As a third world country, Nepal is rated as the 12th poorest (economically) country in the world. With more than 85% of the population being rural, providing proper healthcare for Nepalese people has been difficult. There is no health insurance, HIPAA or socialized medicine.
Dzi: Himalayan bead that bestows health & protection upon wearer
Healthcare costs, however, with clinics like ARP and western medical healthposts, there is a rise for more free healthcare in these remote areas. As is often the case in third world countries with minimal healthcare, there are more serious, unique diseases (than developed nations) that are more likely to be undiagnosed and untreated to therefore spread.
In Nepal, Chronic Obstructive Pulmonary Disease (COPD) is the most common non-communicable disease. In the rural areas, COPD is mostly caused by the indoor cooking stoves (see right photo) that have no ventilation. China and Nepal did not historically use chimneys. China has done a conversion plan to create ventilation for their peoples’ cooking stoves. But Nepal has lacked the resources to fund this, or better said the corrupt government has channeled the money for their own self-interest. I have many elderly women patients, who have never smoked a day in their life, that have COPD from the unventilated indoor stoves. There is an American, non-profit organization that is partnering with remote communities in Nepal to convert many stoves to being smokeless. For more information or to donate, see www.dzi.org The dZi (pronounced “zee”) Foundation is named after the ancient Himalayan etched stone beads that provide health and protection upon the wearer- see above photo
When you hear the Nepali people’s health stories, you deeply realize how early detection is so important to prevent long-term suffering and unnecessary health costs. Typhoid Fever is endemic in Nepal and spreads by the bacteria, salmonella through mostly food and water. Its incidence is at its peak during the monsoon season in summer. Untreated, this disease can cause high fevers sustained at 103-4 degrees. Other complications include GI bleeding and perforated intestines. Thus, early treatment with antibiotics can prevent long-term complications and febrile-related diseases. 2 of my patients formerly had Typhoid Fever and were left with long-term effects: one had a febrile-induced stroke and another chronic joint inflammation and burning skin and dryness. I mentioned in my previous blogpost the young patient with Rheumatic Fever from untreated strep throat, leaving her with a heart and connective tissue disease. I didn't treat any patient with symptomatic TB, however, one patient underwent the grueling 6-month antibiotic treatment for TB. Thankfully, Healthposts seem to be on the rise in rural areas of Nepal to help find early detection of these serious diseases.
The most common complaints from my patients were orthopedic issues. As explained in my blogpost, "Walkabouts in Nepal's Agricultural Nirvana," this is understandable, considering how hard these subsistence farmers work into their old age. Even though the Nepalese population has less of an overall weight problem then the developed world, they still have a significant number of patients with diabetes and hypertension. Many patients will tell you they have “gastritis” which in Nepal is an umbrella term for heartburn, ulcers, gastroenteritis, gallstones, pancreatitis, Chrohn’s Disease or IBS. Therefore, when patients come in saying they have ‘gastritis’, we have to query and examine the patient for a more specific diagnosis. A big problem in Nepal, like many third world countries, is the misuse of antibiotics and NSAID’s. When experiencing any type of pain or infections, they can go to the pharmacy and cheaply buy antibiotics or NSAID’s over the counter without a physician’s prescription. From this, their digestive flora, biomes, immune system and stomach lining are compromised. As a more holistic alternative, at the ARP clinic, Chinese herbal formulas are offered, that can be amazing for many of these gastrointestinal issues or arthritis. Especially if the patient’s complaints are from a virus or indigestion, the herbal medicine is a much more effective option. I found the Nepalese patients to be very compliant in taking these herbs.
Interestingly, none of my patients mentioned osteoporosis or cancer. There can be many reasons for these diseases not being diagnosed, with one being due to minimal healthcare. However, I believe that their laborious farming lifestyles outside with fresh air and sun (vitamin D) have a lot to do with their strong bones and leaner body mass.
As for no reports of cancer, I believe a lot has to do with their simple diets without preservatives or pesticides, like Monsanto’s Round-up. There is an organization, STOP Monsanto in Nepal (on Facebook), that is a powerful voice for Nepalese farming sustainability. I walked by this little girl in our village, as an adorable poster child for this movement.