Exeter University 2018

Medical, Nepal Pokhara

My overseas medical placement was months in the making. MyTrip, Work the World’s placement planning dashboard, was great in the lead up to my trip. It gave me lots of useful information about my placement hospital, the house I’d be staying in, and the village in which I was going to undertake my Village Healthcare Experience. It was also nice to see who else was going to be in the house during my stay. There was also a useful checklist for the months and weeks leading up to the trip to help with organising things like insurance and flights.

Dupont, Seren

I arrived in Pokhara at around 11pm after taking a bus from Kathmandu, Nepal’s capital city. I was tired, but grateful to have finally arrived.

A member of the Work the World team was at the bus stop waiting to meet me and drive me back to the house I’d be living in. When we arrived, the team showed me up to my room so I could settle in before heading to the kitchen for a generous serving of homemade curry and rice.

I shared my room in the Work the World house with a medical student from Denmark who had been in the house for a couple of weeks already. I was also sharing with a nursing student from Scotland who had arrived earlier that day, On this point, I actually made loads of friends from all over the world, many of whom were from different healthcare backgrounds. There were nursing, midwifery, pharmacy, physio and medical students from the UK and Ireland, Australia, Denmark and Germany.

Dupont, Seren

The room was comfortable with 4 beds, mosquito nets, plenty of storage space and a shared bathroom. The house had spacious living areas and a large dining room, a kitchen where our chef cooked us incredibly good food every morning and night. There were amazing views of the snow capped Himalayas from the rooftop.

My first full day in Pokhara was a day of orientations. I had a welcome briefing with Pokhara’s Programme Manager in the morning. We discussed the details of my placement and the village healthcare experience I’d be undertaking once my city-based placement was over. We discussed what the hospital’s expectations of me were, as well what my expectations were. This helped prepare me for the coming weeks. The team gave me a great map of the local area, with some details of nearby places to visit, like waterfalls, a mountaintop pagoda and some caves.

Dupont, Seren

Our first outing that day was for a tour of Pokhara. We saw the area of the city nearest the house, then went to an area called Lakeside, where all the backpacker bars, restaurants, cafes and shops were. We tried some of the local food, including sel roti—a rice based doughnut eaten with curry—and Dhal Bhat. We picked up local sim cards and phones, and visited some of the best places for getting local crafts like traditional wood carvings and cashmere scarves. One highlight was taking a boat out onto Phewa Lake to visit a small temple in the lake’s centre.

The team then showed us how to navigate the local bus system and what say to the drivers to get to important places. One such place was our placement hospital.

When we arrived back at the house, we had our first language lesson. We learnt introductory Nepali phrases and questions, and some body parts and numbers; all useful for communicating with patients and local staff. We had weekly language lessons thereafter, helping us interact with people in a much more meaningful way than we would have otherwise been able to achieve alone.

Dupont, Seren

The following day, my clinical placement began. I was based in the Emergency Department of one of Pokhara’s larger teaching hospitals. Speaking openly, the first couple of days were a culture shock; the hospital environment was very different from hospitals in the UK in which I’ve undertaken placements. I was particularly aware of the lack of privacy for patients, as there were no curtains around any of the beds. With regards to the nature of the patient-doctor interactions, patients seemed to have very little autonomy in decisions made about their care.

Some of conditions patients presented with were familiar; acute exacerbations of COPD, stroke and myocardial infarctions. There were, however, more patients who had suffered trauma from road accidents and burns when compared to what I was used to in the UK. I observed and assisted with the management of these injuries, and learnt a lot from doing so.

Dupont, Seren

It was fascinating to see how Nepal’s health system worked. Patients were expected to pay for investigations and treatments, including everything down to the gloves worn by the nurses when taking blood samples. Relatives were often expected to pay for and collect medication and to assist with care, taking patients to and from the imaging department. For patients requiring immediate care, treatment was given with the expectation that it would be paid for by the patient and their family in retrospect. The hospital did have a patient fund available for anyone who couldn’t afford the treatment they required, but this was very closely monitored. Some families had to decide between paying for treatment or feeding their family. This was quite hard to take in, and it made me appreciate the importance of the NHS being free at the point of care.

I also had an opportunity to visit a local hospital for those with leprosy. We went on a tour of the site to see the wards, the prosthetic workshop, the physio gym and the workshop where wheelchairs were made and repaired—it was fascinating. Interestingly, I found the hospital to be more advanced than the government hospital we had spent our placement in, which was most likely due to funding.

Dupont, Seren

I spent a week in a rural village, which was the highlight of my placement with Work the World.

I stayed with a family in a small village in the Himalayan foothills. We were accompanied by a Work the World guide and interpreter, as local people spoke very limited English if they spoke it at all. Each morning, we walked up to the village health post and sat in on the clinics. We’d help by take blood pressure, dressing wounds and giving injections. The facilities were basic, and it was really interesting to see what level of healthcare was available in a rural village setting. Each afternoon, we took part in different cultural activities, to get a real taste of Nepalese village life. We cooked traditional food, helped weed the millet fields, ground grain into flour, grazed the village goats and tried on traditional clothing. We were treated to some beautiful sunrises with views of the mountains from a hill above the village.

Dupont, Seren

Pokhara was the perfect base for an overseas placement. There’s a balance of local culture and backpacker hotspots, and there are some beautiful places to visit. The house is outside of the main tourist area, so I felt like this allowed me to see what living in a city in Nepal was like for local people. In the evenings, we went to Lakeside’s cafes, restaurants and bars to socialise. The lake was beautiful, and there were opportunities to go for afternoon trips to caves, or hike up to the Peace Pagoda for amazing views of the city. We also went kayaking on the lake and white water rafting on weekends.

Dupont, Seren

The Teej (Women’s) Festival took place during my stay. One of the members of the lovely Work the World team arranged for all the girls to borrow sarees to wear for the day, and we joined in with the local celebrations. We were treated like celebrities (being the only non-Nepali people there) and invited to sit in the VIP area. Before we knew it, we were up on the stage dancing in front of thousands of people.

Dupont, Seren

My time in Nepal was amazing. I learnt a lot about the Nepalese health system, about managing conditions that I haven’t seen in the UK, as well as improving my knowledge of managing conditions I had seen before. I also gained insight into the challenges of remote and low-resource healthcare. I gained confidence in my own abilities in diagnosing and managing patients, which I am certain will benefit me in my final year as a student and as I begin my career.

Being immersed in such a different healthcare environment was eye-opening. My overseas placement was an experience I will remember forever. I feel so lucky to have had such an incredible opportunity to broaden my knowledge, improve my skills, develop personally and professionally and experience new areas of medicine.

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