University of Edinburgh 2011

Nursing, Nepal Pokhara

I served my elective nursing placement in Pokhara, Nepal for 6 weeks, working in the Emergency Department (ED) and Surgical Department of the Regional Hospital and worked in the health post of a local village, working with a team of students hailing from the UK, Canada and New Zealand. 

Ali-ali Nepali bahasa ramro cha

As the saying above goes, knowing a little Nepali goes a long way in helping you adapt and fit into the environment. A massive source of help to us was the free language training offered by Work the World. A language tutor came to the house to teach us basic Nepali phrases for us to employ in our everyday communication. The fact that we tried our hardest to chat with the other staff and patients in Nepali was recognised and respected by them, the effort showed our enthusiasm to learn and opened us up to many opportunities over the 6 weeks.

Tight healthcare spending is the mother of improvisation.

In Nepal the budget for healthcare is significantly smaller than the UK's, resulting in a considerably different methodology of healthcare delivery. The impact of this is most visible in the approach towards disposable equipment, particularly Personal Protective Equipment eg gloves and aprons. While staff have access to sterile latex gloves, these are washed and cleaned after use for repackaging. My introduction to venupuncture in ED was when I had to assist the nurse by acting as a human tourniquet, applying pressure while the nurse inserted the needle. If no assistant was available, the nurses sometimes used an IV line as a tourniquet instead. While some of us were taken aback initially at the level of improvisation needed, we all agreed that it was the only way to maximise the use of the limited resources available.

This explains why, when we donated the medical equipment we brought to Nepal at the end of our placements, what was appreciated most were the gloves and alcohol gel which we took for granted back home.

Everything tastes better with Roxy

The definite highlight of the 6-week elective was the village experience. A Canadian medical student and I worked with the local staff in the village's health post, assisting in diagnosis and treatment delivery. The medical student demonstrated how to conduct physical examinations while I demonstrated aseptic wound dressing techniques and wound assessments. As the only dressing we were to use to was gauze, it led to a degree of improvisation that would make my Nepalese mentors from ED proud, from makeshift slings to abscess-packing material. A point of concern was the general lack of gauze dressings available, so we had to bring our own. In addition, as many of the patients spoke Gurung, a local dialect, our fantastic guide would act as an interpreter.

In the afternoons, we got to explore the village, going on hikes and learning more about the village life, such as the maintenance of beehives and the collection of their honey. Evenings were spent with our hosts, an incredibly hospitable couple who introduced us to the local moonshine, Roxy. Suffice to say, I can't recall much of what occurred in the evenings after Roxy consumption!

Life in the house and R&R

The Work the World house was great - set away from the bustle of the tourist centre of Lakeside. With a full capacity of 17 students, we were never bored, conducting bonding activities whenever possible, from Vodka Mondays to the Wednesday Barbecues. Many firm friendships were forged, tempered by our adventures. Whitewater rafting, paragliding, boating and hikes occupied our free time. We also had the fortune to participate in Asar Pandhra, the Rice Plantation Festival celebrating the coming monsoon season with games centred around rice planting. As a result, we got to understand a lot more on local means of farming while spending the day playing in mud. Who said that learning culture had to be boring?  

Friday afternoons were strictly reserved for time with the orphans from the Destitute Children's Home, an orphanage near Fishtail Gate, teaching the children dance moves ranging from the 'robot' to the 'Soldja Boy Bunny Hop', topped with the all-time-favourite, 'Big-fish-little-fish-cardboard box'.

Conclusion

An elective placement is meant to widen one's horizons, exposing an individual to the literal world of global health. The overall experience in Nepal matured me considerably in my attitude towards my profession and I would not hesitate to go back in a heartbeat. My advice to anyone thinking of going is simple: Go. Now. And pack gloves!

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