By Grace Chua
“Open heart, open mind.”
These were the words I wrote to myself in my journal before arriving. It was my first time in Nepal, my first time in an overseas hospital, not to mention in a developing country – I did not know what to expect.
I spent 6 weeks attached to United Mission Hospital Tansen (Tansen Hospital for short) in Nepal, located more than 300 kilometres away from the capital city of Kathmandu. This was part of my school’s overseas medical elective programme where we could spend 6 weeks in a hospital of our choice, to experience a different healthcare setting from Singapore. Together with my batchmate, we took a domestic flight followed by a 2-hour drive to reach the hospital. The following day after we arrived, some returning doctors had to endure an 8-hour journey following their domestic flight just to reach the hospital. This was because of a landslide along the way, which is very common.
The hospital has 169 beds, with both local and foreign doctors working there. Foreign doctors are Christians from all over the world who have chosen to work in Tansen Hospital on a voluntary and self-supported basis, while local doctors may be from Tansen or even towns on the other end of Nepal. Tansen Hospital offers a wide range of services including medicine, surgery, maternity, and dentistry, as well as testing and treating for various conditions such as Tuberculosis (TB), HIV and leprosy. More information about the hospital can be found at this link: https://www.umn.org.np/umht.
A different world
My 6 weeks here were filled with experiences of a lifetime – things I have seen that I cannot unsee, emotions felt that I am unable to find the right words for, moments of loss as I stood in a ward full of machines beeping, patients dying and families crying, yet nothing I could do about it.
Some stories are sad – like how the paediatrician was telling us about a young boy who was very sick, yet his mother was insisting that she had to bring him home. On further probing, it was because their family had a buffalo back home that she needed to take care of. I was initially quite shocked to hear this. How could a buffalo be more important than her son’s life? Yet on further explanation, the buffalo was the family’s only source of income – for milk, for cheese, and eventually to be sold for its meat and hide. If the buffalo died, the whole family would not survive, and what more her son. The truth of this cold, hard reality hit me hard.
Some stories are happy – like the elderly lady who was bedbound for almost 4 months due to a hip fracture but did not seek medical treatment as she could not afford it. How she finally came to Tansen Hospital I do not know, but she underwent hip surgery and was finally able to stand up, with the medical fees covered by the hospital. Being able to receive surgery that she could not afford was a blessing to her. Being able to see Tansen Hospital help patients in need was a blessing to me.
It is the little things that count
My time in Tansen also taught me to appreciate the little things. I still remember one of my happiest days in Tansen when I found a toilet in the hospital with a toilet bowl, and toilet paper provided! While this would be a norm in Singapore, one quickly realises that all the toilets in the hospital (and probably everywhere else in town) only had squat toilets available with toilet paper not being provided. One might find this funny, but it would not be uncommon to find a roll of toilet paper in a ladies’ handbag.
I asked some of the local junior doctors why they chose to work at Tansen Hospital even though it is far away from their hometown, and pays less than other hospitals too. They said it is because Tansen Hospital does not turn away patients who are unable to pay for their treatment. If a patient is unable to afford the treatment fees, they can tap on the Medical Assistance Fund (MAF) for help. Patients are assessed (the equivalent of Singapore’s means testing) based on their housing, how much land they own (if any), or how many buffaloes, goats, chickens etc they have. No one gets refused treatment because they cannot afford it. That is what they like about Tansen Hospital, and that is what I like about it too.
Gratitude goes a long way In Singapore, how often do we complain about long waiting times? Yet over there, patients can travel for days to reach the hospital, with some even crossing the border from nearby India. These patients have to walk to take the bus, then walk again to the hospital – hobbling on a fractured foot, sometimes taking too long to reach the hospital that maggots have started to feed on their wounds. I remember sitting in the clinic and telling myself not to complain about Singapore’s healthcare system when I am back.
Yet, Tansen Hospital is a small hospital with its limitations. From a medical perspective – when patients need urgent CT (computerised tomography) scans – a much more advanced form of X-ray scans – there is none available on their grounds. We had to send them to the nearest centre 30 minutes away by vehicle, with the CT report only coming in days later. Even in clinics or in the wards, the question by doctors is not “what blood tests should we send for”, but “are these blood tests available in our hospital”. It is almost a given that we can test for any blood test in our Singapore hospitals. Such are the things I never even realised I was taking for granted.
Working with foreign doctors was a huge encouragement to me. These foreign doctors had to leave their families behind, forking out their own money for their journey to Tansen. They had to pay for their visas and pay for accommodation. They had to deal with angry patients, unreasonable families or malfunctioning equipment. All this without getting a salary. Yet each day they still return to work with a smile, with a renewed passion to serve the people – be it patients, their families or hospital staff.
Why Nepal? Before, during and even after the trip, I was frequently asked, “Why Nepal?” My answer to the question would be somewhat different each time, because the journey to getting there was a complicated and uncertain one, that sometimes I do not even know how I ended up in Nepal. This was especially so during a pandemic when most hospitals were not open to having foreign students on their grounds. But the short answer would be that I did not choose Nepal – God chose Nepal for me. So even though I do not know why, I believe that God has a plan for me, just as He has a plan for each of us.
On my first day in the operating theatre, general surgeon Dr M told me, " I'm still waiting for the day when I'm able to give back to Tansen more than what they have given to me." I did not fully understand what that meant then, but now I do. Tansen gave me a whole new perspective on learning to appreciate the little things, not taking anything for granted, and finding joy in giving without expecting anything in return. And Tansen gave me a family while I was far away from home – the love, care and sincerity of the community there is something I will never forget. Tansen will always have a special place in my heart.