I first read about PHASE in the Royal College of General Practitioners magazine in 2013. My interest was kindled and it took about four years for that spark to mature. Whilst I still had reservations about the usefulness of a short stint abroad, attending a PHASE meeting in London 2017 changed my views on this. I realised that the philosophy of PHASE was sound, as a well thought out and genuinely community based NGO.
A couple of months later, and with some trepidation, I was on a plane to Nepal, not quite knowing what things would be like, with a three-week stint ahead of me.
My first day was in Kathmandu, staying with a wonderful family as a “homestay”. I then travelled for a day with another GP to Gorkha, before we separated to our locations. My first placement was in the village of Kashigaun, an eight-hour trek away.
Kashigaun had a well-staffed health post, and including me there were five people in the clinic: two Government Health workers, a fully trained and experienced nurse, and an ANM (auxilliary nurse midwife) student working for PHASE. However, the main government health worker had only been there for a month, so before that PHASE were the main presence.
I managed to gently support and work well with the various health workers to make the best use of all our skills and knowledge. They were very competent in many ways, and certainly more familiar with local conditions and guidelines than I was. I helped them to gain more knowledge of things they had less experience in, particularly with skin conditions such as urticaria, which was not covered in the guidelines. I was there to help when a patient was brought in unconscious, with what turned out to be Conversion Syndrome.
The most common things we saw in the clinic were cases of diarrhoea, chest infections and skin conditions, interspersed with occasional drama, such as an eighteen-year-old girl brought in with conversion syndrome, and some pregnancy issues requiring transfer down the mountain by stretcher!
It was interesting to note slightly different attitudes to medicine than back home, with some patients having very high expectations of Western medicine. It was also harder to reassure some patients that their problem would be able to go away by itself.
I mainly tried to concentrate on teaching the other staff practical examination techniques, and ways to improve taking a patients’ history. They were very impressed by some of the technology I had brought along, such as the Body Works I had downloaded. If I return to Nepal, I will sort out some more formal computer presentations to show the Nepali staff, as technology proved to be a very popular way for them to learn.
As I had heard described previously, life in the village was taken at a very slow pace, and there was a significant amount of ‘down time’. Probably the hardest challenge for me was the language barrier which sometimes made communication tricky, but all the PHASE workers were very friendly, and I tried my best to help with the food preparation and the daily chores.
PHASE were very supportive when I decided to slightly change plan and finish this placement a bit early, partly due to an unfortunate dog bite, and due to the nurse in the following placement going on leave suddenly.
I saw other projects, such as a 65km path construction and agricultural support, which were both impressive and interesting to observe. They also fitted well with the aims of the health project. This all gave me a good insight into how development projects are implemented, how they work, and the challenges associated with them. It also showed how the donations following the earthquake had made a genuine difference to people’s lives on so many different levels – donated chickens clucked in so many homes!
On my return to Kathmandu, I was again hosted wonderfully by the family at the homestay, and it was real privilege to be a part of Nepali family life.
I felt really looked after by PHASE, and they were very well organised in a Nepali style. It took me a bit of time to realise that things tended to happen more slowly, but once I got the hang of this I was just able to go with the flow. My experience was pretty much what I had expected from hearing about the experience of other GPs, and PHASE had presented an accurate picture before I went on the placement, including the most challenging areas! The Nepali people were even more friendly and dignified than had been described.
The ethos of PHASE, that I had understood previously, was very much backed up by what I experienced. The projects are thoughtfully and sensitively constructed, with genuine attention to involving the local community in the whole process. I have certainly gained hugely from the experience and pushed my comfort zone a lot, and I hope I have given back to the Nepali people by sharing some of my experience.
Jonny Rae, 2017
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