Oregon Health and Science University 2012

Medical, Nepal Pokhara

I went to Pokhara, Nepal, with Work the World for a two-week placement in the labour and delivery ward of the government hospital, after completing my second year of nursing school. I had always wanted to volunteer overseas, so when two fellow nursing students found Work the World, I joined up with them for them to do the placement in Nepal.

At the time I did not know much about Nepal, other than it sat between India and China and was home to the legendary Himalayas. While I read other student’s case studies, I knew that the experience was likely to be nothing like what I have experienced in the United States and kept an open mind.

After I applied for a placement, the Work the World team helped me to prepare with the online timeline to keep me on track and several phone calls to answer questions and make arrangements. Before I knew it, it was August and time to get on a plane. 

After nearly 30 hours of travel my two nursing classmates and myself arrived in Kathmandu, Nepal, to tour for a few days before flying to Pokhara. Initially the city was intimidating to me; the vehicles speeding down the narrow streets and assertive shopkeepers made me nervous and quite certain that I would be lost or run over. However, after a day or two of settling in and catching up on sleep we were all enjoying the city and visiting popular sites like the monkey temple and Dubar Square in spite of the rain and heat of monsoon season. 

Flying into Pokhara was magical; within Kathmandu I had no concept of the Nepalese landscape. While the monsoons had delayed our flight and prevented us from seeing the Himalayas, the green foothills, rivers and cliffs all shrouded in fog were breathtaking. Sunil, the program manager in Nepal, was at the airport when we landed in Pokhara. Both Sunil and Renu, the assistant manager, were wonderful at making us feel right at home and getting us acquainted with Pokhara before our placements began. 

Renu got us all to the government hospital the next day to begin our placements and ensured that we all met our unit charge nurse. While I had learned a few Nepali phrases from the Work the World materials, I was worried about how much English the staff would speak or if they would expect me to know more than I did. As I found, while some of the staff spoke almost exclusively Nepali, many, especially the nursing students, spoke English very well. Almost immediately staff took me under their wing and had me observing in each of the unit sections. The nursing students in particular were extremely friendly and happy to share what they knew. 

In some ways working in the labour and delivery unit was difficult for me. The birth process seemed to be similar to an assembly line; women under 4cm are in one room, then moved to another after 4 cm, then are walked to the delivery room when they crown. The delivery beds have no stirrups, so the women much put their toes around poles at the end of the bed to hold themselves. The nurses almost always conduct the delivery, and women almost never get pain medication unless they are a first-time mum and receiving an episiotomy, in which case they get local anesthesia. Families provide much of the care for the women, such as bringing food and emptying their urine. In spite of the lack of the supplies and facilities that I am used to in the United States, in some ways I loved the unit. Nurses and students refer to the women as “didi”, or older sister, a term of endearment. It was clearly an intimate experience within the women of the family. One nurse described to me that birth was a rite of passage, that by enduring the pain and labour of birth women were set apart from men. 

Because I was on the unit for such a short time and of the general protectiveness around women and children I was limited to observation for my placement. It was a great learning opportunity and I experienced doctors’ rounds, post partum care, deliveries, active labor care, and caesarian sections. It seems amazing now how different and yet similar things are between my own country’s practices and those in Nepal; while culture and resources are very different, the work, dedication, passion, and care for patients are the same. 

Being in Pokhara was wonderful. Waking up on the clear mornings to the Himalayas took my breath away, and I enjoyed the openness of the city and evenings down by the lakeside. My favorite memory of the trip is how cars would honk like crazy at people and weave politely around the cows relaxing in the middle of the street. Everyone at the Work the World house took wonderful care of us, and meals with Deepak were always phenomenal. I loved getting to know the medical and nursing students in the house and enjoyed adventures with them like the hike to the peace pagoda over the lake. 

The final day that I was in the hospital happened to be Teej, which is a festival that celebrates women. We were invited to join the staff in the celebration and were even taught how to dance, which earned us a lot of laughs. Following our placement we continued to tour Nepal for a few more days and stayed in one of the national parks. Notably, we discovered exactly what people meant by it being treacherous to travel by road during monsoon season when we narrowly missed a landslide. Planes are certainly the way to go during this time of year. 
I learned so much from this experience, from being a minority with a language barrier to medical care in a country with a different culture and set of resources. I left having met so many amazing people and look forward to visiting this amazing country again someday.

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