Deborah Mayne shares her elective experiences in the Himalayas

It was going to be such an original elective--to Nepal--until I discovered that at least five other students in my year had had the same idea. However, not to be deterred, I decided that Kathmandu was not my image of Nepalese culture and so I opted for the wilds of the Himalayas.

I spent the first three weeks trekking, definitely the best way to start an elective especially as finals were only just finished. The "walk" from Jiri to Everest Base Camp is spectacular, and watching the sun set over the highest mountain in the world has to be one of the most beautiful sights to be seen (even if it was -10⁰C).

While trekking, I carried out a research project aiming to find out if there is a genetic susceptibility to acute mountain sickness. After my initial reservations about approaching people and asking for their blood, I managed to get 93 people in the study and became known as "the vampire of the Khumbu."

Kunde Hospital
I then spent the next few weeks working in Kunde Hospital near Namche Bazaar at 3545 metres above sea level. It was built in 1966 by the Himalayan Trust (set up by Sir Edmund Hillary), and is run by one Western doctor and four Nepalese staff. The hospital has 15 beds and provides medical care to 10 000 people in the local area who may walk for three or more days to reach it.

There are clinics from 9 am until 5 pm six days a week, and 24 hour emergency help if needed. Basic investigations can be done, such as haemoglobin, white cell count, glucose, dipsticks, and basic x ray examinations. They also carry out minor surgery and can undertake caesarean sections

The main drawback of the hospital is that there are no funds available to evacuate patients who are seriously ill. This can be very frustrating especially as there are daily helicopter evacuations from Pheriche carrying trekkers who may not be as ill as the locals.

I lived in a nearby lodge which was basic--no running water, toilet at the end of the field, and so cold at night that I often ate dinner wearing hat and gloves. However, the view down the valley was spectacular with Ama Dablam in the distance just asking to be climbed.

Joining the Gurkhas
After five weeks of living in the mountains, I flew back to Kathmandu from Lukla. This was quite an experience--you wait on a concrete platform until your 16 seater plane arrives, run to the door so you don't lose your seat, and then close your eyes as you take off along an incredibly short runway past wrecks of the planes that did not make it.

I then travelled across Nepal to Butwal in the Terai region and joined an area welfare centre for the Gurkha army. Life was very different here, not only was it warmer, but the place had a definite army discipline to it and was quite formal. Tea was brought to my room at 6 am and there were two meals a day at 11 am and 7 pm. It was always dal bhat (lentils) with the addition of meat for dinner. Luckily, it tasted nice and after eating mostly potatoes in the mountains it was quite a luxury.

I was there during pension payment week when 1400 retired Gurkhas visited the centre to collect their pensions and seek medical advice if they needed to. I worked alongside the medical assistant and personally saw about 30 patients each day. They expected me to be able to question, examine, and treat patients independently, so I was taught some essential Nepalese in two days. The medical cards were written in English which made things a lot easier and most of the complaints were of gastritis, arthritis, hypertension, and chronic obstructive pulmonary disease.

We also spent four days in the hills to the west of Butwal where we set up a clinic in a room where we also slept. Meals were cooked on a clay fire (still dal bhat), and water came from a hand pump in the backyard.

Overall value
The whole elective was a great experience and although I went by myself, I hardly spent any time alone. Nepal has a great deal to offer outside the Kathmandu Valley and there are numerous places to go to for an elective.

I will definitely return in the future and would consider working at Kunde Hospital or at the Himalayan Rescue Post in Pheriche (unfortunately, you are not allowed to do an elective there). There are many mountains to climb and vast areas to explore which are off the beaten track.

For further information on Nepal see Peter Chamberlain's elective report in the August
issue (studentBMJ 2001;9:288-9 August.) www.studentbmj.com/back_issues/0801/life/288.html