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Posted by Bibhusan Basnet

Chanakya Timilsina, Health Assistant providing oral re-hydration solution and encouragement to a member of the Armed Police Force.

I was just starting to doze off when I got a call from the emergency department (ED).  We had some police men in the ED who were seriously ill.  They had continuous vomiting, several episodes of diarrhea, and a high grade fever.

The police inspector who accompanied them told me further about the symptoms and duration of illness, and informed me that there are even more men who have been experiencing headache, vomiting, and diarrhea since lunch.  I called the nurses from the inpatient department (IPD) for help, and asked them to prepare intravenous cannulas and medications to control the fever and vomiting of the patients who were making their ways toward Bayalpata Hospital.  Our ED was packed until midnight with thirty sick policemen, and we had a strong suspicion that there was a food poisoning in the police camp.  Thankfully, we had stabilized the patients within a few hours and felt that we were somewhat done.

The next morning I rushed to the ward to see how the patients had fared during the night.  Surprisingly, I found around 100

Armed Police Force members sleeping in Bayalpata’s Emergency Department, while Health Assistants busily triage patients and insert intravenous catheters.

more policemen in the ED with similar complaints.  Apparently, the police chief had screened the rest of the men from the camp, and had brought them to the hospital early in the morning.  We then had to triage them and kept those with the worst symptoms in the emergency room, while others were shifted to the lawn.  Most of our staff members helped us deal with this disaster.  Some were busy making oral rehydration solution, while others administered intravenous medications.  This helped the patients a lot, and many of them were sent back to the barracks after 24 hours of treatment and observation in the hospital.

On the third day of admission, one of the patients developed seizures.  His friends informed us that he had passed bloody stool

and had been vomiting continuously.  He also had a high grade fever and associated stiffness of his hands.  It was very frightening to see, and challenging for me, Dr. Duncan Maru (co-founder of Nyaya Health), and Dr. Payel Gupta (Director of Clinical Operations), along with three police men to try to help him through the seizures.  The seizure was finally controlled after

Khadak Jung Thapa, Health Assistant calculating intravenous fluid intake for the Armed Police Force food poisoning patients.

half an hour of struggling with different injectable drugs, and he instantly began to calm down.  We also began to administer broad spectrum antibiotics, to help him recover from his illness.  Just the next morning, when I went to talk to him, he replied cheerfully with a thankful smile.  I was relieved that he only had minor residual slurred speech and blurry vision.

Our patients eventually improved and all were discharged, but we didn’t know the real cause of the poisoning, which must have had an incubation period of around 6 hours.  Some of the most common suspects include bacteria like Salmonella, E. coli, Shigella , and Clostridium perfringens.  I wanted to send a sample to the Department of Food Technology & Quality Control (DFTQC) in Kathmandu, a city about 48 hours by bus from our hospital.  This would have enabled us to analyze it for poisons and toxins, but was not possible due to the distance from Kathmandu.  Nevertheless, we were relieved that we could help these policemen combat the food poisoning in their barracks.  Every moment is a challenge when working in such resource-constrained settings, and it is always inspiring to see our staffs work in as a team, even in such circumstances.  Ever since then, whenever I pass their barracks on my bike, I never forget to wave hello to my police friends.

 

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Dr. Bibhusan Basnet , MBBS graduated from B.P Koirala Institute of Health Sciences,Nepal. He has a special interest in Emergency Medicine and Psychiatry and is the former Medical Director for Nyaya Health

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