Namaste! A Medical Elective in Nepal

Peter Westwood on a mountain trek in Nepal

It was a nervous wait for 6th July 2011; Results Day. My fourth year medical exams were the hardest yet and the thought of not being able to go on my elective filled me with complete dread. Fortunately, I passed and all the preparation for my elective, the flights, organising the hospital and accommodation was all worth it; next stop Kathmandu, Nepal!

By Peter Westwood (98-05)

First of all, here are some facts about Nepal. It is a land-locked country, between two Asian giants, China and India and has a population of about 30 million. It is located in the Himalayas and therefore has eight out of the top ten tallest mountains in the world, including the tallest, Mount Everest. Nepalis are very religious with Hinduism and Buddhism traditions being followed by the majority of the country. Nepal is one of the world’s poorest countries and so healthcare, both in terms of expenditure on health and the size of the workforce fall well short of the regional average. Finally, the life expectancy is hovering around the mid-sixties for both sexes, so it is a challenging environment in the world of healthcare.

I’m not sure what attracted me to Nepal, but ultimately I wanted to experience medicine in a less economically developed country to witness what can be done with limited resources. Furthermore, after the completion of the elective placement there would be an opportunity to travel for a couple of weeks so I wanted to go somewhere I had not been before.

I had organised to join the General Surgery team for four weeks and the Internal Medicine team for the remaining four weeks. Alas, nothing ever runs smoothly, especially in Nepal, and upon arrival in the Kathmandu Model Hospital I was told joining these teams would not be possible. Instead I worked with the Orthopaedics department and the Plastic Surgery department, so all was well. After the commute to the hospital on local transport, witnessing the chaotic, overcrowded roads and inability to give way I thought these departments would probably be a very busy and exciting place for a medical student! I wasn’t wrong.

There were two very contrasting worlds in Orthopaedics; spending time in surgery and then in clinics. Surgical ward rounds were filled up with major trauma from road traffic accidents where clinics were inundated with lower back and knee pain. Both environments were useful in their own ways; assisting in surgery is always interesting and educational and I have become accomplished in interpreting X-rays and putting on plaster casts.

The team was very welcoming and patient considering I have never studied orthopaedics before so a lot of the material was new to me. The language barrier proved difficult and rendered any history taking impossible. This is where the Nepali doctors were fantastic as they would translate everything into perfect English so I could keep up and feel involved. I was allowed to perform musculoskeletal examinations on willing patients so I could improve those skills I already had too.

Orthopaedic surgeons often get stereotyped as being chimps who like using hammers and drills, something

Kathmandu Model Hospital, Nepal

which all orthopaedic surgeons would contest. My supervisors were far from this stereotype; however the operating theatre did give me déjà vu from my days in Mr Goldsborough’s Metal Work classes at the RGS! The doctors were interested in where I was training and when I said Leeds, in the majority of cases the reply was “Ah, Leeds United”. However, Mr Shrestha, the consultant, was more familiar with Leeds than most.

“I love Leeds” he said with a longing look. “Oh, have you been?” I asked. “No. But my favourite album of all time is The Who: Live at Leeds”.

I struggled to contain my laugh, “you’re in luck” I said, “I have their greatest hits album on my iPhone”, unashamedly trying to impress him.

For the rest of the operating list I was quizzed on my 60s and 70s classics whilst listening to The Who. Plastic surgery is another field I have yet to have any experience in, so I was looking forward to new pastures. Every morning started with the surgical ward round, traditionally a junior doctor’s nightmare back in the UK, but in Nepal it was quite a pleasant experience. The majority of cases were cleft lips/palates and burn contractures with the odd occasion when an emergency came Watching the surgeons at work was very impressive and I found it more fascinating than the orthopaedic operations. There was an artistic skill about their work and their desire for aesthetically perfect outcomes was infectious (I apologise). My knowledge of anatomy was always under scrutiny and without doubt it improved over the four weeks with the Plastics team.

My time at Kathmandu Model Hospital was not as hands on as I was hoping but I have gained an awful lot, not only about the two specialities I was attached to, but also about applying knowledge to overcome obstacles with limited resources. Everything I was taught in Nepal had the prefix “this is what you do in your country, but here we can’t afford that so we do it like this”. The doctors’ hunger for knowledge was remarkable and I found myself learning a lot about basic science and disease presentation. I have to be honest and say that confidentiality and building patient rapport were not on the Nepali radar, which was a shock to the system as it is of utmost importance here in the UK.

So my eight weeks were over and that just left enough time to explore what Nepal had to offer on the tourism front. It is a beautiful country with extremely friendly people and breathtaking (literally at 5,000m up!) scenery. Some friends and I found time to trek the Annapurna Circuit over 10 days which incorporated the Thorong-La Pass, the highest pass in the world at 5,416m. Needless to say it was incredible and one of the best adventures of my life. Our surroundings were both peaceful and intimidating as we spent almost a week without seeing other trekkers and were watched by the imperious Annapurna Range every step of the way.

I would like to take this opportunity to thank the ONA for their humbling support. Their generosity provided me with both an educational and extremely enjoyable trip for which I am enormously grateful.