I chose PHASE Nepal for a medical volunteer adventure because of their commitment to supporting healthcare for the least accessible communities and up-skilling locals rather than deploying foreign workers.
PHASE Nepal is a local NGO that employ entirely Nepali staff on the ground with a fundraising arm based in the UK called PHASE Worldwide. They were well established before the 2015 earthquakes and instrumental in supplying building materials, man-power and medical assistance in the aftermath.
On my first day at the head office in Bhaktapur I learned that PHASE Nepal has a broad development strategy beyond public health and primary care. They are also involved in engineering, agriculture and education.
My original schedule changed because landslide made a two day walk too unpredictable. Instead I was assigned to Hagam, a small village half a day drive from Kathmandu and a few hours trek up a mountain.
Hagam and surrounding villages were obliterated by the earthquakes, although I wouldn't have known had I not been told - the reconstructed village was a bustling warren of small huts, corn drying on rooftops and baby goats.
Clinic days saw a steady stream of patients, many who walked from neighbouring villages and waited on the ground outside the clinic chatting. I was surprised to see so much familiar pathology - bladder infections, smoking related chronic airways disease, eczema and ear infections. Then conditions related to the challenging environment such as skin infections, injuries, cataracts and diarrhoeal disease.
There were people with Vitamin A deficiency and night blindness. Sadly we also treated children with severe malnutrition and failure to thrive. Phase provide invaluable perinatal care and I smiled to see a Pinard's aluminium fetal stethescope pressed up against a woman's belly.
One evening our health workers were called away to deliver a baby girl. The following day during a storm, her father and proud extended family brought the baby to our home to have her examined on the kitchen floor.
On non-clinic days, we walked across mountains to local schools where the health workers run health education classes. Sometimes we walked to a government health-post where a mothers group gathers to discuss improving health literacy in their communities. After hours, the health workers and I practised history and clinical examination skills.
We were lucky enough to find plenty of patients to supplement teaching - an old man with rheumatoid arthritis hand deformities, a woman with a Shingles rash and plenty of people with back pain to practice neurological examinations and peripheral reflexes. It reminded me that most information can be gathered from a patient without blood tests and imaging.
One of my favourite things to do while travelling is to collect health promotional posters. Here are some from Hagam -
By the end of my trip I realised it wasn't the medicine I found most challenging as I'd originally feared. Primary care at its core is the same on a mountain as in the city - building relationships, sharing stories and finding strategies that work for an individual with their unique life circumstances - what I found challenging was showering fully clothed, being a pseudo-celebrity and attracting attention while brushing my teeth outside and living without the noise of media, mobile phones and internet. It was confronting to learn how dependent I was on those distractions.
What I valued most from my time with PHASE was the opportunity to meet and befriend the health workers who live away from their family and friends. They are often young women living solo in a community that is not their own, with 12 months of formal medical training, who are available 24 hours a day to bring comprehensive primary care to people who otherwise would have none. It was humbling to see their commitment and resilience.
You can read more about the work of PHASE Nepal and PHASE worldwide through Dr Gerda Pohl's personal reflection, here - "Looking back on 2016 in Nepal." She describes the rebuilding effort, the new Nepali calendar where time is counted BEQ and AEQ (before and after the earthquake) and the tragic loss of one of their nurses in a helicopter accident.