By Jason Peck, 2nd Year Paramedical Science Student
We were led down a dark, somewhat cramped corridor: daylight poured in from the doorways of adjoining rooms, illuminating the damp floor and the stained, peeling plaster on the walls. A line of wooden benches and rusted beds were placed to one side, up against a ply board partition that separated the corridor from the ‘Emergency room’. From underneath mosquito nets draped over the beds, quiet faces watched us; a mother lying together with her child shuffled and blocked out our intrusion. Each room we visited- surgery, obstetric (childbirth), laboratory, a ward- had a recurring theme: they were rudimentary, worn and mostly dilapidated. Our tour complete, we emerged back into the heat and humidity outside, grimly aware of what ‘normality’ meant here. Noticing our expressions, one of the nurses questioned me with a sense of perplexity; “Jason…are hospitals in Australia different somehow..?”
My colleagues and I- a group of Australian paramedics and student paramedics- were witnessing first-hand the reality of healthcare in the remote district of Okhaldhunga, in the east of Nepal. The terrain of Okhaldhunga is characterised by rugged, mountainous landscapes that are both sweeping and dramatically beautiful. Small towns and farmsteads can be found scattered along the extensively terraced slopes, which are used for subsistence farming. The region is accessible by unsealed and winding mountain roads, but for those living on the slopes themselves, walking up and down mountains on narrow, precarious paths is a daily reality. This can make accessing healthcare very difficult, especially for those who are sick or disabled. Numerous times we witnessed people being carried on stretchers up and down treacherous mountain tracks. People rely on their friends and relatives to get to medical aid; those without people to carry them simply do not reach healthcare at all. According to the district’s main hospital, only 10% of people who require healthcare are actually able to reach it.
But arguably the greatest challenge that affects Nepali health services, and those who need it, is poverty. Nepal is one of the poorest nations in the world, with around a quarter of its population living in poverty. Rural poverty is a major issue, with the rate reaching nearly 50% in some areas. Many people cannot afford to pay for their treatment, and with limited free medical services, complex and chronic medical issues are often poorly managed or ignored.
Moreover, Nepal’s healthcare services are systemically afflicted by their low funding. The health system utilises only a small fraction of the money that would typically be available in a similarly sized developed nation. Subsequently, there are problems with the resourcing, the quality, and the delivery of healthcare services.
At the core of Backpacker Medics is the principle of working in parallel to the existing medical system, as paramedicine does with medicine. Anecdotally, we found that Nepali health system in Okhaldhunga was largely reactive to illness and injury, and sometimes only addressed the symptoms present rather than the underlying issue. However, a significant proportion of the health complaints we received at our clinic were preventable. We often found ourselves taking on the role of preventative health education, taking our time to explain illnesses to patients. In addition to this, we ran education sessions aimed at engaging the community in healthcare and teaching them proper hygiene practices.
We can’t fix the healthcare system in Nepal, or even in Okhaldhunga district. But working alongside it, we can help to improve it- and the outcomes for the Nepali people.