Portsmouth University 2011

Radiography, Nepal Pokhara

My three week elective with Work the World was quite possibly the best three weeks of my life, both educationally and socially.
The Pokhara house is a hotbed of activity, from breakfast in the morning, to dancing through the monsoon back to the house every night. I'll admit that I was hesitant about living in a shared house, having not done so for nearly ten years, but I really loved the social aspect that it brings to the experience. The house is huge and the rooms are well distributed so while there's always someone to talk to, there's also always somewhere quiet to go read a book.

It's also in a fairly ideal location, just a couple of minutes' walk from where the buses take you to the hospitals, and where the taxis take you wherever you like (after a good haggling session). I spent many an evening down in Lakeside (the nightlife district) sometimes on my own, making use of the free wifi and chatting to the locals, and other times in a herd, dancing the night away. One particularly memorable night involved randomly bumping into Prem, our wonderful Nepali teacher, dancing the Céilidh in the Jazz Bar, helping clear up after a motorbike crash, and running through the monsoon! On top of partying with Dr Janie and Dr Subash every Friday, it certainly made the taxi fare (and associated haggling) worth it!

We didn't need to leave the house to have a great time though, weekly BBQ nights on the roof were legendary, and they led to hours of lively conversation while the moon rose behind the mountains.

But now onto the serious stuff...

With over 700 beds, the private teaching hospital in Pokhara is the largest in the region and serves a wide variety of patients. The facilities were basic but better than I had expected. The radiology department had a one slice CT scanner, a 0.35T open MRI scanner, a CR x-ray room, and a CR fluoro room, which wasn't in operation when I visited. There were also two ultrasound rooms, a mammography suite, and the dental department had a CR x-ray unit. Downstairs in the basement was the radiotherapy department, with a linear accelerator and a treatment simulation suite.The 3 weeks that I spent in the department taught me more about radiography and healthcare in general than I could have imagined, as well as reinforcing ideas and methods which I had already been taught.

In rooms where geckos and cockroaches wander freely, handwashing is a rarely practised procedure. Equipment is rinsed and reused, and surfaces such as the examination tables will still have fluids from the previous patients on them when the next patient is laying there. As you can imagine, infection is a very real risk to patients and the stories of antibiotic use are worrying.
Patient confidentiality and radiation protection are two concepts which are neither acknowledged nor adhered to in the x-ray department, but after a conversation with the medical physicist it appeared that this was an endemic problem caused by poor training and low salaries.

But aside from the depressing and unpleasant aspects, I saw some of the best examples of patient care during my placement. The staff I worked with, especially the CT tech, Shashi, were incredibly knowledgeable and I learnt so much watching him work. The radiologists were more than happy to show me interesting cases, including some which were in the process of being submitted to academic journals.

The breast screening program is gaining popularity, and every woman who has a mammogram will also have a follow up ultrasound of both breasts whether or not a malignancy is suspected. These scans will then be reported by two radiologists and the results will be provided the same day.

Unlike the long MRI waiting lists in the UK, a patient arriving with an MRI referral will usually be scanned the same day and it's the same for CT. Reports are produced immediately, usually with the input of all the radiologists in the room, meaning that treatment can be started straight away. This is absolutely imperative, as patients here don't tend to present with mild symptoms, and usually diseases won't be diagnosed until they are chronic and advanced. Tumours will be life threatening, and neurological conditions such as neuro-cysticercosis will be well beyond the treatable stages.

Patients can be reluctant to go to hospital, partly because it can be expensive just to get there (ambulances are virtually non-existent) but also because it will mean having to stop work, which could result in catastrophic loss of income. There is also likely to be an inherent fear of the unknown, as they may not wish to be treated using methods they do not understand. In spite of this however, the patients I met were all friendly, especially the children, who were eager to have a conversation using basic Nepali, English and drawings! They were also, equally, some of the bravest people I have ever been around, undergoing painful and invasive procedures through gritted teeth.

My elective in Nepal was hugely beneficial to me; it's a beautiful country with so much to offer, from the world's highest canyon swing, to stunning jungles, to raging white water rapids, and with breathtaking mountains everywhere you look.

I miss those mountains.

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