A fascinating write up of life at a remote healthpost in Nepal

Visit to Deusa Healthpost, Solukhumbu (March 2009) 

Trekkers overlooking view from Gokyo Rei over Ngozumpa Glacier & Cholatse Range, Everest Region, Nepal

My name is Alina, and I am a medical student from the UK.  In February, with my boyfriend Euan, a nurse in A&E, we walked to the village of Deusa in the Everest region of Nepal.  We were away for just over 6 weeks. Having walked for 4 days from the nearest road, 4 incredible but very long days of going up mountains, then down to rivers, then up and down again, the village we stayed in was extremely remote.  Although most homes have a radio and a few have one light at night powered by a solar battery, there is practically no infrastructure as we know it, and life is very different to back home.  It was an amazing experience, both culturally and medically. We went to this village, Deusa, to help out at the health post.  There is already a midwife there, whose wages are paid for by a doctor in the UK.  As we found out, Deusa is very lucky to have a nurse that is qualified and actually turns up each day.  She works there 6 days a week, and is the nearest port of call for 6000 people.  The nearest hospital is a 6 hour walk away.

THE LODGE
The family we stayed with were lovely, cooked great food, and kept their house really clean.  Our daily routine fitted into theirs.  We had tea when we woke at around 6am, breakfast at 9.30am, then we went to work at the health post from 10am till at least 2pm, and then an evening meal at 8pm.  Meals are essentially referred to as ‘khana’, or food, as they are usually always rice and vegetables.  Dal Bhat is the epitome of Nepali cuisine; rice, curry, dal, and a little pickle.  The ones in Deusa are the best I’ve eaten, and I’ve eaten a fair few!!

The toilet was at the end of the garden, and the shower was a bucket outside, where we also washed our clothes and cleaned teeth amongst the chickens.  There is no electricity in the lodge apart from a solar powered light in the evenings, so a torch is a must.  There is also no running water so the family have to fill numerous buckets from the nearest water tap and carry it back.  We were therefore extremely conscious of how much we used.  However, they are very hospitable, and we had all we needed. The only thing I would suggest if you are going there is bring a book and pack of cards, as the evenings can get very quiet!!

THE HEALTH POST
The health post was an amazing experience.  We had up to 30 patients one day…perhaps to see the spectacle of two foreigners!  Dev Kumari, the nurse is young and like many Nepali women, extremely shy, but she is also very bright and competent so we shared the work between the three of us, asking eachother what we thought…  (I have come to love ‘Where there is no doctor’, it saved us a lot.)  Her English is better than she lets on, and will understand most things with patience!

It seemed the norm to have all the patients sauntering in to the consultation room, so there were sometimes up to 15 people milling about, gossiping, having a look at the rash, or sore, regardless of where it was on the body.  Euan and I tried to get people waiting outside in order to see one patient at a time.  We’d then see and try to treat the patients. Dev Kumari would translate from Rai, the local language, to Nepali, to English.  Having only been there for a few weeks, and not speaking Rai or Nepali, there is only so much you can understand about the culture and beliefs of the people.  However, through Dev Kumari, and lots of sign language and basic words from phrasebooks, the work is extremely rewarding and the experience definitely a positive one.

We saw a lot of diarrhoea, coughs, eye problems, wounds, epigastric pain and general aches and pains, and lots of babies with fevers.  Although we tried to be thorough, looked at books to make sure we didn’t miss anything, and checked with each other a lot, playing doctor was still pretty scary.  Whenever we weren’t sure, we suggested going to Phaplu, to the nearest hospital.  But even this brought up problems…being six hours away, and with lives taken up with the present day…farming and cooking, would people really go?  And yet after a while, it got easier.  One woman returned after a week with oranges for us.  I didn’t recognise her.  A week before she had the most terrible sounding chest, and could hardly breathe.  A week later, having been given an inhaler, she was transformed.

Despite initial appearances of darkness (again take a torch) and dirt, the store room is surprisingly well stocked, but I don’t think Dev Kumari knows or feels comfortable using some of drugs.  There is plenty of Paracetamol, and we have ordered some Ibuprofen and Diclofenac.  There are also a range of antibiotics, and Euan wrote out a protocol for when to use which ones…this should be stuck on Dev Kumari’s desk.  There are condoms, the pill, depo injections for family planning.  The ‘examination’ room also has a well stocked cupboard with dressings, antiseptics, as well as books including some OHCM, OHCS, and ‘Where There Is No Doctor’ in English and Nepali.

THE SCHOOL
Whilst we were there, the students at the school were busy revising for exams, but Euan and I did go for the afternoon to run a first aid session. We kept it simple and focused on general hygiene and  keeping teeth, hands and wounds clean etc.  We did demonstrations and updated their first aid kit.  This was a worthwhile visit and I would definitely recommend doing something similar.  The children are very sheltered in Deusa and feed off outsiders with enthusiasm.

EVEREST
After a few weeks, we set off for Everest base camp.  We had a two day walk to find the main trail.  That two day walk was interesting….the paths would peter out in front of us, or open out to four paths, and we would have to find someone to ask in our very limited Nepali.  Having been guided the wrong way by an old man we met on the way, we stayed with a family on our first night.  But we found the path the next day and were revelling in the lodges that had menus!, the hot water, and the general comfort that we missed.

The trek to Everest Base Camp was brilliant.  Although extremely cold and barren, it was really beautiful, and the crispy mornings with peaks of mountains over 7000m surrounding you were spectacular.  We met up with an Irish couple whom we went up to base camp with, and luckily none of us suffered too much from the altitude.  We did all feel it though!  Walking got progressively harder and slower.  I felt my heart pounding in my sleep, and sometimes just couldn’t get enough breath.

So, summed up by outside showers, or no showers at all, rice, rice rice, Euan and I going a little mad, resorting to ridiculous games to occupy the quiet evenings, but incredible scenery, a beautiful village with a fascinating culture that we only saw and understood a tiny part of, Deusa has taught me a lot, about culture, health, illness, and life in Nepal, but also to appreciate how lucky we are at home.

We started a visitor’s book in Deusa with similar notes, suggestions and impressions, which we left with Purna’s family at the lodge.

Alina and Euan

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