The art and science of medicine developed out of compassion and out of need. It aims to improve life, make health better, prevent diseases, and promote health and well-being.
Previously we used to see more cases of infectious diseases and nutrient deficiencies: typhoid, diarrhea, dysentery, malnutrition, etc.
Now we see more cases of non-communicable diseases and overweight: hypertension, diabetes, chronic airway disease, anxiety, depression, etc. In the Ayurvedic clinic, we see more cases of joints/back pain, gastritis, indigestion, bowel disorder, constipation, hemorrhoids/piles, fissure-in-ano, insomnia, menstrual disorders, sinusitis, allergic rhinitis, etc.
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A. Untreated fracture (malunion)
------------------------------------- What to do when a fall/an accident leads to fracture/sprain/strain? What is first aid for fracture? How to immobilize? How can we prevent injuries? ------------------------------------- What are the types of fractures? What are the most common sites of fracture? What factors play in the healing of fracture? How traction is done? How reduction is done (to make broken bone come in proper position)? How is fixation done? What are types? What is splinting? Why and how immobilization? What is slab or cast? What precautions and complications? What are the complications of treatment or not having treatment of fracture? ------------------------------------- What is Universal Health Coverage (UHC)? ------------------------------------- I found an elderly woman whose forearm was fractured but could not access treatment due to multiple reasons (including lack of healthcare facility nearby, and also her husband was alcoholic and uncaring to family).  |
B1. Let's prevent non-communicable diseases (NCDs)
------------------------------------- Which are the most common Non-communicable diseases? Does anyone you know have any health issues? What's your weight? What is your blood pressure? Does anyone you know have diabetes, chronic respiratory disease, cancer, etc.? Which games/exercises do you prefer? How long are you active each day? What proportion of fruits and vegetables do you eat? Do you use tobacco- or alcohol-containing substance? How can we prevent diseases and promote health? How can we prevent accidents (physical injury) and mental health problems? ------------------------------------- * Take healthy food (avoid excess refined/sugary food, salt, smoking, alcohol, etc.). Have a balanced diet depending upon your age, work, weight, and health status. * Have appropriate exercise (Physical activity, yoga, or just walking for at least 30 minutes per day or five days a week) * Take appropriate rest, and sleep for about 6 to 8 hours (for adolescents to adults). * For the early stages of the disease, lifestyle changes can work well. * For progressed disease, take medication as prescribed by physician/doctor. Don't alter doses or stop medication without consultation with your doctor.   * Get your health check-up done periodically (blood pressure, blood sugar, etc.). Monitor your health status periodically. Video: दिर्घ रोगको दर्द Cost of Chronic Diseases | रोग निको नहुने, खर्च भइरहने: जनताको गुनासो (2020) |
B2. Promote Healthy Lifestyle
------------------------------------- Which factors are related to chronic diseases? Which behaviors help to have better health? What about the physical activity/games/yoga, amount of fruits and vegetables, stress management, amount of refined food, amount of meat, avoiding tobacco/smoking and alcohol, etc? ------------------------------------- Video: Let's create/protect space where children can play. बालबालिकाले खेल्ने ठाउँको सिर्जना/सुरक्षा गरौ।
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C. Understand, Support, and Regulate Traditional Medicine
------------------------------------- Which traditional medicine are you familiar with? Why do people opt for different medical systems? What are the strengths and weaknesses of traditional medicine? What is complementary and alternative medicine? What is integrative medicine? Have traditional/herbal medicines been basis of new drug discovery? How to protect from fake traditional medicine? ------------------------------------- In Nepal, people seem to prefer traditional / Ayurvedic medicine for conditions like gastritis, hemorrhoids/piles, fistula-in-ano, constipation, sinusitis, allergic rhinitis, arthritis like knee pain, back pain, etc. People prefer western/allopathic medicine for infections, surgery and emergency conditions. In some conditions people either use any system of treatment or use more than one system of treatment. Video: Ayurveda and Yoga in Karnali Nepal, 2019
Strength of Traditional Medicine 1) Native, culturally friendly, growing demand for Ayurveda medicine, trust of the people, time-tested (opportunity of health tourism, relaxation, rejuvenation: herbal massage, herbal therapies, etc.) 2) Eco- (nature-) friendly (most of the natural things like herbs are used) 3) Local products are more suitable to the natives as per the classical texts (A big economic opportunity) 4) Anyone knows a few herbs and can form a few herbal medicines at home 5) Preventive and health promotive aspects for sustainable health has been more emphasized in the classical text (diancharya, ritucharya, yoga) 6) In words: priority to traditional and native Weakness of Traditional Medicine 1) Less rigorous research; Less opportunity for higher education and research within the country; Less standardized services, limited health facilities for tourists (more well trained human resources for tourism) 2) Threat to the environment: overuse (over-harvesting) of herbs 3) Most of the Ayurvedic medicines are imported from other countries (a huge economic loss in import of medicine) 4) Poor quality products, adulterer medicines, (more quality norms to be followed, more quality control needed) 5) Less awareness about preventive and health promotive aspects (healthy lifestyles) in practice 6) In action: less support/budget/research/services How can we get protected from fake practices? Video: Let's not use fake Ayurvedic medicine and prevent the harm नक्कली आयुर्वेदिक औषधि प्रयोग नगरौ र हानीबाट बचौ |
D. Let's talk about Mental (Psychosocial) Health Issues
------------------------------------- What kinds of problems are mental health problems? What kinds of health service/facility is appropriate for mental health problems? -------------------------------------  * Just like we have physical health issues/problems, we also can have mental health issues/problems * Mental health problems can be reflected in our thoughts, emotions, behaviors * Don't feel guilty or ashamed just because you have some stress or mental health issues * We have the right to health, not just to our physical part, but also to our mental aspect * Sharing our issues with healthcare providers (doctors, nurses, counselors) or with near and dear ones can be substantially helpful  मानसिक स्वास्थ्य महत्वपूर्ण छ * शारीरिक समस्या जस्तै जो कसैलाई पनि मानसिक स्वास्थ्य समस्या हुनसक्छ। यस्ता समस्या विचार, संवेदना/भावना र व्यवहारमा प्रतिबिम्बित हुनसक्छ। * यी समस्याहरूको लागि दोषी ठान्नु वा लज्जित हुनु आवश्यक छैन । * स्वास्थ्य सेवा प्रदायक वा चिकित्सक वा नजिकको व्यक्तिसँग कुरा गर्दा सम्बन्धित समस्याहरूको व्यवस्थापन गर्न पर्याप्त सहयोगी हुनेछ। * हामी सबैलाई स्वास्थ्यको अधिकार छ। स्वास्थ्यको शारीरिक पक्षको मात्र होइन मानसिक पक्षको पनि ख्याल गर्नुपदर्छ। * Let's respect everyone's human rights, right to dignity, and right to well-being. We are all equal in terms of laws. We all have similar human biology. We all share the same planet earth. Keep healthy boundaries with others in a relationship. Respect others' identities and choices. Be yourself. If anything is not right (or unfair) say 'no'. * Let's learn and grow well. Let's learn to deal with situations positively, and cope with stresses. Let's talk with trustworthy relatives or friends. Let's not expect everyone to be just/fair all the time, take precautions (and also don't doubt much on others). * Let's listen to people around us without judgment. Let's not try to please everyone. Let's not harm others or ourselves. Let's not believe all fake things to be true, even some of our thoughts can also be wrong. Let's follow the trustworthy agent or information. * Let's try to follow a proper routine of work, rest/sleep, and eating. Let's eat healthily. Let's drink water well. Avoid harmful substances. Let's learn some exercises, dance, yoga, meditation, or music. Let's write journals. Let's join prayers. These things also can help. * Let's try to excel, be the best at something. But it's usually not an exception to have some learning through failure. It is perfect to be/feel imperfect. Keep practicing. Keep working. Know your limitation and strength/possibilities. * And also let's talk with social workers, counselors, therapists, other health professionals like physicians, or psychiatrists. Let's ask for help (like - legal, social, medical) and accept help when required. It's normal to do so. |
E. Adolescent and Sexual Reproductive Health (ASRH)
------------------------------------- What kind of health services do adolescents need? What is natural development? What is safe practice? How to have trustful relations? When to go to utilize health services? ------------------------------------- * Adolescent is an important stage of physical, mental, and social development. * Adolescents may be easily influenced by others, but they should be provided with the right information and services. Make them able to know right and wrong. Make them able to decide what is good for health and relationship. * Issues related to sexual and reproductive health should not be stigmatized. * Early marriage (before 20 years of age) is illegal. And sometimes risky to have a pregnancy when one is not fully physically, mentally as well as socially well. Early life is for education and learning something useful for life and for earning. * Talking and co-working with different friends of any sexual sexuality or sexual orientation will let you understand differences/diversity. * Have the patience to know the consequence of anything one might do. It is good to be able to take responsibility for one's work. It is good to work slow and better to maximize healthy and happy moments in life rather than to work impulsively/hastily and worry later. Better is not making any mistake than learning by making mistakes.  * Planning for marriage and having children is important. Spacing childbirth is also important for appropriate care and the development of children. * Sex is not bad. Neither is sex everything. Sexual behavior should be careful, safe, and pleasurable. It's primarily for continuity of life, for having children. * Before planning children, know about the care of mother and children and also about healthcare services/facilities. * It is good not to have any sexual relationship with an unknown person. It is good to have a sexual relationship between the married couple (with your spouse only). Having/Maintaining a monogamous relationship is the safer, more reliable, and happier/joyful manner. Try to understand/help each other. * Mutual understanding (consent) is important. And protective measures (like the use of condoms) should be adopted to protect from unwanted pregnancy and sexually transmitted diseases. Also, respect social, cultural, and legal norms. 'Do no harm' (love yourself and 'respect each other's rights' too.) * When you are not ready it's right to say 'no'. Maintain healthy boundaries in friendship or any kind of relationship. But it's not bad to have a respectful dialogue about any proposal. Don't force others into your affair/dream because they can also have separate plans, and you might get the next better candidate. Don't harm others physically or verbally if they don't accept your plan, otherwise you might get punished. * Don't behave rudely on the basis of one's physical appearance or liking or family/social/cultural background. Society has diversity. It may be worth rather than a problem. Respect each other's norms and values unless they appear to harm. * Everyone has the right to their body and the right to decide about choosing their relationship/friendship. Know that touching others or their private part, or talking or dealing with others in a culturally inappropriate way, and may be punishable. Children are now taught that anyone who touches private parts (or whole body, especially chest, face, and groin regions) may be doing something against others' rights. (good touch vs bad touch) * Use your rights, but also respect others' rights. Be human. * When you encounter some problem, don't hesitate to take appropriate health services, and also legal services if needed. They provide care without judgment/opinion, and with respect to your dignity and confidentiality. * Instead of having doubts or believing myths (and/or taking everything in the pornography to be appropriate or standard) take counseling or appropriate information from authorized service providers. Now some health facilities provide adolescent-friendly services. * While taking any medicine know about possible harms and benefits. Don't use emergency medicine or abortion procedure as a treatment for everyday use. * Don't discriminate against children on the basis of gender. Give them equal opportunity for education and earning. |
F. Gut Health Matters
------------------------------------- What kinds of problems can we have with the gut? How can we prevent such problems? What kinds of treatment can be helpful? ------------------------------------- * Take meals timely * Take a healthy and suitable meal (that does not harm) * Don't eat in excess or don't have a long gap * Eat when hungry, eat according to your age, work, health issues (e.g. weight, etc.) * Take the appropriate amount of vegetables and fruits * Avoiding tobacco- or alcohol- products. * Don't eat refined foods, junk foods, and/or animal products (e.g. meat) in excess * Avoid any foodstuff that does not suit you * Take water in a small amount time and again * Don't hold the urge to defecate for a long time * Taking professionals help (healthcare service: doctor, dietician, etc.) if needed |
G. Occupational Health and Safety
------------------------------------- What is occupational health? What are safety principles? Why does health at work matter? ------------------------------------- * Use protective equipment (gloves, mask, glasses...etc. ) * Make a proper alignment of body parts when working. Don't over-stretch or bend body parts. Don't carry excess loads. Don't push excess of a limit that the body can tolerate. * Protect yourself when working, sitting, or sleeping. Protect from physical, chemical, and psychosocial hazards. * Balance work and rest, earning and spending * Have a healthy relationship with others in society, at work, at home, or in any relationship. * Take appropriate medical, technical, legal, and administrative measures to protect from hazards, for hazard mitigation. * Follow a healthy lifestyle so as to keep yourself healthy/strong/resilient/well-functioning. |
H. Ambulance of the people for the people and by the people, EMS Ambulance in Rural Nepal
------------------------------------- Why emergency care is needed? What factors affect the care of people needing emergency care? What kinds of cases/patients need emergency care? What is ABC? What is FAST scan? What kind of transport facility (ambulance) is available in different parts of the world for emergency care? What kinds of health facility (medicines, equipment, personnel, communication/GPS) is needed in emergency medical transportation? What is the condition of emergency care in Nepal? How to improve it? ------------------------------------- You may think, after watching the video clip, this shows how people used to carry someone when s/he became sick in the past. But this is not in the past, this is a part of day to day life of people in most parts of Nepal. In an emergency situation, each second is important to save lives. If we have a vehicle (ambulance) with needed medicines/drugs, equipment, and trained persons (like EMS personnel), that makes a huge difference. It saves time, saves a life. There are still many things to be done in the health care sector in Nepal. One of them is in EMS Ambulance Service. We have to learn from developed countries. Neighboring countries like India and China have already begun advanced EMS Ambulance services, and are continually improving and expanding the services. Ambulance of the people for the people by the people. While there are a lot of improvements in the lives of people all over the world, our people are away from that sort of facility and care. The government has brought many positive programs and changes, there are many things yet to be addressed well. People manage their needs themselves because the government has practically no investment for advanced EMS cum Ambulance service, and maybe in other sectors too. Another problem is of lack of roads for vehicles, this problem is bigger in hills and upper mountain regions. There is no government transport system. The constitution/government says health care is the right of the people. How can people get their rights? The way they get right is in their effort- like the homemade cot to act as an ambulance. This also helps- but is not sufficient/effective/efficient and advanced as compared to that in developed places/nations. Many questions are to be answered. Many problems are to be solved for better coverage of health care services. Sometimes people are found arguing, "People pay tax, follow rules, and give votes. What do people receive- effective services, care, dependable leaders, support in development work ... ?" This is an appeal for change. Let's work together. We all people including leaders, bureaucrats, etc. should work forward to make positive changes. And change is possible. Many countries have shown practically. We can learn from the experiences of all countries including India and China. We need determination. Banda/Strike makes ordinary people's lives even worse. So, please stop banda, stop complaining, stop being irresponsible, stop corruption. Be proactive, start doing something, even a small attempt worth a million rather than talking big or doing nothing. Let's do our humanitarian duty! Let's make better changes! |
I. Ascaris lumbricoides | Roundworm | जुका
------------------------------------- What are the causes of pain abdomen? What are the differential diagnoses? What is acute abdomen? What is intestinal obstruction? What types of worms are common in your area? What are the complications of worms? How is acute abdomen managed? How can we prevent such conditions? ------------------------------------- Note that - One boy of 16 years old presented with pain abdomen for the last 5 days, vomiting (vomitus contained Roundworm), not passing stool and gas/flatus, abdominal distension. Bowel Obstruction is caused by roundworms (Ascaris lumbricoides). Sanitation and a small tablet to deworm help you not to suffer.  Video clip of that living worm coughed out: एकजना व्यक्तिले खोक्दा निकालेको जीवित जुका। उनको आन्द्रा जुकाले अबरोध गरेको थियो जसको उपचारका लागि अप्रेसन गर्नुपर्ने हुन्छ। सरसफाइमा ध्यान दिनु पर्छ। आफ्नो स्वास्थ्य सेवा प्रदाएक/स्वास्थ्यकर्मी को सल्लाह लिनुहोस् र जुका हटाउने औषधि लिनुहोस्। Mind sanitation. Deworm, take worm-removing medication after consulting your health care service provider. |
J. Management of anterior shoulder dislocation
------------------------------------- What are the common dislocations? How to manage the dislocations: shoulder, elbow, hip, temporomandibular joint (TMJ)? What are the prognostic factors? How can we prevent injuries? How can we keep body/joints/bones/muscles stronger? ------------------------------------- Anterior shoulder dislocation is the most common type of shoulder dislocation. It can be easily reduced just by gentle traction. A click sound is heard and the patient feels immediate relief. A player came with a painful and deformed shoulder just after falling on the ground while playing volleyball. He could not raise the hand above the shoulder joint. If difficult, it should be referred to a higher center. A case of shoulder dislocation: When he arrived, he was holding his left hand by his right hand and expressing pain. In Fig 1. The left shoulder joint is depressed in comparison to the right. The white arrow on the left shoulder is showing the humeral head.
I (better we) applied both method B of Fig 4 and Fig 5 simultaneously, a gentle traction brought the ends back together. It reduced. You need at least 2 people to give traction and counter traction. Fig 6. You can compare Fig 1 and Fig 6. It is done. The patient became happy.
Relevant Links Shoulder Dislocation, Anterior Shoulder Dislocation 1. Sports Ortho 4. RadioPedia 6. Medscape7. Joint Pain Expert 8. Davis and DeRosa Physical Therapy 9. Merk Manuals 10. Royal College of Surgeons 11. Wikipedia |
K. Hyperthermia & Hypothermia
------------------------------------- What are the common causes of fever? (Differential, prognosis) What care should be taken while managing a patient with a fever? How can we prevent febrile illnesses? ------------------------------------- Fever is one of the major symptoms/signs, a major complaint in everyday life. In fever our body temperature increases (hotness increases), while we feel cold. [We feel cold because our altered set-point in the brain is higher than normal body temperature (normal set-point in the brain).] There are many causes of fever, and treatment procedures vary; the common approach is bringing the temperature to normal, finding the cause, and treating. Normal Body Temperature 36.5 - 37.5 degrees Celsius (97.7 - 99.5 degrees Fahrenheit). K1. Hyperthermia Generally about more than 101 degrees Fahrenheit (38.3 degrees Celsius). A young boy was brought with complaints of fever. His body temperature was 105 degrees Fahrenheit (40.5 degrees Celsius), taken from the axilla. Then the core body temperature must be more than that. He was not fully oriented. .JPG) And then I asked for Cold sponging. The water was just at room temperature. After about 30 minutes it was 102.1 degrees Fahrenheit (39.1 degrees Celsius) .JPG) My diagnosis was viral fever. --------------------------------------------------------------------- Added later - Sudden onset of high fever (temperature 106.0 degrees Fahrenheit) in an elderly male. Date 29th March 2015, 8:35 PM.  K2. Hypothermia The most common cause of hypothermia is alcoholics sleeping in open places like roads or parks. Others - elderly, drowning, etc. A girl of age 18 years old was brought by the police. According to the police, she was lying in rain. According to some of her relatives, she was drunk. Her ABC was ok. First, her temperature was not recorded by a thermometer. After about 15 minutes her temperature was 93.4 degrees Fahrenheit (34.1 degrees Celsius). Below 95 degrees Fahrenheit (35 degrees Celsius), it is hypothermia. Her cold clothes were removed. And she was wrapped in a warm blanket. She was given slightly warmer (similar to room temperature) DNS infused with vitamin B complex 1 ampule in a slow drip, approx 30 drops per minute. She regained her full consciousness after about 6 hours. Then her temperature was 96.5 degrees Fahrenheit (35.8 degrees Celsius). The next day she returned. |
L. Congenital Chest Wall Deformities
------------------------------------- What congenital deformities are common? What factors could play a role? What modalities are used in managing congenital deformities? To what extent such conditions can be prevented and how? ------------------------------------- Congenital Chest Deformities Congenital Chest Wall Deformities A 30 years old male presented with a cough, and a painful chest while coughing. He said his chest wall was deformed since birth.  |
M. USG (Ultrasound) for Maternal and Child Health: Screening Fetal wellbeing
M1. Fetal Ascites & Hydrops Fetalis
------------------------------------- How can we have healthier pregnancies? How can we care for pregnant mothers and babies to be born? Which tests and supportive vaccines/medicines are suggested to mothers and babies? What are the complications of pregnancies and childbirth? Is Ultrasound necessary? Is it safe? ------------------------------------- Fetal ascites Accumulation of free fluid in the fetal abdomen. Hydrops fetalis Accumulation of free fluid in at least two fetal compartments. Below is the picture of a fetus of a pregnant woman who, according to her last menstrual period (LMP), was in her 25th week of pregnancy. Previously she gave birth to a dead child, probably intrauterine fetal death.  This is the fetal abdomen in cross-section (above). The yellow arrows show the abdominal wall. The white star is floating on the black [hypoechoic (darker) region] which is free fluid in the abdomen. The red star is on the solid structure (grey colored) which is the viscera. This is a longitudinal view of the fetus (below). A red star is in the darker (hypoechoic) region which is free fluid in the abdomen. A yellow star is on the viscera. A white arrow is showing the abdominal wall. A yellow arrow is showing the vertebra. A red arrow is showing the neck of the fetus.  USG helps to know fetal well-being; and helps in screening. Radiopedia: Fetal Ascites Wikipedia: Hydrops fetalis Radiopedia: Hydrops fetalis |
M2. Fetal Hydrocephalus
Fetal Hydrocephalus Increased fluid (CSF) content in the brain of the fetus. Some called it ventriculomegaly too. This was found in a fetus of a pregnant in her 32 weeks. USG (ultrasound, sonogram) is helpful to find out the general well-being of the fetus.  The rounded structure is pointed by red arrows in the margin of the head/scalp bone. The anechoic (complete dark) structure shown by the yellow arrows is fluid. |
N. General Health Tips in Brief
------------------------------------- What are different types of health problems? How can we prevent disease/discomforts and promote health? ------------------------------------- * For Infectious Diseases- Cleanliness, washing hands before and after each meal, washing hands after toilets (using soap and clean water), not defecating in open (using toilets), not eating stale or dirty foodstuffs, keeping surroundings and water sources clean, protecting from flies/mosquitos, protecting from infected animals ... - wearing masks, keeping distance in case of respiratory infections ...  * For Malnutrition- appropriate nutrition for mothers (of a breastfeeding child) - delivery in a health facility, vaccination, timely care for health problems, proper social support, training, and employment to certain families, ... * Protect from Bites of reptiles/birds/mammals- be careful of snakes, dogs - take an appropriate treatment (e.g. vaccines) from a health facility * For accidents and injuries- follow rules - safety first - stay away from hazards - learn well before doing, obey safety and general rules - use protective equipment - keep emergency services ready - give first aid training to everyone * For Non-communicable Diseases- proper diet/nutrition (take balanced food, avoid excess amount of refined/sugary food/salt), have proper physical activity, pollution control, avoiding harmful substances (tobacco, alcohol, etc.), take appropriate rest/sleep, take periodic health check-ups, ..  (rules for life, found in social media) * For mental health issues- no stigma, no shame, no guilt (anyone can get any sort of problem) - talk about a problem, share your concerns/issues with near ones or social workers or health professionals - learn to manage/handle stress/relationships (routine, exercise, balanced diet, healthy communication, diary writing, a healthy boundary in any relationship ...) - not just the body, but also the mind matters (hidden/subtle parts are also important for a productive and happy life) - get proper counseling/treatment These are important to prevent untimely and unnatural deaths. Provide curative as well as promotive/preventive health services. Keep the health system ready and resilient. |
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