Queen Margaret University 2011

Physiotherapy, Nepal Pokhara

As a fourth year Physiotherapy student I was given the opportunity to organise a three week elective placement. I, along with two friends, approached Work the World for help as we wanted to undertake this in a developing country.

The staff were very helpful to get the placement organised and provided straight-forward guidance on how to prepare.  I was very quickly offered an adult neurology placement in Green Pastures Hospital in Pokhara, Nepal.  I would be working with patients that had leprosy, spinal cord injuries, amputations and strokes.  Immediately I knew this was a unique placement offer and it lived up to its expectations!

General impression of life in Nepal

The Nepali culture is great to experience.  When in Kathmandu I had the chance to learn more about the main religions in Nepal (Buddhist and Hindu) from a friendly tour guide at Durbar Square.  Some of the guides just want your money so it is important to make sure he knows what he is talking about!  It is very common to have people approach you and try to sell you something.  They might give you information or act as a porter and then ask you for money.  We very quickly learned to be firm and say no - in Nepalese of course!

Driving in Nepal involves chaotic narrow roads, no road markings, and practically no rules!  There are buses, taxis and motorcycles everywhere and lots of people walking.  I found this so different from the culture in the United Kingdom, especially the Nepalese's major overuse of horns!  It is a crazy experience but one you learn to love!

The Nepalese are incredible people - very friendly and helpful.  The best example I can provide is with regard to our lost luggage!  On our first night in Nepal we stayed in the Ambassador Garden Home in Kathmandu, but we had to move on to Pokhara the following day.  When our luggage finally arrived in Kathmandu, the kind manager of this hotel picked it up and sent it to us in Pokhara on a safe tourist bus, all the while not even so much as requesting a fee!  Life saver!

My placement

On my first day I was given a warm welcome by all the staff at the small rehabilitation hospital I was to be working in, followed by a tour.  The hospital was surprisingly well equipped, especially the Physiotherapy department.  There was also an Occupational Therapy department, X-Ray department, a surgical theatre and orthotics workshop.  We saw all the types of patients we expected to see and took part in lots of assessments and treatments.  We found that the Physiotherapy staff were enthusiastic about passing their knowledge on to us.  We were specifically allocated one long-term inpatient where we could take charge of the treatment sessions.  This gave us the opportunity to act independently but also learn more Nepali.  Several times a day, the Nepalese have tea.  Although this was frustrating as it meant less time was spent on the patients, we had to embrace the culture and also gave us a chance to get to know the staff at the hospital.

It was challenging at times to observe the methods of treatment that was sometimes undertaken.  The Physiotherapists always had logical reasoning behind the treatments that were chosen.  However, much of the treatments were passive and it was uncommon to prescribe exercises to inpatients to do in their own time.  This is in contrast to Physiotherapy in the UK where we tend to encourage the patients to take responsibility for their condition.  The Doctors commonly prescribed bed rest (usually weeks) which meant patients were becoming weaker through lack of exercise.  Although treatment approaches were different we recognised that in all circumstances the staff had the best intentions for the patients.  Overall, I recognised and appreciated how well developed the NHS is, and the experience served to make me desire to help encourage best practice in the future by returning to Nepal or another developing country.

Living at the house

Living at the Work the World house was brilliant!  The house held about 19 people.  Some people came alone, while others had come in groups of three or four.  We were the last to arrive to the house.  We quickly made friends, and it was very comforting being able to ask others about good places to go and how to get there.  Some evenings we all stayed in and played board games, while other evenings we went to some of the little bars at Lakeside.  We all had breakfast and our evening meals together, served up by Khrishna, the cook.  These were always good and gave us all a chance to contemplate the day ahead together or reflect on what had happened that day.  They were also good times to organise outings together.

Sunil and Aneeta, the Work the World staff were very helpful with giving information about the local area, especially regarding the local strikes called bandhs.  They were also very helpful when some of us were ill, giving support and advice.  One of them was usually around if help was needed which was very reassuring.

Much of the time in Nepal there is "load-shedding" and therefore electricity blackouts.  This meant we spent many meals in candlelight!  Although for some a lack of electricity may be worrying, but it was actually very easy to get used to especially as there were always torches and candles available.  The only time where it was difficult was during our Nepali classes with Prem.  He would teach while the sun was going down, so it became more and more difficult to see the whiteboard with all the new words written on!  However, Prem is an excellent teacher and the classes were so interactive and enjoyable that it was not a big problem!

I had a great time in Nepal and it was down to the Work the World staff, the Nepalese, Green Pastures Hospital and its staff, and the other students living in the Work the World House.  I miss it already and want to go back!

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