The Lung Clinic in Nepal
Nepal is envisaged by most of us as a high altitude country with unspoiled nature and air. This implies healthy lungs of the inhabitants. Unfortunately, there is a big gap between the impression we have of Nepal from photos and reality.
Nepal is one of the poorest countries and therefore, young people can only make their earning by leaving their home country for taking up some low pay jobs in other countries, mainly India and Arabian countries. The children are taken into the care of their grandmothers who still live in houses with very basic conditions using in-house opened fire for cooking and heating without proper ventilation. These conditions can be envisaged by a visit to Ballenberg, where there are traditional Swiss houses with similar conditions which were used until the late 1800s (picture). Under such conditions, the air inside the house is polluted with a high load of small ash particles and toxic fumes, which the people cooking at these fire places in particular, inhale several times during the day. The effect on the lung is the same as experienced by cigarette smokers and in consequence a large number of women in their 40’s and 50’s develop the smoker’s lung (COPD), which no doubt will leads to premature death. More importantly, these conditions also worsened the lungs of children. Increase studies showed that damage to the lung structure in early childhood may be poorly repaired and results in a life malfunction. As a consequence, children are growing up in these circumstances even for the development of asthma and COPD marked. Avoiding this is a goal of our research.
Open cooking stove in an old farm house where smoke, ashes and gasses are released into the room air and inhaled day and night by the occupants.
Kitchen of a Swiss farm house in 1880
Kitchen of a common Nepalese Farm house in 2015
In 2014, the clinics of pneumology (University Hospital Basel) together with lung doctors from Dhulikhel Hospital (Kathmandu) initiated a support project which was financed through a charity fund of OFID (OPEC Fund for International Development). The aim of the project is to provide knowledge and technology to Dhulikhel Hospital that enables the doctors to diagnose COPD as early as possible and at least delayed the progression of the disease. Within the next 5 years, we would like to help them to continue this project which will establish a new pulmonology clinic at Dhulikhel Hospital, and enable young doctors from Nepal to receive short term training as lung specialists at the University Hospital Basel. We would also like to provide them with easy handling technical equipment (portable spirometers) for enabling them to diagnose lung function and early stages of COPD in existing medical outposts of Dhulikhel Hospital.
In addition, we would like to help the personnel of Dhulikhel Hospital to extend lung function testing to children who are living with their grandmothers under the conditions described above. Some studies in other countries have shown that the risk to develop asthma or COPD later in life can be reduced significantly by vitamin D supplement.
To continue the support of the medical education for lung specialists (one doctor per year). Furthermore, the supply of needed equipment for diagnosis and treatment for hospital of Dhulikhel. The doctor will be enabled to come to Basel for 2-3 months to attend intensive training in up-to-date diagnostic and therapeutic skills. At Nepal he will be able to teach local nurses and younger colleagues. Once a year a doctor from Basel will visit Nepal for one week and teach locally. Furthermore, we aim to provide a monthly phone conference with Dhulikhel Hospital to help them with the diagnosis of difficult cases. This will improve the overall healthy conditions in Nepal. The costs for this service were estimated as: 52'000 CHF/year.