Clinical placements

Don’t take the NHS for granted

An eye-opening elective placement in an emergency department in Nepal reminded nursing student Christopher Maguire why a world-class service free at the point of delivery is such a blessing
Kathmandu_tile_iStock.jpg

An eye-opening elective placement in an emergency department in Nepal reminded nursing student Christopher Maguire why a world-class service free at the point of delivery is such a blessing.

In my final year of nurse training I undertook an elective placement in Nepal, spending three weeks in an emergency department in Kathmandu.

In the UK, we walk in to an emergency department and are treated with up-to-date, evidence-based care, and we dont have to pay a bill at reception as we leave. In Kathmandu, this was not the case.

Nepals ambulance service was pretty much non-existent. Instead, there were privately-owned white vans with oxygen cylinders in the back, which required payment on arrival. This meant that critically ill patients often arrived at hospital by taxi, which was cheaper.

Lack of

...

An eye-opening elective placement in an emergency department in Nepal reminded nursing student Christopher Maguire why a world-class service free at the point of delivery is such a blessing.


In Nepal, health care is neither free nor safe.            Picture: iStock

In my final year of nurse training I undertook an elective placement in Nepal, spending three weeks in an emergency department in Kathmandu. 

In the UK, we walk in to an emergency department and are treated with up-to-date, evidence-based care, and we don’t have to pay a bill at reception as we leave. In Kathmandu, this was not the case. 

Nepal’s ambulance service was pretty much non-existent. Instead, there were privately-owned white vans with oxygen cylinders in the back, which required payment on arrival. This meant that critically ill patients often arrived at hospital by taxi, which was cheaper. 

Lack of hygiene 

After being triaged, patients were lucky if they got a bed to themselves. At their most unwell and vulnerable, and despite paying for the service, patients often had to share a bed with a stranger.

The treatment was relatively similar to that in the UK, but the difference was in the resources. The hospital provided specialist equipment for use in resuscitation, but this was often washed rather than replaced after patient use, highlighting a worrying lack of hygiene. 

The only time cleaning appeared to take place was in the morning, when family members were asked to leave and cleaners arrived to mop the floor with dirty water. 

Unbearable to see

Beds were never washed, nor was the equipment in the department, which was used for every patient. There was one sink for staff to wash their hands but no soap, meaning you were almost guaranteed to leave with some sort of infection. 

Trying to undertake CPR was difficult. The beds were so old and unstable that someone had to hold the bed still as you compressed the chest. There were no machine ventilators in the department, so if a patient needed to be ventilated this was done manually with an ambubag. 

Due to insufficient staffing, critically ill patients were ventilated by their family members. This could go on for hours, with everyone in the department watching, as there were no curtains for privacy. It was unbearable to see, and I often volunteered to take over for the family. 

A blessing 

In the UK, we have a maximum four-hour waiting time in emergency departments, but we know patients often wait longer. In Nepal, patients could wait three days or more to be admitted. Food was never provided: it was the responsibility of the patient’s family to feed and wash them.  

The staff did incredibly well to manage in such challenging conditions, and my fellow students and I were always treated with the utmost respect and understanding. 

This experience changed the way I look at the NHS and reminded me why we should continue to support it and never take it for granted. Yes, it has its problems, with patients on long waiting lists and staff under extreme pressure, but to have a service that is world class and free at the point of delivery is such a blessing. 


About the author 

 

 

 

Christopher Maguire is a nursing student at Queen’s University, Belfast 

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursing standard.com and the Nursing Standard app
  • Monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs