GP Lives: Medicine in Nepal

Dr Gerda Pohl discusses two decades improving medical care in remote communities

When the Nepal earthquake hit in 2015, Dr Gerda Pohl had spent many years travelling to and working in the country. At the time, she was supporting the work of PHASE Worldwide in Nepal - a charity she had co-founded in 2005. She is almost lost for words when describing the devastation which killed 9,000 and injured 22,000.

Dr Gerda Pohl

“The earthquake was a major disaster, hard to imagine. I was visiting a project in a village at the time and every single house was reduced to rubble and everyone who was inside a house was either injured or dead.

She adds: “We spent time doing first aid but we were completely cut off. The following day a small team of us walked for half a day along the road that had been blocked and all we came across were people burying their relatives and people being brought out of the rubble. It was apocalyptic.”

One striking aspect that sticks in Dr Pohl’s mind is how everyone stepped up to help each other out. “Every single health professional just turned up at work, the local army did all the digging and in the remote communities they just helped each other, it was really impressive.”

Overnight, her voluntary work with PHASE Worldwide changed from health systems development work to managing a relief project. “It wasn’t so much medical skills that were needed at that time. What they needed was food and shelter – the basics.

“Most of the PHASE projects in the far west of Nepal didn’t get affected by the earthquake which also meant we could provide some relief staff for a few weeks in the districts badly affected. Even now not everyone is fully recovered. You don’t really get back to completely normal within a few years.”

Her previous work in Nepal had included setting up antenatal care and finding ways to tackle child malnutrition. Now working with Gurkha veterans through the 21 clinics and 160 medical staff the charity has throughout Nepal, the focus is on diseases of ageing.

“It seemed like this job was designed for me because it brings together all the things from my NHS role and charity role. We aim to deliver healthcare comparable to that in the NHS but providing that level of care is not so easy because of the context.”

What it means for her medical staff is up to date knowledge of chronic disease management. “Almost everyone has hypertension or COPD or diabetes. It’s interesting to develop skills like setting targets, lifestyle education, shared decision making, keeping up to date and so on and that’s where friends and colleagues from the UK can be really helpful.”

The remote nature of some communities in Nepal brings specific challenges says Dr Pohl. The GWT has seven big clinics in urban centres with doctors providing family care and 14 smaller centres with advanced nurse practitioners in constant phone contact with the doctors and prescribing all done remotely.

The Covid-19 pandemic seriously impacted the GWT, given the demographic of the patients it helps. In response, it switched to remote consulting where possible and steppedup home visits to reduce the need for elderly patients to visit the centre. It also ‘sealed off’ the Trust’s two residential homes, with staff living on site to maintain infection control; however, despite their best efforts, two of their 38 residents sadly died. Now that all staff and residents have been fully vaccinated, the staff are commuting again; but lack of vaccines across Nepal, including second doses for vulnerable people, remains a key concern.

“I’ve been involved in Nepal for coming up to 20 years and there have been huge changes in many areas. When I first started there were a lot of young children who didn’t go to school and that has been almost eliminated now. Rates of maternal care and maternal and child death have really improved. A lot of villages had no access and now have a road. And the government has invested a lot in building skills,” she says.

Her aim is now to do more work on developing services to meet the needs of a group of patients who are getting older and frailer. “When they have a fall or illness, they may need round-the clock medical or nursing care for a while; we run two nursing homes and we have developed some space for rehabilitation for short-term care.” She adds: “We are also trying to develop palliative care services – that is one of our biggest projects for the next year.” •