Posted by Piali Mukhopadhyay, as told to her by Dr. Jhapat Thapa
Chronic Obstructive Pulmonary Disease (COPD) is a debilitating condition that takes a severe toll on those it afflicts. Common causes of COPD in developing country settings include smoking and exposure to indoor air pollution; the latter is often associated with stoves that burn biomass (e.g. animal dung). In Nepal, the prevalence of smoking in the male and female adult population is extremely high, especially among the elderly who smoke conventional cigarettes or home-made cigarettes (bidis). Indoor air pollution also poses a significant threat as the majority of families in rural areas utilize firewood as their primary cooking fuel. Not surprisingly, COPD is one of the most common diagnoses made by Nyaya Health’s clinical team, particularly among older patients.
The burden of COPD is increased by traditional firewood-burning stoves.
A few days ago, a 55-year old housewife was carried for an hour on a stretcher to Bayalpata Hospital. The patient had intermittently suffered shortness of breath – a common symptom of COPD – for four years. She was previously a smoker, but had quit. In the past three weeks prior to the visit, her breathing problems had worsened and she had additionally experienced cough and swelling in her lower limbs. As a result, her activities had become substantially restricted.
When the patient arrived at the clinic she was having difficulty breathing and her lips and tongue were bluish in color, a sign of respiratory failure. After eliminating the possibility of tuberculosis, the team diagnosed her with COPD and heart failure. Though she required a nebulizer, the hospital was facing electricity outages that day. Due to these circumstances, she was unable to receive critical medication. The patient was kept overnight for observation, but the power problem persisted the following day. Realizing the severity of the situation, the staff decided to improvise. They rewired the nebulizer, connecting it directly to a box that was receiving electricity; the patient was able to receive much-needed oxygen and steroid bronchodilators. She was additionally given antibiotics to manage any infection in her lungs and was kept at the hospital for 72 hours of observation.
Our head auxiliary nurse, Urmila Basnet, treating the COPD patient.
While the clinical team at Bayalpata most likely saved her life in this instance, the patient must continue living with the challenges of her chronic condition. Treatment will enable her to live more comfortably, but will not stop the progression of COPD. Individuals with advanced stage COPD can experience shortness of breath almost constantly, in addition to other symptoms. Chronic diseases are often severely debilitating for those in developed countries who have regular access to high-quality health care and other means of managing their condition. In resource-poor setting like Achham where people often struggle for basic nutrition, travel long distances on foot, and engage in manual labor to survive, the challenges are that much greater.
This patient’s story also highlights the obstacles presented by Bayalpata Hospital’s unreliable electricity source. While Nyaya has invested in both an inverter/battery system and a generator, these backups have now proven insufficient during periods of severe power outages or mechanical failures. Beyond daily inconveniences, the absence of electricity can prove life-threatening for patients. The story described above underscores the importance of developing and implementing technologies that circumvent this problem. For example, a low-cost nebulizer that operates without electricity would have immense applications in settings like Achham. Taking into account such realities, Nyaya Health continues to explore sustainable and cost-effective technologies that can help to improve the delivery of health care services.
