Crazy, chaotic, but intoxicating – travelling to Nepal for my four-week medical elective was an amazing experience. Steeped in culture and set upon the majestic background of the Himalayas, Nepal is an extraordinary country. The relaxed, friendly Nepalese attitude is often in contrast to the bustling, dusty streets crowded with overflowing buses, local vendors and the occasional wandering cow. Pokhara is anchored by the sumptuous Phewa Lake – the perfect setting for my time in Nepal.
I spent my medical elective at the local teaching hospital, an imposing red-brick building tucked away amongst the snow-capped Annapurna range. Having just completed my first year of Medicine, I found it an exciting and challenging experience being in the hospital environment. Given my limited clinical exposure, I spent much of my time observing; however, there is definitely the opportunity to be more ‘hands-on’. My medical elective was divided amongst two departments – two weeks in paediatrics, followed by two weeks in general medicine.
In paediatrics, I was given the opportunity to spend time in both the Neonatal Intensive Care Unit and the general paediatrics ward. In the morning, we were able to follow the consultants around as they completed their ward rounds. Ward rounds are completed in a rapid Nepalese exchange between the patient and the consultant – it is definitely advantageous to make friends with the interns, as they are willing to explain the presenting case in English.
During my time in the Neonatal Intensive Care Unit, I saw a number of interesting cases such as hyperbilirubinemia, premature babies (some were tiny – at one point there was an 800g baby), meconium aspiration syndrome, haemolytic disease of the newborn and thrombocytopenia.
I found my time in the hospital to be an incredibly rewarding experience. The interns and consultants are all very knowledgeable and willing to teach"
In the general ward for paediatrics, I was also given the opportunity to write a number of discharge summaries. These were interesting as you were able to see the presenting problem, the history behind it, the investigations that had been undertaken and the resulting treatment plan. Whilst I was able to see some unusual cases such as seizure disorders, neurocysticercosis and nephrotic syndrome, the majority of children presented with bronchopneumonia, pneumonia or gastroenteritis.
My last two weeks in the General Medicine Department provided a great opportunity to observe the disease profile in a developing country, and to be exposed to a number of different conditions. The main cases we saw were COPD, cardiovascular conditions such as atrial fibrillation, and liver disease. We were also given the opportunity to attend the Outpatients Department, where we could practice some basic physical examination skills as well.
There are definite differences in healthcare provision compared to Australia – I found my time at the hospital really highlighted how privileged we are under the Australian healthcare system. A key distinction I noted was the lack of privacy given to patients – at times there would be up to 15 or 20 medical students crowding around one patient, prodding, poking and asking questions. It is also evident how central family is to healthcare in Nepal – there would often be several anxious faces peering at the consultant – concerned mothers, fathers, sisters, brothers and grandparents.
Overall, I found my time in the hospital to be an incredibly rewarding experience. The interns and consultants are all very knowledgeable and willing to teach – however, you have to make sure that you ask questions and are proactive. It was a great opportunity to see healthcare in a setting with a different disease profile and the challenge of healthcare provision with limited resources.
Work the World House + Pokhara
The Work the World house is located in a Nepalese suburb, set upon the background of the breathtaking Himalayan range. It is a relaxing, safe place to come back to after a day at the hospital or a weekend exploring. The staff are lovely – generous, accommodating and helpful in providing a local perspective of Pokhara. My favourite part of living here was definitely the food – every night, we would be presented with a veritable feast, prepared fresh that day by Deepak.
On Monday and Wednesday nights we were taught Nepalese by Prem – a lovely, enthusiastic local who owns a language school that is endearingly titled ‘Cosmic Brontosaurus’. Our lessons covered a range of topics, from basic phrases to anatomical and medical terms that we could use within the hospital (although I must admit, my attempts at speaking Nepalese were often met with amused glances!).
During my four-week stay, I also discovered the plethora of experiences Pokhara has to offer. My weekend activities included trekking, paragliding over the Annapurna (highly recommended!), white-water rafting in the crisp blue waters of the upper Seti, exploring the World Peace Pagoda and canoeing over Phewa Lake at sunset. If I wanted to relax I would spend time in Lakeside – a strip of brightly coloured restaurants and shops with views of Phewa Lake. I highly recommend the chapatti wraps and jumbo milkshakes at Perky Beans – I quickly became a regular there during my stay!