The streets are alive! Dilapidated buses, battered cars, honking motorbikes, giggling children and petite Nepali frames (carrying double their weight in wares) somehow thread their way precariously around not only the local ‘wildlife,’ but also vast potholes, dusty sidewalks and piles of rubble. It is a truly unforgettable and breathtaking experience!
Beanies make great ear-muffs whilst you become accustomed to all the night-time noise. During my one night stay in Kathmandu I was woken by barking dogs, moo-ing cows, chirping geckos, crowing roosters, and the sounds of song and dance during Tihar (the festival of brothers and sisters). Whilst the noise takes time to grow on you, looking back it is one of the things I miss most about my time in Nepal.
In Pokhara, when the mist lifts and you turn your eyes away from the action of the streets, the sight that greets you is spectacularly beautiful. Bordering the town lies a crown of snow-capped mountains sighing peace and stillness upon the commotion below. To wake to a clear day with a view of these white giants from your bedroom window is truly magical.
During my stay in Pokhara I shared the Work the World house with a hilarious crew of nursing and medical students. There was also a lovely bunch of Work the World staff who made us feel right at home. With their insider knowledge of Nepali culture and the practicalities of daily life, settling in and planning travels became a piece of cake!
Power cuts are very much a part of everyday life and made for quite a bit of fun by the light of lanterns. Needless to say, however, they're not so appreciated when you're in the middle of a shower!
Whilst the hospital was not as poorly resourced as I expected it to be, it is still far from the standards we have at home.
Autoclaved newspaper is the norm for sterilised hand towels, sharps containers consist of cardboard boxes, and gloves are a quite a luxury. Patients’ families are expected to provide all the nursing care for their loved ones and they camp out in the corridors in large flocks.
Yet what the staff are able to do with so few resources is truly remarkable. Diagnoses are made primarily on clinical history and examination as opposed to by countless investigations. There is also a commendable notion of social justice with hospital staff all contributing money from their own wages to a poor patient fund, to allow the less fortunate to receive necessary tests and treatment.
In addition, outreach clinics are run in the slum areas where people are seen for free and medications are given for close to nothing. It is a long way off first world standards but it is a good system that means health care is not only a luxury for the wealthy, but also available to those less fortunate.
I had the pleasure of carrying out my elective in paediatrics and I have such happy memories of the adorable smiling faces of so many kids. I’m sure their parents all had a good laugh prior to morning rounds, when I tried out my pigeon Nepali, performing a rather disjointed history and clinical examination!
In Nepal, paediatrics is infectious disease, infectious disease and infectious disease. Typhoid, post-streptococcal glomerulonephritis, encephalitis, meningitis, TB, neurocysticercosis (due to pork tapeworm which is the most common cause of seizures in kids in the developing world), mumps, and pneumonia, in abundance.
As an outsider it is really interesting. But sadly so many of these diseases are preventable, either by hygiene and sanitation or by vaccination. For Nepal, due to poverty and lack of resources, such measures are still a fair way off.
Bargaining and staring aside, Nepalese people are the friendliest, most helpful and lovely people. They greet you warmly on the street, welcome you into their homes and go out of their way to help you find your way.
During my two hour wait for a plane from Kathmandu to Pokhara I had two invites to people's homes. The first I did not accept (although in retrospect it was probably fine). The second was a lovely girl with whom I became good friends, visiting her and her beautiful family numerous times during my stay in Pokhara. During my first visit the family brought me out a plate of food and sat there waiting to watch me eat it.
I was highly embarrassed and really worried they did not have enough food for themselves. So I insisted they share the food with me, which they did, rather uncomfortably. I discovered later that in Nepal it is a sign of respect to feed your guests first and bring out food for the family later. However on my next visit I was allowed to help in the kitchen making momos (delicious Tibetan dumplings)!!
During my wanderings around the neighbourhood I also had numerous offers from people to marry me off to their sons ☺
The Village Experience
The steep ascent up to the quaint Gurung village of Nalma is most certainly worth all the sweat and exhaustion. The health post is at the top of the "green mountains", and from the “staffroom” (a good patch of grass) the circumferential view of the Himalayas is just magical.
I have such fond memories of our lovely host family and their happy dog Jojo who followed us everywhere (even inside the health clinic)! During our stay, we got the full experience of village life engaging in lots of cultural activities like making ghee, harvesting crops, cooking dahl baat, pummelling millet for roxy (a millet based alcohol), and the dreaded cold bucket showers!
The health post was horribly under-resourced with just twelve medications available, primitive dressings and no access to lab tests including simple urine dipsticks or blood glucose levels. Given the lack of sterile gloves and equipment, wound infections were a big issue, particularly when there were so many wounds from goats, sickles, axes and the like in the midst of harvesting. Nonetheless, there is much to be said for the healing powers of sunshine and mountain air!
With the Himalayas almost on your doorstep, Pokhara is really a gateway for thrill and adventure. Some of my most exciting memories include paragliding over Pokhara, with an extraordinary view of the lake, hills and snowy mountains. White-water-rafting along the Seti river was also amazing, especially on the day of Shiva when the bridges and river banks were adorned with garlands of flowers.
And in Nepal, if you walk uphill anywhere you’re bound to be rewarded by an astonishing view!