, especially in rural areas, is something that I have not previously been forced to think about. There is nothing like watching a porter strain under the load of two-hundred pounds of medicine to awaken one! Admittedly, this trek has given me a fine appreciation of the logistics of rural health care delivery. As well, it has engendered in me an appreciation of the health care we enjoy in our urban and suburban communities in the United States.

It might seem this medical trek was a lot of work for just two medical camps, lasting a total of only eight days. But, if one is to look at what we achieved medically and compare this to the cost of the trip, I believe that our trek was a great success. On the most basic level we offered comfort and hope to the people of two villages in rural Nepal. Putting a dollar amount on this is impossible, but in ways hard to measure I can assure you that it was very worthwhile.

If we were to empirically look at the cost of the trip, I feel the trip was also a success. Assuming free medication and doctor's time (both donated), the average cost to treat each patient was between ten and fifteen US dollars. Some of these treatments were as mundane as giving a patient anti-acids and a reassuring word while other treatments were as complex as a medical evacuation. With HHC making four medical treks a year to these villages, one would be hard pressed to argue that the medical treks are not a good way to spend health care dollars.

Finally, being in a country like Nepal that has an over abundance of health care needs and limited health care resources ("Where all cannot have all") forces the doctors to make tough decisions. Literally, one is forced to decide who will live and who will not live. Thankfully, during this trip I did not have to make a decision that hastened one's remaining time. All of my patients were relatively healthy, and our Tamang woman with septic shock was young, hence the decision to spend HHC's limited resources on a life-saving helicopter rescue was an easy one. However, had she been older, or the situation been different in any number of ways, perhaps no medical decision would have been made, allowing nature to take its course. This "life-deciding" decision making based on limited available resources, is not an issue I have had to address before, due mainly to the fact that I have trained and practiced medicine in a country of plenty. I am very aware, though, that if I continue to work in rural areas, especially where health care dollars are short, I will be forced at times to make these tough decisions. I realize that it is part of being a doctor. With time and experience I hope some of my unease with this role will lessen.