A Taste of Medicine (Gerkhu, Nepal)

I have almost finished my Psychology degree. Although I hurriedly chose to study Psychology in 6th Form, it just wasn't the career path for me. It's a fascinating subject that I enjoy studying, but I didn't fancy any of the career options. Since my GCSE's even, I actually wanted to study Medicine. That's followed me all the way through university until now, and I can't ignore it. So last year, I decided to go for it!

Getting into medical school in the UK is difficult. Having prior experience of a medical setting is essential. Getting a genuine taste of the medical profession is very hard to come by. That's what stopped me going all those years ago.

It's not so much about convincing the university admissions that you're prepared, it's honestly about convincing yourself. Can I do this? Will I be good at this? Will I enjoy it? These were important questions that I needed to answer, just for myself.

I knew of people who lied about all of their experience and won their places at medical school unfairly. As I predicted at the then, the challenge hit them in places they weren't prepared for, it wasn't what they imagined, and they ended up dropping out in their first year.

As time went by, I managed to gather a few nuggets of experience. I started volunteering in a local hospital in Wales. It's been great! It's giving me a taste of the interpersonal aspect of healthcare: how to meet patients, how to talk with them, adapt to their needs, and how to be sensitive and empathise with them. It boosted my confidence - I'm great at it!

But this year I decided I needed something more 'real'. I felt I needed to expose myself to something more robust, so see how I would cope. Here in the UK, there are a multitude of laws and documents that stop me from even observing the medical profession in action.

I found a way around it:

 'Leave the UK then', I thought.

I looked for volunteering programs abroad, and was immediately attracted to Nepal. After shopping around, I chose the organisation I wanted to go with. I would be volunteering in a rural medical centre in the Himalayan foothills. This would surely be exciting!

I was beside myself with excitement, but also incredibly terrified. I'd never ben to Asia before, and this was also the first trip I'd ever taken alone. When I arrived in Nepal, I was in a state of shock. There was a weird smell in the air, the roads were chaos and dangerous and there was a lot of loud noises! I was introduced to so many people at once and forgot their names straight away. That first night was a complete blur!

The next day, after a 14-hour sleep, I got an outstanding tour of the city. It was a lot calmer and I could digest it a lot better. Every turn in the street was a thrill!




After 3 days in Kathmandu, I had to make my way into the mountains, where I'd be living for 3 weeks. Before I left, I met three medical students who had recently returned from the medical centre I was going to. They said it wasn't a nice place. They warned me that the medical staff there had no training whatsoever, and were giving out dangerous medical supplies to anybody who asked for them. From this point, I started to doubt whether this was a good idea.

I bet Bibas, whose family I'd be living with, and we caught a bus out of Kathmandu. After one hour in transit, the scenery transformed! The dirty, dusty city has been swapped for lush green valleys, bushy mountaintops and misty waterfalls. The roads grew more dangerous as they snaked around cliffs, above sheer drops! We then had to catch another bus to go deeper into the mountains. For this bus, we had to sit on the roof. It was a relaxing journey at this point. I was pretty scared for my own life!

We reached Gerkhu eventually, where I was to be living. It was adorned with dense vegetation, guava and banana trees, and rich rust-red earth right along the hillside. Every colour was completely saturated! I set up home, met the family I was staying with, and showed them photos of my family and my hometown. I was nice and settled, and was ready to start helping out at the medical centre.



The next day, me and Bibas walked to the medical centre. It was a short walk along the mountainside, and the local people came out of their houses to say hello. It was lovely! I met the medical staff at the centre, and they seemed really nice too. I started helping the staff by taking patients' vital signs, like reading their blood pressure with a sphygmo, taking their heart/breathing rate, their temperature, etc. I'd practised how to do these before I left home, and even brought my own equipment! Keen bean!

After my first day, the medical centre started to appear worse then I expected, despite having set that bar low myself already!  The two 'doctors' were women from nearby villages who had no schooling. I was alarmed, but reminded myself not to judge them. These women were much older than me, have probably seen lots in their time and they'll probably know what they're doing.

Very quickly, I started to realise that this was not the case. They didn't seem to know what they were doing at all. They would dispense antibiotics to anybody who just asked for them, and that's never a good thing. Sick infants were being given adult doses of antibiotics. If somebody came in for a temperature or a cough, they were given anything from Vitamin B tablets to indigestion tablets. I was becoming very worried, but kept observing with an open-mind. It turned out that they couldn't read English, and so they couldn't understand the labels on any of the drugs. They didn't know anything about dosages, how long of a course to prescribe them for, or anything about side-effects. It started to become clear that they didn't know what drugs they were giving people. About one week in, one of the women tried to insert a cannula into an old man's hand. She attempted it 8 times, without changing the needle, and would stick it into the bed mattress between attempts. Generally, equipment was never washed unless it looked dirty, and the medical centre was never cleaned. It got to the point where I couldn't watch it any longer.


So do I do something? I mean, I'm just a visitor in their village after all. What right do I have? I'm not at all qualified to tell them how things should be done.

I decided to be constructive, and started to point out what was wrong. I started to point out things they could improve about cleanliness. I made them 6 litres of saline solution using table salt and bottled mineral water, so they could wash thermometers and stethoscopes between use. It was better than having nothing. Me and Bibas made a medical record log, so all patient visits would be documented, and patients' prescriptions could be noted should anything bad happen later. These were all great ideas - I surprised myself! Me and Bibas explained to the other staff about antibiotic resistance. We explained how they should only be given out for an infection, and how the patient had to complete the full course as suggested in the instructions, to make sure no resistant strains were left.

It wasn't sinking in however. They thought my ideas were plain weird and they just wouldn't consider them. After persisting a few times, and being as polite as can be, they started to mock me a bit. It was clear from the body language from everybody in the room that they were ranting about me, it began to feel very awkward.

Had I have had the option, I would have given up and went home. But I couldn't. I was high up in the mountains. If I had just left, I'd have to make my way down the mountain through a wild leopard zone - not cute! Only one person - Bibas - could speak any English. I had to stay here. It was a very scary situation to be in. 


My popularity took a bit of a tail-spin. I would only give people drugs according to the instructions, and the guidelines that the medical students had left. It's the only information I had, so I was going to stick to it - it was better than giving out drugs willy-nilly. It was difficult, and I was pressurised by a lot of visitors, who were used to getting the big, colourful antibiotics for their headache, not paracetamol or ibuprofen.

 
I brought along the MacLeod's Clinical Examination textbook I borrowed from the university library, which I would read on the porch at night as the sun went down. I read up on how to check for symptoms of anaemia, cataracts and different fevers. If I was able to identify any serious signs like this, then I could recommend people to the medical centre in Trishuli town, and make a note of any observations so they could take it with them.



When children came in it, it was lovely! Most of them came in with a cut or a graze, so I would wash it with some saline and plaster or bandage it. Children were always grateful, and were so resilient with pain. They were also very curious, loved to try their English, and were fascinated with my pale skin and light-eyes. Even if I was dabbing salty water into their wounds, they just sat quietly and smile.

After 3 very, very long weeks it was time to head back to Kathmandu.

As much as I wanted to be out of the situation, I'm very glad for it. I never expected to be put in such an awkward position when I signed up for the experience, but it's helped me grow. It's taught me how much I really care for people. If I didn't truly care about the well-being of other people, I would have detached towards all of the things I saw, and not have made an effort to change things. But I just couldn't let myself do that - even if it would have been the easiest option. Standing up for my views in this situation has taught me how to introduce my ideas to people, while being respectful of their own habits and customs. It's a difficult situation to work with, but I tried, and that's what matters. I'm happy with how I handled it. Honestly, I would hate to be in that situation again, but if I ever do end up in a similar circumstance, I hope I'm better skilled and trained to handle it.




Hope you enjoyed the adventure!

Anthony


CONVERSATION

2 comments:

  1. Although I commend determination to make a difference to a community, there are a number of things that concern me here. I am by no means trying to demean your efforts but I question how many new skills that you can learn from a textbook. Detecting lung sounds is all well and good but do you really have enough experience to tell the difference between 'normal' and pathological states? Further, the GMC has strict guidelines on what is acceptable experience, yes you may have taken blood, advised on new techniques, dressed wounds and even hypothesised a diagnosis or two but as an untrained and untested individual without the appropriate accreditation if you mention any of that at interview you will likely be heavily penalised due to the fact that making decisions that affect patient care without having the authority to do so is irresponsible and dangerous. You are a simple student with no medical training you are nothing more or less. Do not think that what you did in Nepal makes you an exceptional candidate. A good medical student simply needs to listen, and learn not think that they know better then someone else. As for the basic lack of understanding of scientific principles that you refer to, did you consider that at one time you were as ignorant. You should not judge based on your own knowledge.

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    1. Hello CC, thanks for your comment.

      I would like to say, I absolutely don't endorse any of the choices I made in the medical centre! In fact, many were completely foolish! Having said that, I completely understand why you are concerned, as well as any other medical professional in the third world would be!

      I should point out that this experience was incredibly complicated and involved a lot of moral turmoil for me. To somebody more experienced perhaps it would have been a lot simpler! But to somebody inexperienced and unqualified like myself, it was a very difficult position to be in. I hope you understand. I can honestly say in retrospect that I let my instincts get the better - and I don't mention that as a good thing! I could think of 1001 reasons why that approach is wrong. At the time, I just responded as a person - not as any kind of professional - just as I might if a friend had injured themself or grazed their knee. Only the situation was a bit more complex there, as most village people could not afford to even travel to a doctor, let alone afford consultation fees.

      I would like to argue that I fully intended on having a passive role in the medical centre, as I mentioned in my post. I certainly didn't enter that situation thinking I knew better than any of the staff. But after observation I did see serious problems with hygiene and staff giving out extremely large doses of simple drugs (which was mentioned by previous volunteers also). I personally thought that if I didn't do something, somebody might be harmed. That was a moral responsibility for me as a person, not as any kind of professional.

      Despite the sloppy decisions, I am still grateful for this experience for letting me confront these issues first-hand. I wouldn't exactly want to do it again, but we all learn somewhere.

      :)

      Anthony

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