Global Health Care

Giving New Meaning to Rural Health Care

By Jennifer Coombs, PhD, MPAS, PA-CJune 18, 2019

Photo credit: Jennifer Coombs

The Utah PA program recently completed its 6th Annual International Elective to rural Nepal.

“You are never fully prepared to hike in the Annapurna region of Nepal.”

Those were the words of the University of Utah PA program’s (UPAP’s) medical director and Pokhara site coordinator Richard Backman, MD, as he prepared our group, comprised primarily of University of Utah PA students, for our Nepal International Elective. We had been meeting for pre-trip planning at his home in the mountains of Emigration Canyon outside Salt Lake City, hiking with snowshoes on the steep slopes during the middle of winter in an effort to get in shape for our upcoming adventure. Pre-trip advice included this inauspicious email: “Fitness: Start hiking now – plan on doing at least one hour of aerobics 3–4 times per week for one month or more before your arrival in Nepal. Speed is not the goal; stamina, confidence, and continuity are. Rather than gradually ascending trails, most Himalayan trails point almost directly up, close to a 90-degree angle, requiring a lot more effort — and especially when descending, a lot more concentration.”

UPAP completed its 6th Annual International Elective to Nepal on the day of the anniversary of the 2015 earthquake. Students and faculty had just made it through the trekking portion to the small town of Ghandruk to set up health camps with the Nepalese PA analogues, our friends from the many years of UPAP involvement in this region. We brought medicine and medical supplies and, alongside Nepalese health assistants and translators, saw a large variety of medical conditions. We also hiked from Ghandruk back down to Kimchee, a rural community within the Annapurna region, and at every location, our health camps were very well attended.

Author (second from left) with PA students Marc Fredrick and Jamie Plimpton and PA faculty Catherine Platt, MPAS, PA-C (far right). Credit: Marc Fredrick

During the following week, we hiked Poonhill, considered one of the easiest but longer treks in the region. This required us to get up at 4:00 a.m. and hike nearly 7.7 miles — more than 20,000 steps, according to the iPhone health data app. The final elevation was just slightly more than 10,000 feet. Unfortunately, it was raining that day, so there were no views of the nearby Himalayan peaks that tower more than 26,000 feet.

Faculty members Don Pedersen, PhD, PA-C, and Kathy Pedersen, MPAS, PA-C, founders of the International Elective, hosted the final lunch for the students and faculty at a restaurant in Kathmandu called Rum Doodle, a University of Utah tradition. In addition to founding the International Elective, the Pedersens have been on every one of the University of Utah PA program’s trips to Nepal. On this trip, they did the full trek through the Annapurna circuit with the PA students and faculty. At the final celebration of the successful completion of the health camps and the Poon Hill trek, Dr. Pedersen was asked to show us his arm tattoo of Swayambhunath Stupa (or Monkey Temple). The tattoo included the date of the 2015 Nepal earthquake (also known as the Gorkha earthquake) that killed nearly 9,000 people, injured almost 22,000, and rendered 3.5 million people homeless. It occurred on April 25, 2015, at 11:56 a.m. Nepal Standard Time.

Following the earthquake, Dr. Pedersen returned from the U.S. to Nepal with Project Hope to help care for the injured. Scott Brown, PA-C, an adjunct faculty member and alumnus of the Utah PA program, and a longtime volunteer in Nepal, was also in Kathmandu at the time and was involved in rescuing people trapped in the rubble. He was also on our recent trip to the region.

Although the hiking was difficult, and it was challenging to have limited health resources while treating patients, having Scott as the leader of the rural portion of the Nepal trip was essential to the success of the program. Also contributing to the successful expedition was the fact that the PA students this year received language instruction in Nepalese and were able to engage more politely with the warm and friendly people of Nepal. This added an additional layer of connection for the students, who said how much they had learned on the trip about work in remote regions outside the U.S. At the conclusion of our visit, all of the students and faculty expressed a tremendous “dhanyabad,” or thank you, to the Nepalese people.

Until the next time — namaste.

Jennifer Coombs
Jennifer Coombs, PhD, MPAS, PA-C

Jennifer is an associate professor at the University of Utah PA program. A frequent contributor to the Journal of Physician Assistant Education, she is also the Lessons Learned feature editor and a past recipient of PAEA's Research Achievement award.