When In Rome...Get an Endoscopy

Endoscopy in Nepal
Reports of quack doctors, botched surgeries, corrupt hospitals, and indiscriminate antibiotic use had me prejudiced against seeking medical care in this developing country.
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On your first visit to Nepal, you quickly learn to avoid many things: little kids with snot-and-dirt-covered hands, public restrooms, unwashed produce, water from unknown sources. 

You also learn to avoid almost anything medical-related. At least, that’s what I did when I first moved here.

Reports of quack doctors, botched surgeries, corrupt hospitals, and indiscriminate antibiotic use had me prejudiced against seeking medical care in this developing country.

But I was forced to change my thinking when I came down with a mysterious stomach ailment that lasted for months on end.

Here in Nepal, there is a medical facility that caters to the needs of expats and tourists who require the highest standard of medical treatment. State-of-the-art equipment, an international English-speaking staff, and the ability to accept insurance make them an obvious choice for any ailing visitor to the country.

I had, in fact, visited this facility on another previous occasion to treat a parasite infection, which treatment was successful. There was simply no valid reason why we shouldn’t go to this trusted institution so I can’t say I regret the decision we made at that time. But overall, this particular attempt to identify and cure my mysterious stomach ailment was extremely disappointing.

I spent all of three minutes in an interview with a doctor (a sweet English girl) who told me there was nothing wrong with me. Every lab sample came back normal, vitals were normal; it must either be stress-related or some parasite that the lab tests missed. The doctor gave me the option of taking either an antacid to quell the burning or an antibiotic, just in case. 

Neither option sounded sufficient, but I opted for the antibiotic. Just in case.

$90, one hefty dose of Cipro, and twelve hours later saw me curled up and crying on the bathroom floor with the most painful reaction to an antibiotic I’d ever had. Another twelve hours and I was madly scouring the Internet for signs of a C. difficile infection.

Needless to say, I didn’t finish the antibiotic course in spite of my strong convictions to the contrary. I just knew—in my gut—that I needed a more definitive diagnosis before I let another indiscriminately prescribed antibiotic trash my system.

But where else could I turn?

My husband and I were discussing my tummy troubles with a neighbor one day who made the dreaded recommendation: go to some government-funded clinic that was located in the hole of the wall of some dubious dark alley. A doctor at this small hospital had a solid reputation of treating gastrointestinal issues.

At this point, with nowhere else to go and desperate for relief, I was willing to give anything a try. So off we went to the local Nepali hospital.

Our first visit to the drab concrete clinic saw me shuffled around to various rooms for lab samples, vitals, and blood work before being parked on a hard metal bench in the hallway outside of the gastroenterologist’s office.

As I nervously eyed my fellow patients packed around me in the waiting room who were clutching their stomachs and moaning with nausea, my husband busied himself with a game on his phone. 

This was the first time I started to really worry about my condition.

All I wanted was relief from the pain. I wanted to be able to feel hunger, again. I wanted to salivate in anticipation of a steaming plate of freshly cooked rice and lentil soup. Until this point, I wasn’t thinking that I could be suffering from anything too serious.

But now, sitting here outside a strange doctor’s office in an other-worldly clinic smack in the middle of a foreign country, I suddenly had a horrifying thought:

“What if I die out here in the middle of nowhere?”

What if I pick up some freakish infection from just sitting here around all these sick people?

What if, being the yes-man that I am to authority figures, I just let this foreign doctor do whatever he wants to me and I become the poster child for anti-medical tourism campaigns?

I could die from stomach cancer or an ulcer that perforated the stomach wall or an aortic aneurysm or a staph infection and my family back in America wouldn’t even know until after the fact.

Although I had my very supportive and optimistic husband sitting at my side, I can barely put words to the loneliness and anxiety I felt in that moment. The helplessness and uncertainty were quite overwhelming, despite the fact that my condition and discomfort were likely far less serious than those of the other unfortunate individuals seated around me.

All I could do was wait.

I felt almost immediately better the instant I met the gastroenterologist. He didn’t bat an eye at the fact that I was perhaps the first American patient to walk into his office for treatment. 

There was an awkward and bumbled exchange of about thirty seconds as we tried to figure out which language to communicate in; I’m fluent in Nepali and was pleasantly surprised to find he was fluent in English. 

That, for me, was Lesson Number One: real doctors here have a very good education. They’ve interned abroad and have extensive experience in treating foreign patients and speaking English.

Shame on me for being surprised that this dignified medical professional wasn’t star struck by my white skin.

My new gastro was a very pleasant and calm individual who made me feel like my stomach problem was no longer my problem. I sensed that I could trust him with getting to the bottom of this.

The conviction that I had made the right decision became stronger when the doctor carefully listened to my list of symptoms and asked some probing yet non-judgmental questions. I left his office with a prescription for a low dose of proton pump inhibitor and instructions to come back after one week.

That first visit to the Nepali gastro (medicine, consultation, and lab work included) cost me the equivalent of a cool five bucks.

I honestly thought I was cured after the second day of taking the Nexium-like medication. But it clearly wasn’t enough to calm the burning beast in my belly. I was grateful to be back in that gloomy clinic by the end of the week.

My next visit with the gastro confirmed that whatever was going on with my stomach was a localized problem and one he would need to take a closer look at.

The doctor suspected an H. pylori infection. I had, as well, thanks to my habit of self-diagnosing with Google, but I was happy to let the professional do his thing.

How would my doctor confirm whether or not I had a bacterial infection? Did they have that breathalyzer test I’d read about online?

Remember, this is a government clinic in Nepal. There is no machine here that would make life so easy. The only option was to take a biopsy. I’m no doctor, but I already knew that would involve an endoscopy.

And anesthesia, right?

No, this is a government clinic in Nepal.

“But on the plus side,” my gastro reassured me, “we can offer a numbing throat spray that reduces the gagging!”

Now that’s an offer I can’t refuse. 

In all seriousness, however, I couldn’t refuse. This was the only and, arguably, the best way to find out once and for all what had been plaguing my stomach for the past eleven months. Getting this over with would give me peace of mind.

We scheduled the procedure for two weeks from that day. The doctor upped my Nexium and I left after shelling out another two dollars. 

The day of the endoscopy procedure dawned bright and I was feeling pretty good. I practiced a mindful sort of Stoicism, telling myself that there was just no way this day was going to end without me getting this necessary task out of the way.

My husband accompanied me to the waiting room outside of the operatory where my gastro was performing his scheduled endoscopies for the day.

I got a pretty good view of the patients who were coming out from the operatory. They were coughing uncontrollably, unsteady on their feet, as medical staff handed them over to the care of their companions. 

Some patients lunged to the bathroom at the end of the hall. Some were crying. One lady was in the operatory for a whole ten minutes, far too long for a simple endoscopy. They had a hard time getting the camera down her resistant throat.

I was soon approached by a confused-looking short man wearing a striped polo, shoulder-length rubber gloves, rubber galoshes, and the kind of apron you might see on someone who works in a slaughterhouse. He was bearing an aerosol can and told me to open my mouth.

The aerosol burned my throat the instant it hit me. It was bitter and had the flavor of cloves. I gulped obediently as the medical assistant commanded me to swallow. He then doused my gullet one more time with the anesthetic and informed me that my turn was coming up.

I was getting quite shaky, now. I had skipped breakfast per the doctor’s instructions and my body was complaining from the lack of sustenance. This didn’t help my growing anxiety.

Petrified as I felt, I tried not to show it. I kept telling myself that if I just stayed calm, the whole thing would be a breeze. Act like I have an endoscopy every day and maybe it won’t feel so weird.

Before I knew it, I was called in. There was no going back. It was show time.

Why, oh why, couldn’t I have been sedated for this, I wondered helplessly one last time.

That was my last coherent thought.

What happened next I can only describe as a nightmare. I had this feeling of being trapped in my own body. A sensation of trying to run away while my feet were cemented to the floor. I was a piece of meat passed around and being prepared for a sacrificial offering.

There’s an overwhelming sense of panic and disconnect from your own body when you are ushered into a room full of strange people covered in strange rubber garb and find that your once-familiar doctor is suddenly there in front of you clad in equally strange gear. 

He’s wearing goggles. A mask. Huge gloves. That butcher’s apron. He’s wielding a large black snake which just barely had time for disinfection since the last patient was on the table.

It feels almost like some kind of violation; all of these unknown faces crowding around me while I’m the most vulnerable I’ve ever been. All of them waiting for the moment they get to force their eye down my throat to see some part of me I’ve never seen before. 

I’m led to the operation table but I don’t remember climbing on or lying down. The nurses around me are all telling me something in Nepali but my brain isn’t processing a thing. They begin helping me roll to my side and gently pull my arms around me so that I’m hugging myself.

Then they strap on the rubber straightjacket.

Fastened in this way, my mind suddenly snaps awake. I realize that there truly is no going back. So let’s get this done.

The bite block clacks over my teeth, depressing my tongue and providing smooth clearance for the bright light that’s already so close to my face.

The light disappears and I’m told to swallow. Swallow again. Keep swallowing.

I’m in disbelief as the thick black snake forces its way past my epiglottis and keeps going down. By the time it reaches my stomach, I feel surprisingly calm.

I glance up at the monitor but just as quickly seal my eyes shut. My irrational fear of being swallowed alive does not let me see what the camera is seeing right now inside of me.

The procedure is over quite quickly. It took less than two minutes. I had braced myself for pain when the biopsies were taken, but they weren’t painful, at all.

The doctor told me to cough as he backed the camera out of my small intestine. And then before I knew it, that huge black pipe was pulled up my throat and out of my mouth, dragging along with it a nauseating mass of mucus.

The medical team handed me a huge wad of tissue to spit into and started their disinfection process of the gear and my rubber restraints.

I was led out to the waiting room, shaky on my feet and quite nauseated, where my husband was ready to catch me. 

We paid our $25 bill for the endoscopy and left.

My gastroenterologist summoned me back within a week to discuss the results: mild to moderate generalized chronic gastritis caused by, yes, H. pylori.

Another round of heartburn meds accompanied by a much gentler antibiotic (metronidazol) saw me feeling better after two weeks. Once the entire ordeal was over with, I went out on a date with my husband to our favorite Italian restaurant and gleefully stuffed down an entire pepperoni pizza.

Thankfully, there were no cameras present to record that embarrassing gastronomic event.

My treatment process for chronic gastritis here in Nepal was terrifying. But, oddly enough, it was also one of my most enlightening experiences here in this fascinating country. I learned that there is far more qualified help to be found here than I originally believed. Paying for healthcare out of pocket can be ridiculously cheap. There’s even something to be said for the cold, automatic, butcher shop-like efficiency of the operating room I was in. The team’s quickness was a blessing to me and a testament to their skill.

Friends and family members cautioned me to avoid many things when I first took off for Nepal. Some of those people would be utterly horrified to hear about my decision to pursue medical treatment in a Third World country. And at one point, I would have felt similarly.

Developing countries may still be developing, but that doesn’t mean that every aspect of their society (including healthcare) is automatically inferior to that of western lands. In fact, the local professionals may even have a better idea than the foreign doctors of the ailments that are likely to affect people living in the area. What works for the locals should work for almost anyone there.

Let’s do the math one more time: $90 for no diagnosis and an unnecessary prescription versus $35 for specialist consultations with an excellent doctor, medications that worked, and a diagnostic procedure that resulted in a wildly successful recovery.

It all adds up pretty easily for me now.

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