Chitwan

One of the things that Nepal is most famous for is Chitwan National Park. It is described in the Lonely Planet as 'one of Asia's best wildlife-viewing spots'. It was something I missed out on last time I was in Nepal and was really pleased when the opportunity arose to go this time. The only downside of going to Chitwan is the return to the Terai and therefore over 40C heat. It is very warm. However,  after living in it for 5 weeks I was a little more acclimatised than the others which I was very grateful for!

The best way to see Chitwan's selection of wildlife is to do a walking tour which starts off with a canoe ride down the river and then a safety talk from the guides. I had heard about the safety talk from others so wasn't surprised to hear that to escape a rhino you climb a tree while you stay in a group if there is a sloth bear. However, the more I was hearing about sloth bears the less I wanted to meet one. What I thought was a fairly docile creature turns out to be very fast and keen on taking off people's noses. Luckily it is fairly rare for tourists to see them and even more rare for them to be hurt by them.

And so with the implication that everything was out to kill us in Chitwan we set off on our walk with all of us trying to walk quietly. However,  as one of the group was wearing waterproof trousers we weren't really that quiet.

Our two guides were incredibly experienced both in finding animals and in dealing with tourists - with the latter potentially being the more difficult of the two skills. Most people who come to Chitwan are here to see rhinos and so the first part of the walk was quite stop-start while we looked for them. We spent a while waiting at lakes to see if rhinos approached and our patience was rewarded.

We saw one rhino getting out of the water and another settling into it to cool off. It may seem obvious but they are huge and, even from a safe distance, they seem massive. Because of their size it seems difficult to believe they can move that fast but it is not something I want to put to the test.  Their sight is poor but their hearing is excellent. You could tell they were constantly listening as their ears swiveled around and if something made a noise in the jungle their ears were immediately pointing in that direction.

The rhinos were incredibly impressive to see and it was amazing to watch this huge creature lumber out of the water. It is definitely a creature I was happy to see at a safe distance however!

After seeing the rhinos the guides seemed to relax more and I was able to chat to the older one. He has been guiding for many years and is a Tharu, the local people in Chitwan. Their culture is slightly different to the rest of Nepal and I was able to see some of their native dancing the previous evening which, as always, made me feel very untalented. When I was talking to him I mentioned we were lucky to see rhinos. He smiled at me, shook his head and said 'No, I know where to find rhinos'. This really made me laugh as it wasn't arrogance on his part but the knowledge that he is good at his job and has been doing it for many years. We were very lucky to have our two guides, who were both excellent and incredibly eagled eyed.

Chitwan was great and walking in the huge jungle was lovely, if very hot and sticky. The rhino was impressive but we were also lucky enough to see monkeys, deer and crocodiles. Deer are far more common than the rhinos and so we saw many of them. They are all very graceful and one of the guides cheerfully referred to them as Bambi as they did look exactly like the cartoon. I would definitely recommend visiting Chitwan but, if you get the option, probably in a slightly cooler season! 

Panchasse

Another of the lesser known treks around Pokhara is a walk to Panchasse, a small village with wonderful people and a beautiful walk.

To begin the trek you get on a short bus ride to a town nearby. It may be a short bus ride but it was also the bumpiest I have ever been on. I've been on many mountain roads and poor excuses for paths but this one was like driving on constant, very uneven, speedbumps. It was great fun! Although not the most relaxing bus ride I've been on and definitely not one where I was going to be reading a book.

Once again we employed the tactic of ask at every junction and this worked to our advantage more than ever. As we got further from Pokhara there were fewer people that spoke fluent English but all seemed to know where we were going and pointed us in the right direction. One gentleman had excellent English and told us that we were going in the right direction but there was a much better and easier way to get there. This is just one of the many hundreds of examples of the Nepalese attitude of going the extra mile to help people.

This new route also placed us in a town called Siduane in time for lunch. As we walked into the village a lady stopped us and, clearly understanding that we were doing the trek and it was lunchtime, offered to provide us with plenty of daal bhatt for a small price. I think this is why I love travelling in Nepal so much - even if you are in the middle of no where there are people you've never met before happy to help and offer you any assistance that they can. It makes it so easy to travel as there is much less that you need to worry about as a random Nepali stranger has probably worried about it for you!

After the daal bhatt had settled and we were given more directions we started the final stretch of walking. As we had been getting higher we were getting great views of the valley and we had been very lucky with the weather as it hadn't rained. It was a good day's walking but a long one and I was very glad to get there, wash the sweat off and not think about climbing more stairs!

The way back down from Panchasse was much easier than the way up. Although it sounds obvious that going downhill is easier than uphill it is often not the case as going constantly downhill can be very hard on your joints. However, we went a different way down that involved a lot less stairs. The weather was quite misty and so we didn't get great views of the mountains but, having grown up in England, I am more than happy to walk in misty and rainy weather and it is better than England as it is not freezing cold.

It was a lovely trek that was much more relaxing than the longer treks I have done. It also makes me want to do more of the lesser known treks in Nepal as walking in more isolated areas is a very different experience. We saw no other tourists and so making the trek incredibly peaceful and everyone we met seemed to be there to help us. Technically we are an industry and tourists are the income for many of these people but it didn't feel like it at all. We were welcomed warmly everywhere and, as always, people went out of the way to help is. But it isn’t with the attitude that they expect something back but simply because it is the culture here and just because we are from a different country doesn't mean we are exempt from this. It is going to be a bit of a shock going back to England and especially the London attitude!

Homestay

One of the lesser known things to do in Pokhara is a very short trek to a village called Lalchowk where you can organise a homestay. Nepali people are very welcoming and they love being the welcoming host!

We have done many walks around Pokhara now and one thing that we've learnt is that the quickest way to get to where you want to go without getting lost is to ask. We had a map of the area but, being Nepal, I'm not sure when it was last updated. We quickly realised this when we crossed what we thought was the first bridge only to establish that a fair amount of construction has happened in the area since the map was printed.

Luckily Nepali people are all to happy to direct lost tourists and at every junction there was someone happy to wave us in the right direction. One gentleman even stopped his truck to give us directions with a big smile - not something you get in London.

We were welcomed warmly on arriving and were ushered in and sat down with tea before we had time to think. Even with no forewarning about us visiting the lady we stayed with, Puma, welcomed us as though our visit had been looked forward to for months. A very welcome reception after a hot days walking!

Puma's home is beautiful - her house looks over the paddy fields with the valley in the background and it is a very peaceful setting. We were able to sit and watch as the monsoon rain came along the valley. It was lovely to sit and watch the rain approaching from the safety of shelter and we were glad wr hadn't walkd slower!

Having lived with four Nepali girls I have seen the energy that they can have but Puma takes it a step further. She is bubbling over with enthusiasm. She may not have a huge amount of English but she could get across whole stories using exaggerated mimes and a few words. I don't think I saw her keep still for any great length of time for our whole stay and she was great fun, if a bit tiring, to be around.

The next day we were taken to the temple, which we were told was an hour away. Temples are commonly on top of hills and so, once again, we braved many, many stairs. It also turns out that the 'one hour' was a Nepali one hour and so two hours later we arrived at the top. It had been a nice walk, but one that was much more difficult than I expected. I had been decieved by Puma wearing sandals and a saree into thinking it would not be that difficult. However, I have seen women wearing sarees and flip flops carrying huge packs on their backs up hills in the rain. I  think this is in large part because of necessity as flip flops are cheap and accessible but I do wonder what they think when they see all the tourists wearing huge hiking boots.

It was great to stay with Puma and I really enjoyed being back in a Nepali's home. I like being in parts of Nepal that are off the beaten track as, although it is nice to have the comforts found in the tourist areas, I find people are more welcoming and friendly in lesser known parts amd tourists are seen as less of an industry and more as people. If ever someone in Pokhara wanted something different to do I would definitely recommend visiting Puma.

Peace Pagoda

The World Peace Pagoda is one of the main sights to see when in Pokhara and I visited last time I was in Nepal. Having visited it the normal way previously - by crossing the lake and climbing the hill - this time we decided to take the slightly more scenic route of walking around the lake and then up the hill. It turns out that we didn't just take the scenic route but the very scenic route.

Once we had gone around the bottom of the lake amd started up the hill there were multiple paths to follow and logic suggested that we just head upwards and we should reach the Peace Pagoda. However, it turns out that just heading upwards results in a much more up-and-down route than heading around a little first! Having sat in Bhaunne for five weeks it was nice to be moving, even if it was still quite warm and muggy. By the time we reached the top both of us were very sweaty!

Luckily, we were rewarded with a spectacular view. As the Peace Pagoda is on top the hill you can see across Pokhara and it is much bigger than I realised and I suspect it is growing to cope with Nepal's increasing population. I would love to come back in ten years to see how much it changes as I suspect many more of the green areas of hills will be covered by houses, which will be a huge shame but I think it is something that is happening everywhere.

Due to our very scenic route we also got to see the other side of the hill. Esentially this is a valley filled with houses and, again, there were many more than I would have guessed. It was a reminder that as tourists we tend to stick to the same areas in Nepal and we forget about the rest. This combined with talking to other travellers makes me realise how lucky I was to essentially have lived in a Nepali's house for five weeks.

I was able to see a part of Nepal barely seen by Western tourists and it is a beautiful part of the country. I was also able to get a feel of what it was like to live and grow up in a village where there are few opportunities. Lots of people want to move out of Bhaunne and I think the girls at the clinic would all like to move to somewhere bigger as there really is little to do there and the job prospects are limited to farmer or shop keeper. It is so different from where I grew up in a very multi-cultural city that offers many different opportunities. It makes me realise how lucky I am.

After eating lunch while appreciating the view we headed back down.  The man running the restaurant we ate at mentioned the local bus and ten minutes later when the heavens opened we realised why. It is, indeed, monsoon here and that particular afternoon it poured with rain. It was heavy enough that there was no point in trying to keep dry but to just except that you were going to be soaked through and be glad that it wasn't cold!

After a much shorter route back (half the time) we squelched back into Lakeside, the touristy area to Pokhara. We got many a strange look from people and I was very glad to get back to the guesthouse, peel off my clothes, and have a shower!

Back in Kathmandu

Josh and I left Chisang Clinic less than a week ago but it already feels like it's been weeks since we were there. It has been nice being in a cooler climate as although it is still always above 25C here and quite humid it is much cooler than Bhaunne. It is a novelty being able to sit in the shade and to not be sweating and it also means that a lot more can be done in the middle of the day.

Debendra has very kindly allowed us to stay at his house while we are in Kathmandu and so we are very lucky. Not only does this save us money but it is much nicer staying in a home where you get a bit more space - it is the first time I've my own room in 5 weeks and it's quite nice having some space to sort my things out. It also means that we don't have to stay in the tourist district of Kathmandu, called Thamel.

I remember Thamel from when I was last in Nepal but it was still a bit of a shock turning up there after being in Bhaunne. It is much busier than Bhaunne and the shops and restaurants are worlds apart. It is much more developed and there is a huge range of things available. Having eaten rice and lentil curry for 5 weeks it was strange to see so many choices on the menu from different parts of the world and for meals not to have to contain rice!

While Thamel serves a purpose and there are few places as good for souvenir shopping in Nepal it is nice to be able to leave it. It is quite hectic and people there are trying to make a living and consequently everyone is trying to sell you something which can be quite tiring. It's therefore nice to escape and it's also nice seeing another part of the city as Kathmandu is absolutely huge.

The people of Kathmandu and the valley surrounding it seem to have a very different attitude to white skinned people compared to those in Bhaunne. Everyone is still friendly and lovely but seeing us is less of a shock. When walking near Debendra's house people look at us with curiosity as, clearly, we are a little out of place but it is not with the amazement that people in Bhaunne stared.

The standard of English is also phenomenal. Many people speak English with barely any accent - old as well as young. One little girl, less than 10 years old, was talking to us and her English was fantastic. I would guess that the best schools in the country are in Kathmandu and that the standard of education in the capital is much higher than the more remote parts. Tourists from abroad rarely go to the far east or west of Nepal and so English would not be not heard as commonly and the need to speak English for tourism doesn't exist in the same way.

Continuing our very touristy few days we also went white water rafting. We had a great group of people and, again, it was strange being surrounded by English rather than Nepali and umderstanding everything that was said! The rapids were great and you really had to focus when going through them and listen carefully to the instructions from the guide. The stretches of rapids are relatively short which is actually quite good as paddling can be very tiring! To have short intense bursts and then a chance to relax was perfect.

In stretches of calmer water you were also able to go swimming and floating down a river is possibly the beat was to travel. It was a good opportunity to cool off as the sun was very strong that day! The only downside was getting back into the raft which was anything other than dignified.

It's been a busy few days and it's been great seeing more of Kathmandu and doing some touristy things as well. It's definitely a seperate world to Bhaunne! 

Leaving Chisang

Yesterday morning Josh and I left Chisang Clinic for the final time. Time seems to have moved very strangely during the five weeks we were there - at times the days felt very long when there was little happening but equally at the end of each week the time seemed to have slipped by quite quickly.

Nepali goodbyes are not quite like English goodbyes, there is much less emotion and hanging around. This may partly be because they are more used to long seperations than people in England. As far as I am aware the girls only see their families once or twice a year, despite some of them living within a couple of hours of the clinic.

It was, however, very sad to leave. It may have been a bit of a shaky start but the girls were absolutely wonderful, crazy but wonderful. Debendra had told us the girls were a lively lot which, to start with, didn't really show. However, once we got to know them the girls proved this statement to be incredibly accurate and they were the polar opposite of dull - even if we didn't always understand exactly what was going on!

Admittedly it would have been nice to see a few more patients but seeing how the healthcare system works in a totally different setting is an important part of an elective and Chisang Clinic proved to have many differences to what I have experienced at home.

The first obvious difference is the huge reduction in choice of medications. At home there are multiple antibiotics and seemingly hundreds of anti-hypertensives to choose from. Here the choice was a lot less which, I have to admit, makes it easier for someone who's pharmacology needs some work!

Another very apparent difference for me was the lack of privacy for the patients. At home you would never expect to give your medical history in front of anyone except the healthcare peofessional and your family. Here, the history was told in front of whoever happened to be in the clinic at the time. I think this reflects the cultural differences as much as the medical ones as there is less privacy here, mostly out of necessity. Houses are smaller and there are many people to a room so you are not going to have the luxury of mich privacy. However, I did wonder whether people are put off from visiting Chisang because of this but it is impossible to tell without knowing the community better and being able to speak directly to the villagers.

Many of the patients at the clinic were the same worried parents that you find in any GP surgery in England who want to ensure the cough or temperature their child has is not serious. The vast majority are not and just need reassurance and some calpol. This is where Chisang can really make a difference as it is a not-for-peodit organisation and so do not charge examination fees or make a profit on medication. This allows these parents to be able to afford to get medical advice for something that they may be very worried about, even if it is not life threatening. Even though a lot of the cases may not be very challenging it can make a huge difference in this community and the girls do a fantastic job.

Whilst living in Chisang I saw a whole new side of Nepal that was very different to my time in Gorkha. In large part because we were living in a Nepali's house and so we had no choice but to fully immerse ourselves in the culture, which was brilliant. I am going to miss the girls a lot and it's a very odd and also very sad to know that, after living with someone for five weeks, we will probably never see them again.

Trips to the Hills (2) - Ilam

Our second trip to the mountains has been on the cards, but not fully planned, for a while and this was a whole-clinic trip to Ilam, a part of Nepal famous for tea.

It was also meant to be an early start but 6am rapidly became 7am as Laxmi wasn't out of the shower at 6am and then, obviously, all the girls (and me) needed our make-up doing. The taxi driver who would be driving us all day is probably used to this as I know he does most of the driving for Chisang. He happily sat with a cup of tea while the girls all did their make-up and found the correct shoes. Some things in cultures don't change.

Our first stop off on this day-trip was a temple. I had been told that there were 100 steps up to the temple and I don't know whether I hadn't been listening or there was a mis-translation but 100 wasn't even close; which I quickly realised as around every corner there were just more steps. Again, the girls fitness isn't quite up to our own as they are all stick thin with little fat and even less muscle. Therefore, there were many stops on the way to the top which all served as an opportunity to take many photos which, if taken by a Nepali, are all at an angle - I think they must think we are a strange for taking them strictly landscape or portrait!

1,039 steps later we got to the top and had nicely warmed up. Before going into temples in Nepal you are meant to buy something from one of the stalls outside. I had never done this before as I have only ever been to commercial temples that I have had to pay for entry and never with someone who knows what they're doing. This time, however, we were encouraged to find something and so I had fun browsing the stalls and eventually found a bracelet. Nepal comes across as a very religiously tolerant country as Buddhism and Hinduism exist very happily side by side and I have not heard of it ever causing any problems. Among the things on sale there were also crosses and so it does suggest a general acceptance of any and all religions.

The temple was shrouded in mist which gave it a very nice atmosphere although the monkeys appearing out of no-where was a little alarming. There is always a smell of incense around as this is one of things that is placed in the temple - along with bracelets, small sweets and flowers. It's a good atmosphere, even for the unreligious, and everyone is very tolerant of foreigners and don't mind if we take photos or don't follow the exact rules. Again, a good reflection of the Nepalese attitude.

After walking down a path that would belongs on a trekking route we headed off for lunch and then went to see the tea plantations. By this point it was grey, misty, raining and felt very like and English summer. I had been advised that I should bring a jumper and had dug it out from the bottom of my bag and was now very grateful - I had expected to be using more suncream than layers!

To visit the tea plantation we literally stopped on the side of the road and walked into them. This is the great thing about visiting places with people from the country who speak the language and know what they're doing. You can avoid the touristy parts! We wandered amongst the plantations along mud paths which, as it was raining, were fairly slippery. Flip-flops weren't the best choice of footwear and Laxmi gave up and just took hers off. It was great fun wandering about and the girls insisted on many photos and Laxmi was in hysterics at one point for reasons I'm not quite sure about but everyone seemed to be enjoying themselves.

As we headed back towards the van there were some ladies picking leaves who very kindly allowed me to take a photo. I have found this all over Nepal that people don't mind photos as long as you ask. When travelling in South America I found exactly the opposite but the attitudes here are very, very different. One woman made a comment to me including 'ram-ro' which means good and I would guess she was commenting on my kurta and it was lovely to hear from a complete stranger!

Before getting back into the van I managed to give Laxmi something else to laugh at as I slipped down the last bit of very steep and muddy pathway. As always, her laugh was good natured and it was pretty funny and, luckily, I only had one muddy knee so didn't look too ridiculous and wasn't too muddy for the drive back.

While we didn't actually have any tea from Ilam I would guess it's fairly similar to what we drink everyday here anyway. Plus visiting with the girls was much more fun than it would have been on our own and we got to see places that I'm sure we wouldn't have if we were on our own. It was a great day out for the whole clinic. It is also a reflection of how relaxed Nepal is that they can happily shut the clinic for a day with absolutely no warning!

Trips to the Hills (1) - Dhankuta

Over the past week we have made two separate trips to the hills in Nepal. They may not count as mountains here but I'm sure they would in England!

The first was to Dhankuta where two of the girls from the clinic were taking an exam. As there are not many patients coming into Chisang they asked if we would like to come to which is a chance we jumped at, as much to get away from the heat as anything!

The morning began very early - we were told we would be leaving at 4.30am. Naturally, this is Nepali timing and so we wondered out of the clinic at 5am to start the fairly long journey up to the mountains. As soon as we started climbing the mountain road we got a fantastic view over the valley and I realised how well populated it was; there are many more houses than I expected. I do not know if it is the different places that I have visited or if Nepal has moved forward a lot in the past four years but it does seem richer than when I was last here. There are quite a few houses that would be impressive in England, let alone by Nepalese standards.

It was a relief to get to Dhankuta and we settled into the hostel and enjoyed the feeling of sitting still without sweating and then went to explore the town a bit. After spending four weeks in the plains of Nepal it was a bit of a shock to suddenly have to climb a hill! Although after living in Sheffield I think both Josh and I fared better than Alka who had to stop regularly due to pain in her legs.

We visited a market in Dhankuta which was similar to the one we visited in Bhaunne, although on many more levels. Everyone sits on their plastic mat with their vegetables / clothes / whatever they are selling in front of them and people wander about and choose. We normally attract a fair bit of attention as it's very unusual to find foreigners in Bhaunne or Dhankuta and even less common to find them in a market. In fact when I bought my kutra in Bhuanne I turned around to find I had an audience of women who had been reviewing my purchase!

The visit to Dhankuta was only a couple of days but we found time to go for a walk. After many days in the clinic it was nice to go for a longer leg-stretch in different scenery and it really couldn't have been more different. Just outside of the town there is a fairly unpopulated part of the hillside that we could walk to the top of and see across the valley. It is always very peaceful in the mountains and you can spend a surprising amount of time sitting and watching the valley below. It always amazes me how much you can hear. Despite barely being able to see the bus on the road winding along the other side of the valley we could still hear it!

On the final day in Dhankuta was Alka and Degu's exam, which started at 4pm. Shockingly, this did start on time and is the first thing that I've encountered in Nepal that has done so. We wondered off to get a drink and returned when they had finished. After every exam that I have completed at university we have immediately walked out of the exam hall and into the pub. However, after their exam everyone needed to get back to where they came from, and some people had travelled considerable distances. Therefore there was a mad rush as everyone tried to get on a bus. We managed to cram onto one and, after filling it with as many people as possible, we started the 4 hour journey home. It is very different to the post-exam feel back at home which normally involves a good few drinks!

It was great to visit the mountains and see a bit more of Nepal but it was also strangely nice to get back to the clinic - and also Laxmi's cooking!

Monsoon

Considering we are in Nepal at the height of the monsoon it has had very little affect on us. It normally rains at night and the main difference that we notice is that it becomes much cooler, which we are all very grateful for. However, there are two notable exceptions when the monsoon has lived up the reputation of being all-consuming.

Once was during our first week when it rained very heavily overnight. I had been vaguely aware of this having been woken briefly by the thunder and the lightning. I became far more acutely aware at around 5am when I was awoken to the sound of splashing and giggling. Laxmi giggles at most things and it was 5am, which is early even for here, and so I wasn't paying much attention and was hoping that she'd stop giggling and go back to sleep. However, when I rolled over to find the source of the splashing I realised it was because Laxmi was standing in the middle of our room which was covered with a good inch of water.

One of the benefits of sharing a room is that the girls had stopped me from putting my bags on the floor, they had not explained why but it was one of the many things that didn't seem worth arguing about. And now I was very grateful! Josh wasn't so lucky and so lots of his clothes got a free wash. Once they were hung out we started clearing the water from the rooms. All of the floors are concrete and so the water was literally swept back out of the doors and onto the balcony and from there drained outside. Concrete floors make the whole job significantly quicker (although not quick enough at 5am) but whoever designed the floors so that the rooms were an inch lower than the outside was clearly not having a good day. Luckily, however, this does not happen often. I still keep my bags firmly off the floor though.

The second time the rain caught me out was when I was walking back from the internet cafe. It is only a 30 / 40 minute walk over a flat road and in England I would cover this distance most days. Here it is the furthest that I ever walk simply because everything else is either too far away and you need to get a bus or, as most things are, they are closer. Therefore when I stepped out of the internet cafe and it started to rain 5 minutes later I realised that I was going to get quite wet.

The rain here can be light drizzle that is seen in England or it can be torrential downpours, frequently switching between the two with some fairly impressive lightening in between. This one was a torrential downpour and so I stopped at a shop to wait under cover with a drink while it abated. We have stopped at this shop before and the women seemed happy for me to sit there and wait for the rain, although it is always odd sitting and knowing that people are talking about you but having no idea what they are saying. It gives me a new appreciation for never talking about patients as if they're not there.

The rain eased off and so I headed back, but it was still raining sufficiently to mean that I was soaked by the time I got to the clinic. I had also been wearing flip-flops due to the lovely sunshine when I left so I returned looking like a drowned rat with mud splattered on my legs and back. Needless to say this set Laxmi off giggling but it did mean I got a cup of tea!

Wound Care

Chisang Clinic sees many patients, old and young, that need wounds taking care of. Some of these are minor things that, in England, would probably be sorted out by making sure they're clean, some germolene and a plaster. Some of them are more serious and would probably go up to A&E in England.

One such boy came in a few days ago. He came in limping, so it became apparent there was something wrong with his leg / foot. However, only when he sat down did we see the wound. On the back of his ankle was a cut about 2cm long and 2cm wide that had cut away the skin so that it came loose in a flap - a sheet of tin had apparently fallen and cut open the back of his ankle. It didn't look pleasant.

He seemed fairly cheerful about it until we started cleaning it. First with saline and then with iodine it was clearly a very painful procedure for him due to the depth of the cut. It didn't help that due to the awkwardness of getting to the back of the heel he was kneeling on a chair as I'm sure he must have been feeling slightly faint and sick. It is vitally important to keep wounds clean here and it is not as easy as it is at home. Therefore wounds are cleaned and then covered with iodine ointment, which is waterproof, to prevent infection.

One of the biggest contrasts that I have noticed in Nepal compared to England is how people react to injuries. Admittedly, I haven't done much wound care in England as I haven't completed my A&E attachment but children in GP surgeries scream at the idea of having their chest listened to. Here, people put up with what must be quite painful procedures with barely any fuss. This doesn't just apply to older people but to many of the children as well. I think they are aware that they are at the clinic because they need to be, rather than many of the children that are at the GP surgery because their parents are double checking. Therefore they know it is necessary and so put up with it much more stoically.

I was very glad for this boy's sake when the wound was clean and the bandage on although his limp did seem much more serious after it had been bandaged! It did mean his mum got a bike to take him home which, given the look of the wound, seemed fully justified.

Momo Making

The Lonely Planet describes momos as 'Nepal's unofficial delicacy' and, having tried them before, the steamed dumplings are very good. After talking about them a little with the girls they agreed to show us the process of making them. Little did we know what we were letting ourselves in for.

After purchasing the ingredients we started with the chopping. We started at about 3pm with three of the girls chopping vegetables and I was peeling garlic. Everything has to be chopped very finely for momos as it is more like a paste in the middle of the dumpling than chunks of vegetables. At home this is fairly easy as you can just put everything in a food processor. Here, everything has to be done by hand.

So, after much chopping we were ready to start assembling the vegetable momos. The chopped vegetables, garlic, ginger, spices and salt was all mixed together and then placed in the prepared dough. A relatively simple process that required a few stages - one person rolling the dough and then one person adding the filling. It sounds simple but each momo is 5cm big this had to be repeated many times. To speed up the process we had a each person working on one stage and it was a good effort of teamwork!

Even once the momos were prepared they take 45mins to steam until ready and so once the first round of momos were finished we were all getting quite peckish. And we hadn't even started on the chicken momos.

While we had been chopping the boys had been sent out to get the chicken and I don't think Josh was really prepared for what he had let himself in for. Electricity here is sketchy at best and few people can afford fridges anyway and therefore there is only one way to keep meat fresh - alive. When you go out to buy a chicken you buy a chicken that is still clucking and they kill it there in front of you and then chop it up for you. I wasn't aware of this and Josh certainly wasn't. He's now debating vegetarianism.

Once the chicken had been brought back it also had to be chopped into very fine pieces, and I was quite glad to be part of the momo making factory at this point. Once chopped it was added to what was left of the vegetable mixture and then the momo making started again.

Eventually all the momos were made and the mixture used up and we waited for the last of the momos to be steamed. By this point it was almost 8pm and it was a very hot evening! The momos were very good but I have to admit I'm not keen to make them again whilst in Nepal! It was a very long process that does produce delicious food but shows how different our attitudes to cooking are. It is difficult to persuade many people in England to cook a proper meal, let alone spend the whole afternoon cooking one!

Betana

There are many people that walk in and out of the clinic on a fairly regular basis and one of these is a young boy called Nakul Karki. We were talking with him about local wildlife and he seemed very surprised that we had never seen tortoises and so he took us on a trip to see them at Betana, a park near to Bhaunne.

Before we went into the park we bought two packets of crisps to feed this fish. I'm sure an environmentalist wouldn't be too pleased if they realised it is fairly normal for the children here to buy oily crisps and throw them into the river to attract the fishes and tortoises. The animals themselves, however, seemed fairly happy as for each crisp many fish came to the surface to fight over it. There were fish of all sizes, but some of them can grow pretty big - they were over a foot long and apparently can weight over 3kg!

Among the fish there appeared a tortoise, that seemed very serene among the mad fight for each crisp. Apparently some of the tortoises around here can reach up to 40kg, which this one certainly wasn't, but it was very graceful among the grappling fish.

Betana is a very peaceful place and there is also a lake where you can hire a boat for Rs100 (less than a pound) to row around. It was very warm in the sunshine and it was lovely to idle around the lake for a while and it was a good way to spend the afternoon. I think it was partly nice as we were totally off the main tourist trail and so there were no other foreigners there. That is one of the joys of living in a community rather than visiting, as you are able to visit places that locals know about but that tourists often miss.For the Nepalis there I think we were as much of a novelty as the park itself and I think we are the subject of a few of the photos taken by people visiting that day.

Jaundice

It is now nearing the end of my third week in Nepal and it seems to have gone very fast! I have settled into the pace of life at the clinic and, as well as seeing (the still few!) patients that come to Chisang we have also been visiting places around Bhaunne. Some patients are more memorable than others as, like at home, there are always certain conditions that will be more common than others.

One patient that has particularly stuck in my mind is a 13 day old baby that came in with jaundice. Jaundice is not uncommon in newborns and is normally nothing to worry about. However, it is less common for a baby to present with new onset jaundice at 13 days old.

This may still be a physiological response as babies who are breast fed, which almost all are here, are more likely to develop jaundice. At home this case would probably be referred on for paediatric review, just to be on the safe side. However, in the clinic, we are not able to do this. This is one of the cases where we have to rely on our own clinical judgement but also have to adapt to what resources the clinic has. At home we would probably run more blood tests to rule out more serious causes but, at the clinic, this is not possible.

In cases of jaundice the levels of bilirubin are monitored as they can become high and if the levels become too high then it can damage the baby's brain. This is made more complicated as the units they use for bilirubin here are different to the ones we use at home and therefore we were unsure what level of bilirubin is considered dangerous. The test was run and the results came back showing the bilirubin levels where raised, but Yamina assured us that they were not significantly high. As going to hospital is a very serious decision here that is not taken lightly this baby was not sent on for further testing and the parents were advised to come back and have the bilirubin checked in a few days time.


It is cases like this that highlight the real differences between the two healthcare systems. A trip to the hospital is free and generally easy in England and therefore people are sent there much more freely. We also live in a culture where everyone is scared of being sued and therefore doctors are likely to be more cautious rather than less. As we have been trained in this environment it did make me feel a little uneasy that we were doing nothing for him, especially as this would definitely be a case that I would ask someone more senior about at home. However, I think this is an important part of going on elective, to learn to trust more in your own clinical judgement in a situation that you have to adapt to. You are very much forced to work beyond your comfort zone, even if it isn't 9 to 5 work!

Chisang Clinic

We have now been at Chisang Clinic exactly one week although, as always, the first week feels like it has been much longer!

I have to admit our first night was quite intimidating as we arrived late on the evening when everything was dark. We met the four girls who run the clinic - Laxmi, Ulga, Yaumena and Duge - although at the time I could not remember any of the names except Laxmi. They did not speak much English on the first evening and we speak no Nepali. Neither me nor Josh really knew what to do or what to say and I went to bed feeling that I had no idea what I had let myself in for. It didn't help that it hadn't rained yet and even sitting in the breeze I was pouring sweat. It was an interesting night.

The next day, however, things immediately started looking up. It rained overnight which brought the temperature down to a bearable level, although still warmer than England. To start conversation I asked Yaumena to teach me some Nepali and she very willingly obliged and was very patient with my horrendous pronunciation. They have many sounds that we don't have and languages do not come naturally to me anyway, but she is a good teacher.

Over the past week the girls at the clinic have opened up immensely and their English is much better than we thought on the first night. Debendra (who set up and officially runs the clinic) mentioned that some of the volunteers have been less than ideal and, in hindsight, they were probably as wary of us as we were of them. If two total strangers were coming to live in my house for a month I would also be quite wary of them.

Now it is hard to believe we have only known them a week as everything has settled into routine nicely and they are extremely helpful with everything. They do laugh at many of our mistakes with language and helping with chores but it is friendly laughter and, to be honest, many of our mistakes deserve it!

The Clinic itself is set in Bhaunne, a rural village in south-east Nepal. The patients that come in the door can be anything and the Clinic is the first port of call for anything medical in the area and serves a similar function to a GP surgery in England. Treatment here does not come free and therefore it is not quite the same as at home. However, there still seems to be a huge variation in the wealth of those who walk in the door but often it is hard to tell.

The girls have been working here for at least two years and, although none of them are qualified as doctors, the coughs, colds, ear aches, tummy pains and things that make up a lot of community work they are fantastic at dealing with. Part of GP at home is also to provide social support for people and the girls also seem to provide this amply. While I don't understand what is being said many patients, especially the women, stay for much longer than a medical conversation would take and I assume they are discussing village life, gossip and the troubles people have at home or they see around them.

Since we have been here there have been a couple of notable cases that have come in that are outside the usual snuffly children or coughs. These are the cases were Josh and I can be useful. We are having a major crash course in speaking through a translator and it does highlight which questions are useful and have to be answered and which can be left out. We are also learning how to simplify questions to make them understandable and translatable. It also highlights the usefulness of examination, although this can be a challenge if you cannot translate what you need the patient to do!

There are fewer patients who attend the clinic than we expected and this is partly due to the heat as during the day it really is too hot to be doing much. Therefore we are keeping ourselves busy doing other things and there is lots of time for reading! Debendra is visiting in a week's time and he said there are cases that he wants us to review and this will be interesting. Partly to see the kinds of cases and also it may be a test of our medical knowledge, but I am looking forward to this.

I hope everyone is well at home and that the weather is getting warmer!