It had probably been building for a few days but the culture shock hit me today. We spent the morning on a ward at the Fishtail Hospital and things were done differently to how we are used to doing them in Australia. It is not that they were good or bad, but just different. I am trying to be especially mindful that I am in a different culture and I am not a wise woman from the east coming to tell others how things should be done, but rather an observer in a foreign land. I will admit though that processing all the differences at once was exhausting. One of the main differences was the ward had 15 patients with one nurse in one large Florence Nightingale style open ward. Admittedly every patient is also accompanied by numerous family members who take care of the activities of daily living (ADLs) such as feeding (they go and purchase food from the hospital canteen for the patients), wash them, toilet them and make sure they are comfortable. They also take the doctors prescription to the hospital pharmacy and pay for the medication before bringing it back to the ward for the nurse to administer.

The medications were slightly different to what we were used to in Australia with all patients receiving IV antibiotics having a small amount injected intradermally to check for a reaction. Cannulation was predominately between the thumb and wrist. Observations were taken using manual instruments (sphygmomanometer, thermometer with temp taken under the arm, and oximetry and pulse taken with a small portable pulse oximeter. Respiratory rates were not taken. Interestingly no patient had their blood sugar checked, even those admitted with pancreatitis and type II diabetes.

After lunch we visited Naulo Ghumti Nepal, an NGO set up to help people with drug addictions and/or HIV. They offer drug counselling, treatment and rehab programs of 3-4 weeks and provide community engagement with needle exchange programs and education aimed at reducing the stigma of IV drug users, people with HIV and those with mental health problems. Over 40,000 Nepalese people live with HIV with 37% of these people not using antiretroviral therapy. We were pleased as a group to present Naulo Ghumti with money we had raised prior to our visit which they will use to continue their efforts in Pokhara.

We then visited the Himalayan Eye Hospital where we were able to present the items we had collected for this hospital. Being at such a high altitude with people living way into the hills surrounding Pokhara, there is a high incidence of cataract of the eye. The eye hospital provides over 5000 surgeries each year and is responsible for restoring and maintaining sight in many Nepalese people. Our donations were very well received and we were promised will be put to good use.

Tomorrow we are back at the hospital. I will keep observing and trying to make sense of what I see, however I think that a lot of this will not become concrete until towards the end of the trip or even once we are back in Australia.