Public Health Research in Nepal

It’s been exactly a month since I last wrote the blog regarding my research project in Nepal. Within this month of January, I, along with other members of our team Swastha Nepal, got to have an experience of a lifetime while we were in the country. I could not update the blogs about my project while in Nepal since we were detached from computers and pretty much all forms of technology while we were in the village. However, now that I am back to civilization and have access to the internet, here’s a summary of the project and my Nepal trip experience.

About 24 hours after departure, we reached Nepal on the evening of January2nd.  We were in Kathmandu, and our agenda for the next few days was to tour different hospitals in the valley to get an idea of how health care system works in Nepal. As planned, we went to see different facilities in the city. We went and visited all types of hospitals, like the government hospitals, mission hospitals and private level hospitals.  Even though the physical setting and the facilities did not quite match what we have been used to in the US, we found out that those hospitals were all national level hospitals providing services to the people in large numbers, and were regarded good ones in the country. The crowded ER and the sanitation techniques were not in their best form, but ideal for the services they were providing.

Apart from the hospital visits, we also had our meeting with Mr. Kul Chandra Gautam.  He is renowned in Nepal and elsewhere, and has served as the Deputy Executive Director of Unicef in the past. He is also the founder of Nepal Public Health Foundation, and he gave our group a general overview of some of the problems in public health relevant to Nepal. He gave us an idea of where Nepal stands in terms of public health, what are some of the issues that are understudied, and how it has been progressing compared to the past. From what he said, it seemed that Nepal was progressing in many issues that were seen before, like availability of basic health care facilities, and nutrition related problems. However, he also pointed out that issues like child bearing behavior and women status in Nepal need to further improved in order to uplift the overall public health status. The conversation we had with him was a very good transition for us from what we had learnt about Nepal’s health related issues when we were in the US and what we were going to do for the next few weeks i.e. our public health research.  Dr. Gautam was a very decent and nice man to talk to and we were really glad that we got to meet him. His insights were definitely very valuable for us, and will be considered while we work on our project further.

Our visits to these hospitals and meetings in the capital were followed by sightseeing in Kathmandu. The visits included the famous Swayambhunath Stupa (also called “the monkey temple”), the famous Hindu temple of Pashupatinath, Boudha Stupa, and the tourist town called Thamel where we stayed. We absolutely admired everything we saw there- whether it was the chaos in the streets with constant honking of vehicles, the colorful crowded shops, or even the cute little monkeys sitting on the roof of many temples and stupas we visited.

After about 5 days of becoming accustomed to the city and getting to know a little bit of Nepal, we left for a village called Bhumlutar for our free medical clinic and public health research. The journey to Bhumlutar was fairly short (about 3 hours from the city), but we were all glad to reach the top of the hill to our destination alive because the bus ride on the winding, narrow, bumpy roads saddled by huge drops offs, resting thousands of feet above sea level was frightening. The driver and the 30 other team of doctors and nurses who joined us for the camp however, were familiar with these types of roads and did not seem to be as frightened as us. When we reached the village, we were warmly welcomed by the villagers with “Namaste” and little bouquets of flowers in their hands- this made us completely forget the harrowing bus ride we just went through to get there. We then started our camp around the afternoon. The medical clinic was quickly set up at a school with different rooms assigned for lab work, physicals, eye exam room, etc. The local volunteers helped us manage the patient flow, the nurses quickly checked the patients’ vitals (blood pressure, weight, temperature) – and would send them to different rooms depending on their medical need. After seeing doctors, the patients would go to the “pharmacy” to get their medicines and after they were done, I (or Shrishti- another native speaker in the group) would approach them for interviews. The interviews were conducted in order to find out what their basic lifestyle was, what they do when someone gets sick, what their general views are on sickness and such. It seemed that health awareness programs and general educational programs about health and sanitation could definitely benefit this community, and we plan to incorporate such programs for our subsequent visits in later years.

Conducting these interviews was definitely a new and interesting experience for me because their lifestyle and thoughts are different than ours and it helped us understand them better. Besides the interviews, we also have the prescription slips and their medical records (which are also anonymous), and we will be transcribing these resources we have during this semester to understand common illness, their causes and prevalent issues in the community.  Our time at the village was very memorable.  We spent our free time playing ping-pong at the school with the local kids, or walking around and drinking tea at the local tea shop. Everywhere we went, the villagers were really friendly and hospitable.  Their trust towards us was such that they would tell us everything about their lives, and share their sorrows and happiness with us.  Their wide expectations sometimes made me wish I could do something for them, anything. And we did. By the end of third evening in the camp, our medical team had seen about a thousand patients, and we had interviewed about 60 people. We had provided basic medicines to the people at their doorstep for which they would have to get to the city far away (even though some of them walked for as long as four hours to get to us).

Our camp at Bhumlutar ended on the third day. Even though we had just spent three days with them, we were emotional to leave – we had been attached to these people, who had cooked for us, let us stay in their home, and appreciated us so much. The kids even played with us when we were bored and showed us around their village, becoming our friends in the process. Our farewell at Bhumlutar consisted of short thank you speeches from us and their village representatives, flowers, and the villagers put red powder, or “tika,” on our forehead and face as a blessing. We packed up and left for another village called Naldum. After another frightening three hour bus ride, down the hill this time, we reached Nagarkot- a famous hill station. Since it was late, we stayed at a hotel in Nagarkot that night, and went to see the sunrise above the infamous Himalayas from a tower the next morning. Although it was too early in the morning , 5 am, and the weather was freezing , the mesmerizing view of the glowing sun rising; casting its rays over the vast Himalayas and drenching the peaks in gold was definitely worth the cold.

We reached Naldum later that day after a two hour bus ride from Nagarkot. This time we were welcomed with garlands of bright yellow flowers and different bunch of smiling faces.

We started our camp there in the afternoon, and had patients overflowing after a few hours. We carried out our work in a similar fashion to that done in Bhumlutar. The interviews, the medical clinic were all the same – the only difference was the community we were in. This time we had a lot of Tamang locals as our visitors (which is one of the caste groups in Nepal). Quickly, from the interviews, we came to know that the lifestyle in this village was different from the previous village. We spent two days in the village, and saw 700 patients. Even though the physical comfort we had in this village was less comfortable (we did not have a village house for staying this time, we slept in floors at the school using our sleeping bags), we tried to get as much from the trip as possible by singing and dancing along with our whole group of locals at the campfire during the end of our last night there.

After the camp, we got back to Kathmandu and had a few days to rejuvenate ourselves before we finally head back to the States. The interviews and the prescription slips (both of which are anonymous) that we brought along with us are an integral part of our research. Since they are paper slips and notebooks of surveys, we will be transcribing these data into our computers and analyzing them to see what issues need to be addressed in the communities we visited. We still have to analyze these data to discover what conclusion our research leads to, and this is what we will be working on this semester. This research conclusion will help us figure out what needs to be done for the next trip, and what should be the main health focus in the community.

Even though the time we spent in Nepal was short, we encountered so many new people and truly made a difference in some of their lives. For instance, when we were in the village of Naldum, one of the doctors from our team saved a life of a woman who was about to die because of improper access to treatment of tuberculosis.  The medical team directed her to the hospital for free medical care and helped her recover. We were glad that during the short period of just five days, we were able to help about 1700 patients by providing basic health care and access to basic medicines.  Even for us, this trip was an eye-opening and a great learning experience. This blog definitely cannot do justice of explaining how important this trip was for us and how grateful we were for it, but we had an experience of a lifetime. We learned a lot about research skills, and we believe that for undergraduate students like us, it is a very valuable asset. We are not doctors yet, but for us who intend to be involved in medical field or even other careers, this experience could be very important. We are very glad we were a part of this trip, and that we made it happen. We dedicated our time to help the people in need who are 7000 miles away from us, and this made us realize that if we are truly determined to do something, we can definitely achieve it.