Here is a list of organisations I have assisted in. Click on the links to get involved.
Asia
Phase Nepal : Mentoring Villiage Health Care workers in rural Nepal. Commitment minimum 2 weeks.
Institute for Rural Health Studies: Mentoring Village Health workers in Telengana, South India. Ideal for General Practitioners. Commitment minimum 2 weeks.
Comprehensive Rural Health Project is an incredibly successful community health development project which has spread its model worldwide. It also runs courses on community health development and accepts visitors.
Mae Tao Clinic on the Thai Burmese border assists Burmese people with healthcare. They accept final year medical students to specialists. This is an incredible set up and service to people who really need it.
Africa
Africa Health Placements will help you to work in a government hospital in South Africa. They will arrange your paperwork and you will be paid well for the work here.
Europe
Doctors of the World have many opportunities for GPs and nurses to work across Europe with the refugee crisis. I have just returned from Greece.
They also have a clinic they run in London called Project London for people who are struggling to access health care in the UK.
The 9 hour trek further west to Jair was simply beautiful, wandering past mini hydro mills with old ladies grinding their grains in the dusty dark shelters and, banana and papaya trees scattered in the lush green wheat terraces. Smiling faces, weak sweet Nescafé and peanut cookies comforted our arrival. By this point Kishwor (supervisor and lab technician), who had been accompanying me and helping with translation, had taught me a little more Nepali. Being able to join in on a few of the laughs and understanding the basic medical consult made this a memorable final health-post to visit.
Jair is perched low in the valley by a rushing river thriving with fish, and humans eagre to catch them.. The village bustled with villagers, buffalos, chickens, goats and mice. The three health workers and the agriculture technician live above a stable for a water buffalo family. The huge mother buffalo jaw rhythmically chewing on hay, with eyes closed warming it’s massive head in the sun was nothing but hypnotising.
The team have a small kitchen area with wood fire stove and vent, two bedrooms and a bedroom/store room/second consultation room, and in the hallway is the main consultation area where the examination bench doubles as the desk.
The daily dal bhats were slightly different here. The team liked their meat, and I rarely eat meat. We got delicious fish from the river, and then less appetising dried goat and all the bits of a fresh hen.
Snack time in the kitchen
The Clinic
The clinic usually sees 40 to 50 patients a day. People can walk 7 hours in the mountains to get there, returning in the dark. The government health posts close to them are often unmanned or without medicines. This clinic is solely run by PHASE. The calmness and respectfulness of the staff here to their local host community was impressive. The staffs skills in treatment and diagnostics improved significantly while I was there, as a result of their determination to learn. We discussed how to rule out serious illness and when suspected how to manage it, which they really knew better than I did as it is a setting they know more about.
Delayed presentations were common, in part due to reliance on traditional treatments first, or distance from health post. Although many patients were advised to go to hospital, money and distance remain a hinderance. Chronic gastritis was rife, and large burn scars from traditional treatments common. Ayurvedic herbs were used for some wounds occasionally to good effect. I have since met many who experienced benefit from Ayurvedic treatments. It strongly emphasises prevention as well as treatment- a holistic approach through changing lifestyle, diet, yoga as well as herbal therapies. Seems great on paper, something i’ll look into more.
Mothers group held by Health workers
Final Note from Nepal
This was my last health post. I had visited five in total, and it got easier and more enjoyable with time. I understood better how and what to teach, also a little more Nepali language plus feeling more in tune with the local culture helped. The Nepali people I met along the way also make it a pleasure to be there, their warm hospitality and kindness glows. The keenness of the healthcare staff is inspirational and rural Nepal is just beautiful. Its no wonder Nepal remains such an attraction for the numerous NGOs present here. If you get a chance and have a couple of weeks spare, I couldn’t recommend this more, even if it does mean a 3 day walk, a plane journey, and 2 buses!
Beautiful views enroute to RuginOn the way to Rugin with Kishwor- some traditional housesiNGO arrives in the village on Holi to give each family one goat.Holi festival- a day off dancing and smearing red paint on each others faces.The old grey building was the health post being used- it has no electricity. There is one store room, and a small room for seeing patients, and a delivery room. The blue and white building was started a few years before by the local politicians- however there has not been the resources to complete it- hence it lays dormant.This is the delivery room. There were 2 deliveries in the time I was there, and both without complication. The room is dark, with the only light coming from one small window and the door if open.‘Helping’ beat some local grains.One of the older community members who was working on her roof top.The local school- each family gives some money towards the education. The many rooms are bare with old benches and a blackboard. We came here to advertise a community health awareness programme.The dedication of the healthworkers was demonstrable by their willingness to live in difficult conditions- cooking on fire in their room meant burning eyes and harsh lungs. I would sit with a blanket over my head, while the others incredibly endured it. Some local families get smokeless stoves installed by an international NGO working in the area. Many of the local older members, especially women, suffer with COPD as a result of the smoke.Farewell and onward to the final village a long days walk ahead.
View through the villiageThe healthworkers sat by a small fire at the entrance of the village to greet us
Journey to Dhim
The 6 hour trek through the midday sun seemed never ending. The last 3 hours were a punishingly steep incline, and i was ready to throw my backpack down the hill. I arrived slightly sun stroked and beaten, and Yogesh ( the healthworker supervisor) with broken shoes. We were pleasantly welcomed to smiles, laughter, tea and home made cel roti (a bit like doughnuts). Then 2 paracetamols and a sweaty sleep beset upon me before waking for Dal Bhat.
Dhim and the community
It was spectacular, the healthworkers’ narrow balcony overlooked mountains folding in like huge interlocked fingers deep into the valley. During the week the weather changed dramatically from sunshine to perpetual rains and snow higher up- the shifting views were incredible. One early morning I decided to meditate on the sun rise over the distant mountains. Phase staff often used early mornings for studying phase guidelines in bed- ‘when the mind is fresh’! Impressive dedication, which inspired me to get back into daily early morning meditation and yoga.
The very small doors- even for me meant many knocks to the head!
The water tap for the village was very far away from all residents. You would see people throughout the day, including very young children carrying up to 40 litres of water. I forced the health workers to let me help them collect water, partly to help, but also not to feel guilty for using the water that is so arduous to collect.
The water tap far into the distance- the healthworkers had organised a community clean of the area surrounding which was heavily litteredKalpana-ji cooking up delicious food
The communities gratitude to the health workers presence resulted in donations of spinach, coriander or fresh buffalo milk and even some nettle curry on one occasion. It was interesting in the community, by looking at the children, you could see some families managed to keep their children well nourished and clean, while others struggled. In clinic, the health workers were counseling mothers of malnourished children well, proved by impressive weight increases on follow up. There seemed to be many children not in school, which was a problem in all the villages I visited. Without an education it made me concerned for the development of future generations to lift themselves out of poverty.
Up the narrow stairs was the living quarters for the Phase staff
The health post
Kalpana and Sumjana are two healthwor
View through the villiage
kers based in Dhim and have had the clinic running for 3 months. Strangely the government also set up a sub health post 2 weeks before I arrived, but as they do not have many medicines patients prefer the phase clinic, and also prefer the service. I can see why. The health workers spend time with the patients, and check everyones blood pressure as per the patients expectations. However, patients here like anywhere will complain that they have been waiting too long! A very small fee is charged to the patient for the upkeep of the clinic, and most are happy to pay it, and if they cant afford it they are not turned away. The government plan to build a new better health post in the village to accommodate the phase and government staff. Phase being present means more community development work, more medicines, and support and company to the government health workers. I wonder how frustrating it must be to be a government health worker here with limited medicines, limited training and no guidelines to help, while also being isolated from family and friends with little communication to the outside world.
The Phase ClinicExamination bed
Interestingly in this community the women rarely call the phase staff for help with birthing as culturally having tears sutured is not well received. Women prefer to risk the complications as there is a perception it would otherwise affect future pregnancies. The tradition here is also to keep the mother and baby below in the barn for 20 to 30 days, they are also not allowed to use the public tap at the same time as others and would ideally bathe in a local river or stream. They are not allowed to touch anything or enter the house. When menstruating also the women follow the same rules for 4 to 5 days. The phase staff attempt to raise awareness that the lack of hygiene and cold conditions in the barn are a major risk to the newborn and mother.
Phase clinic
The clinic was very quiet, it usually is for some reason. But the bad weather made it less likely for people to come. We did still see many cases of severe malnutrition, gastritis, skin problems, psychosomatic complaints, and significant neurological disease. Delayed presentations were common. Time, money and the many days journey to a hospital meant many lived with serious disease in the community risking long term complications or worse.
May 2015: The above account was written pre-earthquake- however I understand that this part of Nepal has not been so affected as the Ghorka regions also discussed in this blog. I wish the best for all the people of Nepal in this very difficult time. I understand the healthcare workers here had returned to Kathmandu for their routine break and training, but have volunteered to some of the more affected rural communities to offer their support.
2 days after returning from Gorkha and enjoying some sights around Kathmandu with Maria I was ready to plan my next venture out to far west of Nepal. This area has some of the poorest and hard to reach communities, resulting in the worst health indicators for Nepal. When we arrived in the Phase office, I met Yogesh, a very friendly and relaxed health supervisor who would accompany me to the
Loading the bus.
west. We did some planning for the 3 health posts I would visit and decided our route. The first leg was a overnight 16 hour bus journey, that with frustration seemed to break less than hourly for unknown reasons. We took with us 16 boxes of medicines, a solar battery, and an oxygen cylinder and some special food health workers relatives had given to us to deliver to them. The roof was packed, and to get to your seat you had to clamber over dozens of solar batteries which fitted so neatly into the isle, it was as though the bus was designed for this purpose. Once again my down jacket rescued me, as cold air blasted through the broken window for the many hours to come.
In the darkness of the early morning, one long break was next to four identical rustic chai stalls, with warm welcoming fires enticing you to sit down to greet the new day with a tiny cup of milky sweet goodness. We arrived tired in dusty hot border town of Nepalgunj. After some rest went shopping for more essential goods to take back to the far west. Another sleepless night came as I wasn’t prepared for the onslaught of Mosquitos and couldn’t wait to get back up into the mountains.
Onwards to Kolti
The small 9 seater plane to KoltiView from the plane
The following days chartered plane ride was beautiful. Flying through impressive mountains and again lush wheat terraces dotting the rough brown valleys. The people here believe these 3000m plus mountains to be hills, I wondered what they would think to the mountains we think we have in the UK. We landed in Kolti, a low lying part of the west with the ability to grow banana, papaya, guava among all sorts of veg. People still stick however to potato, spinach and occasionally just tobacco in their gardens. That is why Phase has agriculture advisors here who promote better kitchen gardens, with more variety and improved nutrition.
Safe landing in Kolti with Yogesh
Other Phase staff here work in the local primary health post along side government doctors and midwifes improving the service provision. The delivery room is so cold however, that they prefer to deliver the baby on a mat outside in the sun, overlooking the valley behind the primary care centre. Sounds nice in a way.In Kolti, there was a midwife from America, who had impressively been staying in the west for 2 months. They are currently building a new accommodation for the staff who at present squeeze into 2 bedrooms. She was helping to improve the standards, and it was great to hear some of her insights before I ventured onwards. I slept incredibly well that night. The next day was a strenuous hike deeper into the mountains to visit 3 more health posts over the next 3 weeks.
Yogesh very happy to reach the top of a heavy uphill climb to an incredible viewEn Route to Dhim along the valley from Kolti
Walk to Sidibas through the gorka valleyThe last steps upto the healthworkers house past the pagoda.
The trek from Keraunja to Sirdibas
the long bridges over the valleyBreakfast in the kitchen
I met Maria (my partner, also volunteering with PHASE), Sunita (a health supervisor) and Peyma (helper/porter) at the bottom of the valley. It was 2 further days trek in the stunning Ghorka valley to Sirdibas, with more long drop waterfalls and beautifully striped boulders smoothed out by the rapid icy blue waters.
Next to a striking pagoda was the health workers house, just minutes from the clinic. Kalpana and Uma were the Auxillary nurse midwifes(ANM) here, and Sangita was the on the job ANM trainee. They have to cook on a fire, and the smoke can sometimes get intense in the kitchen. They still manage, and cook great dal bhats! They are lucky to have a water pump right outside their house, so water collection is not a problem. As in all villages, bathing is public and the water is bitterly cold.
The Health Post
In the clinic room with healthcare staff and supervisor
The Phase staff were all supporting a government health post that was run by a newly trained Auxiliary health worker. A new health post, 5 times the size was part constructed nearby. Currently patient confidentiality is compromised, with no doors to the clinic room, and any procedures done in the waiting area. The confined space and the high number of potential TB patients coughing and spitting outside the clinic door made me feel a bit uncomfortable so along with the other health-workers I wore a face mask.
I was sent here as they were seeing a high number of complicated cases, and I really found this to be. Severe burns, septic arthritis, plenty of potential TB, and potential malignancy were all on the cards in the limited time I was there. The long distance from any road or hospital, along with the poverty made referral difficult and frustrating. Helicopters are occasionally sent out by the government for pregnancy cases. Otherwise the community may club together to pay for a helicopter for someone if they see fit. But it costs 100,000 rupees (about 650 pounds).
In the clinic waiting area with staff at the end of a busy dayTeaching session in the evening
The government supply 32 medicines which the government staff are trained to give. Extra medications and staff are supplied by phase. This can have the affect of sometimes encouraging the government health staff to spend more time at the clinic with less isolation and more medicines from Phase. It is well known for government health posts to be left unmanned and without medicine for long periods, hence the need for PHASE support. The phase staff will dedicate time also to community outreach or holding health education sessions.
It is a tricky community- people travel for hours to attend, while commonly speaking a different language to the health workers. They have even further to travel than Keraunja which makes it difficult to refer. Patients will often prefer a treatment and hope for the best than be referred to hospital for necessary investigations. A common scenario maybe gastritis, where endoscopy might be indicated, but the patient is unlikely to go even after counselling.
Teaching
It was difficult to teach due to my lack of Nepali,, but the government health worker, with slightly better english, attended all our teaching sessions, and helped with translation. While in clinic I focused on helping the team with taking clinical histories, examining, and ruling out serious conditions. Phase teach health workers to stick to their comprehensive clinical guidelines, and I tried in most cases to reinforce this. It was incredible to see the improvement the health workers made during the few days I was there, and the keenness to learn. It was also very special to see their dedication to the community they were serving.
Upper Gorkha and the PHASE School and clinic
Maria with the puppies from upper GorkhaChekumpar- Maria with the health care staff
Maria went onwards and up the valley to higher snowy ground to visit two further health posts and a school created by PHASE. Being higher up meant it was colder and people were less likely to wash. Many carried their own silver spoon to eat with since it was more hygienic than the traditional hand. Kids faces were more intensely snot encrusted, and the vibe got more Tibetan as you reached the border.
Warming up at the fire in Upper Gorkha health post
The clinics were quieter, but still well appreciated by the communities there. The views were spectacular, with mount Ganesh at one point of the trek in full view. On their return they bought a yak tail and 2 puppies with them that one if the health supervisors had requested. Of the hundreds of adorable, excessively fluffy puppies we saw on the walks, the two they returned with were exceptionally cute with slightly weird blue eyes.
The hacked stone from the rocky paths leading into the village are the same stone the houses are built from. A stone grey with bright sparkling silver glitter embedded in layers, which rubs off on your jacket as you lean against the walls. Sumjana and Apsara, the 2 phase health workers greeted us with big smiles and sweet ginger black tea. We sat around with the small but strong lady who carried our bags and we slurped on 2 minute noodle soup together. I peered around just wishing I could converse a little with the conversation being all in Nepali of which I had regretfully failed to learn a little before hand. I realised the hospitality here was going to be overwhelming, however, my lack of Nepali meant many frustrations to come between me and the health workers.
Stunning walk through the valley to the outreach village
Outreach
The first day was an outreach clinic which meant a 2 hour walk along a beautiful valley with a snowy mountain backdrop over to the next village. Again I stumbled down lush green terraces with the health workers and set up a few chairs outside a large school
There was a sea of women who had come for their contraception injection. This was a good opportunity to go over some of the main issues to consider when issuing contraception with the health workers.. Then usual cases of gastritis and dizziness ensued – cases reminiscent of my GP registrar job in hackney. A problem here was that this out reach had only a few chairs, no private room, no drug cupboard, no tests. The community had been asked to organise a drug cupboard, a bed and a curtain for some privacy but had not managed to as yet. It was clear instantly the difficult conditions the health workers were in and at the same time
View into the village
managing remarkably well. Some people were asked to come to the health post where we can check HB and do urine dips for glucose, and also have an otoscope. It means a 2 hour walk one way and maybe a day less crucial income from work, this means a few do not turn up.
The local female community health volunteer invited us to sit inside around a fire pit to cook our 2 minute noodles, drink tea and toast some rotis before heading back to Keraunja. On the way out we were asked to see a very sick groaning elderly patient in her dark tiny shack of one room held up by worn stilts. It was the first time of many to come that I realised the tribulations of falling sick this far from any hospital and being poor. I can only assume she died in the coming weeks where we left her. It left me feeling somber as we climbed up the hill back to Keraunja and for days after. I wished I had some decent advice, a few ideas later popped into my head that may give some symptom relief. We sent a message for a relative to come to our clinic so we could give them some advice, but they never came. The staff will follow up in the village after a month so I hope to find out eventually. Maybe they used a traditional healer, or maybe she died, or maybe by miracle she got better.
Mustard crops overlooking the mountains from the outreach village
Children of Keraunja
Keraunja’s children, like many rural mountain kids often wore thick snot on their upper lip with raw skin underneath. Muddy hands and dry dusty skin seems to be commonplace, but kids being kids maintain their cuteness to a high standard. The staff say it is lack of awareness of hygiene, but also it is bitterly cold and a lack of fuel to heat water. There is no private area to bathe, so it means washing under the ice cold public taps. I didn’t wash for the time I was there. With a constantly running nose, I joined the club of occasional snot hanging from my nose and with the my lack of tissue had to join the tradition of blowing it out aggressively on to the floor. My attempts often ended up a little messy and embarrassing at best, I have a long way to go before mastering this technique. However good I get I probably shouldn’t be trying it out in London. I think I’ll stick to tissue.
Although there is a big school close by many kids are not there, instead doing household chores or working in the field. I hear also however often the government teachers are not at school when supposed to be, and the quality of education is not good. I wonder how without an education the younger generation will lift out of poverty, maybe some will, but I imagine the majority will not.
Poverty
Someone explained to me even though many people are poor in Nepal they are happy and wear a smile on their face and spend time laughing. They told me the age old quote that ‘money doesn’t bring happiness’ but then agreed some is important. I left unsure how many of the people here fit into this category of having enough to be happy. I have studied a module called ‘understanding poverty’ I understand why people become poor and poverty traps but I will never understand what is like to be poor. With never being poor how can you ever really understand how you would be in that situation. In some regions Phase has community mobilisers who do needs assessments and try with very little resource to act on some of the solutions that come up in community meetings. I write more about this later when I meet a community mobiliser in west Nepal. I suppose you need the opportunities, and if there are none, then the probability is you will accept your situation and try to survive.
Keraunja Village in the distance
A couple of months ago visiting a tribal health project in India, regardless of the mild malnutrition and rogue kids not in school, the villagers sit and laugh and appear relatively happy. The health workers here tell me people in general work until they have enough to survive then will stop for a few days. I thought it is good they have that option, and so much work is available, but if this was the case then why is there malnutrition? Is it lack of education on what constitutes a good diet, or is this less of a priority over other needs.
In Keraunja everyone seems to be working- women, men, children and the very old also seem to be grafting hard. When I went to the bathroom in the morning I would look up the valley to see streams of mostly women zig zagging down the mountain at speed occasionally barefoot with baskets strapped to their heads, and puffing on a cigarette. It wasn’t a surprise why musculoskeletal problems were a common problem in the clinic, especially knee pain. I went on to teach the health workers basic physio exercises to try out and teach their patients. They really appreciated it, and the patients also seemed to show some interest. But asking them to rest was not a realistic option, as resting meant no money for that day, and hence maybe no food.
Teaching
We covered a lot of topics in the week I was there, including discussing consultation skills, and taking a good history to rule out serious illness. We reviewed all examination techniques and the importance of follow up advice. It was incredible to see the improvements achieved over the week, and very rewarding to teach such keen health care workers.
The health post built with the help of an NGO
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Another GP was sent out the following month and sure the team there will benefit even more. Taking into account the health workers 29 months of training to be Auxillary nurse midwives plus a couple of years in the field, they do a great and very necessary job of providing primary care to an in need population.
Me, Anne (retired UK GP) and Rita and Namratha (two health supervisors) set off to Soti the jumping off point before our respective hikes to different villages. It was an overnight and 2 bus rides to Soti- the dust was phenomenal- a rusty brown coated all areas exposed to the air. Me and Ann cramped up on the hard seats- being prepared Ann had a cushion to gentle the pain. As I ponder about what I have done since comp
The first Dhal Bhat
leting my GP training- a handful of locums, travel and now this I wondered how I can pass my appraisal. Luckily Ann is an appraiser and shared pearls of wisdom and comforting words that made me feel confident that with my experiences I could prove to the powers that I remain a competent GP. I hope!
It was impressive already Soti and we w
Very friendly and humble lady who helped carry our bags
ere only just about to start our walk. Crossing of the first classic hanging bridge and oncoming weary mule train was within minutes of the start point. Milky blue glacial waters roared through the valley with long drop waterfalls already in sight. The health supervisors were amazing- they organised our every step from food and accommodation and hustling for us to pay non-tourist prices. They were great company and offered me an introduction to the Nepali culture of never ending hospitality.
The trip was the start of never ending combinations of rice, dhal, spinach and potato with the odd roti and egg treat provided. I managed well with the diet and to be honest my gastritis improved no end with the nourishing food.
The first hike was 5 hours across the valley- Rita tells me that they counted 108 waterfalls at one time. Mule trains, and people carrying incredible loads over strapped around their heads were a plenty. The backdrops of dusky to radiant green terraces contrasted out, and the intermittent brief smell of musty mule urine encroached on the fresh mountain air. I still feel very slightly embarrassed by my expensive walking boots while the locals manage in wrecked flip flops. But I definitely recognise my inferior walking skills as children hop and skip up and down rocky slopes and I watch every step.
The climb a thousand or so metres up on the second day was eased out as we had a local woman help carry our bags- she was incredible. We 3 ambled up the mountain via the dry muddy terraces, bullock carts, and hard working farmers of all ages scattered along the valley side. As we tipped over the brow lush green wheat terraces emerged and a sprawling village of Keraunja where I was due to be for the next week.
2 days after arriving in Kathmandu Dr Gerda (PHASE medical coordinator and one founder of PHASE), in her ever busy schedule, calmly arranges plans for me and Anne ( a retired GP) and my partner Maria (Development Intern with PHASE) over the coming few weeks. Dr Gerda herself is an inspiration- selflessly dedicating over a decade of her life to rural Nepal and its people and helping to create and develop PHASE. She does this all now while working a full time job in CIWEC clinic in Kathmandu- to me a person who seems to fit 36 hours of work into a 24 hour day. I look forward to the day I find these hiding hours.
A flurry of shopping ensued in the Thamel to haggle hard for the best and cheapest of the openly counterfeit North Face goods on offer. With images of a recent real life horror video of the stripping of goose feathers me and Maria proceeded to buy a few geese worth of jackets and sleeping bags to ensure our comfort from the could mountain air and the backpack straps. Now I just need to keep the bits of rogue down out of my beard.
I am a newly qualified UK trained GP and among other things I love the mountains and I love the concept of health and wellbeing for all. Hence I was accepted as a volunteer with an incredible organisation called PHASE which is working to provide such help to poor remote Himalayan communities. Just because they were born in this far flung environment in an economically deprived country they are the victims of the unequal distribution of healthcare, education and opportunities to earn an income.
PHASE
PHASE ( Practical Help Achieving Self Empowerment) has been running approximately 9 years. It is well respected through its achievements of bringing health and wellbeing to so many.
‘It specializes in improving health, education services and livelihood opportunities for disadvantaged populations in very remote and resource poor Himalayan mountain villages in Nepal. PHASE aims to support the most vulnerable people to break the cycle of poverty; by assisting communities and local authorities to lay the groundwork for a self-sufficient future.’
PHASE has demonstrated success – Between 2006 – 2013 we treated over 230,000 patients in 13 health centres for an average cost of £2 per person. At least one child’s life is saved every month. 294 women completed our literacy classes and we have trained 306 teachers. We have provided 647 farmers with agricultural and livestock training.
Volunteer GP’s, often from the UK, regularly take time off to hike out to the villages to help in teaching the health workers who have little formal training in primary care itself. The government assistant health workers themselves have only 15 months training before sent out to these remote areas to do the job I would do as a UK GP (10 years of training), however in a very difficult environment with limited medicines, no lab, and a hospital a rough few days away by foot and road. With this in mind, the health workers do an impressive job with care and dedication. Because of this the communities often see them as treasured members. The role of the GP here is also to provide some moral support to the very dedicated young staff that work and live in a community often very far from their own home and comforts.
I am currently set out to visit a total of 5 health posts. I have been to 2 in the beautiful Ghorka area and will set out tomorrow to go to the far west Bajura to visit 3 more. Ghorka was quite developed for the rush of tourists that come through a few months a year where as the rural west has little development and very poor health indicators.
Travelling with General Practice 