Links for Medical Work Overseas

 

Phase clinic

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.

Rugin, Bajura, West Nepal in pictures.

Beautiful views enroute to Rugin

On the way to Rugin with Kishwor- some traditional houses

iNGO 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. 

Living and Mentoring healthcare workers in Dhim, Bajura, West Nepal (pre earthquake)

View through the villiage

The 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 littered

Kalpana-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 Clinic

Examination 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.

With a community member

Flying to the far West Nepal

Swayambounath- enjoying some time in Kathmandu

Journey to Nepalgunj

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 Kolti

View 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 view

En Route to Dhim along the valley from Kolti

Mentoring in Sirdibas, Gorkha, Rural Nepal

Walk to Sidibas through the gorka valley

The last steps upto the healthworkers house past the pagoda.

The trek from Keraunja to Sirdibas

the long bridges over the valley

Breakfast 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 day

Teaching 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 Gorkha

Chekumpar- 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.

Send off- thank you Sirdibas!