South Asian experience.

Abstract

I was recently awarded a Princess Mary’s Royal Air Force Nursing Service (PMRAFNS) travel scholarship. I volunteered to work in one of Nepal’s government hospitals. Many of the practices and routines I experienced made me reflect on the nursing service in the UK. In October 2013, I worked for two weeks in the emergency department (ED) of the Western Regional Hospital in Gandaki Pokhara and a further week in a remote mountainous health post. The government-administered hospital was hugely under-resourced. There is no GP service in the country so patients arrive at the overcrowded doctor’s desk, describe their symptoms and the doctor writes a prescription without examining them. The patients pay for their requirements, including dressings and equipment, at the pharmacy. They then find empty beds and wait for the doctor or nurse. They rarely receive a definite diagnosis – doctors list all the possible diagnoses and treatments account for all possibilities. While I was there, the same five nurses were on duty in the ED, day after day. They had a broad range of skills and consistently achieved high standards of care and organisation in difficult conditions. For example, a pregnant woman arrived one day and dropped to the floor. The nurses reacted very efficiently and delivered her baby with no problems. There were no nursing records or observation charts. Doctors would write a diagnosis on a piece of paper with the treatment plan and prescribed drugs, and nurses would tick off when treatment had been administered.