I had the most amazing month away on my medical internship in Nepal with Projects Abroad where I had the opportunity to learn lots and received diverse hands on experiences. The healthcare challenges in Nepal are different from the UK, but the staff are truly inspiring and overcome very tough challenges sometimes with limited resources.
The program seamlessly blended professional learning with cultural immersion as we also had the opportunity explore the gorgeous landscapes and absorb the culture through visiting Temples and meeting the people of Nepal.
After two nights in Kathmandu getting settled and meeting the other volunteers we transferred 6 hours on the bus to Chitwan where our medical placement began. We spent the week in several private and semi-private hospitals across Chitwan learning about Nepalese healthcare, culture, and the environment.
My group started off in Summit Hospital, which is a small private hospital a short drive away from our hotel. We visited the pharmacy which was small but had everything it needed. The pharmacist told us what medicines they would prescribe most commonly (amlodipine for high blood pressure and metformin for type 2 diabetes).
There was a small physio room with one physiotherapist who let us observe some patients and suggest stretches that could help with their pain. She explained to us that in Nepal medicine is a 4 year course, where you study one year of general medicine and then you can choose to specialise in other areas like physiotherapy.
We met with Dr Guarav Neupane who is an orthopaedic surgeon and he had prepared a slide show of his most interesting and common cases for us. There were a lot of road traffic accidents in the populated areas and the rural areas had more rare cases like crocodile scratches. The rural areas are very difficult to access with vehicles and ambulances are expensive so the patients will usually have to walk or in severe cases be carried for a few days or even weeks to reach a hospital.
To finish off our day in the hospital, one of the nurses taught us suturing and let us practice on foam blocks.
We attended a Nepalese language class in the evening to help us in the future when we would be communicating with patients.
We visited National City hospital to shadow Dr Barun Shrestha a Gastroenterologist and consultant physician. National City was a lot bigger than Summit healthcare and was a minute walk across the street from our hotel.
We observed Dr Shreshta’s consultations and he allowed us to assess the patients and give a potential diagnosis. We checked each patients body weight, temperature and blood pressure to be noted down. The patients were asked about personal history (smoking, drinking etc) and medical history. Then the patient would lie on the bed and we would examine the eyes for jaundice and check for any swelling. The most common case that Dr Shreshta sees is liver cirrhosis which is caused by the levels of alcoholism, Hepatitis B and Hepatitis C in Nepal. As most people cannot afford a liver transplant their cirrhosis has to be managed medicinally.
In the afternoon we went with Dr Shreshta to the endoscopy ward and observed his patients there. Some of the patients from the morning consultations were referred straight away and given their endoscopy or colonoscopy in the afternoon.
In the evening, we did a lecture on tropical diseases and looked specifically into typhoid fever which is common in Nepal and surrounding areas.
We visited the Chitwan Medical College (CMC) teaching hospital which was the biggest hospital we attended. We went to the radiology department where we got inside the rooms for X-rays, CT scans and MRI scans. We also visited the surgical ward and interacted with patients using our Nepalese. We then moved on to the ER where there were 60 beds maximum and the doctors said they averaged about 80-90 patients in a day. Most of these patients had been in some form of road traffic accident.
In the evening, we had a lecture on how to take patient history and the importance of this as a doctor. We also learned about vital signs and how to find them using the different equipment.
On Friday we took part in an outreach program with a local school to give a lesson on dental hygiene and interact with the many amazing children there. We brought toothbrushes and toothpaste along with us to give to the children to take home with them.
We climbed 1,800 steps to visit the Maula Kalika temple and were given a blessing of good fortune at the top. The views were spectacular and worth the long hike.
We then travelled to Chitwan national park on Saturday to stay for a night. We saw the elephant sanctuary and went on a jeep safari tour to observe all the different types of wildlife. We spotted lots of deer and different birds. We were lucky enough to even see some rhinos and woke up to one sleeping outside our hotel room! We then went along to the local culture program and saw Nepalese dances (and even had the opportunity to join in).
After escaping the rhino in our hotel we returned back to Hospital Road and were excited for week 2 of volunteering!
I got the opportunity to visit the operating theatre in CMC for the day and observed a collarbone reconstruction and an emergency hemicolectomy for a perforation of the bowel.
We had an evening class on antenatal care counselling.
We visited the college of medical sciences to take a lecture on anatomy and discovered that Nepal doesn’t have an organ donation program in place. Organs are only allowed to be taken from unclaimed bodies to be transplanted. This makes it particularly difficult to get a transplant as there aren’t enough organs being provided.
I visited the dental department in CMC to observe procedures in the oral surgery ward and talk to the interns there where I learned more about the education system in Nepal. For dentistry they have to complete a 5 year course and then do an internship.
We were to complete a case study that day so I visited the CCU in the afternoon to investigate. Here was my study:
CCU patient bed no 7
86 year old female patient
Sudden onset of chest pain with a throbbing nature radiating to the neck, left shoulder and upper left arm.
Blurring of vision, nausea, headache, palpitations, sweating fainting, weakness of left limbs
Spinning of surroundings, this was found to be associated with her tinnitus.
Patient was well a day ago and came to hospital just after midnight when she was given an aspirin tablet and then referred to CCU for further investigation.
- History of anorexia, constipation (passes stool every 2-3 days) and acid reflux (heart burn)
- No history of seizures
- Past history with COPD where she spent 8 months but no further details were given.
- Consumes and mixed diet
- Occasional smoker and drinker
- Normal sleep and appetite
- Normal CNS
- Normal bladder
- Heart rate normal
- Respiratory rate normal but there’s a wheeze present
- Blood pressure is 100/60 so just bordering on being low but not a major concern
- Haemoglobin is low (10.9) normal 12.1 to 15.1 for females
Provisional diagnosis was given as acute coronary syndrome (ACS) of the inferior wall. (Bottom of right ventricle). This occurs when the inferior myocardial tissue supplied by the right coronary artery is injured due to thrombosis (blood clot) of those vessels. Sometimes an inferior myocardial tissue infraction can extend to the posterior region of the heart and an associated posterior wall myocardial infarction may occur.
This cardiac disease can lead to diminished O2 (which would explain the low haemoglobin rate), increased metabolic demand which can cause weight loss, angina and heart failure.
This condition is usually related to smoking or an unhealthy diet or a lack of physical activity.
She was given morphine in an IV to help with the pain and a Lasix (furosemide) in an IV. Furosemide is a diuretic drug and it treats swelling by reducing excess fluid in the body by increasing the amount of urine produced.
She is being kept on this treatment until further investigations are made to confirm her diagnosis.
We visited the natural hospital to learn about their remedies and how they treat patients without using drugs (and join in with some yoga and singing bowls). One thing I found particularly interesting was that they use cows for a lot of their treatments. They have 300 cows kept on site as other cows are given hormones to stimulate more milk production and this can create a hormone imbalance in the body when consumed by us. They vaporise the urine to help treat asthma patients or patients with other respiratory problems by getting them to inhale it. The cows milk is used for several things as they believe it is purer than milk from any other animal.
Then we started our weekend with a sightseeing day and a gorgeous sunset walk.
On Sunday we visited a government funded hospital to see and help with basic procedures. This experience was very different from the private hospitals we had been in so far. This hospital consisted of the basic departments needed, all packed across four rooms. They averaged 45-50 patients a day who mostly came from the surrounding villages. For 3 days every month the doctors and nurses go out and do an outreach program to make sure everyone is up to date with vaccinations.
We began week 3 with a lesson on hand washing with the most amazing kids at Lotus Academy. The children were so interactive and loved getting involved with the songs and games we created to assist the learning.
The next day we got the bus to Pokhara to stay for a few days. We did a lot of sightseeing (and shopping) in this beautiful area. We visited the World Peace Stupa, the Bindabasini Temple and Davis Falls. We were blessed with more beautiful views and lovely walks.
We headed back to Chitwan on Thursday and after a day of recovery we were back in the hospitals for placement.
We began the week in the Chitwan human service home learning about the people there and interacting with them while helping chop the food. They take homeless people who have no other family off the street and let them live here where they provide mental and physical rehabilitation for the residents. They rely purely on donations or money from the volunteers pockets.
We visited the ward in the CMC cancer hospital and observed how their chemotherapy regimes work and learned about the general cancer care in Nepal. We visited the chemotherapy lab and saw where they arrange the chemicals into the IV bags ready for use.
We had an evening class on suturing and I got to practice again and solidify my knowledge on the different types of sutures and what they are used for.
I was back in the operating theatre and had the opportunity to observe an ankle reconstruction and a colectomy.
We were in the National hospital with Dr Barun Shreshta watching his consultations, talking to patients and observing endoscopies and colonoscopies. We learned more about the health insurance in Nepal and since its so new the people of Nepal sometimes have a false idea of what it is for. They can be under the impression that it is free money that they need to spend getting every test and examination done even if they are not ill.
We then travelled back to Kathmandu and visited the gorgeous Monkey temple! We had the most amazing views here and watching the monkeys run around was very entertaining.
Overall, my time in Nepal was transformative, offering not only professional growth but also a profound appreciation for a different way of life. The blend of medical education and cultural immersion made this internship an unforgettable journey. The dedicated medical professionals I met left a strong impact on me and my plans for a career in medicine in the future. Exploring the natural beauty of Nepal gave a refreshing balance to the hard work in the hospitals and schools.
My month in Nepal with was a unique and enriching experience. It has shaped my approach to medicine and deepened my understanding of global health challenges and cultural diversity.