Robert Gordon University 2014

Radiography, Nepal Pokhara

 

Nepal became my home for four weeks while undertaking an elective placement in diagnostic radiography. I was fortunate enough to win the place through a competition run by the Society of Radiographers, in conjunction with elective placement company Work the World.

Upon arrival, Nepal was a culture shock for me. Surrounded by the Himalayan mountain range and temples, lays the idyllic town of Pokhara, where I was based. In my placement I divided my time within the radiology department between x-ray, CT, MRI, ultrasound and mammography.

 

From the Work the World house, the hospital was about a 45-minute drive on the local bus. From the bus window, the snow-capped Annapurna mountain range was visible and the drive also provided the opportunity to immerse myself in Nepalese culture. I was able to mix with locals and witness daily life and living conditions. I found the standard of living to be very poor and overcrowded, with many homes constructed out of concrete blocks and corrugated iron. The average Nepalese person has very limited access to healthcare due to its expense. The relaxed attitude towards sanitation creates a breeding ground for infection and disease. The busy roads mean road traffic accidents are a very common occurrence.

For many Nepalese people, a visit to hospital is a last resort. Local pharmacists and ayurvedic doctors are often consulted first as they offer cheaper treatment remedies. It was emotionally tough for me to watch patients dismiss themselves from hospital after diagnosis, as they could not afford treatment. This was especially hard when a life threatening condition was evident from images I had been involved in taking.

it allowed me to deepen my understanding and appreciation of the implementation of evidence-based practice

I now have a greater appreciation for the National Health Service, and feel privileged to be able to access services that I had previously taken for granted. The standard of care given in the Nepalese hospital is vastly different to the service I have been training to provide. Patient interaction is brief, with no explanations given to patients about the procedures they are about to undergo. Medical staff are task-orientated and leave patient care to relatives. There is also little evidence of infection control, with no hand washing procedures in place or records kept of infection rates. The most alarming difference within the radiography department is the non-compliance with radiation safety procedures. The x-ray department takes over 250 patients a day in one room. Several patients are brought into the room at any one time and the door is left wide open. Both patients and relatives are exposed to radiation repeatedly, while collimation is left open wide unnecessarily. Only the staff retreat to a safe distance behind lead lined shielding.

This manner of working was shocking to me, it allowed me to deepen my understanding and appreciation of the implementation of evidence-based practice. The staff within the department were aware of new safer practices, but they lack resources.

 

However, I do have great admiration for the staff, who were relentless in their efforts to provide the service with limited resources, working 12 hour shifts six days a week. I have to commend and respect their work ethic and resilience when working under such conditions. I have realised how lucky I am to be able to learn and work in such an advanced healthcare system.

The hard working attitude of the staff is something I will take back with me and incorporate into my future practice.

In the time off during the weekends, I joined fellow housemates in exploring the lakeside town, visiting many of the temples and joining in with some adrenaline activities.

I was fortunate enough to join in a local rice planting festival, go white water rafting, paragliding and found time to travel down to the town of Chitwan to go on a jungle safari on an elephant.

This once in a lifetime experience was everything I expected and more. I enjoyed meeting peers and students from all over the globe. While observing alternative ways of working was challenging, it was also very rewarding. I would recommend doing an elective here to everyone.

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