La Trobe University 2018

Occupational Therapy, Nepal Pokhara

The final words I wrote in my travel journal at the end of my five-week adventure in Nepal were ‘It's been fun, real, exciting, challenging, amazing, confronting, inspiring, magical, and life-changing.’

To find out why all of these things were true, we have to go back to the beginning...

Langdon, Laura - Main

- Meeting new people and making friends along the way -

As I stepped off the plane and onto Nepali soil, I was as much buzzing with excitement as I was with nerves, barely noticing how sleep deprived I felt after 24 hours in transit. After months of planning, preparation, and gawking at photos in travel books, it was hard to believe that I was actually there seeing everything with my own eyes at last.

My travel buddy (and partner in crime for duration of the trip) was my fabulous cousin. We claimed our luggage from the tiny collection area, and walked out of arrivals. A member of Work the World’s Pokhara team was there to meet us, as promised. The cultural experience began from the get-go; the three of us climbed into the back of the taxi to head back to the Work the World house we were going to stay in. As the taxi pulled out onto the road, I noticed that there were no lanes. There were no traffic lights either, nor were their road signs. Footpaths were entirely absent. The roads were shared by cars, bikes, buses, tractors, pedestrians, dogs, cows, and any other creature that felt like a stroll—or a nap—in the middle of the traffic.

There was a constant chorus of car horns as drivers used them not out of frustration, but to politely let other road users know that they were either approaching or about to overtake. The same thought played over in my mind throughout the journey—”well that’s something you don’t see in Australia!”

Something else that struck me was just how much colour there was everywhere. The clothing, buildings, flowers... it was beautiful. I couldn’t help but smile as I absorbed the Nepali vibes.

Langdon, Laura - Main

- Pokhara is a vibrant and colourful place -

We arrived at the house and settled in. Then, the Work the World team took us on the grand tour, showing us the kitchen, dining room, lounge, bedrooms, balconies, rooftop terrace (The view from which was breathtaking), and the laundry room. On that point, you won’t find many washing machines in Nepal the art of hand-washing will become familiar to you!

The staff were absolutely delightful. They were kind, helpful, and always approachable. It didn’t take long for me to regard the Work the World house as home. I loved its quirkiness, with traditional Nepali artefacts hanging on mint green walls, and potted marigolds lining the balconies.

The following day, we underwent our orientation. It started with a welcome briefing from the Work the World team, covering things like like healthcare in Nepal and what the role of an occupational therapist was there. We then took a tour of the city, where the Pokhara staff taught us how to use the bus system. This was another experience that was different from home; picture a tightly-packed minivan with people sitting, or standing hunched against the roof, and a man hanging from the wide-open door calling out the names of destinations to people along the streets in order to drum up business.

Langdon, Laura - Main

- Finding a waterfall on a mountain hike -

The next stop on our orientation tour was the specialist rehabilitation hospital in which I was going to spend my clinical placement. The team introduced us to the Medical Director, orthopaedic surgeon, and physiotherapists. Following their lead, we took off our shoes before going inside. It was immediately obvious that the concept of privacy was one that differed between our two countries. The patient list, for example, had everyone’s name, age, and address written on a whiteboard outside the front of the main hospital entrance for all the world to see. And upon walking into the OT Department, we saw five patients all receiving treatment at the same time with no barrier between them.

Our orientation continued with a stroll around Lakeside—an area on the banks of Lake Phewa around which the city sprawls. We had lunch at a local restaurant called OR2K—if you get a chance to go there, the mint lemonade is heavenly. Following lunch, we went canoeing on the Lake.

Back at the house, we had our first language lesson, which was when we first discovered how much of legend the language teacher was. His lessons were so engaging and the language we learned really did come in useful. I was chuffed when I could understand a few words here and there at the hospital. Soon enough, I was able to communicate basic instructions to my patients as well. They loved it when I made the effort, and often laughed at my pronunciation, but the laughter was excellent for building therapeutic rapport.

In the hospital

Langdon, Laura - Main\

- Working in the hospitals, barefoot! -

The first couple of days in the hospital, were a challenge. It took time to adjust to the unfamiliar setting and the cultural differences, and then to build up a bit of confidence that I was capable of working with the patients.

During my two weeks, I mainly worked with stroke patients, as well as some spinal cord injury cases and children with cerebral palsy. On occasion, I was able to observe some physiotherapy interventions for carpal tunnel syndrome, Guillain Barre syndrome and early-stage motor neuron disease.

As daunting as it was to begin with, I am grateful that we were encouraged to get actively involved in providing patient care. It enabled me to get so much more out of the experience than I would have if I’d given in to my apprehensions and passively observed.

I had packed an OT textbook in my suitcase and spent a little time each morning reading up on the conditions I saw at the hospital. I looked into the evidence-based interventions that would be employed in Australia. Realising how different it was for patients and staff in a resource-limited setting was confronting. Every case presented us with new challenges; the environment, occupation, and the individual patients themselves meant that many of the go-to strategies used back home were either unavailable, unfeasible, impractical, or inappropriate. This wasn’t a reason to give up, it just meant that we had to focus on the strengths and resources that available to us, incorporating them into our interventions. We also learnt a lot from the techniques that the physiotherapists applied.

Langdon, Laura - Main

- A view of Pokhara valley after a hike -

The Nepali OTs and physios were incredibly resourceful. If the ‘right’ implement was unobtainable, they always manage to find something that worked just as well. To give you Some of the objects that we used for sensory integration and muscular strength exercises included tennis balls, spiky balls, bean bags, Velcro straps, string, a basketball, a roller from a broken foot massager, matchsticks, and a water bottle. I was keen to make sure that the exercises we introduced were function-focused in order to attach a sense of purpose and motivation to the task. My cousin and I worked in tandem; one of us demonstrating exercises while the other supported the patient’s movement. This worked effectively in terms of getting around any language barrier there may have been.

The Nepali OT model differs from what we practiced at home. Patients were typically discharged from therapy once they were mobilising independently. Any improvement in deficits to upper limb function, speech, or cognition was a bonus but not a priority. There were a multitude of reasons for this, but the one that kept cropping up was the cost of treatment. Without public healthcare schemes, patients weren’t able to access treatment unless they could afford it. It was saddening to realise that for every patient I tended to, there must have been many others with treatable diseases and injuries that were left untreated. The distance patients had to travel to the hospital from their villages was another factor. Patients were eager to return home and get back to work so that they could continue to provide for their families. Long-term therapy just wasn’t feasible for many.

I also had the opportunity to visit and tour a hospital in Pokhara specialising in treating and caring for people with leprosy. The Occupational Therapists there were astounded when I told them that I had never seen a patient with leprosy before. They were happy for me to observe a group education session in which they discussed things like skincare, and dealing with the stigma of having leprosy. It was fascinating to see the farm where patients were provided vocational training, the wheelchair workshop, the prosthetics workshop, and the physiotherapy hall. Like my main placement hospital, this specialist leprosy hospital was a stark contrast to hospitals back home, but a very special facility all the same.

Exploring Nepal

 

Langdon, Laura - Main

- The Annapurna Mountains -

Finishing placement in the early afternoon each day left our afternoons free to explore Pokhara. We went on some lovely walks and hikes. Across the lake we hiked up to the Peace Pagoda, explored the Bat Cave and Mahendra Cave, visited Devil’s Falls and a Tibetan refugee settlement. We learned about Nepali history and culture at both the Gurkha Museum and International Mountain Museum, and spent evenings checking out local bars with new friends from the Work the World house.

We made the most of our weekends, too. One Saturday we hiked to the top of Sarangkot—a huge mountain—to watch the sunset. We stayed overnight, waking up early the next morning to watch the sunrise over the Himalayan mountains. The way down was much faster than the way back up, as we chose to paraglide rather than walk, which was awesome. The following weekend, the whole Work the World house went white water rafting together—something I highly recommend.

Langdon, Laura - Main

- Whitewater rafting with housemates -

Pokhara was truly stunning, and local people will welcome you with open arms. It’s a place I would love to return to.

We stayed in Nepal for a further two-and-a-bit weeks after finishing our placement. First, we enjoyed a rejuvenating yoga retreat, then set off to conquer Poon Hill—a multi-day Himalayan Mountain trek. We then spent a few days seeing the must-see sights in Kathmandu; the famous ‘Durbar’ Squares, Monkey Temple, the Palace Museum, Garden of Dreams, Boudhanath Stupa, and the magnificent Mount Everest.

In total, we were in Nepal for just over five weeks. It was long enough that we were able to see the country and experience the culture without feeling like we were rushing. I would’ve happily stayed longer, which I think is the best indicator of a trip worth taking.

If you’re thinking of heading to Nepal for your placement, get ready to have the experience of a lifetime. Namaste!

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