Practicing Medicine in Nepal: Before, After, and During the Earthquake

To say the Himalayan mountain villages that University of Utah students visited during an international rotation to Nepal last April are remote is, perhaps, an understatement. To get to their basecamp, a place called Ghandruk, required an hour-and-a-half drive followed by more than six hours of hiking. From there they visited two additional villages — one took an hour by foot to get to, the other took six. The treks were made more difficult by large backpacks full of medical supplies that they carried with them.

The remoteness of the Annapurna region, where these villages are found, means medical care is difficult to come by. When health care providers do come onsite, those who can’t afford medicine often won’t go in for treatment. (The Nepalese government provides certain medicines at no cost, but not all.)

The Utah group was able to provide free medical camps in the villages — the six participating students had held fundraisers to purchase supplies and medicine prior to the trip — and people came from several hours away for care. Even still, “every patient that we saw was unfailingly polite and never seemed to get frustrated,” said student Dylan Taylor. “The character and positive attitude of those people was remarkable.”

Alongside Nepalese doctors and health assistants (HAs) — the analogue to PAs — and with the help of interpreters, the Utah students treated everything from arthritis and joint pain to common colds and diabetes.

“It was challenging to have limited resources while seeing patients, but it made me remember the basic fundamental skills I have been taught in school,” said student Karli Sibley.

The group from Utah amidst the Himalaya Mountains. (Credit: Nick Pedersen)

The group from Utah amidst the Himalaya Mountains. (Credit: Nick Pedersen)

Scott Brown, PA-C, a recent Utah alum, organized the rural portion of the Nepal trip. You could hardly ask for a more qualified person — he’d been to the country some 63 times as part of an outdoor leadership nonprofit that he runs.

“One of the things that got me to go to PA school was the work I was doing in Nepal — seeing elderly people and infants dying of bacterial diarrhea, which is very treatable, but they just didn’t have access to health care,” said Brown.

The group also held community health education classes for women (the Nepalese culture is matriarchal) about topics that included hygiene in the kitchen and the importance of hand washing.

Bookending their work in the Himalayas was time spent in Kathmandu, the country’s capital, where they treated patients at Manmohan Memorial Teaching Hospital.

“I was blown away at the skills and knowledge of all the providers we worked with,” Sibley said. “They truly are all remarkable physicians and health assistants with as many skills as their U.S. counterparts.”

The trip ended with a joint medical conference called the “1st International Seminar on Health Assistant and Physician Assistant Collaboration,” organized by Utah faculty members Kathy Pedersen, MPAS, PA-C, and Don Pedersen, PhD, PA-C. In addition to the Utah group, regulatory agencies, doctors, and HAs attended.

“We talked about the differences and similarities between PAs and HAs — one of the primary differences was clinical problem solving,” said Brown. “And how we could help to add curriculum to their program.”

Don noted another difference between the two models. “The U.S. team concept doesn’t really exist in Nepal. The HAs are trained right out of tenth grade then sent out to the health posts. They have no previous experience,” he said. “They really want to update to a U.S. PA model for their HAs.”

The Earthquake

Buildings largely destroyed and piles of bricks on the ground

Upon returning to Nepal, Don found “heartbreaking” damage. (Credit: Ted Wendel, PhD, from A.T. Still University)

When the earthquake hit at 11:56 local time on April 25, the Utah students should have already been in the air on the plane home, but their flight had been delayed by 30 minutes.

“Growing up in Utah, I was constantly drilled in elementary school about what to do in case of an earthquake,” Sibley said. “Nothing can prepare you for the real thing.”

Everyone ran out of the airport — Sibley said it felt like running on a waterbed. The airport was one of the safest places the students could have been. It’s a solid, one-story building, and damage was little more than a few ceiling tiles falling down. The students were safe, and five hours later, their flight left.

Scott Brown’s flight was scheduled for late that evening. When the earthquake started, he was in Kathmandu standing outside his guesthouse, talking to a friend. Surrounded by tall buildings, it was as if “bricks were falling from the sky,” and Brown and his friend ran to an open area. Once the earthquake stopped, he ran back to his room and grabbed his ID, stethoscope, and a T-shirt with medical symbols on it so that he could be identified as a health care provider. He went to the nearest building that was destroyed — search and rescue providers were already on the scene. They spent the rest of the day going from building to building. A young Nepalese man “came out of nowhere” and followed Brown around, acting as his interpreter.

As the day went on, Brown knew he had a decision to make. Get on his scheduled flight, which hadn’t been cancelled, or stay and continue to help with rescue efforts. Knowing he was supposed to meet up with the Utah student group during their layover in China, Brown enlisted the help of a friend with a motor scooter to get him to the airport.

To Brown’s knowledge, the people that the Utah group met during their four weeks in Nepal are safe. The remote villages they visited are largely intact.

Returning to Nepal

Don Pedersen with patient. Rubble in the background

Don treats a patient in a makeshift clinic with rubble from the earthquake in the background. (Credit: Ted Wendel, PhD, from A.T. Still University)

Kathy and Don Pedersen had boarded their homeward flight before the earthquake. Soon after, they were contacted by a friend about the possibility of returning to Nepal with Project Hope. Kathy had previous commitments, but Don decided to join the group, which would return to Manmohan Memorial Teaching Hospital.

What I liked about Project Hope was that they’re in it for the short term, but they’re also in it for the long term,” Don said. “We spent a lot of time working on what this particular hospital might need in the future.”

When they arrived at the hospital two weeks after the first earthquake, there were still some 60 patients being treated for injuries related to the event.

“By then all the acute problems had been dealt with. People had had their surgeries or were in line to have surgery. So the nurses on the floors were doing a lot of wound care,” Don said.

After the second quake on May 12, 30 more patients arrived, and Don assisted in the emergency room.

Toward the end of his time in Nepal, Don decided to visit the community that lives near remote Swayambhunath, also known as Monkey Temple. The temple was destroyed; the area was devastated. Don’s initial plan was to help however he could — possibly even just moving bricks — but local organizers, upon learning he was a medical provider, set up a makeshift clinic under a tent for him to see patients. Don encountered primary care issues, primarily, along with contusions and lacerations related to the second earthquake.

“They were not neglected, but it would have been a long trek for them to get health care,” he said.

After two weeks of volunteering with Project Hope, Don returned home. He, Kathy, and Brown are still planning to offer the Nepal rotation again — now there’s an even greater need.