Preparing For Your UniBreak Trip to Nepal

COUNTRY: Nepal
PROGRAM: UniBreak
PROJECT: Medical Placement (Radiotherapy & Paramedicine)
WRITTEN BY: Thanh Vu

My final blog post is about the little things (and not so little things!) to prepare for before you leave for your Nepali volunteering experience.

1) Go into volunteering in Nepal with a completely open mind.
Having no expectations ensures you embrace all opportunities.

2) Do some research beforehand.
During placement there will be free time at the weekends. All activities are flexible and you don't need to stick to the scheduled programs. Be proactive!

3) Beware of over-packing toiletries and clothes!
Changing between a few pairs is all you'll need. Honestly.

4) Finally, a packing list to ensure you are ready to go
~ Toilet paper!!!
~ Head torch, for those pesky power cuts
~ A rechargeable battery for your phone (just in case the power is out and you're on 1%...)
~ ATMs are often out of order outside major cities, so prepare beforehand how much money you will need for future expenses, spending money for trips etc. if you find a good ATM, stick to it, and remember, many have limits of how much money you can withdraw!
~ Winter in Chitwan has very cold mornings and nights, but is sunny and quite warm during the day. Bringing a warm thick jacket is very useful, plus a thinner jacket for later in the day.

But most importantly, remember:
~ A cheery disposition: your mood will affect all the other students you are with.
~ A teamwork orientated mindset: you will need to compromise to reach a mutual agreement.

Good luck, and enjoy your UniBreak adventures!

Reflections On My Time In Chitwan

COUNTRY: Nepal
PROGRAM: UniBreak
PROJECT: Medical Placement (Radiotherapy & Paramedicine)
WRITTEN BY: Thanh Vu

Reflecting on the experiences I have had during my placement in Chitwan, I believe I have developed in the following aspects of my life:

Personally
Coming into this trip, I had already made a few personal goals to achieve. In the 3 weeks here, I feel like I have met these goals, all the while becoming more self-aware of my own personal strengths and weaknesses. I have learnt that I do have the capacity to become more patient, and with this, learnt how to compromise with others, when to agree and when not to, and how to do this in an amiable manner.

Professionally
I have learnt how to better incorporate my personal lifestyle into the way I view myself with colleagues, in the workplace and with my superiors. To expand on this, I find that I am able to readily distinguish what type of appropriate behaviour to follow while still enjoying my time. Even when faced with topics that are closer to the controversial side of the spectrum, I have improved my ability to diffuse tension by showing more understanding and empathy on the subject matter, and to opinions of others.

Socially
Who runs the world? Sadly, it is not girls, as Beyoncé sings about in her song "Runs the world (Girls)". Rather it happens to be the dollar bills. Nepal is such a country that lacks vastly in wealth, and as such, it is no wonder that the people living here place certain things we normally don't in high priority. Living in a neighbourhood that faces these challenges, coupled with a culture where an individual's appearance is everything, was an immense challenge for myself and for many others on this trip. While we would have complaints about pimples, and knotty or greasy hair, they would have it about items of clothing, food, and of course the intense desire to become white. I think many of us have realised what little they have, and as cliché as it would be to say, we have learnt not to take anything for granted, that is entirely and of the utmost truth.

Emotionally
We have learnt to feel more compassion towards the Nepalese. They have the saying that they treat their guests as if they were gods, and this sentiment could not be more true. I, and so many others in the group, was taken aback on many occasions by the wonderful hospitality that these people have showed us. Although we had met only a few times, many of my colleagues invited me to their house for dinner and to meet with their family.

Spiritually
Having been very interested in different faiths and beliefs, I was so excited to learn more about what the major faith in Nepal was, and if there was any particular system that it followed. I have stayed with a traditional Hindu family for the past few weeks, and I have been able to learn so much about their traditions and the beliefs that lie behind them. There is just something extremely fascinating about understanding and being exposed to such a beautifully sacred practice that on normal occasions one would not get the chance to learn about first-hand.

Top 5 must do's of Chitwan in Nepal!

COUNTRY: Nepal
PROGRAM: UniBreak
PROJECT: Medical Placement (Radiotherapy & Paramedicine)
WRITTEN BY: Thanh Vu

1. Attend one of the many, many holiday celebrations in town.

Festivals are often celebrated with the family, where most of the members don't go to work. Quality time is spent eating, laughing or cooking traditional dishes for the occasion. Sometimes the festivals are held outdoors, where a vast assortment of shops and companies congregate to advertise their products and entice you with their treats. There are even some activities to get involved in like going for boat rides (if you can stand the long lines!) and taking pictures with historic cultural sites.

2. Go hiking to a rural village in the mountainside.

Chitwan is more commonly known for it’s National Park and wildlife, however many people aren’t aware of some of the intense but amazing trekking trails. One kind of hike that our group had just ventured through recently was a 2-day trek up some amazingly steep and beautifully green mountains and hills. The climb to the top where our very cosy cabin sat was more of a mental challenge than physical. While it was quite strenuous on the legs, many of us felt like the battle was all in our minds. My trick was to not look up at how much we had yet to climb, but rather, to look back at how much we had already climbed. After making it up through the first leg of the hike, most of us were flat out exhausted and a few were just a little on the more queasy side. But we pushed on and the final steps up to the top tasted very sweet.

3. Spend a weekend at the Royal National Park.

The iconic tourist destination of Chitwan is a big, big must. While our group has not gone on a trip through the jungle safari yet, we have plans to explore the National Park's exotic vegetation and wildlife. We are anticipating the visit to the elephant breeding centres, riding through quiet rivers on canoes to watch the small crocs sun-bake and delving into the deep forests in hopes of catching a glimpse of a rhino.

4. Dal bhat power 24 hour!

A good depiction of Nepali culture, this meal is eaten almost every day. Extremely large servings of rice are not unusual, as it seems like the amount of rice is directly proportional to ones ability to power on throughout the day. Their staple dish consists of rice and legumes such as lentils. When in any part of Nepal, one cannot go without the Dal bhat experience. That is, eating the rice, lentil soup, potato curry and sides of chutney and or pickles... using only your right hand! One feels like they are truly Nepalese once Dal bhut is eaten the way the locals do.

5. Stay with a host family.

Last but not least, something I would recommend to anyone wanting to explore the lifestyles and living in Nepal. It takes you away from the comfortable tourist seat and into the deep end of cold showers and to the front-line of frequent power cuts. However, these issues are quite negligible when given the opportunity to live side by side with such kind-hearted people. I am having an extremely pleasant time with my family; more often than not I familiarise them with my own family back in Australia. The family dynamics and the way everyone acts in their society, what is expected from each family member etc. is really tangible as you yourself are placed in a Nepali family, where you are treated as a proper member of the family.

A day in the life of a medical volunteer in Chitwan

COUNTRY: Nepal
PROGRAM: UniBreak
PROJECT: Medical Placement (Radiotherapy & Paramedicine)
WRITTEN BY: Thanh Vu

A standard day starts early in the morning, where our host family makes us breakfast. A milky rice-like breakfast is often served, and it tastes better than it sounds! Other times a serving of bread and jam is also given. With our complimentary tea and coffee that seems to be available 24/7, we are off to our respective placements by 7-8am.

There are eleven of us students on this trip; two are placed at the teaching community school to teach the kids English, six nursing students and one paramedicine student are placed at the local community hospital and two are placed at the cancer hospital.

Myself and another student are placed at the cancer hospital, which treats a patient load far larger than its limited staff should be dealing with. But they adapt and manage the stress exceptionally well. On the first day we were introduced to all the main doctors and heads of each sector; they were immensely welcoming and extremely friendly, encouraging us to exchange our procedures with theirs. Their head technologist said, "We are all students, constantly learning. You are a student, I am a student. We are all equal here." To myself and the other student, this was overwhelming, but in the best of ways.

For these first days we have just been observing the way the procedures are carried out. For the most part, the concepts and the procedures done are very much the same. Even the type of treatment units are the same back at home. We are all bouncing off ideas off each other, myself, the other student and the doctors and technologists, getting a grasp of how things are done. We have lunch in the canteen, which varies each day from the standard Dal bhat- a rice dish with some potato curry and a mixture of side dishes like picked radishes, to a spicy noodle dish.

After lunch we resume our observing and then make our way homes to our families, which is about a 5 minute walk for us and the teaching students, and 15 minute walk for the community hospital students.

After getting home, we spend time sitting outside, going for evening walks- in which we can see many buffalo, goats, chickens and pigs in the neighbourhood- playing with the kids, drinking plenty of tea and coffee, eating mandarins all the while struggling to understand the Nepali and English language, but we have the best laughs from it all.

Later on the families retire for the rest of the night or have a nightly praying session which includes reading from historic Hindu texts which is inevitably followed by lots of dancing and signing.

UniBreakers in Nepal: Volunteering, living with a host family and travelling

COUNTRY: Nepal
PROGRAM: UniBreak
PROJECT: Nursing and Paramedics
WRITTEN BY:  Amelia Walsh & Ellen Brown

The week started with an exciting trip to the Trisuli River for some white water rafting. It was great fun, although we found it would be better suited for the warmer Nepali months. Braving the freezing water with our comical and cheeky rafting guides, we took on the icy rapids with only one overboard incident… Nice pink undies!

The exhilarating first day of rafting ended with a campfire on the sandy banks of the river. Fresh faced and bleary eyed we bravely took on the rapids for a second time the next day. Needless to say there was a lot of cheering when it was the other boat that capsized, plunging into the artic waters. Ekta and I decided to brave a rock jump though could not convince the rest of us to follow. The two days of laughter and memories were well worth the hyperthermia!

After an interesting and eye opening first week we have begun to settle in at the hospital (though nothing seems to make the 6am starts any easier). With our professional relationships with the staff beginning to strengthening we are seeing many interesting cases.

The most significant and distressing patient I saw in E.D. was a lady being half carried in with obvious chest pain, even through the language barrier. Ten minutes later it was decided that an ECG should be done and as it was being printed I noticed the most obvious anterior STEMI I had ever seen. Though, the most shocking part of this patient experience was that this lady had to lie in the emergency bed, being untreated for over an hour before it was decided she should go to ICU for treatment. This was especially hard to watch, especially since we tried to suggest treatment options and they were dismissed.

Another significant patient was a baby less than one year old, who came in looking very limp with a low level of consciousness. It was decided by a nurse that suction was necessary as the baby was suffering respiratory distress. This didn’t seem to improve the baby’s state so it was then nebulized with salbutamol. Hours later, the baby was sent to the paediatric ward and was diagnosed with late onset sepsis.

As well as feeling more comfortable in the hospital we are all feeling right at home with our host families. With a lovely visit from our older host sister and her husband from Kathmandu, we brought 'Christmas' to Nepal when we hosted a large family dinner. After a grueling recipe search we decided on fritta and salad with honeyed banana pancakes for dessert. Although the food was well received and devoured within minutes a second Nepali dinner was needed to keep the hungry masses at bay. Continuing in the Christmas spirit we stayed home with our families the next day for a rare festival treat of Sel Roti- deep fried ring of ground rice, sugar and ghee- and momo, which are Nepali dumplings. The family roared with laughter as our poor Western mouths were shocked after tasting the extremely hot momo filling (our lovely sister then watered ours down with mashed banana).

The second week ended with a trip into the jungle with a visit to the tourist region of Sauraha! Meeting up with the boisterous Antips health team from Kathmandu and our brilliant Dutch friends we bravely took on the jungle on foot with a surprise close up sighting of a Rhino. We basked in the beauty of the setting sun and relaxed in the tranquility of early morning canoe ride down the foggy river. We took full advantage of the Western amenities, thoroughly enjoying our first hot shower in weeks. With a break from Dhal Bhat we enjoyed the hospitality of the resort and partook in some much need relaxation and retail therapy.

UniBreak mixed health team set foot in Nepal

COUNTRY: Nepal
PROGRAM: UniBreak
PROJECT: Nursing and Paramedics
WRITTEN BY:  Amelia Walsh & Lachie Graham

Nepal is an amazing, fresh and vibrant country with strong history, culture and traditions. We started off not knowing what to expect and slightly nervous about staying here for over a month.

On arrival in Kathmandu, we were greeted by Rajesh and Prima. That night we stayed in their granny flat/hut out the back of their house with walls made of clay and wine bottles! We had to climb up very steep ladders to get to our rooms in the attic… which made getting our 26kg bags up there quite a challenge! Rajesh showed us his office, where one wall is covered in over 300 photos of all the previous volunteers. They went through the basic cultural norms with us, from greetings to use of squat toilets (this was even demonstrated). Apparently we’re not supposed to use toilet paper in the squat toilets because it clogs up the ‘sewerage’ pipes. We have to use bins instead.

The day we left Kathmandu for Chitwan was a very early start. Driving through the main street, the bus actually swerved an elephant just casually standing outside a shop in the middle of the road. Two minutes after embarking on the bus ride, we had to stop for fuel. Between the ‘bus-ride naps’, we saw monks teaching little kids how to clean their teeth on the side of the road. The bus trip was 150km and took over 6 hours! Lesson learnt to take Kwells before leaving next time.

When we got off the bus at Chitwan, we were met by a small taxi which we were somehow all meant to fit in. Being the structural engineers that we are, four of us not-so-small-adults crammed into the tiny back seat. Not the most comfortable drive. When we arrived at Rishi’s, we were all given freshly picked bunches of flowers and cups of milk chia. Then we were given our Nepali names. Ellen became Etka, Amelia became Ambika, Chloe became Kamala, and Lachlan became Laxman. After a couple hours of being taught how to act respectful around our new Nepali families, we were at our new host houses!

We three girls stayed together and ‘Dr Laxman’s’ home was a few houses down the road. Living here is very different to living at home from the harder mattresses to the squat toilets. The hardest part to get used to was definitely not being allowed to throw toilet paper in the toilets. The food is good though! Lots of rice (‘baht’ in Nepali) with every meal, we’re learning the consequences of eating bulk rice all the time- something our digestive systems are definitely not used to.

Nepali people usually don’t eat breakfast like Australians, but eat brunch instead. We get breakfast made just for us, which is usually a rice form of porridge with milk and banana or freshly made roti which we dip in chia – our favourite! Our families also took us to make out traditional Nepali dresses called Gouttars, where we picked out the fabric and had tailor-made for just over $5. Everything is so cheap here!

At Rishi’s house there are three levels. On the second level are the children, or "God's gift to me" as Rishi calls them. On the second night, the children put on a dancing and singing performance to welcome us again. Rishi is very appreciative of us and calls us “not guests, but family” and it is always his pleasure to have us and see us happy. He has been fundamental in the coordination of our time at the hospital and has given us a brilliant insight into the Nepali way of life.

The hospital where we are based is considered modern, new and clean. It is located on a road that houses approximately 60 other hospitals (both public and private). Without a doubt the health system here is different. It is hard to watch some treatment, especially since it is considered offensive to recommend something. C-spine injuries and orthopaedic injuries are often ignored and the patient can be left without any stabilisation and immobilisation for hours. On a positive note, the patient flow within the hospital is very fast; patients are treated and discharged often within the hour. In Australia, patients usually stay within the Emergency Department for a minimum of 3 hours. Here patients leave quicker and often self-discharge.

Overall, week one has been a very steep learning curve and has demanded rapid adaptation. Nonetheless, it has been successful and truly a great experience. I know there's much more to come, so stay tuned for week two!

Flinders University students confront challenges in Vietnamese healthcare

COUNTRY: Vietnam
PROGRAM: UniBreak Groups
PROJECT: Community Healthcare: Paramedic & Nursing Students
WRITTEN BY: Laura Bainger, Flinders University

Hello again! We left you on our last night in Hanoi before we embarked on the main part of our trip - to the Mai Chau Valley, about 4 hours west of Hanoi. It is a very poor region of Vietnam, but the town that we are in (Mai Chau) is absolutely stunning. Imagine enormous jungle covered mountains towering over an expansive flat, covered in irrigated rice fields reflecting the mountains perfectly in them. Housing is basic - many wooded houses on stilts with shutters on the windows (and usually a cheeky satellite dish on the roof). It is so peaceful and just gobsmackingly beautiful!

We have had a few additions to our group! We have a couple of Vietnamese med students, an Emergency Doctor from Hanoi and two guides. They are a really great bunch of people who are great translators and are super keen to help us have the best experience possible.

We visited the hospital in Mai Chau. In rural areas it is very hard for them to retain doctors and they get paid a lot less than their urban counterparts. The hospital was even more basic than the one in Hanoi. We got to spend a few hours there and got to see and open appendectomy (the power went out just as they did the last suture), a natural birth, a nursing student who had some seriously old-school traction on a broken leg which included a pin through his foot (only on panadol), many underweight and malnourished anaemic kids and much more. They had a intensive care unit, and very small room with 12 beds crammed into it. Pain relief, oxygen and adequate heart monitoring was very sparse, it's so hard to convey the disparity between Australia and here.

After 2 nights in Mai Chau, we headed up to the small mountain village of Pa Co. This was where our work really began. The small medical clinic there had a doctor and a few nurses, 4 assessment rooms and a couple of admin rooms. They usually get about 300 patients a month...in the three days we were there we saw 250. Our group of 15 nursing and paramedic students split up into an couple of groups. One group was on the trial desk (remember the organised chaos reference?), a couple of groups assessed and another did health promotion. Assessing was a little like being a GP with very very limited resources. At our disposal we had a few blood pressure cuffs, a thermometer, scales and a height chart. Talking to the patients was really hard work, the chain of translation being English to Vietnamese to h'Mong and back again (ie through 2 translators). The common complaints were back pain, neck pain and headaches, due to the fact that the women are the farmers and carry ludicrous weights on their backs; stomach upsets and diarrhoea, worms in kids and a lot of rotten teeth.

We still can't get over the fact that 99% of patients had had their symptoms for over 12-18 months, and even longer, some up to 20 years. On the second afternoon we were faced with a very sick patient. It was a 3 year old girl who had a kidney infection, a chest infection, a fever, and a A LOT of fluid in her belly. We gave the mum money to get her back to the Mai Chau hospital. The next morning we saw an 18 month old baby who had a congenital heart defect and was only 5kg. She was scheduled in to have surgery in 2 months...that was the soonest she could get in. The worst thing was that we could only send her home. The care here is so basic. A few girls got to feel 2 women with abdominal aortic aneurisms (AAA). If a paramedic came across that in Adelaide you would be in an emergency department before they would know what had happened! Knowing that there is so little that can be done for these people who can't afford to get to a hospital is really difficult and totally foreign concept for us. All of the patients that we treated were treated for free, and we donated a lot of medicines including antibiotics. Every patient received a jar of tiger balm, a sheet of panadol and multivitamins. The health promotion consisted of showing kids and adults how to brush their teeth (we gave out free tooth brushes and toothpaste), and also showed kids how to wash their hands properly (and gave them free soap).

We may not have been able to solve everyone's problems but hopefully the people there will be more trusting of western medicine and won't put up with diarrhoea, headaches and stomach pains for so long.
 
Our homestay was at a local family. The bedding was, well, rough. Imagine a bed sized coffee table, covered with a bamboo mat and a 'mattress' about 1cm thick...safe to say a lot of us had bruised hips after the first night! But the family were very nice. Amenities consisted of a ceramic squat toilet and a shower. Basic but sufficient. One afternoon the house grandmother was chopping wood! The women work very hard, physically their bodies are tried and tested day in and day out. On the final day we got to purchase some homemade crafts, mostly bags from the house mother (I don't want to spoil any surprises that might be in our suitcases!). Over all Pa Co was an incredibly rewarding experience. We got so much hands on experience, saw things we will possibly never see again in our careers, and gained a whole new appreciation for the Australian Health Care System.

After returning to Mai Chau for a night and being taken on an absolutely amazing and forever memorable bike ride around the rice paddies and surrounding villages by our guide Dan, and a trip to the local markets, we set up another clinic at a smaller village an hour towards Hanoi from Mai Chau - Noong Luong. It ran very similarly to the clinic we did in Pa Co, but the biggest difference was the people. In Noong Luong the main tribe is White Thai and they are slightly more westernised, and appeared far more eager to see us and engage with us during consults. At the start of each session Dan would hand out around 30 numbers which meant being mobbed by women all grabbing at him to get one. To us that came across as rude and extremely intrusive to Dan, but obviously it was just a cultural difference that we had to get used to! People here had slightly better health, but we did see A LOT of tonsillitis, so much so that we wondered how some of these kids were breathing...we also (attempted) to assess a woman who was in severe psychosis - speaking in her own language, shouting compliments aggressively at people, bursting out in song and then hiding in the corner of the room. I personally have never seen anyone like that in my life. Even if we had been able to treat her, there is very very little care for mental health patients in Vietnam, which doesn't help the population realise that people who act like that aren't possessed like they did in Noong Luong.

On our final night there we were treated to a traditional dance at a local hall, where lots of mums and kids joined us. A few women dressed up in traditional clothing and did a few dances, and even some of the younger girls got up and had a go! It was gorgeous.

We have formed great friendships within the group, and even the people more inclined to whinge have done so in good spirits! There have been a few moments of homesickness and wishing there was some of mums food on the dinner table instead of rice but everyone has been very supportive of each other. We are already planning pub meals together when we get back!

From here we will head back to Hanoi for a few days to recuperate and then hello Halong Bay - just a cheeky few nights on a junk boat in one of the 7 wonders of the world!