Oncology in Nepal – what happens to patients with cancer in the developing world?

Wednesday, August 10th, 2011

For my Work the World elective I travelled to Pokhara, Nepal and spent four weeks in a General Government Hospital. I did two weeks on a paediatric ward and two weeks on a surgical ward, including experience in theatres. One of my focuses was on cancer in Nepal.

The hospital I was working in was small and so had limited specialist equipment or resources – there was an endoscopy unit, which can be used for colorectal cancer screening but it did not have a Magnetic Resonance Imaging (MRI) machine, which can help in detecting cancer metastasis. There was no official oncology ward, so patients who were suspected as having cancer tended to turn up on the surgical ward.

Abby2011 13 150x150 Oncology in Nepal – what happens to patients with cancer in the developing world?

Families provide the care in Nepal

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Mud, mud and more mud for Work the World Nepal students in Nepal.

Tuesday, August 9th, 2011

Depending on where you go, students have the opportunity to get involved in lots of local festivals. It’s a great opportunity to meet the community and experience the culture of another country.

P6030055 150x150 Mud, mud and more mud for Work the World Nepal students in Nepal.

Dancing to traditional music

Nathan, a Sheffield student in Nepal, sent us this report about the festivities in Pokhara this week…

“We all went to a mud festival in Pokhara today – it was absolutely amazing, so much fun!

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Infection control – the reality of developing country hospitals

Thursday, August 4th, 2011

For my Work the World elective I travelled to Pokhara, Nepal and spent four weeks in a General Government Hospital. I did two weeks on a paediatric ward and two weeks on a surgical ward. One of my focuses was on infection control.

Nepal not only has a Gross Domestic Product (GDP) significantly lower than that of the UK, but they also spend a lower percentage of this on health care. This results in a much lower amount being spent on people and their health needs (World Health Organisation, 2011).

Abby 2011 7 150x150 Infection control   the reality of developing country hospitals

Paediatrics ward

In Paediatrics, the most commonly observed problems were Respiratory Tract Infection (RTI), Pneumothorax, Diarrhoea and Vomiting, Nephrotic Syndrome and pyrexia of unknown origin (PUO). In surgery the most commonly observed problems were appendicitis, burns (burns unit was part of surgical ward), diabetic feet, cholelithiasis, and stab injuries. About 70% of illnesses in Nepal are attributed to infectious diseases.

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The weekly question – What tips can you give for making the most out of your clinical experience?

Tuesday, August 2nd, 2011

We always try to prepare students as much as possible before they head overseas for their placement. Past experience has shown us that the more committed, enthusiastic and pro-active they are, the more likely it is that they will get some fantastic hands-on experience.  This week we have decided to ask the students in each destination “What tips can you give for making the most out of your clinical experience?”

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Paediatrics in Argentina

When we asked the students in Mendoza they all agreed on one thing: don’t be afraid to ask questions! “Even if you don’t master the language, leave your shyness at home and ask everything you need to know” also, “make sure that you explain from the very beginning what you are capable of doing, what you want to do and the things that you are interested in seeing” said Kimberly.

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My radiography elective in Nepal…. the rants of Cherry Black!

Saturday, July 23rd, 2011

Olesia’s pre-birthday birthday dinner on Saturday night. We went to a restaurant in Lakeside called “Once Upon a Time” (quite a few places here have really inventive names; the language school which Prem, our Nepali teacher, runs is an easy winner with “Cosmic Brontosaurus”). We had dinner, and I got to catch up with George and Daniela who had both spent the previous week in Nalma treating patients in the remote village. Then after dinner Olesia went to the toilet, and Claire and George ran over once she got inside and essentially locked her inside by holding the handle shut, whilst her surprise birthday cake was adorned with candles. Not many people get held hostage on their pretend birthday in Nepal, I’m sure, but now I know of at least one person who has. Unfortunately when she was released from the loo, the fan did a great job of blowing all the candles out so a quick reset was required, but I think this all just added to the charm of the evening. Afterwards we went to the downstairs area of the restaurant where they have a TV and semi-decent DVD collection, but due to Nepal’s licensing laws, we were kicked out of the bar just as Ocean and his 11 were about to break into the casino’s vault!

I spent my last full day in Pokhara down by the lake; I was going to rent a canoe and head over to the peace pagoda but it was swarming with tourists and I really didn’t fancy it. I’m sure it’s beautiful and I know I’ve missed out, but this is not my only trip to Nepal, I will be back; if only to implement a draconian infection control regimen in the hospitals here!

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Dental Outreach in Nepal – 2011 projects so far.

Thursday, July 21st, 2011

Our Work the World house is based in Pokhara city, so each year we try to set up the Dental Outreach Project in the Pokhara valley as this gives us the opportunity to provide free dental care in the communities in which we work. This year though we decided to also set up two projects outside of the valley in Nuwakot, just a couple of hours north of Kathmandu. We thought it would provide an interesting comparison and help us decide where we are most needed.

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The welcome ceremony at Jurethum

The first camp was set up in Bidhur, a charming hill top settlement that overlooks a beautiful river valley with ancient temples scattered around the main village square. The last dental camp was conducted over a year ago by the rotary club, so it was a good opportunity for us to follow up on the good work. The community screening and the treatments were carried out at the village school with the portable dental equipments brought in from Kathmandu. ‘The Famous Farm’ was our student dentists’ home for 2 weeks – a restored Newari manor house, tastefully decorated with traditional Nepali furniture. The kitchen served wonderful local food and the cook also bent backwards to accommodate our student’s request for some western food!

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The Weekly Question – What is the most interesting piece of local curiosity or handicraft that you have seen and tell us a bit about it

Friday, July 15th, 2011

We know that students love to travel at the weekend and often find fantastic souvenirs or witness fascinating ceremonies. This week we are asking the students “what is the most interesting piece of local curiosity or handicraft that you have seen and tell us a bit about it.”

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Kandy centre

Sri Lanka is a treasure trove of exotic delights and crafts you can take home with you. Jan and Rebecca, 3rd year Midwifery students from New Zealand have packed their cases full of pashminas and tell us that the “batiks look really cool, they are great for wall hangings and cushions. But make sure you barter hard for them and buy them of the central market and not Queen’s Hotel shop. The pashminas are really beautiful and good quality. Once again barter. Pay no more than Rs.650 for the plain and Rs. 1100 for the patterned.

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The weekly question – What is the most interesting and positive encounter you’ve had with a local outside of your placement?

Thursday, July 7th, 2011

We love to hear about what students do in their spare time when you are overseas; from tea drinking between shifts with the local staff in Nepal to attending loud and lively weddings in Ghana…This week we asked the students “What is the most interesting and positive encounter you’ve had with a local outside of your placement?”

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The Maasai Market

Carol in Arusha reports that “Haggling with the locals in the Maasai market is a bit intimidating at first but great fun once you get into it.” Fiona agreed and said “it’s a good way of practicing Kiswahili too.” Louise has even made friends with some of the Maasai mama’s “Making friends with the ladies in the maasai market gets you a good bargain! They remember my name and call “Louisa” every time I go there.”

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My Radiography elective in Nepal – the rants of Cherry Black!

Tuesday, July 5th, 2011

Today was very chilled out, music playing (the radiologists spent most of the morning playing Bryan Adams songs on YouTube. My head hurts!), everyone smiling, I even got on with some CT scans in the afternoon which was cool. Apparently tomorrow is going to be a massive party, it’s my last day at Manipal and also the head of department is going to be away for 3 weeks so everyone’s celebrating!

Thursday night’s send-off for Debraj was really nice, we went to Club Amsterdam for a bit, and watched the most enthusiastic tambourine player that I’ve ever seen, before heading over to Busy Bees to finish the night. A different band was playing, but the setlist was the same, it’s like an alternative cabaret and I like it. We hit the shisha and practiced blowing smoke rings until hypoxia set in, and then we ordered some pizza. It was a lovely evening, but for once I wasn’t the last one in the door because the sleep deprivation is starting to have an effect and it isn’t much fun.

101 3321 300x225 My Radiography elective in Nepal – the rants of Cherry Black!

My colleagues

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My radiography elective in Nepal…. the rants of Cherry Black!

Monday, July 4th, 2011

Today I spent the whole day in the basement, in the radiotherapy department. This was especially interesting as I’ve never even been to RT in the UK before. I was impressed that the hospital had an expensive LinAc machine.

Outside the LinAc room is a row of chairs opposite the control room where the patients sit and wait their turn for treatment. The rad tech sits in the control room and calls the patient to go to the LinAc before the previous patient is even off the table, something which I had a problem dealing with. There was a breast cancer patient who had had a complete left mastectomy lying on the table with her chest exposed while the next patient, also suffering from breast cancer but who had not had surgery, got changed into a gown 4 feet away. I know that the people here are much much hardier than us Brits, but there is no way they are unaffected by these experiences. I also saw a 7 year old boy with a brain tumour come in for what was I think his 6th radiotherapy session; he came in to the room, clambered onto the table and positioned himself prone with his head on the awkward restraint, as if it was the most normal thing in the world. Very difficult to watch.

But while it was very distressing to watch, the overall experience was actually very high quality and quite efficient. The patient was brought in for planning following diagnosis the previous day, and had treatment immediately afterwards. The medical physicist and oncologist drew up a comprehensive plan of action taking in to account the patient’s age and current health, ensuring that they only endured what was absolutely necessary for their condition to improve, rather than faffing about with procedures which may lead to increased suffering and discomfort in the long run.