Glasgow Caledonian University 2010

Nursing, Nepal Pokhara

I always knew I wanted to do one of my nursing placements abroad I just wasn’t sure where. After discovering Work the World I knew it was definitely for me and after speaking to Abby I chose to go to Nepal. My knowledge of Nepal was very limited before I chose it I wasn’t even sure of where it was but after hearing about the Himalayas I knew it would be a once in a lifetime opportunity.
I spent 6 weeks in Pokhara working in the surgical department in the Regional Hospital which I loved. The hospital is run by the Nepali government and provides cheaper healthcare for the poorer population. However as it is ran by the government it lacked funding and resources especially compared to the UK. In the surgical department I got the opportunity to care for pre and post op patients, neurosurgical patients, infectious diseases and burns victims. My role as a student nurse was very similar as it would have been in the UK. I got the chance to prepare patients for theatre, do dressings, remove stitches and surgical drains as well as other nursing skills. 

Despite the similarities, some of the differences I noticed in the healthcare between Nepal and the UK were profound. One of the main differences was infection control. Often the water in the hospital would be turned off so hand washing was either not carried out or done in a basin with mucky water. I would recommend bringing a supply of alcohol gel with you. Also disposable gloves used for procedures like insertion of NG tubes, catherisation and dressings were reused multiple times only getting rinsed out with water to clean them. 

Another difference I noticed was in the illnesses and the advancement of disease. Many of our patients' illness or disease was far more advanced than you would ever see in the UK.

One man in our ward had gangrene in his toes but didn't come to the hospital until his toes were hanging off with the bones exposed. In the end he needed a bilateral above the knee amputation as the gangrene had spread so much. Another thing I noticed was that although we were treating patients for a surgical problem many of our patients had secondary illnesses for example malaria, typhoid, cholera or HIV positive. 

The poverty of the country can be difficult especially in the hospital. Many of our patients couldn't afford their treatment which was only £8 for major surgery. The lack of the resources in the hospital is a shock at first. However I grew to learn lots of new skills from this. For example making splints out of cardboard, making dressings from swabs and using milk bottles for traction to pull a fracture back into place. I found it amazing how the staff could work and improvise with what limited resources that were available to them and feel this was a great opportunity to learn how to not to rely on technology and equipment. The staff in the ward were lovely although sometimes it looks as if they lack compassion when it comes to patient care however this is what the nepali people are used to and never question the healthcare staff. It seems just part of the culture we had to accept. Also all the personal care in the hospital is done by the patients families who often sleep on the floor of the ward in order to stay close by their relative which is nice to see how important family is in Nepal.

The majority of staff spoke English and all the patients notes are in English so if you were unsure of anything you could look it up.

The staff were very interested in me and always let me get involved in things and I even got lots of presents when I left. In the end I didn't want to leave.

The Work the World house was lovely and the in country team were great. At the weekends I managed to do a few trips as well. Paragliding from Sarangknot is an amazing experience especially if you get clear skies which we did. Rafting and the Chitwan National Park safari are great if you get the time. The 6 hour bus journey to Chitwan is not so good especially if you get stuck in a landslide and have to wait another 4 hours with a drunk nepali man sitting next to you on the bus which I did. It was a good adventure though! I also got a motorcycle drive from one of the other students through the Himalayan valleys which were a great way to see the country plus I had never been on a motorcycle before. There is also a lot to do in Pokhara itself including boating or kayaking on the lakes, Devi's falls and the peace pagoda but be careful; I got chased by wild monkeys up there! From the roof of the house you could also see the Annapura mountain range in the mornings which was a spectacular view.  It was apparently Monsoon when I went although it didn't feel it. It mostly only rained overnight which is still a lot better than rainy Scotland by a long way. Bring a raincoat and you will be fine.

Pokhara is a wonderful place to stay the atmosphere is laid back and relaxing. I had such an amazing trip and learned loads. I'm definitely going back to visit my Nepali friends and do Everest base camp in a few years time!

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