For my elective, I went to Okhaldhunga Community Hospital, a rural mission hospital about 7 hours jeep ride east of Kathmandu. It is surrounded by beautiful hills and farming communities with the nearest town a 40-minute walk away. The hospital was set up in 1962 and is under United Mission to Nepal along with the larger Tansen Hospital. I was required to go through a UK based sending organisation, so I went via Interserve.
Most of the doctors were GP trainees and would deal with anything that came in so there wasn't much sub-specialisation, and this meant I got an extremely varied experience with general medicine, general surgery, paediatrics, obstetrics and gynaecology and even a bit of psychiatry.
A typical day would begin with morning devotions and handover at 8.30am then the team would split in half for the ward round (which was either on the paediatric and O&G wards or the general adult ward). This would be followed by a break for tea and breakfast in the canteen before the team split up again and either went to the emergency room, the outpatient's department or main theatres. The hospital has an average of 60-70 in-patients with a reasonably busy outpatients and emergency department as the hospital serves a population of 250,000. Many of these patients must walk for several days to reach the hospital so they recently opened a maternal waiting home for expectant mothers to reduce the chances of them going into labour on route. Working days finished at 4pm and Nepal has a 6-day working week, so I was on placement Monday-Saturday.
Patients spoke no English, so I couldn't take any histories and no formal language lessons are offered at the hospital, so I was only able to learn some very basic Nepali. Thankfully, most staff had some level of English and all clinical notes were written in English, so it was possible to understand a patient's condition and treatment. I spent a lot of time observing how things were done differently in this context and was able to get involved in quite a lot of practical things going on - examining patients, practicing my suturing, scrubbing in for theatre, applying back slabs and plaster casts, doing new-born checks on the ward round, carrying out abscess/ cyst drainage, wound dressings and burns debridement. I did have to be quite vocal about ensuring adequate supervision, but staff were usually very accommodating.
The most common presentations were trauma with suspected fractures, various infections with a lot of abscesses, burn injuries, COPD exacerbation and alcohol dependence. Some more unusual presentations included insects stuck in ears and a chicken bone removed from a patient's pharynx! There is also a busy obstetrics department with regular deliveries.
In my free time I went on walks around the hospital, visited the local town (a 40min walk uphill!), played table tennis with the doctors, had tea or lassi in the nearby canteens, experienced Nepali church and weekly fellowship (all in Nepali) and went on a 3 day trek to Pikey Peak which takes you through a stunning rhododendron forest and can have great views of the Himalayas, weather-permitting. After my elective I was able to spend some time exploring Kathmandu which has some interesting tourist sites and Pokhara which has a beautiful lake and some fantastic paragliding opportunities.
The hospital only accepts one student at a time, so it did get a bit lonely at times and I found the church/fellowship a bit draining after a while, but I still had a great time and overall an unforgettable experience!
