The CIWEC Clinic Newsletter – October 2012

CIWEC Clinic 30th anniversary celebrations were held in May 2012. On this occasion, we held an all day conference on Travel and Tropical Medicine and invited interested doctors from the country. This was attended by over 160 participants and we had a combined national and international faculty giving the talks. We also launched Nepal Society of Travel Medicine that is conducting talks on Travel Medicine related topics on a monthly basis . We are very happy to share the knowledge that CIWEC has gained in 30 years of the clinic’s existence and expand the field of Travel Medicine in Nepal.

Staff News

The medical team consisting of Drs Prativa Pandey, Rashila Pradhan, William Elson and Kishore R Pandey have been joined by Dr Helen Clements from South Africa. She is a GP with experience in Travel and High Altitude Medicine having recently completed a diploma in Mountain Medicine. We will be working with our excellent team of subspecialists at the clinic. Our nursing pool continues to grow while all of our senior nurses remain with us.

Anju Sharma, with 28 years of banking experience has joined the management team of CIWEC in the capacity of Executive Director from July 2012.

Health Camp at Namo Buddha

Monks from a monastery at Namo Buddha were suffering from many stomach related complaints and we were asked to run a health camp. We went out there with Rakesh from the lab, Bhawani from the nursing dept, Drs Prativa Pandey, Rashila Pradhan and Samrat Bashyal and organized a health camp that included health talks, interactive question/answer sessions, diagnosis and treatment of different conditions. It was highly appreciated and hopefully will have a lasting impact.

CIWEC expansion project

The expansion project is nearing completion except for the installation of lift and few interior items. We are looking forward to open up the new wing sometime in the next month with added services. We thank you for putting up with the noise and pollution related to the construction work – the end is in sight!

As the BIG holiday season will start soon, we would like to let everyone know that the clinic is open 24 hours a day 7 days a week. We DO NOT CLOSE FOR HOLIDAYS. It is business as usual for us during the holiday season. Also, would like to remind you that we are much more than a clinic since we have an active inpatient service, laboratory, radiology on – site and an ambulance service.

Vaccines:

We have a small stock of Herpes Zoster vaccine which is a vaccine that is given to people over 60 years of age to protect against development of Herpes Zoster or shingles which is a debilitating painful illness that can cause chronic pain. The virus that causes Chicken Pox called Varicella Zoster  Virus or VZV resides in the nerve cells after someone is infected with Chicken pox. This can reappear years later and cause Shingles or Herpes Zoster. This illness is most common in persons over 50 years of age or in those who are taking immune suppressive drugs. The vaccine can prevent development of Herpes Zoster thereby eliminating the possibility of post herpetic neuralgia.

Diarrhea Research:

Diarrhea is the most common problem of travelers and expatriates in Nepal. CIWEC Clinic has been at the forefront of research in traveler’s diarrhea, etiology, epidemiology and antibiotic resistance that has helped to plan treatment strategies in patients with diarrhea. We will be starting with another traveler’s diarrhea study soon that will look at etiology, resistance and risk of post-infectious irritable bowel syndrome post traveler’s diarrhea. The study will run for 2 years and we will be looking out to enroll cases and controls. Since the results will benefit all of us, we would greatly appreciate if you would consent to enroll – we would only approach you if you qualified to enter as a case or control.

Planning for a trek

Many persons will go trekking in the Nepali mountains in the fall season. Any person who is mentally prepared to trek and is reasonably fit, can safely do so. If you are taking high blood pressure medication and are not sure what to do, please continue to take your medication while you trek. Blood pressure tends to go higher at high altitudes. It is important to have a first-aid kit in case you encounter health problems like diarrhea, cough/cold and altitude illness while trekking. Use of birth control pills including the continuous use oral contraceptive pills is considered safe during trekking.

Altitude illness can start to occur at 2500 metres but serious symptoms are rare below 3000 metres. The early symptoms are headache, nausea, loss of appetite, fatigue and poor sleep. Serious symptoms are mental confusion, ataxic or drunken gait, cough with gurgling sound in the chest, extreme fatigue or shortness of breath at rest. Mild symptoms can resolve while you stay at the same altitude and you can continue your trip. Serious symptoms require that you descend immediately by helicopter or by walking/getting carried. It is important to know that there is great individual susceptibility to altitude illness and you may be the only person in a group to have symptoms.

Diamox (acetazolamide) can be used for prevention of altitude illness if you know that you have been susceptible to altitude on a previous trip or if you are flying/driving directly to high altitude places like Lhasa, however, it is not recommended for sulfa allergic people. The dose of diamox is ½ of a 250mg tablet twice daily for adults. For children, a dosage of 5mg/kg/day can be divided into 2 doses. There will be tingling noted around the mouth, fingers and toes in most people taking diamox. It is slightly uncomfortable but not a worrisome side effect.

If you are taking children to high altitude or if you have any medical condition that you are concerned about, we suggest that you see us before your high altitude trek. Detailed information on altitude illness and on the topic “trekking with children” can be found on the CIWEC Clinic website at: www.localhost/kazi/ciwec. A handout on altitude illness and its prevention is also available in the clinic waiting room. A first aid kit with an instructional booklet prepared by the clinic doctors is available at the clinic.

If you wish to be added in our list of people receiving newsletter, kindly send an email to Smriti Tuladhar at manager@localhost/kazi/ciwec or Anju Sharma at anjusharma@localhost/kazi/ciwec

Thank you.
The CIWEC Team