Cardiff University 2020

Physiotherapy, Nepal Pokhara

When I decided to do a placement overseas, I knew that I wanted to experience an entirely new culture and healthcare system. Nepali culture intrigued me and there’s such a varied landscape all within one country. 

I am keen on outdoor pursuits, so Nepal offered the perfect mix of culture and adventure activities. Pokhara is a smaller city compared to Kathmandu and has a stunning backdrop of the Annapurna region.

Wesley, BethanI was unsure of what to expect and apprehensive about starting my placement. However, on arrival the Work the World team were really welcoming. 

The rehabilitation centre was much smaller than I anticipated, and I was surprised that it was mainly run by just two physiotherapists without much MDT input. The outdated and basic equipment made it feel like a very foreign environment. 

I was pleased with how accepting and friendly the patients were to have someone from another country and culture assisting with their treatment.

The physiotherapists in the rehab centre were great at taking the time to explain why they were assessing and treating patients in the way that they were. 

They were patient when answering my questions and keen to express their opinions on physiotherapy in Nepal. This really helped me understand the health care system better and understand how Nepali culture and patient beliefs can affect their practice too.

Communication was a challenge during my placement, but this helped me to adapt and improve my non-verbal communication skills. 

Wesley, Bethan

Some of the ways in which patients were treated were very different from what we would do at home so I learnt to be non-judgmental and accepting of their culture and beliefs. 

I became more resourceful when assisting with setting patient exercises.

Due to the lack of recourses and old equipment, I became more resourceful when assisting with setting patient exercises. I often used beanbags to create functional tasks to practice or used scarfs to act as supports and aids. 

Assisting with the treatment of patients with cognitive deficits, in addition to the language barrier, meant that when I was facilitating patients I had to be very accurate and straightforward to prevent confusion.

I observed a variety of neurological rehab cases that were all memorable for different reasons. 

I was fascinated by one case of a teenage boy who had a brachial plexus injury following a road traffic accident. He had paralysis of his left biceps and had lost innervation to many of his muscles in this arm. 

I found this case rewarding because over my four-week placement I saw him improve his function and built up a therapeutic relationship.

There was one other case that really had an impact on me as I empathised with the patient’s distress and was shocked by her story. 

The patient had a stroke 10 days after a C-section to deliver her second child and had been in hospital since, unable to see her baby. Her main goal was to to be able to return home and have the ability to hold her child again. 

It was amazing to see how hard she worked towards the goals that were so meaningful to her.

Wesley, Bethan

The biggest difference in practice was the use of electrotherapy for every patient despite low evidence base behind this practice. 

The staff explained to me that this was due to under-recognition and education on the importance of exercise and activity in the public. Even other medical professionals in Nepal were often uneducated on what physiotherapy involved and would often refer patients to have electrotherapy. 

As patients paid to receive physiotherapy there was a pressure from management to give the patients what they wanted as they were the customer. Due to this, it was very difficult for the therapists to explain to patients that electrotherapy may not be the best treatment modality and it would take time to update practice to more evidence-based care. 

Family is an integral part of Nepali culture. When patients were in hospital their family stayed with them, fed them, dressed them, and looked after them. 

Family members were taught the patient’s exercises so they could continue their care at home. This was an effective and supportive system that allowed patients to be discharged when they couldn’t afford on-going care. 

However, family involvement can add complications when trying to teach a patient exercise as they can give too much assistance which can lead to the patient being passive in the rehabilitation process.

Wesley, Bethan

Pokhara had incredible opportunities for exploring and there was lots to get up to in my free time. The city had caves and waterfalls to visit and endless swing-bridges to cross. 

The lake beside the city was beautiful and you could hire boats to go out in which was really relaxing. There were plenty of temples and stupas to find, some of them with spectacular views over the lake, city and mountains beyond. 

The Himalayas were the highlight for me. They were absolutely stunning even from the roof of the Work the World house. 

I went on two 3-4 day treks up into the mountains which were so easy to organise and prepare for once I was in Pokhara. These were really accessible routes that you don’t need to be a keen hiker to enjoy. There were shorter walks near Pokhara too with great views and the chance to paraglide down again. 

When I paraglided, we were very lucky to have clear skies that made the experience unreal. I also managed to fit in some white water rafting and hired bikes to cycle around the lake which was great fun. 

Just wandering around the city, shops and cafes it was easy to lose track of time and immerse yourself in Nepali life.

Wesley, Bethan

I would 100% recommend undertaking an overseas placement! I feel like I have gained a brilliant insight into a different culture and healthcare system. 

Understanding the challenges and differences in care and adapting and developing my own individual skills to overcome these will be invaluable. I have learnt a lot that will help me improve my practice and make me stand out in job applications. 

The chance to visit another part of the world and have time to explore the surrounding area is an opportunity that you should not pass up. I had an incredible trip, made great friends and have made memories for life.

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