I travelled to Nepal from Brisbane, Australia in September 2016. I chose PHASE Nepal because of their commitment to supporting healthcare for some of the most isolated and inaccessible communities, employing entirely Nepali staff on the ground and up-skilling locals rather than deploying foreign workers. On my first day at the head office in Bhaktapur I learnt that PHASE Nepal has a broad development strategy involving, not just health, but also agriculture, education and rebuilding after the earthquake. My original schedule changed because a recent landslide made the two day walk too unpredictable. Instead I was assigned to Hagam, a small village half a day’s drive from Kathmandu and a few hours trek up a mountain. Hagam and surrounding villages were obliterated by the 2015 earthquakes, although I wouldn’t have known, had I not been told – the reconstructed village was a bustling warren of small huts, corn drying on rooftops and baby goats.
Clinic days saw a steady stream of patients, many who walked from neighbouring villages and waited on the ground outside the clinic chatting. I was surprised to see so much familiar pathology – bladder infections, smoking related chronic airways disease, eczema and ear infections. Then, conditions related to the challenging environment such as skin infections, injuries, cataracts and diarrhoeal disease became more apparent. There were people with Vitamin A deficiency and night blindness. Sadly, we also treated children with severe malnutrition and failure to thrive.
PHASE provide invaluable prenatal care and I was delighted to see a Pinard’s aluminium fetal stethoscope pressed up against a woman’s belly. One evening our health workers were called away to deliver a baby girl. The following day during a storm, her father and proud extended family brought the baby to our home to have her examined on the kitchen floor.
On non-clinic days, we walked across mountains to local schools where the health workers were running health education classes, and to a government health-post where the mothers groups gather to discuss improving health literacy in their communities. After the clinics closed and the work was done, the health workers and I practiced history and clinical examination skills. We were lucky enough to find plenty of patients to supplement teaching – an old man with rheumatoid arthritis hand deformities, a woman with a Shingles rash and plenty of people with back pain to practice neurological examinations and peripheral reflexes. It reminded me of how much information can be gathered from a patient without the luxury, or need for, blood tests and imaging.
By the end of my trip I realised it wasn’t the medicine I found most challenging, as I’d originally feared. Primary care, at its core, is the same on a mountain as it is in the city – it’s about building relationships, sharing stories and finding strategies that work for an individual with their unique life challenges. What I found most challenging was showering fully clothed, being a pseudo-celebrity attracting attention while sheepishly brushing my teeth and the absence of noise from media, mobile phones and internet. It was confronting to learn how dependent I was on those distractions. What I valued most from my time with PHASE, was the opportunity to meet and befriend the health workers who live away from their family and friends – they are often young women, living solo in a community that is not their own, with 18 months of formal medical training, who are available 24 hours a day to bring comprehensive primary care to people who otherwise would have none. It was humbling to see their commitment and resilience.
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