The CIWEC Clinic Newsletter – April 2010

Staff News

Dr. David Kraklau, one of our long time CIWEC doctors got married recently to Shayleen Burgoyne a Lincoln school teacher in a romantic setting in Ethiopia. He will stay in Nepal for a while and will be working part time at the clinic. We congratulate the couple and wish them all the best for a beautiful life together. Francoise, one of our long time CIWEC nurses also got married the French way to Jerome Edon recently and we wish them both a happy life ahead. We bid farewell to Nicola who is leaving Nepal and will be getting married in June. This certainly seems to be the wedding season at CIWEC.

Dr Mary Miller from the dental clinic has had to return to the USA due to an emergency back home and the clinic is currently being run by a very competent Nepali doctor who trained in the Philippines, Dr. Niranjan Sharma.  Dr Sharma has worked at the clinic for the past few years with Dr Brian Hollander and is familiar with the workings of the clinic and is known to many of the regular patients.

We welcome Judy Podziewski back to the clinic. Judy is an emergency room nurse from the USA who is undertaking an online course to become a nurse practitioner. She will help us out in the busy season.

New plans for CIWEC expansion

We are proceeding with expanding CIWEC clinic to allow us to develop additional services. The design phase is complete and final details are being worked out. We will start construction work in the summer. The expanded building is going to give us 4 additional examination rooms including a minor operation theatre on the ground level, several inpatient beds on the first floor, specialty examination rooms on the second floor and an operating theatre on the third floor. There will be extra space on the fourth floor in case we decide in future to add a labour room. All of this expansion work is possible through your continued support as CIWEC is self financing and does not have any source of outside funding. Please let us know if there are additional services you would like us to offer at the clinic.

Swine Flu or H1N1

We had several confirmed cases of this disease in November 2009 around the same time that India reported an outbreak of H1N1. Now that the weather is warmer, we do not expect this disease to cause any problems. We have ample supply of the antiviral medication Tami flu but do not have the vaccine since it is not available commercially. Many diplomatic communities have obtained it from their home countries but for others, we hope that this disease remains a mild illness as has been the case so far.

Diarrheal illnesses

Diarrhea risk doubles in the pre-monsoon months of April, May and June. We believe that this is due to the presence of flies in the environment that are seen in abundance in the spring. Flies transport bacteria from feces to food.  No matter how careful you are you can still get ill, therefore we ask you to take reasonable precautions, and treat if it happens.

If you suffer an episode of diarrhea, it is important to replace fluid and electrolytes to prevent dehydration. This can be done fairly easily with an electrolyte solution mixed in a liter of boiled and filtered water or one liter of mineral water. Some commercially available products are Nava Jeevan and Jeevan Jal. Other fluids that can supplement the oral rehydration solution are: coca-cola/sprite without the bubbles, herbal teas, clear soup, tang solution, Gatorade or weak tea.Alcohol and heavily caffeinated products should be avoided. It is important to urge young children with diarrhea to drink liquids frequently since they can get dehydrated quickly from seemingly small fluid losses. Adults should drink 3 liters or more fluids per day depending on the amount lost as diarrhea or vomiting.

Bowel paralyzers, such as loperamide (eldoper locally), can give temporary relief of abdominal cramps and diarrhea, but do not shorten the illness or treat the cause. The use of bowel paralyzers is justified, however, when there is severe watery diarrhea or when facing a long bus or plane trip, or when you are trying to trek. To treat with loperamide, take 2 pills to start, and 1 pill after each loose stool (not to exceed 8 pills a day) until the diarrhea stops. Do not use loperamide alone if you have bloody diarrhea or fevers unless you take an antibiotic with it.

Planning for a trek:

Many people will go trekking in the Nepali mountains in the spring season. Any person who is mentally prepared to trek and is reasonably fit, can safely do so. If you are taking high blood pressure medication and are not sure what to do, please continue to take your medication while you trek. Blood pressure tends to go higher at high altitudes. It is important to have a first-aid kit in case you encounter health problems like diarrhea, cough/cold and altitude illness while trekking. Use of birth control pills including the continuous use oral contraceptive pills is considered OK during trekking.

Altitude illness can start to occur at 2500 metres but serious symptoms are rare below 3000 metres. The early symptoms are headache, nausea, loss of appetite, fatigue and poor sleep. Serious symptoms are mental confusion, ataxic or drunken gait, cough with gurgling sound in the chest, extreme fatigue or shortness of breath at rest. Mild symptoms can resolve while you stay at the same altitude and you can continue your trip. Serious symptoms require that you descend immediately by helicopter or by walking/getting carried. It is important to know that there is great individual susceptibility to altitude illness and you may be the only person in a group to have symptoms.

Diamox (acetazolamide) can be used for prevention of altitude illness if you know that you have been susceptible to altitude on a previous trip or if you are flying/driving directly to high altitude places like Lhasa. It is not recommended for sulfa allergic people. The dose of diamox is ½ of a 250mg tablet twice daily for adults. For children, a dosage of 5mg/kg/day can be divided into 2 doses. There will be tingling noted around the mouth, fingers and toes in most people taking diamox. It is slightly uncomfortable but not a worrisome side effect.

If you are taking children to high altitude or if you have any medical condition that you are concerned about, we suggest that you see us before your high altitude trek. Detailed information on altitude illness and on the topic “trekking with children” can be found on the CIWEC Clinic website at: A handout on altitude illness and its prevention is also available in the clinic waiting room.

Health risks from the sun:

Although being in the sun may be enjoyable, it must be remembered that excessive sun exposure is a health hazard due to the effect of ultraviolet (UV) radiation on the skin.  UVB causes sunburn which can range from intense erythema to blistering and ‘burnt skin’ similar to a burn from hot water or fire.  Sunburn is more likely when, in addition to direct exposure from the sun, UV is also ‘reflected’ from water, sand or snow.  This risk is greater at higher altitudes when there is less protection from the earth’s atmosphere.  Both ultraviolet A (UVA) and ultraviolet B (UVB) radiation are known to cause premature cancers.  Drying of the skin can result in exacerbation of facial seborrhoeic dermatitis.

Especially vulnerable groups: Include babies and small children.  Fair skinned people with red hair or blue eyes.  Those with certain medical conditions such as albinism or previous skin cancer and also those on medications such as tetracyclines including doxycycline, oral hypoglycaemic drugs and diuretics.

Precautions: Babies under 9 months should be kept out of direct sunlight.  Children should wear long sleeved, loose fitting shirts, hats and high-factor sunscreen.  The greatest risk is from the midday sun, usually from noon until 14:00 hours (15:00 in tropical regions) when precautions are especially important.  Adults should wear a broad brimmed hat, long sleeved shirts and sunglasses.

Sunscreens:Sunscreens do not replace the precautions described above but they can help absorb UVB and to a lesser extent UVA.  Waterproof sunscreens can prevent their removal by sweat or water although they should be reapplied regularly.  There is a voluntary star system for sunscreens grading UVA protection; more stars indicating greater protection.  The Sun Protection Factor (SPF) refers to the protection against UVB (e.g. ‘SPF 8” allows approximately 8 times longer sun exposure without burning than with no protection).  To gain effective protection a cream with an SPF value of 15 or above should be used.  Sunscreens are expensive – be wary of cheap sunscreens which may not give adequate protection and remember to check expiry dates.


All the doctors and staff at CIWEC hope that we are providing an effective and efficient service.  However, in view of the complexity of problems we deal with, we cannot guarantee that everything will always be perfect.  If you have any comments or suggestions to help us improve our service please let us know. If you have any complaints about the care that you have received at the clinic, please drop a sealed note c/o Medical Director or Business Manager into the clinic reception desk.


As the clinic has no outside source of funding it is totally reliant on the money received from patients seen at the clinic.   If you are resident in Nepal and wish to be billed monthly for your treatment at the clinic we would like your help in completing a form with your contact details and other information.

Thank you.
The CIWEC Team