I arrived at the ‘work the world’ house at around 2pm on Sunday the 10th of March. This was going to be my home for the next four weeks; I was shown to a room which I would be sharing with four other girls. The staff at the house were welcoming and friendly, I was given a tour of the house and we then waited for the other two girls who were due to arrive that day. In the evening the other housemates who had gone away for the weekend arrived back. The Manager and assistant manager took the three of us out for dinner as the cook in the house has the weekends off, the other housemates joined us. It was Maha shivratri so there were many bonfires around. Maha shivratri is a Hindu festival which is celebrated by fasting during the day and an all-night-long vigil. People were placing sugar cane into the fire to heat it and once it was hot they were hitting it hard on to the ground this caused it to make a load bang similar to fireworks. This, we were told, is a Nepali tradition which is followed in Pokhara.
The following day was orientating day. We woke up to a lovely breakfast of eggs, toast, fresh fruit salad, choice of cereals and spreads. After breakfast the manager give us a briefing of what we would be doing for the rest of the day where our placements were, what time we should arrive, what we were expected to wear and take with us on placement. Afterwards, it was time for a tour of the city and to buy a sim card so calls and text messaging home would be cheaper.
I was taken to Manipal teaching hospital where I would be working for the next three weeks and introduced to the doctor who was in charge of foreign students on elective within the hospital. I was also introduced to the matron, who took me on to the general medical ward where I was going to be based for two weeks and introduced me to the nurse in charge. I also had a quick tour of the hospital including the emergency department where I would be spending a week. The hospital was a huge and very impressive building.
The assistant manager from the house showed me the bus route I could take to and from the hospital, where the bus stops were and also gave me her mobile number in case I had any problems on the following day when I was due to start my placement.
The journey to placement was fairly simple and not as daunting as I had anticipated, as a fellow student who had arrived a week earlier than me was travelling to the same hospital. I arrived on to the ward and it seemed to be fairly quiet - I later found out that the nursing staff were waiting for the doctors to arrive for ward rounds which usually began around 9:30am. The ward can hold up to sixty patients at any given time and is split into four separate sections. Unit one was the Chronic obstructive pulmonary disease (COPD) block, unit two was general, unit three was the private area and finally unit four was psychiatric block.
During ward rounds the doctors assessed the patients, request any investigations which they would like to be carried out that day, prescribe the medication for the following twenty four hours and discharge patients. The staff nurse makes notes of all these request changes and amendments into the handover book. After which the nurses who are in charge of the unit will carry out the task filling in appropriate forms which are then handed over to the patient’s relatives, who are present all the time, to go and pay for the item of medication and take it back to the ward. The relatives provide all the care and dietary needs to the patient. The food is usually bought from the canteen which is in the basement of the hospital or if they live nearby it is bought from home.
The medication rounds consisted of wearing a pair of disposable gloves for the whole round and attending to the bedside of the patient with the patients drugs chart and taking the medication from on top of the patients drawer, handing the medication over to the relatives and telling them this is required now and signing that the medication has been given. It also involved setting up IV drips and providing injections. The documentation method is same as we have here in the UK.
Patients are admitted on to the wards via two routes either the emergency department or the outpatients department which people attend when they are unwell. It’s similar to our general practitioner system. In Nepal there are no GPs; people usually attend the emergency department or the outpatients department which is open between the hours of 8:30am and 4pm. Patients have with them a yellow book which contains all their past medical history and any medications that they may be on. This is the patient’s record and they bring that with them when they need any medical attention.
Manipal has a poor patient’s fund which can be accessed by patients who are unable to pay for treatment. They will be given a reduction on the cost or even in extreme cases be provided by free treatment after an assessment of the income has been made, therefore not many patients would be left to die because they cannot pay for their treatment.
The final week of my placement was in the village which was around three hours away from Pokhara. It was in a government health post which is usually has a doctor who is in charge but it is ran by an auxiliary nurse who see patients for minor ailments which can be managed as well as delivering babies. I attended with her to remote villages to provide free childhood vaccination. These had to be carried in a cooler box whilst we walk to different villages.
This was an extremely valuable learning experience, it give me the opportunity to look at a different healthcare setting. Nepal is a poor country and how they manage and treat their patients is different, which is understandable as they don’t have the same kinds of resources that we have here in the UK. Nursing care is similar in certain aspect, but they work with limited supplies and provide the best possible care within these limitations. It also aids my understanding of how a different community works and the extent the country is going to in order to provide childhood immunisations and other valuable service which we take for granted.