I undertook my 5-week medical elective at Okhaldhunga Community Hospital (OCH) in Nepal. Okhaldhunga Community Hospital is one of two Christian mission hospitals (alongside Tansen Hospital) overseen by United Mission to Nepal (UMN). I went on this elective through Serving in Mission (SIM) UK. This was a deeply moving experience which provided me with an insightful perspective on medical mission and many fond memories to look back on.

Before reaching OCH, I spent 4 days exploring the vibrant and culturally rich city of Kathmandu. For all its beauty, the capital of Nepal is equally as chaotic! I had a lot of fun here, and it was great to visit some of the nearby sight-seeing spots and to begin adjusting to life in Nepal. The 8-hour jeep ride to OCH was exhausting. Recent flooding and landslides have destroyed many of the direct roads, resulting in a very bumpy journey with frequent diversions. Fortunately, I was able to share this ride with the Medical Coordinator who was also my elective supervisor, and he was willing to share some of his inspiring life experiences to fill the time! On arrival in Okhaldhunga, I was greeted warmly by the Hospital Director, who showed me to the Guest House (only a couple minutes’ walk from the hospital) where I was to stay for the next 5 weeks. He invited me for dinner that evening which really set the tone for this elective and shed light on the kindness and hospitality I was to be shown throughout my time in Nepal.

Life on the wards began quickly. OCH is a small primary care hospital that currently has a 50-bed inpatient capacity, and staff are mostly Nepali nationals with several Christian expatriate doctors supporting the work. Approximately one-quarter of hospital staff are professing Christians. During this period I worked particularly alongside the medical officers, who are the equivalent of resident doctors in the UK. I formed some great relationships with the staff during my time at OCH, who were all very welcoming and keen to teach me at every opportunity. Most patients spoke only Nepali or their local language – this made integrating fully into hospital working life difficult and I relied heavily on Nepali staff to communicate with patients. However, the hospital operates in English, so my understanding of patients’ conditions was thankfully not held back too much!

Most of my time was spent shadowing medical staff, although as my experience grew, I was able to partake in supervised tasks such as examining patients, interpreting investigations, and putting forward a management plan. Practically, some of the highlights of this experience were assisting with the delivery of several newborn babies – it was so special to see new life being brought into the world! I was also able to assist in a number of surgical procedures such as an abscess removal, debridement, appendicectomy and a skin graft; a great opportunity to practice my (rather lacking) suturing skills! A deeply moving experience for me was heading up into the local villages with the community physiotherapy team and seeing the long-lasting effects of spinal cord and traumatic brain injuries. This gave another glimpse into the daily struggles of life and the everyday coping required to manage chronic disease. I rotated through each of the hospital departments including medicine, surgery, obstetrics and paediatrics which provided me with a very general, well-balanced and extremely fulfilling time at OCH.

A few things that stood out practicing medicine in a resource-poor setting was the reduced access to medical imaging we take for granted in the NHS. The hospital relies heavily on history and clinical examination findings, with an X-ray machine available if needed. Unfortunately, there is no CT scanner, which meant the many patients I witnessed presenting to OCH with an acute stroke required urgent transfer to a higher centre in Kathmandu. As mentioned, this necessitated an 8-hour jeep ride or, alternatively, a 30-minute flight by government helicopter (an expensive option reserved for those who were able to afford this). It was exhilarating but equally terrifying when we transferred (by stretcher) an intubated patient with cardiomegaly who had just undergone an emergency caesarean section at 34 weeks onto a helicopter for cardiothoracic ITU care.

Cost is sadly a big limiting factor in healthcare for many in Nepal. There are currently some ongoing governmental issues which mean accessing health insurance is challenging. Therefore, many are left paying an unthinkable proportion of their salary on medical care. As a mission hospital, OCH is able to keep its costs low, and it also has a social department to assist those in financial need. Despite this, some afternoons would go by with only a handful of patients attending the outpatient department at all! This, and the extensive travelling required to reach a hospital for a large population in Nepal means disease would often present late. I found this particularly notable in cases of COPD, which is so prevalent due to traditional fire cooking methods in Nepali homes – many patients are extremely breathless at rest and have developed heart failure as a result. I found that doctors at OCH are forced to adopt a broad skill set to cope with the wide-ranging demands of rural hospital work, and this was very impressive to see! For example, most medical officers are able to perform a caesarean section, and there is just one general surgeon at OCH – a humble man and strong believer – who sees most surgical cases that walk through the door!

There is a strong commitment to faith and a deep sense of the holy spirit in Okhaldhunga. Each morning at OCH begins with a short devotional and time of prayer. This routine and consistency provides an important moment of centring on Jesus, thanking God for His goodness, and praying for the day ahead. Both this, and speaking out short prayers before undertaking important medical tasks are small spiritual habits and disciplines I observed which I want to emulate in my own work as a future doctor.

I also enjoyed integrating into the church community! Services were 2 hours long and all in Nepali so could be tricky to follow, but always full of joy and praise. During the week I would enjoy fellowship group which rotated round different members’ homes. We would hear a short Bible teaching and sing Nepali worship songs (some of which are very catchy and became quite familiar towards the end!), whilst enjoying refreshments and ensuring dedicated time to hear about each other’s lives and pray for one another.

As well as this, the Nepali hospitality and sense of community meant I was frequently invited to share in a meal at a church or hospital members’ home, so I very much felt seen and valued. This was especially important for me as the only medical student at OCH for the majority of my time in Nepal. In my final week I was joined by Bethany, another UK final year medical student, on her elective – I was really grateful for the company and to be able to share some of these amazing experiences. The hospital is also surrounded by stunning mountains, and when I wasn’t exploring and buying fresh fruit from the local bazaar, I spent many hours hiking and enjoying the beautiful scenery, often accompanied by the expats who likewise enjoyed spending time in nature. The most memorable moment on the elective was my 2-day trip to Pikey Peak! I hiked up to the 4065m altitude summit at sunrise together with two friends from the hospital, and simply stood in awe as I marvelled God’s wonderful creation, staring into the face of the Himalayas including Mount Everest itself! A few other notable experiences outside of work were celebrating Nepali New Year together with the medical officers where we enjoyed a traditional Nepali picnic, experiencing a local wedding (which went on for several days!), and a very special Easter Sunday service with the entire church community stood worshipping on a nearby rock in the early morning, a tradition they keep each year, celebrating Jesus’ resurrection!

As much as I thoroughly enjoyed my elective and am just so grateful for the experiences I have gained, I must give all the credit to God. I have had to rely heavily on Him, as I stepped into a foreign culture and firmly out of my comfort zone. The Lord was truly faithful, and I have learnt to depend on Him more as a result. God has opened my eyes to the realities and difficulties of life in Nepal, reflecting the struggles so many in this world face. As I look back on my time away, there is also much to take forward as I return to the UK and take this next step and transition to becoming an FY1 doctor soon.

Finally, I want to take this opportunity to thank MMN for your financial support and in making this trip possible. Thank you for all the prayers that carried me through this deeply informative time away. I am very grateful for the opportunity!