by carol

Medical, Nepal Kathmandu, Where Are They Now?

Navin travelled to Kathmandu in Nepal in 2016 where he spent 6 weeks. He is now a Registrar in Emergency Medicine at Leicester Royal Infirmary. We caught up with Navin recently to reflect on his overseas medical elective.  

When did you got to Nepal for your medical elective? 

I went to Nepal in 2016, weirdly it feels like yesterday - or maybe I wish it felt like yesterday. It was such a great experience, it is unreal to think it was actually five years ago.  

I think about my 6 weeks in Nepal a lot as it was such a good experience, words can’t do it justice. 

I went a year after the 2015 Nepali earthquakes. You could still see the country was very much in recovery mode. There were still so many damaged buildings, plus at the time they were going through a fuel embargo with India so the country was struggling with a lack of fuel - it was a really interesting time to be in Nepal. That said, the people did not seem phased, they were so nice and simply getting on with their lives, the country is just incredible. I can’t believe I had not been to Nepal before to be honest. 

What made you choose the University of Leicester? 

Before I went to medical school I was studying Biomedical Science at Newcastle University. The year I applied to go to medical school there was a record number of applications, as the following year university fees were going to increase. I was delighted when I got my offer from Leicester University. I was a graduate entry under the undergraduate scheme so the competition ratios were really high. 

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Why did you want to study medicine? 

So many reasons. It is a great career, you get to work with the greatest minds from so many different professions, which I think is quite a unique thing. It’s not just doctors you’re working with, but also incredible nurses, pharmacists, biomedical scientists, occupational therapists - the list goes on.

Also, the NHS is so unique as well. It is a free healthcare system, it is not a privileged system so literally anyone can get the care they need no matter what your background. There are no judgements in the NHS. I also really wanted to apply the knowledge I had to improve people's quality of life. The non-technical side as well; the teamwork, the communication, the leadership, all encompassed within multiple roles but within one system. It’s something else.

Cast your mind back, what were the highlights from your time at University of Leicester? 

I loved my time at the University of Leicester. It was very open minded for student innovation, and so I created a widened participation course to help people from disadvantaged backgrounds get into healthcare. It was a collaborative course with DeMontfort University School of Nursing. This was a huge achievement for me. It still runs today, and I still have a lot of input in it. 

I got to play sport, a massive passion of mine. I had played cricket when I was at Newcastle University so when I joined Leicester I played for the medics cricket team. We went on to win the National Championship two years in a row. You get to play against people in different year groups and those who you might work with in the future, and you get to travel around the country. 

Leicester also puts students on placement very early, which is great. You get to meet the people you’ll end up working with and will one day be your seniors. I found this incredibly useful. The university was also very supportive. I got to know all of the faculty very well which was a highlight.

The head of the Medical School had an open door policy and was open to feedback. Thinking back, this was a highlight. It was nice to make these connections so early on. 

How did your overseas placement fit in with your degree? 

We had to do our elective in our final year and after our final exams. I choose to do my full elective overseas.

I had originally tried to organise this independently with a group of friends. We had been speaking with a hospital in Vietnam. Trying to organise it privately was such a headache. It was constant back and forth and it fell through at the very last minute. We had sorted our insurance, places to stay, and were just about to book our flights when the hospital decided (at the last minute) they were not going to accept us. The communication was so rubbish, so we all decided to go our separate ways and I then I came across Work the World

One of the great things about Work the World was they did everything for us. It was so easy. It was literally just book, pay, and then Work the World did everything. They took away all the stress. Once booked, I spoke to a friend who was interested in coming away too. She decided to do half her elective in England and then flew out to meet me and did the rest of her elective in Nepal. 

Blog Images - Navin

How was your medical elective in Nepal? 

As soon as I arrived in Kathmandu I was picked up by the team, and then promptly fell asleep once we arrived at the Work the World house after a friendly hello and welcoming meal as I’d arrived quite late in the day.

Then the next day was my city and hospital orientation, which was fantastic. I was taken out, had some traditional food, and was shown places in the city I’d likely return to. The information I got covered everything, and made things familiar when I went out on my own in the following days.

Before starting my placement in Kathmandu’s hospital, I was pretty nervous. I didn’t know what it was going to be like. The experience was totally different from going to a hospital in England that you hadn’t worked in before, as in Nepal I had no prior experience of the healthcare system. 

I soon discovered how nice the staff were, meeting the head of the department right away. He asked me what I wanted to achieve, and suggested a whole host of ideas for my placement I hadn’t considered.

I was given regular opportunities to enhance my practical skills (obviously under supervision) so that was exciting for me. I made the effort to get stuck in straight away and I was very proactive, making sure I was asking questions and getting the most out of my time. One thing that really helped was the fact that one of the consultants had trained in England, so he knew what information would be particularly helpful to me. 

During my first few weeks in Nepal I was slightly on edge as I was waiting for my final results, I got my results when I was out there and thankfully I passed. A huge relief! 

Blog Images  Navin white water rafting

What departments did you spend your time in? 

I was in A&E for my whole six-week placement, and so saw many things that I simply wouldn’t have done in the UK. 

One particular case was a severe rhino attack on a child, who suffered multiple injuries. It was incredibly sad to see. The family had travelled from the countryside -  it took them 24 hours to get to the hospital. Because of this, the wounds were completely infected. You just don’t see this sort of thing in England. Everyone in A&E tried their utmost to help this child.

In terms of practical experience, I got to brush up on my cannulation skills. Cannulation is so simple, but when the family can only afford one cannula, there’s really no room for error. In England, if you miss the cannula you can just go straight to the store room and get another one. If you miss it in Nepal, you have to charge the family for another one, which often families can’t afford. Learning how to cannulate difficult people in high pressure environments is definitely a skill I’ve been able to take back home.

I also helped to insert chest drains, and learnt to read the tell-tale signs of certain ailments. Because you just don’t have the investigative technology available to you, there’s a lot of going back to these basics, which are very valuable.

What did you do when you were not on placement? 

On weekends, I did as much travelling as I could! The team was so helpful with all of this; there’s a noticeboard in the Work the World house with ideas and details for extra travel.

I decided to go to the smaller city of Pokhara one weekend, which I would strongly recommend. 

Pokhara was so different from Kathmandu, and well worth visiting for the contrast. Kathmandu is a bustling Asian city -  busy traffic, lots of winding lanes and hidden temples and craft markets - whereas the pace in Pokhara is totally different. It’s green, mountainous and peaceful. You’ve also got all the extreme sports there too, so I went paragliding and white water rafting! It was incredible.

I also went on a weekend hike in a neighbouring village not too far from Kathmandu. The weather and scenery were incredible; I’d recommend going for at least one hike. I also went on a jungle safari, where I got to see elephants, and went to a local village and see how they made their food.  

Blog Images Navin

How was your time living in the Work the World house? 

Life at the World house was incredible. The food was just so good. When I got there I was mentally preparing to lose weight, but the chef told me that most people end up putting it on, instead. I didn’t believe her at the time, but soon did.

There’s also the weekly BBQ night every Wednesday – a great time to be social. The house was also well situated, walking distance from hospital, very easy to find, and had lots of balconies where we often enjoyed a few drinks, and amazing views.

I’ll admit I’m probably a bit biased, but I genuinely do not believe that any of the other programmes are anywhere near as good as Kathmandu! The team goes above and beyond for every student.

When I was in Kathmandu I really enjoyed exploring within the city. There’s just so many heritage sites and religious monuments: you’ll never be bored. As a Buddhist, there was an incredible amount of cultural history to explore. This was very enriching for me. The scenery is incredible. 

Even if you’re not going for the country and are there just for the placement, it still ticks all the boxes. It’s a struggling health system, it’s got doctors that are probably better than the ones you’ve got in England at times, and who will work to the same level with less resources. There’s just so much you can learn and take home. Blog Images - Navin

So, we’re five years on. Where are you in your career now?

After I graduated, I worked in Leicester Hospital for my Foundation Year 1 and 2. After this, I got a training post in emergency medicine and did my first two years in Northampton General Hospital. That was 6 months in emergency medicine, 6 months in anaesthetics, and 6 months in ITU. I was supposed to do 6 months in acute medicine, but got redeployed to ITU during the first wave of the Covid-19 pandemic.  

Right now I am a Registrar in emergency medicine at Leicester Royal Infirmary. My technical title is Academic Clinical Fellow in Medical Education in Emergency Medicine so I am a nationally appointed research fellow. I spend 25% of my time at the university and the rest of my time in the hospital.

You said you were redeployed due to the pandemic. How has that been for you? 

It has been tough, really tough. In the first wave I was redeployed to ITU which was incredibly hard. We didn’t really know what we were doing because we were learning about this virus as we went along.

The things that we saw were just so difficult to comprehend. I think a lot of us are going to need counselling. There are a lot of thoughts that go through my mind. I was the last face some people ever saw. I was putting people to sleep to then put them on a ventilator and many — too many — never woke up. I had a lot of phone conversations with patients’ relatives, especially in ITU where we didn’t know if the patient was going to survive or not. I had relatives crying to me on the phone, as obviously they could not be with their loved one. It was draining. We just felt so helpless.

Once this tailed off, it became slightly easier. I then rotated to Leicester Royal Infirmary where I was based in A&E. Just as I started my rotation, the second wave hit. The second wave was so much worse than the first, and on top of this Leicester Royal is the busiest A&E in the country. It was difficult for a lot of us. The hours were intense, and we were having all our annual leave rejected as they could not spare any of us as the department was so overrun. We were well supported by the seniors, and they tried to look after our wellbeing. But obviously they had to look after themselves as well.

We’re still seeing the same number of patients in A&E as we did in the second wave, they’re just not all Covid related now. It’s more like a winter wave. We've been going at 100 miles an hour for the best part of two years now, it is certainly hard. 

That said, we really pulled together as a department and as a multidisciplinary team. We supported each other through what was a really tough time.

How do you reflect on your time in Nepal? 

It was one of my most memorable experiences abroad. It was a great mix of a medical placement and a holiday.

As I was a 5th year medic, I got really hands-on. I was doing things that really benefited my practice when I started as a doctor, I gained skills that I probably wouldn’t have acquired had I done an elective in England.

It was interesting to see how healthcare was practiced in a less developed country. And it was really heartwarming to see how they came together to deliver the best care they could.

All in all my medical elective in Nepal was incredible. I reflect on it regularly and constantly tell medical students at Leicester University about it!  I have nothing but incredible things to say about my time there, Nepal has stolen a piece of my heart.

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