Stephanie Carpio - Nurse in Nepal
I was born in El Salvador and moved to the United States in 2000 and have been there since. I’ve always wanted to go back to my country and explore new ones. Projects Abroad was a gateway for meaningful exploration. I was also looking for a break from all the stress of a Medical-Surgical nurse. Before my trip, I had my nursing degree for two years and had been at my place of employment for three years. A change of scenery was what I needed from the burn out I was starting to experience. I was looking at going to Vietnam or Nepal. I ended up choosing Nepal because of the Himalayas, the recent earthquake in 2015 and from conversations with my charge nurse who is Nepali. In August 2016 I ventured out to my first cross-ocean flight.
My arrival in Nepal
I was exhausted from my almost 24-hour plane ride. I was scared and anxious when they were checking my passport in Boston. I was leaving the United States as a Salvadorian national so I was a little worried about being let back into the U.S and attaining a Nepali Visa once I got to the country.
The contrast of the Nepali international airport in comparison to the Boston airport was my first culture shock. Arriving in Kathmandu was pleasant as the air was cool. I got a visa at the airport which cost US$25 and went past immigration fairly quickly as there was no line. I did arrive at night time so I was wondering who was going to pick me up at the airport. I passed the Nepali taxi drivers waiting right at the door and started looking for a Projects Abroad sign. The person that picked me up greeted me, said my name and handed me a letter from the local Projects Abroad staff.
Due to monsoon season and the recent landslides I did not travel from Kathmandu to Bharatpur by bus but rather by plane.
My host family
I was so excited to meet my host family. My ah-ma was out shopping so I was greeting by my ‘little brothers’ (bhai) and their cousins. Their dad works in Saudi Arabia so I never met him. On arrival I was given a white scarf and red powder on my forehead (tika) and welcomed as part of the family. My living accommodation was excellent. I had my own room, running water, electricity that came on at certain times of the day, a pretty view from the second floor, a beautiful garden my Nepali family kept, and delicious meals made by my ah-ma. Nepalese eat Dhal Bhat twice a day every day. It’s basically rice and lentils. My ah-ma always made it with different spice combinations and added some type of grains or vegetables so it tasted different and was always delicious. What I enjoyed the most was the amount of family time we all spent together and the routine of the day. Arrive at 5pm, do homework, rest, talk over dinner, talk some more after dinner, watch TV together and then bed. I truly felt like my ah-ma Susan cared for my safety and comfort. I told my ah-ma that I might arrive after dark one night that I was working in the Emergency Department (ED), so she called me to make sure I knew what to say to the tuk tuk driver so he would drop me off closer to the house because there are no street lights and you really can’t see anything.
My medical placement
On my first day at work, I was picked up at my house on a motor bike. The rest of the time I took a 0.15 or 0.30 cent tuk tuk ride. In Nepal, only the driver has to wear a helmet on a motor bike and only the driver of a bus wears a seatbelt as the local buses are packed so densely that the frame of the bus almost touches the road. I mention this because most of the patients I saw at the hospital travelled for around four hours with severe sepsis, low/high blood sugars, or respiratory illness in those cramped buses. I was instantly humbled at the United States facilities that are available within a close radius to where you live. When a family member goes to the hospital the whole family goes, eats and sleeps at Chitwan Medical College (CMC). There was always a family member at the bedside. I came to see the importance of the family unit and collective society because if the patient needed supplies for a procedure to be done, was hungry or needed medication, it was the family member’s responsibility to get what was needed. This opened my eyes to a new method of nursing because most of the care I would usually do in the US was all done by the family. The health system in Nepal is a pay out of pocket system. Pharmacies with no pharmacists are abundant in Bharatpur, you just bring your prescription and they give you what you need.
There was great flexibility as to the units I wanted to go to - with exception of ICU which you had to have permission to go to. My main staff contact would introduce me to the charge nurse in each unit I went to. He and the rest of the Chitwan Projects Abroad staff were always available to help me achieve my learning goals while volunteering at CMC. My day started at 8am and would end at 2pm or 3pm in the afternoon. I could leave at 12 if I wanted and return the next day or just come back for an afternoon shift. Once in the ED, I came in at 5pm introduced myself, got to work and stayed till 8pm. I enjoyed the ED the most.
Under the supervision and aid of the nurses there, I was able to do a lot of hands-on work. In the medical ward I taught a lot of the nursing students, performed patient assessments, helped the doctors in procedures, did vitals and learned Nepali from the staff and patients. We all got a good laugh from me trying to learn the language since I looked Nepali, but could not speak it.
You also really have to have the initiative to participate in direct patient care. Once I told the nurses I can place IV’s, they started offering if I wanted to do it as well as take patients’ blood for testing. The residents would ask how doctors would do things in the US and the nursing students would ask what the nurses did as well. The staff in general was always welcoming and encouraged my participation in patient care, procedures and examinations.
Having two years nursing experience meant I had a bit of background to not only compare the two healthcare systems but appreciate the limitations of both. The staff at CMC do what they can with what they have. Chronic Kidney Disease with End Stage Renal disease is very common; the doctors know the cause but there are limiting resources for any prevention methods. Looking back at my experience at CMC, I will forever remember the flexibility, ingenuity kindness and thirst for knowledge of the medical students and staff at CMC.
Travelling around Nepal
I was only in Nepal for two weeks so I really only had one weekend to take a long trip to another city. That however did not stop me nearby cities around Bharatpur. Narayangarh had a great outdoor shopping street. There was also the powerful Narayani River where I enjoyed an ice cream from the shore vendors. Trying to find the Bharatpur stupa, I stumbled onto a cricket game being played by a group of boys. It was fun because the US is not a big cricket playing country so I had never seen the game in action. I also stumbled across a local soccer tournament with a vociferous audience, different housing structures, kids getting out of school, random cows, goats and chickens and the crazy street traffic.
I highly suggest walking around your own city and exploring to truly emerge yourself in the culture and general vibe of the country. I never felt lost, in danger or threatened by anyone. I also had my SIM card to call the Projects Abroad staff to ask for directions. The other volunteers were also a great resource as to where to go exploring.
I was so blessed to travel to Pokhara’s (very touristy) Lake Side area where I got to see water buffalo, Peace Pagoda, trek through a jungle, and walk all over the city with my new friend from Scotland.
My overall experience
My trip to Nepal changed my nursing practice; I am more aware of how many supplies I and my co-workers use and the experience has given me a newfound energy to enhance my skills and bring them to other parts of the world.