Scott’s Elective – Weekly Patan Clinic

Anandaban hospital runs a clinic in Patan – a large city on the southern side of Kathmandu – a 50 minute drive from the hospital. This clinic runs six days a week, with the day off on Saturday. Five days a week, this clinic runs a general service, serving patients in and around Patan. However on Wednesdays, this clinic is specifically focused on patients affected by Leprosy. To facilitate this, a team of staff from the hospital attend for the day to run the specialised service. Much like the satellite clinic I wrote about in my second blog post.

Patients are seen by a number of specialists, depending on their current health needs. Nurses replace the dressings of ulcers for patients in the community. Most weeks one or two patients will be referred to the hospital for more complex management of their ulcers. Typically as the ulcer is deep enough to involve the bone. Physiotherapists will monitor and record the nerve function of patients affected by leprosy. This is done at regular intervals to assess for ongoing nerve damage. While the doctors run clinics for their respective specialties. This includes dermatology, orthopaedics and general medicine for patients effected by Leprosy.

Today I spent the morning with the team assessing new patients with suspected leprosy. Patients can present themselves, though the staff also get a number of patients referred from other hospitals who don’t have the same quality of service for patients affected by leprosy. They will take a history and examine the patient for visible signs of leprosy such as skin lesions. Due to the number of patients they see each day, they can perform all of this at incredible speed. At times it appeared that they could just look at the patient and tell if they have the condition.

The same team also provide a service for the contacts of patients known to have leprosy. This screening service comprises a thorough physical examination to look for skin changes and nerve damage. They encourage all close contacts of patients to attend for screening. Even if the patient has commenced treatment, the disease may have been transmitted before the patient started treatment.

The staff team out for lunch together

This afternoon a number of patients required a skin biopsy to be taken. This is a relatively simple procedure that takes approximately 5-10 minutes. It is used when other, less invasive, testing is negative but the patient is still suspected of having leprosy. Biopsy results take many weeks to be returned, as they have to be sent to a larger centre out with Nepal for analysis. Due to this delay, patients are started on treatment at the time of the biopsy, and this can be stopped if the biopsy comes back negative. During my time here at Anandaban I have been taught how to do this procedure, and this afternoon performed a number of biopsies. I have built on many clinical skills during my time at Anandaban, though biopsies are one of the most vital investigations in tackling Leprosy. It has been a privilege to learn from such skilled individuals and be able to contribute to this critical work.

The minor ‘operating theatre’ where skin biopsies are performed

I have attended the Patan clinic every Wednesday during my placement and it is very sad to say this has been my last one. It has always been interesting and enjoyable, as well as a great way to break up the working week. Much like the satellite clinic, the staff love attending the clinic and seem to enjoy catching up with patients they know well from previous admissions.

The team reviewing a young patient

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29th May 2019

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Opinions are the authors own and not necessarily those of The Leprosy Mission Scotland.