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Train of Thought...
May 2011 -All good things must come to an end!

I have just returned from a trip to Nepal and India. The impetus for the trip was an opportunity to implement a spirometry service at Kanti Children's Hospital in Kathmandu. Graham Hall and I were invited to take our spirometry course over there. Care Fusion donated some Micromedical spirometers and Hans Rudolph donated a 3 Litre calibration syringe to the project. Graham and I volunteered our time. We spent a week training doctors nurses and paramedical staff how to perform, quality assure and interpret spirometry. Spirometry had not previously been available in this hospital.

Nepal is a very poor country resource and infrastructure wise and this was reflected in the very basic facilities available for the delivery of Healthcare. This lack of resource was, however, counterbalanced by the dedication and passion shown by the healthcare staff we dealt with. It was sobering to think clinical outcomes were probably not too different despite the pragmatism that had to be applied when it came to investigation. Over-servicing with investigations was certainly not an issue here. Interestingly a great many of the difficulties were politically generated and were really no different to those many of us face here in Australia.

Many things we take for granted here were not available to the Nepalese including clean air and rubbish free streets. On a good day, electricity is available for about 8 hours, 4 in the morning and again in the evening. Power during the rest of day came from generators. People were queuing 3 to 4 hours for rationed supplies of petrol. Roads were in a terrible state of disrepair, and most of the transport we used had long since lost any effective suspension - including the "ambulance" that ferried us between hotel and hospital. Despite this, the Nepalese people always had a smile, always had a helping hand to offer. At no time did I hear people whinging about their lot.

After the course was completed I took a trip to Pokhara, about 200 km West of Kathmandu (a 5 hour drive!). This was a lovely town which is a jumping off point for treks into the Anapurna Ranges - yes we did manage a 4 am rising to witness sunrise over the Himalayas! This was a step back in time as there were a number of "hotels" and cafes bearing names and attractions that dated back to Hippie times. Seemed a lot more recent time here than in "Freak Street" in Kathmandu itself which simply showed its age.

There were aspects of Nepal that were sad. The younger generation were being exposed to junk food at every turn and given 5 years I fear there will be an obesity epidemic. Even the cycle repair shop could offer chips and coke! The school age generation were hooked on computers and are wanting to "better" themselves overseas so there is a separation of modern from traditional values. Businesses that have been in families for generations will start to run out of family to run them. Queues outside the passport office were around the block day after day. Reportedly 200-300 people are leaving Nepal every day, mostly young people.

India was best described as Nepal on steroids. The same chaos, but 10 times faster and louder! Pollution in Delhi was just as bad as in Kathmandu and the streets were almost as dirty. Dodging cow pats made a change from dodging dog poo though! Interestingly many of the lower paid jobs in India are being held down by Nepalese, as the Indian middle class expands at an incredible rate. In this part of the world, times they are a-changing at an alarming rate.

This trip was an amazing experience in many ways I did not see coming. I found myself re-evaluating my values and really pondering what the important things in life are. Call it a spiritual response? Maybe. Life changing? Certainly.

'til next month,

K

May, 2011

kevin.gain@health.wa.gov.au

 

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