Dr. David Loveday in Nepal.
Over the last few years, we have developed a short term volunteer programme for GPs and medics to participate in teaching, mentoring and supporting the staff in PHASE health posts in Nepal.
Over 50 placements have been completed since the first visits in 2009 and in 2015 alone around 20 GPs or doctors have visited Nepal with PHASE. At least 30% of the GPs who go to Nepal with PHASE return a second time and many give an ongoing commitment, returning to Nepal repeatedly or getting involved in other ways. The placements are invariably a fulfilling experience and remind the doctors of the immense rewards that their work can involve.
The health posts themselves are government owned.
PHASE runs a service enhancing and supporting the government work and the aim is to maintain health provision for long enough for the service to be bolstered and the local population to be empowered. Once significant improvements have been accomplished PHASE can reduce its input and move on to areas where there is greater need.
The healthcare at the health posts is mostly provided by Auxiliary Nurse Midwives (AMNs).
The staff have completed an 18 months government run training course with an emphasis on maternal and child health and have some clinical experience prior to applying to work for PHASE Nepal. The staff are always given induction training and ANMs are supported by higher qualified Nurses who work in a ‘floating’ capacity, over-seeing, supporting and visiting the various health posts and ANMs regularly.
ANMs usually have bi-annual centralized training in Kathmandu as well as local and regional training conducted by UK GPs and midwives.
“Living and working alongside the health workers, who themselves live among the communities which they serve, has meant that the patients’ problems have become my problems. Not only have they presented their clinical issues, but to some extent, in some small way, and for a brief period, I have shared in the health challenges faced by these people” Dr. Andrew Moscrop shares his experience on the BMJ blog.
As part of their ongoing training all ANMs have visits from experienced British GPs, up to twice a year.
The aim of these visits is to provide one to one mentoring/training and also to help PHASE monitor that the health post staff are following the comprehensive clinical guidelines that have been developed over several years in collaboration with UK and Nepali Doctors. The visits from the UK GPs usually last no longer than one week in each location and the GP or doctor will live and work with the staff. The GP will not be treating patients directly but will provide on the job training, support and personal tutorials according to specific PHASE guidelines to assure continuity in the teaching.
Over the years we have tried hard to optimise the support we offer our volunteer GPs.
We aim to arrange at least one face to face meeting before any placements are agreed. The written information we offer about the placement includes a handbook (with many teaching ideas and information about the programme, and also a small vocabulary) and an English translation of the clinical guidelines our health workers use.
As well as collecting structured feedback both from volunteers and health workers, PHASE organises bi-annual meetings in the UK for returning and new GP volunteers to exchange ideas and feedback on the programme.
Through small incremental changes that were prompted by this feedback, we have been able to improve not just the volunteer programme but our health services in Nepal overall.
“The clinic at Lho is situated high above the village, perched on the edge of the gorge of the Buri Gandaki. I sit on a bench facing west where the view is dominated by the towering peak of Manaslu (at 8163m the 8th highest mountain in the world and another 5000 metres above me).” Dr. Bob Rivett shares his experience on the PHASE Blog.
The main aim of the GP and doctor mentoring scheme is to improve the quality of healthcare, but there are several other benefits from the GP or doctor visits.
PHASE staff work in quite isolated and culturally different communities for long periods of time without many visitors and thus the visiting GP can be a source of support beyond being purely a professional mentor.
There is of course an added benefit for PHASE, in developing a professional supporter base in the UK, but the benefits to the visiting GPs are also not to be underestimated: The mentor visits are a great way to visit the beautiful country of Nepal, learn a lot about health in a developing country and to appreciate primary care in its most basic and essential form. Many GPs find that they return to their NHS work with renewed energy and enthusiasm, and some have discovered a love for teaching and mentoring while visiting Nepal!
A great number of GPs have returned to Nepal for further visits and their commitment and generosity has been a huge asset to PHASE’s work.
THET have a presentation about this programme on their website. This was presented by Gerda Pohl at a one day conference regarding international partnerships in primary care and public health, which was organised by THET.
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Some more of our GP and doctor Volunteers share their stories here: