King's College London 2015
I chose Work the World because I was impressed by the website; the reviews and student anecdotes were very positive and the range of locations around the world was brilliant. I liked the choices available and the organisation seemed well-organized and responded to my initial interest email immediately.
‘MyTrip’ (Work the World’s personalised online elective planner) was ideal - it was a useful resource that allowed me to keep track of my progress when preparing for the trip. The information pack provided was also very helpful, and I was able to email anytime and could expect a prompt reply.
Sean picked me up from the airport; he was wearing his Work The World T-shirt and caught my attention from the crowd. My flight landed late and I was worried that he had been waiting for a while, but he was lovely. As we drove towards the house he told me about the city and gave me some information about the program and himself.
The city orientation day was great. We took a taxi to the Kingsway and exchanged some money and obtained Nepali SIM cards. After that we walked into Thamel and Sean showed us the points of interest. We ate lunch at a traditional restaurant where I ate some delicious Nepali Dahl Bhat. After that we took a rickshaw to the oldest part of Thamel and saw temples, shops and shrines. Sean told us how much things should cost and gave us some tips for bargaining prices down. We got the microbus back, which was so much cheaper, but a very different experience (I got sat on!), but it was nice to know the different transport options available to us.
Another ‘must do’ activity for me was the Mountain Flight. We flew on a single propeller plane early in the morning, and the views were absolutely incredible – especially from the cockpit and with a glass of champagne!
My hospital orientation was delivered by the hospital’s elective coordinator. It was a very thorough introduction; we spent 5 hours in his office discussing the hospital, its history and facilities. He then guided me around the hospital.
My time on the Burns Unit was eye opening to say the least. The nurses on the ward were lovely and really accommodating, they insisted every morning that I have masala tea with them. They were as keen to learn about me as I was to learn about them. On arrival on the ward I had to change into my scrubs, I was not able to wear my own shoes, but instead had to wear the ward provided sandals (which was a shock). The nurses also wore the sandals, but wore them without socks, so their feet and toes were exposed.
The WTW house was very comfortable. The facilities were great, especially the terraces with incredible views across all of the city. There was 24-hour security and the house was walled and gated. The house is very sturdy and, I felt very safe staying there!
The staff really made my experience in Nepal. MD, the Work the World house caterer was incredible, he made the most delicious feasts for dinner every evening. He even taught me how to cook traditional Tarka Dahl. All of the staff were lovely and really friendly. Sean was fantastic, he helped us to organize trips for the weekend and following the earthquake he went above and beyond the call of duty for us and ensured that we were safe and comfortable.
The ward had a different hygiene standard to what I’m used to; parents are expected to change their children’s bed sheets, they are given the opportunity to change them once a week. The hospital has 3 categories of patients: one group of patients are required to pay for all medications, equipment, procedures and the bed. The second groups are required to pay for medications, equipment and procedures, but the hospital pay for the bed and food. The final group pays for only the medication and equipment, the hospital pay for everything else. Whilst I was there a child with 30% burns to their legs was discharged from the hospital due to the fact that their family could not afford to keep paying for the necessary medications and equipment.
Burn dressings are changed every other day, and all of the patients are seen one after the other in a ‘Treatment room’, regardless of severity. There is a bed in the treatment room on which a small, square cotton sheet is laid (a new one for each patient). The patients are given IV morphine before their dressing is changed, but they are still in immense pain. The children very rarely stay on the cotton sheets due to writhing in pain; they often had exposed wounds touching the bare bed (which was never cleaned). The infection risk was huge. Nurses tried their hardest to maintain aseptic technique but it did not happen; parents were touching the wounds, people were walking in and out of the room whilst dressings were being changed and the children themselves were touching the wounds. The dressings for all wounds were the same and nothing like the ones available here; all of them were made from gauze of varying thickness. A lot of the wounds were infected and green in color.
In Nepal nurses place cannulas, so I was able to watch the nurses gain peripheral venous access. The nurses do not wear gloves whilst undertaking this procedure and re-use the same cannula several times. This is the same when taking blood samples; the procedure is very different to the way it is done in the UK. I tried to explain to the nurses the differences between procedures in the UK and Nepal and they were very eager to listen and learn, but were unsure about how to make the changes themselves. It was an incredibly interesting experience to be able to compare healthcare in Nepal with the UK. It has made me very grateful for the NHS! I saw some very interesting cases during my placement, burns which I would never have seen in the UK. Most of the burns were very large, all over 10% TBSA. The largest burn I saw was 35% and extended from the child’s hips down to her toes. I also saw many facial and scalp burns. One 5 year-old child had a bandage across the whole of her face and head. When I asked how this had happened, the nurse told me that the child was playing with dirt that had been set on fire and had fallen into it. The worst burn that I saw was on a 2 month old boy, who had been wrapped in a blanket and placed in front of the fire by his mother, the blanket caught fire and the child was burnt. The burn extended down the right hand side of the child’s body and was so severe that the child’s knee cap was exposed, along with his ulna and metacarpals.
Outside of the hospital, the biggest culture shock for me was the roads! There are few rules; taxis just pull out when they feel like it, drive at incredible speeds and use the car horn every 10 seconds! It is so different to driving in the UK - most of the roads have lots of potholes and are used by cows and goats too! Although they were a huge culture shock, once you get used to taxi journeys they become a huge source of entertainment and provide loads of stories for you to share!
My favorite activity was the weekend we spent in the Chitwan National Park. We took a bus down to Chitwan which took around 8 hours, but we saw much of Nepal’s countryside, which was incredible. At Chitwan we were able to bathe elephants, trek through the jungle, canoe down the river and even got to dance with a Nepali Hill Tribe as they performed some of their traditional dances. It was an incredible weekend.
Another ‘must do’ activity for me was the Mountain Flight. I did not have time to hike to Everest Base Camp, so the best way for me to see the mountains was to take a flight with a local airline over the Himalayas. We flew on a single propeller plane early in the morning, and the views were absolutely incredible – especially from the cockpit and with a glass of champagne! Again, Sean organized this trip for us, we just had to tell him when. I would definitely recommend.
The best piece of advice I could give any student heading to Nepal is to come with an open mind. It is an incredible and beautiful place and anyone heading out here needs to be prepared to throw themselves in and really make the most of their experience!