I had finally arrived in Nepal, the country that had held so much anticipation and excitement in my mind in the previous months. Sitting on the roof terrace of our house in Pokhara, I reflected on the journey so far and where I had come. The view left me speechless. Behind the nearby ‘hills’ stood the Annapurna mountain range, dominating the sky with beauty and the temptation of adventure! The sounds to accompany this view were incredible. This city that would be my home for the next three weeks was loud, alive and amazing. The sounds filling every waking hour of bells, horns, singing birds, laughing children, running water, cows mooing, music everywhere! Pokhara was breathing with life, work, families and fun. I closed my eyes reluctantly from those mountains, and soaked it all in. What would the weeks ahead bring?
Nepal is a country that forces you to be involved, to live outside your comfort zone and embrace the world around you, be it in the small villages or the big cities. There are few closed doors here. The world goes by as a community, with generations of families and friends living and working as team, supporting each other through the ups and downs, as I soon came to discover while working in the hospital.
The first time I entered Western Regional (Gandaki) Hospital I was shocked by the amount of people there, whole families everywhere, queuing to be seen in accident and emergency. I had been warned. I knew the hospital would be very basic with very little, but this was worse than I could have ever imagined. I was guided to the Obstetrics department, a letter with my details handed over to the sister and there I was left to sink or swim among the turmoil of many women in the throes of labour.
I had never seen anything like it! I stood, took a deep breath and as the waves of anxiety washed over me; I had no choice but to get on with it. There were many people who needed help and as an extra pair of hands that was what I aimed to do.
The staff, it turned out, were wonderfully skilled. The nurses did most of the technical, skilled care, while the families provided the basics. This was very different to back home, and I found it difficult not to run and collect bedding and washing equipment. I soon learned how thing were done here. The most difficult thing to accept was that lack of compassion that nurses showed, they never touched a patient other than for clinical procedures, no matter what pain the women were in. This I could not adopt as my own practice and I continued to nurse instinctively in the most culturally appropriate way, offering my support and kindness where it was needed most.
The language barrier turned out to be the biggest disadvantage with both the nurses and patients, so I took to learning some basics to help get my by, which went down very well. The people appreciated a little effort on my part and rewarded my with the opportunity to be involved in some of the investigations on the ward round. Listening to foetal heart beats and feeling for the lie of the baby were among some of the exciting new things I was asked to do.
There are huge differences between the UK and Nepal in the health care system. Patients there have to pay for their treatment, although in Gandaki, they receive some funding from the government. The paperwork is scarce and the hygiene is definitely not A septic and maintained to the standards we expect here. The notions of dignity and confidentiality and consent do not seem to exist and at first these things are difficult to witness. Among these seemingly negative differences there are elements of the system that I feel we can learn from in England today. The emphasis on family in the care of individuals means that patients often feel very comfortable and safe in the arms of loved ones instead of strangers, and are provided with home comforts and familiarities only close friend or family member can know. The standard of education is excellent and the student nurses had the opportunity to have guided hands on experience spending most of their studies in clinical practice, much how nurses trained earlier in the last century in the UK. They appeared confident, mature, skilled and very well educated, many speaking excellent English.
The country is very poor, it has suffered years of turmoil through the civil war, ending in 2006, with the abolition of the monarchy. This has led to a shaky and unpredictable governmental system which often appears to be disorganised. Although, the hardy and resilient people, surrounded by their culture and traditions ride the waves of uncertainty very well. Taking the strikes, power cuts and lack of government support on their shoulders and complaining very little. The staff at the hospital wanted me to know about the difficulty of the country yet they were very proud of their people and the beautiful land which they live.
From the city of Pokhara and its people we took many wonderful memories. The friends made in the house are for life and the experiences we shared will always be remembered. We climbed to the top of Poon hill, which is actually a plus 3000m mountain. Safaried on the backs of elephants in Chitwan national park, and spent many a happy hour in and on the lake. Not to mention the excitement of Holi Festival! We knew this would be interesting, but nothing could have prepared us for the colourful carnage that we were to face! The battle began before we even left the house between the local children and ourselves. They were ready and prepared for a colour fight like no other, and none of us were left unscathed! We spent the day wishing passers-by “Happy Holi” by layering faces with coloured powder. And by the end of it even the three showers couldn’t remove the yellow in my hair.
In my fourth week in Nepal I had the privilege of spending six days in the traditional village of Nalma. Nalma is populated mainly by the Garung people, and is coloured by their history and traditions. The people live in basic homes and everyone farms one way or another. The concept of money and time are totally different in this place. The village is surrounded by the mountainous ‘foothills’ of the Annapurna sanctuary and behind these rise the incredible peaks of Machapuchare (Fishtail), Annapurna and the Manasulu range. It is beyond stunning to witness the changing colours of the sky dance around the mountains as the weather changes and the dawn and dusk comes and goes. These people are fighting to protect their rich and deeply ingrained culture. The young people now see through the media the appealing life of the cities, and are moving away to study. Great in one sense, but not for the village. The elder relatives left behind can only do so much of the farming, and where the younger generations used to take over the manual labour, they are no longer there to help.
Working in the health post was very interesting. They have a supply of 25 basic medications including pain relief, antibiotics, birth control and skin ointments to treat the manifest of complications experienced in the whole village. Anything too serious and the patients take the next jeep down the very bumpy track to the hospital in the nearest town, 2 hours by jeep and 4 hours on foot. For many the cost is not feasible and they will take what they can from the health post. This post is not manned by any doctor but by a health care worker, trained in basic care. Although most of the interventions are carried out by the elder who has manned the post for the last 20 years, trained by his experiences, and trusted greatly by the community. His skills are very highly respected.
While working in the village, myself and the two medics were included in clinical decisions and our judgement and skills were also put to good use. The people valued our methods and different ideas from our own countries that we had experienced and learned in our own training. This made the health post placement a very interactive and valuable experience. The close nit community also meant that we would often see patients on a daily basis, either in the streets or for follow up appointments establishing a good relationship and element of trust within the village.
Looking back on the experiences I had in Nepal it is hard to believe we managed to discover so much in such a short space of time, although I have only scratched the surface if this magical country. I was privileged to receive warm welcome from so many and to be taught their ways in day to day living and within the health care system. From this I have learned some life changing lessons both personally and to take into my own practice as a student nurse. The allure of the culture will continue to draw me back to discover more stories and secrets waiting in the Himalayas.