Shanti Medical Clinic, Chitre

Simon Wydall, the first HELP volunteer to undertake a medical assignment, worked at a clinic in a small village on the Annapurna circuit trail earlier this year (2013). Here is an edited version of what he had to say about his experiences:

I was a final year medical student having just finished finals, and was completing my elective in Chitre. I found the whole experience extremely enjoyable and rewarding and would recommend it to others wanting to do a slightly different elective away from hospital medicine. I would also recommend it to anyone who is either passionate to help communities such as Chitre or has past experience in similar situations.

Chitre clinic, Simon Wydall 3The Clinic
The clinic is situated in Chitre, a rural village in the Annapurna mountain range in Nepal. It was built and is funded by Himalayan Projects. It is staffed by a Nepalese ‘Community Medical Assistant’ who has had one year formal training. She lives in the clinic building, providing a 24 hour service to patients including home visits. The clinic has an examination room with a large couch, a dental chair and an obstetric birthing table with lithotomy supports.

There is no charge for consultations, however, medication or equipment is purchased by the patient (unless the medicine is provided by the WHO or government for free). The nearest hospitals are in Beni and Pokhara.

Chitre medical clinicThe Population
Chitre has a population of approximately 150 and the clinic also serves surrounding villages. Few people speak English (mainly younger people or those involved with tourism), however, the Community Medical Assistant has a good level of English and knowledge of medical terms.

Pathology
The types of disease you will encounter are very similar to any general practice. Respiratory, gastrointestinal and obstetric presentations were the most common alongside acute and chronic pain. There is a role for physiotherapy in the village especially for the common complaint of lower back pain.

Challenges
• Untreated and often undiagnosed chronic conditions, especially cardiovascular and respiratory.
• Obstetric safety.
• The burden of untreated urological problems such as lower urinary tract symptoms (LUTS) in elderly gentlemen and prolapse in women.
• Local health beliefs and understanding of disease and medication: many people do not know about viruses and bacteria and have the impression that medication will instantly cure disease. Concordance with medication courses can also be an issue.

Chitre clinic, Simon Wydall 4Interventions
• Education:
o Adults
o Children: at both local primary and secondary schools
o The Community Medical Assistant is receptive to new ideas and ways of working.
• Introduction of simple screening/bedside tests (for example urine dipstick testing and capillary blood glucose).
• Your own ideas.

Volunteers
Anyone with medical, nursing or dental training who is willing to help in this rural community will have a great impact! I would recommend volunteering in Chitre to anyone who is either passionate to help communities such as Chitre, has past experience in similar situations or anyone considering an elective special study module.

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Volunteering with HELP offers all the good things of working with a small, personal organisation: in-depth local knowledge from the HELP organisers, and the feeling that one is doing something for the first time.
Daniel CookAlgarah School