My trip to Pokhara_Nepal
Richard Smirk (Dental Outreach)

Soaring, not so smoothly, over the Himalayas in a Yeti Airlines propeller plane, my first experience of Nepal was an awestruck one.  The mountain backdrop out of the window was significantly more impressive than anything the Lake District has to offer.  Yet, Henry in the adjacent seat, head in hands, seemed more concerned with the plane staying in the air and avoiding, in his mind, a near certain death.

We arrived in Pokhara airport slightly relieved but excited about the weeks to come.  After picking up our bags and receiving a friendly welcome from the Work the World project leader Sunil, we set off to meet the rest of the students on our Dental Outreach Project.  After one train, three flights and about two hours sleep in as many days we were less than looking forward to the two hour mini-bus journey and subsequent trek to the village of Birethanti.  However, upon meeting the people we were to spend the next fortnight with, the cheerful, exciting atmosphere soon cured our tiredness.  Once the road became too rough for the minibus to pass over, we continued on foot along the valley floor, using rope bridges to cross ferocious rivers, feeling a little bit like walking an Indiana Jones set.

Upon arriving in Birethanti, we received a flamboyant and slightly unexpected greeting from the mothers of the village.  With flower garlands placed around our necks and "tikas" marked on our foreheads, any fear of an awkward reception off the villagers soon passed.  We finally settled in Green View Guesthouse, a small family run establishment in an amazing setting overlooking a Himalayan river, complete with waterfalls and rapids.  After an extremely welcome meal and an introductory talk off the Work the World team leaders Durapata and Bom we headed up to the school classrooms from which we would conduct our dental treatment over the following days.  Here we were immediately confused by the jumble of temporary dental chairs, air compressors, an electric generator and other equipment.  However, upon the arrival of Sunil and our dental supervisor, Dr Anil, things were soon organised to a level where we could commence treatment the following day.

In the fortnight to come, an attitude of work hard, play hard was adopted by all.  We would head up to the school every morning at around 8:30 where we would set up for the day to come.  Work the World had done a good job of spreading the news of our presence and thus, a lack of patients was never a problem.  In a make-shift marquee outside, patients waited to be first screened in one classroom and then, if required, treated in the one next door.  In my opinion, things ran extremely smoothly considering the complexity of the operation and limited supplies and equipment when compared to hospital dentistry.  Treatment included simple scaling, conservation and simple exodontia.  Everyone became extremely proficient at extractions over the two weeks, tackling often difficult retained roots and badly broken down teeth.  This was aided by the expertise of Dr. Anil, who never failed to remove buried roots when our experience reached its limits, despite the extremely limited supplies of surgical equipment.

One thing that can be said for the outreach project is that it is just that!  The difference from "western" dentistry and health care attitudes was huge.  Levels of cross-infection control that are expected in hospital environments simply cannot be maintained in a temporary clinic miles away from the nearest large town.  It was often necessary to overlook poor levels of cleanliness and lack of sterilised equipment and concentrate on the good we were doing in providing dentistry to those who had often never seen a dentist before.  Often patients had been suffering with recurrent pain and inflammation for a number of years before we were finally able to remove the source of infection.  Overall, our work was greatly appreciated with patients often walking for a number of hours to receive treatment.  Excellent support was provided by a few locals acting as translators whose help and friendship helped make the project so enjoyable.

Once our work was done the evenings allowed us to relax and enjoy ourselves in the amazing setting that none of us had ever experienced before.  Early evenings consisted of trekking the various paths in the valleys around the village and swimming in the less than peaceful rivers with the translators' local knowledge assisting us in not being swept down stream, probably all the way to India.  One memorable activity consisted of planting rice on a mountain side paddy field.  This soon turned into a half hour mud fight in which no-one was left who wasn't absolutely caked, head to toe, in the contents of the field.  However, a convenient 20m waterfall around the corner provided an excellent, if not slightly violent, shower in which we could wash off.  When darkness set in we would head back to the guesthouse for a well earned evening meal, which gave us an excellent opportunity to experience the local cuisine.  Nepali beer and local wine often accompanied Durapata's "sharing time" in which an enjoyable time was spent sharing our experiences from the day.  Following this, the evenings turned to socialising, joining in with the locals dancing to Nepalese music and at least one extremely competitive game of monopoly.

Half way through the project we returned to Pokhara to enjoy a well earned weekend relaxing and exploring the various restaurants, bars and clubs the city had to offer.  Unfortunately, however, the local police failed to enjoy group singing at 1a.m. quite as much as us.  Upon returning to Birethanti we continued the project focusing more on treatment over screening in order to get through the vast amounts of patients already seen.  The rotations were changed to include extractions being carried out on normal plastic chairs, reserving the temporary dental chairs for restorative treatments.  Despite frequent power cuts and a continual flow of new patients by the end of the week I believe we had managed to see all the patients that required treatment.

On the final night in Birethanti almost the entire village turned up to our guest house for a farewell party making us feel greatly appreciated for our hard work.  This included thank you speeches from the local villagers, the Work the World staff and ourselves, as well as being dragged up to dance with the locals and then us dragging the locals up to dance with us by the end.  A great time was had by all with the party continuing till the early hours of the morning.  The next day we awoke to a few more hours of treatment followed by packing up the clinics and an extremely emotional farewell with the friends we had made in the village.  Back in Pokhara we had a final night out with our fellow students, some of the translators who had journeyed from the village with us and a few other students on Work the World projects based in Pokhara.  The following day everyone was extremely sad to be saying goodbyes but looking forward to a variety of subsequent trips including Vietnam, Bali and India.

Henry and I had decided to stay in Nepal for the following 3 weeks and although very different to the dental outreach project the time had was equally enjoyable.  One highlight included a 6 day round trek to Annapurna Base camp where there were breathtaking views of the Himalayan peaks.  On the way back down we passed through Birethanti again and were amazed and glad to see a few of the village children wearing our Work the World t-shirts that we had left in the guest house.  It was amazing to catch up again with the friends we had made in the village and some of the patients we had treated.

Following the trekking we did a three day safari in Chitwan National Park enjoying riding on elephants through the jungle and navigating crocodile infested rivers in a dug out canoe.  We visited bat caves, hired boats on Lake Phewa and trekked to the World Peace Pagoda on top of a hill overlooking the city of Pokhara.  In order to see fellow students from Newcastle University and the Work the World staff associated with our project we decided to visit another dental outreach project, based on a hillside on the side of a large lake.  This beautiful scenic setting, well away from any towns provided an excellent relaxing retreat before heading back to the bustling city of Kathmandu.

In Kathmandu, Bom, who had been one of the two Work the World staff staying with us on our guesthouse, got in contact with us and told us he was in the area.  With him as our guide and friend we were able to explore the side streets, markets, temples and national parks of the Kathmandu valley much easier than if left on our own.  Kathmandu itself is an extremely busy, noisy and polluted city, however, there are many impressive sights to be seen and a short stay here should not be avoided when visiting Nepal.  After saying our emotional goodbyes to Bom we set off home having had a hugely enjoyable and once in a lifetime experience in Nepal.

I would thoroughly recommend Nepal to anyone.  The Himalayan scenery is second to none, the people are some of the friendliest and welcoming I have come across anywhere and with so many things to do and places to explore I could easily have stayed there for numerous extra months and will be going back in the future.  The Dental Outreach Project ran by Work the World was an excellent opportunity to see dentistry in an often shockingly different environment, whilst helping people whose access to dental care would usually be very limited.  Work the World took all the trouble out of organising something that would have been next to impossible to sort out on our own and provided me with an experience I will always look back upon with fond memories.