Monsoon!

Before I left for Nepal, the weather forecast was heavy downpours all week. However up until now the weather has not been too bad - some showers but mostly fair or sometimes even sunny!

Anyway, Yan and I met some medical students from Exeter University who will be at KCH for the next month, and we all went for a meal in Northfield Cafe that evening. During our meal it started raining quite heavily, but what we didn't expect was the water to start coming up through the floor too! By the time we had finished dinner there was at least 3-4 inches on the ground under our table! As I didn't want my shoes to be soaked for the rest of the week, I had no choice but to walk home barefoot through the water in the rain, much to the delight of some local children on one corner!

Northfield Cafe - it doesn't look as bad in the photos!

Cat, Kate and Paul

I also thought I would highlight a few cases I saw on the ward round yesterday. Most cases seem to be of pneumonia, meningitis, enteric (typhoid) fever, or various nephrological conditions such as nephrotic syndrome, but a few stand out:

A 5 year old girl was admitted last week with failure to thrive (not like you get in the UK when they are a little small, she was the same size as her 2 year old sister) and an abscess on the back of her head. When this was drained, they found it to be full of maggots. Thinking there must be more to this, someone requested an HIV test, which came back positive for the girl, and later her mother (who would have passed it to her during pregnancy/birth). The tests on her sister have so far been inconclusive.

A boy, aged about 8 with a diagnosis of rheumatic fever and corresponding heart disease (aortic regurgitation). In the UK we rarely see such complications, but this poor boy was textbook. I felt his 'water hammer' pulse, pulsating dorsalis pedis and carotid arteries, and auscultated the 'pistol shot' sound of his femoral artery.

We also saw a young boy with kwashiorkor due to severe malnourishment - although he must have been only 2 or 3, bis bulging stomach stretched his t-shirt, and must have been a similar size waist size to me. Thankfully malnutrition of this severity seems relatively rare here though.