Rachel Miller - Nurse in Nepal
Namaste! My name is Rachel Miller and I am a 24-year-old mental health nurse from Kent in the United Kingdom. I have been a mental health nurse for three years after qualifying with a BSc (Hons) in Mental Health Nursing, with registration to practice, and an MSc in War and Psychiatry from King's College London.
I currently work as a community mental health nurse and I am responsible for providing an outpatient community mental health service to patients. This includes therapeutic, educational, and mental health promotion regimes, in accordance with departmental protocols and NICE guidelines (National Institute of Clinical Excellence). I have always been interested in global mental health, specifically in health care rights and social justice towards populations facing the consequences of trauma and adverse events such as natural disasters and war.
To date, I have had some experience of volunteering abroad, which included working in Zimbabwe raising awareness on gender equality and HIV; however, I wanted to expand my work experience by seeing how my profession works in a developing country. I had always been interested in visiting Nepal, especially following the earthquake in April 2015. In October 2016, I had the opportunity for a career break, and subsequently spent four weeks exploring this beautiful country.
My arrival in Nepal
I knew I would enjoy Nepal the moment the plane began to descend into the Kathmandu Valley and I mistook a mountain range for clouds; we were a stone's throw away from Everest region and the mountains were spectacular. I landed at Tribhuvan International Airport mid-morning, where I was greeted by a kind and patient Projects Abroad staff member. They escorted me by taxi through the tiny alleys to the hotel, which was approximately six kilometers away from the airport.
Kathmandu was a lot busier and more polluted than I had imagined and the damage from the earthquake in April 2015 was still evident. I was struck by the incredible hospitality and warm nature of the Nepali people, who welcomed me with immense goodwill. I spent one night in Kathmandu, which was ideal in adjusting to the time difference, and was the perfect opportunity to meet other volunteers before traveling to Chitwan, where I would be spending the next three weeks of my placement.
My Nursing Project in Nepal
After six hours of traveling through the mountains via combi-bus and a cozy tuk-tuk, I arrived in the small town of Chitwan. Chitwan is a rural town on the edge of the jungle so temperatures averaged 30+ degrees most days (so my thermals did not come in handy). On my arrival, I was warmly welcomed by my wonderful host family with a blessing, carnations and a cup of tea (how to please a Brit).
I spent three weeks at Chitwan Medical Teaching Hospital between the psychiatric ward, day center for children with learning difficulties and the homeless shelter for people with disabilities. A typical day at the hospital was: arrive at 07:30 am for nurse's handover followed by morning meditation/exercise class, doctor's discussion with staff, ward-round and cleaning the ward/bed making (the sheets and pillowcases were only changed if blood stained - due to limited replacement sheets).
The morning activities would usually finish by 11:00am and I would go to the day center to volunteer with children with learning disabilities or deliver talks to mental health nurses on evidence based psychological therapies utilized in the UK including Cognitive Behavioral Therapy (CBT) or Eye-Movement Desensitization and Reprocessing.
My time at the psychiatric ward was an eye opening, humbling and, at times, challenging experience. Treatment for mental health is limited and those who are particularly unwell are predominantly treated with antipsychotics or benzodiazepine medications, or alternatively Electric Convulsive Therapy (ECT) as a last resort. Nepal's community mental health teams are limited, there is access to very few psychologists and the mental health act is rarely implemented properly due to stigma affiliated with mental illness.
That aside, I was struck by the staff's positive attitude and resourcefulness, in the context of resource scarcity. I have also found colleague's determination and caliber inspiring. Furthermore, the hospital management are open-minded and keen to improve access to affordable mental health care, including psychological interventions such as Cognitive Behavioral Therapy. I am hopeful for the future of the psychiatric ward.
Even though my specialty is in mental health, I was able to spend time in the Emergency Department also. This was interesting, as you would see varied cases of tropical diseases such as Malaria. I was also exposed to TB cases and on one occasion we had a woman who had been attacked by a wild rhino (fortunately she was okay). I have the utmost respect and admiration for the staff I met on my placement. The conditions they endure including their very low wages and low resources are very difficult, yet they are always calm and positive no matter what the situation.
Weekend traveling in Nepal
Going in October was a fantastic experience, as it was the festival season and an important time of year for the local community, celebrating the festival Dashain (apparently, October is the best time to go trekking too). Although this was a lovely cultural experience, it meant it was quiet in the hospital therefore we had the opportunity to immerse ourselves in local festivities and travel at the weekends. I also stayed in Nepal for a week after volunteering which meant I was able to see some of the amazing places Nepal has to offer including: Lumbini (the birth place of the Buddha), Pokhara, Meghali and Chitwan National Park.
Nepal is a beautifully diverse country. My time as a mental health nurse in Nepal was professionally and personally fulfilling, rewarding and at times very challenging. Since my return, I have sent psycho-education materials including mindfulness techniques, CBT books and guided relaxation strategies to the mental health ward. Additionally, following your experience, you are asked to write a report of recommendations and how your experience differs to practice in your home country. Overall, I am glad to have had the opportunity to volunteer in Nepal, I have met inspiring people, made good friends and it was privilege to be part of the Project Abroad experience.
Subhakamana (cheers and good health)!