He came from a poor village three days journey and a long walk down from the mountains. Shobharam Chaudhary, 26 years, a subsistence hill farmer, brought his wife and a 2 year old son with him. Two weeks earlier he had got a puncture wound in his right forearm while working in the rice field. A local “medical hall” dressed the arm in a big tight bandage. Increasing unbearable pain in and from the arm forced him to go to a nearby hospital and then he came to us, in Tansen Mission Hospital.

He came from a poor village three days journey and a long walk down from the mountains. Shobharam Chaudhary, 26 years, a subsistence hill farmer, brought his wife and a 2 year old son with him. Two weeks earlier he had got a puncture wound in his right forearm while working in the rice field. A local “medical hall” dressed the arm in a big tight bandage. Increasing unbearable pain in and from the arm forced him to go to a nearby hospital and then he came to us, in Tansen Mission Hospital.

In Surgical Consult my colleague Indra Napit exposed the arm and found that it needed to be amputated above the elbow because of widespread gangrene. Uneducated, confused and unable to understand the seriousness of his condition Chaudhary refused to be admitted for amputation. But late the day after he came back, was admitted, got morphine as pain relief, intravenous fluid resuscitation and antibiotics. With two fans on full speed in the operating theater to expel the bad smell his best arm was amputated above the elbow the next day

. His general condition improved rapidly after the amputation. A couple of days later it was time to discharge him. During the round I captured him on a photo smiling together with his wife and son! But… Prosthesis for his lost arm? Our hospital has no orthopaedic technician or workshop and no donations towards it.

In spite of thorough information Chaudhary has probably not the ability and initiative enough to go to the referral center in Pokhara where he can get an arm substitute…Continuing the round I tried to encourage an old man who had lost his leg last week, to learn to walk with crutches, and comfort a young man initially wrongly treated in another hospital who now needs an amputation of his right leg above the knee…

Coming on the ward round the next day the little family from the mountains was still there! When I asked why they all began to cry. The little child as well. Between the sobs the wife explained that the hospital bill was 13000 rupees (less than 200 USD) and that they had paid 3000 rupees. That was all they had or had borrowed. With 10000 rupees in debt they were not allowed to leave the hospital and the Social Service Office of the hospital was closed that day. But the next day it opened and with help from the Medical Assistance Fund (MAF) they could return to still worse poverty in the mountains. MAF: donations come from around 40 mission organizations and private persons from around the world. THANK YOU! More is needed!

Dr P-G Ohrn
Orthopaedic Surgeon