Lessons from Global Health

By Richard Backman, MD

Nepal

I had the opportunity and pleasure to take Physician Assistants and Medical students to Kathmandu, Nepal for an International Health elective in April 2017. Let me preface this with I don’t speak Nepalese, I am not Nepalese and I am not an expert on Global Healthcare. We spent time in a local city hospital still under construction with rebar sticking out of its roof, corrugated tin as roofing, and  lacking the luxuries and equipment we find necessary to provide an excellent patient care experience in our own country.

There is no national healthcare in Nepal and the patients must pay approximately $5 US ($500 Nepalese Rupees) to see a doctor for a 5 minute consultation. Tests may be ordered from the visit with the doctor that can be up to 6 times the cost of the doctor visit. This is in a country where the average Nepalese makes $2400 US ($240000 Nepalese Rupees) per year with one quarter of the population living below the poverty level.

The people we saw were gracious, kind, stoic, and resourceful, this includes patients, their families, and care providers. The providers are time pressed to see and treat an enormous amount of patients in a short amount of time. Nepal has a tremendous health care provider shortage, exacerbated by the majority of doctors staying in the Kathmandu Valley for economic and lifestyle reasons. Our students are able to see patients with advance stages of illness not usually encountered in the US. They also witness how a resource limited area addresses health and health disparities. Global health as defined by Koplan states “the ‘global’ in global health refers to the scope of problems, not their location, thus…. Global health can focus on domestic health disparities as well as cross-border issues.”

The Nepalese New Year started on April 14, 2017 and the Nepal government launched a one-year health campaign with the following five goals:

  • Quit smoking, consuming alcohol, and using drugs
  • Exercise regularly
  • Maintain hygiene and take nutritious diet
  • Undergo regular health check-up
  • Be aware of family and community’s health

These goals not only address the health issues facing the people of Nepal, but can be translated to the United States and other developed countries. Our students observed the Nepalese people of Kathmandu and the rural areas exercising regularly, not by performing moderate or strenuous exercise, but the simple act of walking 10000 steps or more a day. It was inspiring to see throngs of people walking around the base of Soyambunath temple and then climb the stairs of the temple. They saw people running, performing cardio workouts, martial arts, and the Nepalese version of cross fit (women carrying loads up to a hundred pounds using a forehead strap and basket on their back). They also observed monks, nuns, and lay people chanting, walking and performing seated meditation on a daily basis. Like our country, many people are trying to quit their consumption of alcohol, drugs, and tobacco, some more successful then others. In the area of family and community health, we could learn from the Nepalese the value of spending more time with our aging population, ensuring they have companionship, food, and assistance with their activities of daily living. There are no nursing homes in Nepal and people still practice extended families living together. In regards to community health Nepal is still recovering from the Earthquake of April 22, 2015, rebuilding roads, temples, and homes. They are faced with extreme overcrowding in Kathmandu, lack of proper sanitation (latrines, water treatment, and waste disposal), infrastructure (roads and electricity), and air quality (smog, dust pollution, open fire cooking). They are challenged with the lack of financial resources to improve these issues quickly. Even with these challenges, the Nepalese people have a positive outlook in their daily life and for the future. All of these “gifts” were important lessons for our students to learn from their 1 month global health rotation.

Richard Backman, MD is an Assistant Professor (Clinical) in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

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