Gynaecology Medical Camp
Gulmi, Midwestern Nepal

28th January - 7th February 2003

The International Nepalese Fellowship (INF) has been based in Nepal for nearly 30 years and aims to provide health care, education and support to the people of Nepal. The charity is very active in the west of the country where poverty is at its worst. Nepal is one of the poorest countries in the world. Education and access to health care are lacking and much of the land especially the mountainous regions are very inaccessible.

One area that INF prioritises is healthcare and there are many missionary families working in the leprosy clinics, local hospitals and in rural healthcare posts. One important aspect of the work of INF has been medical camps which I have been involved with for the last two years. The medical camps address different areas of clinical need in the country, gynaecology, ENT, dentistry, plastic surgery and general medicine. A medical camp goes out every two months and lasts for around 10 days. The local population hear about the camps through word of mouth or through the radio. The medical team and equipment are completely portable usually in three Landrovers. Different villages are visited each time depending on the area of need. Sister Ellen Findlay is the camp administrator who coordinates everything. She has lived in Nepal for 30 years and speaks fluent Nepali with a Glaswegian accent!

Gynaecology Medical Camp - Gulmi, Midwestern Nepal

Our calling was to the town of Gulmi which was quite isolated in the midwestern region in the hilly mid section of Nepal. Our facilities were quite good! The local hospital was well built and run by a local GP who cared for the local population, delivered babies by forceps and performed minor operations only. Anything more than this e.g. caesarean sections, road-traffic accidents, however, patients would have to travel 3-4 hours to the nearest big town in Tansen (most people could not afford this). We had an operating theatre with electricity intermittently) and running water! Previous camps have had no electricity and water from a street tap.

The team.

We were fortunate to have a big team with three surgeons, two anaesthetists, two theatre nurses and two GP which meant that we were able to run two theatre tables at a time which meant twice the number of theatre cases. I went as one of the surgeons. In the outpatients the two GPs Betty and Fiona, working with translators, managed to see 1300 patients in 8 days! A record number. Many women had abdominal pain, infertility, prolapses and a variety of other gynae problems. Clearly the throughput of women was very high and most were reassured, but when a 'serious' case came through the clinic they were given plenty of time and care. For example one, women came with an inoperable cervical cancer and we spent some time with her and her family telling her the diagnosis and poor prognosis. The medical system can be very corrupt in Nepal and many families sell all their land and possessions for very little gain. Our prayers, a supply of painkillers and 'take her home and love her' was the only realistic help we could give. Another recently married women came with no periods. We scanned her and found no womb. This was devastating to her as having children in Nepal can secure a family's economic future and stability. Fortunately she had a loving and supportive husband.

In the theatre we carried out 100 operations which were mainly very bad womb prolapses from multiple childbirth and a lack of midwifery care. These are quite big operations and the women had often left the hospital after 3 days to walk home! (Many had walked for days to get to the camp). There were many sterilisations and a few operations for cervical cancer. The surgery was very challenging for everyone - there was very little patient monitoring, no blood products in case of bleeding and a lot of the equipment was sub-standard. Things went well however, and no major complications occurred.

The days work was from 8am to 6pm. We would have worked longer but a night-time curfew from the Maorist rebels put a stop to that (two policemen were killed on the first day). Although the country is in a state-of-emergency it did seem safe in the day and as long as we were in our hotel in the evening we would be OK. Breakfast was hot sweet tea (chia), a boiled egg and curry, lunch - chia and curry, and dinner, guess what, rice and curry. I never had a touch of stomach upset until I had a European meal in Kathmandu!

Future camps Nepal is a rich diverse country and every camp is different, the people are lovely, warm and friendly and grateful. I hope to go back next year for another camp. Each time I go back there is a bigger part of me that wants to stay.

David Nunns
St Peter's Church, Nottingham
Last revised 21st May 2003