Nathasha in the Mountains
‘A dream is a wish your heart makes…’
Volunteering is a kind of madness. But probably the best kind to have.
In October 2016, I was blessed to finally get back to Nepal and make a teeny tiny difference.
My name is Nathasha Basheer. I’m a Paediatric trainee from bonnie Belfast, living and working in Scotland. In March 2013, following a series of (what I now call) fortunate events, I found myself on the Everest Basecamp Trek in Nepal. That trip changed my life.
Being of Indian origin, I thought I knew it all, Nepal would totally be the same. I was wrong. It took my breath away and it continues to do so every time I go.
I recall the exact moment I found out about the earthquake in 2015. Neonatal ward round, BBC News alert on my phone. ‘Put your phone away!!’ someone kindly barked. No, people are dying. And you have to care.
It lit a fire that burned, and for a whole year and half I tried and failed to get the time from work to go to Nepal and do whatever I could. Cue Wild Medic.
The Wild Medic Project is an Australian company run by a dedicated team of enthusiasts. It is run, so far, primarily for Paramedics. So why not throw an eager Paediatrician into the mix?!I knew my limitations from the word go. Pre-hospital is a different kind of animal, and one that I was very unfamiliar with.
Back before base camp, in 2012 I had put myself through an Expedition and Wilderness Medicine Course run by the UK expedition medicine crew. I had panicked - I’m going to be a doctor up a mountain, what if something goes wrong?!
So I dusted the cobwebs of my Expedition Handbook and began to read ferociously. Handy hints on pre-expedition prep, Oral Rehydration Solution and the best anti-diarrhoeal peppering my brain. ‘I’ll just bring it with me’.
It still didn’t feel enough. And within the months leading up to my trip, I had badgered my Paediatric A+E and surgical colleagues and even a lovely Paramedic student Craig who had visited our ward as part of his routine training. Bless, he had no idea I was to lynch him, demand his contact details and then bug him and his ambulance crew for some time on the road with them.
It was a fantastic experience. And opened my eyes to pre-hospital medicine, the mentality, the ethos and even the risks and dangers often faced by my paramedic colleagues. Not only that, it really helped me, as a hospital physician, to appreciate the patient journey. Ill health starts at home and management and care also start at home. I’ll definitely be taking this forward into future practice.
I hoped my time with the paramedics would allow me to understand how the rest of my group was used to practising medicine. And as the Clinical Leader of the group, I didn’t want there to be a ‘them and us’ situation going on. We are all one, and if anything I am the outsider here.My nervousness at pre-hospital was nothing compared to my nervousness of treating adults again!
There is a reason why Paediatricians do what they do. Ask anybody that works with kids, from the nurses to the doctors to the auxiliaries - why do you work in Paediatrics? ‘Because I just couldn’t do smelly adults’ will usually be the answer.
To tackle some of these fears, I attended a Minor Injury Study Day hosted by my Paediatric A+E colleagues. Ok it wasn’t adult, but it still covered wounds and minor injuries that are often encountered and quite often not dealt with by myself or other doctors but by our Advance Nurse Practitioners. It was an excellent day and a useful recap.
I also spent an evening, with tea and nibbles, that involved suturing lemons and bananas with a friend and surgical colleague of mine. Wounds are not my bread and butter, though they are common in pre-hospital and very common in Nepal. And having never done an Adult A+E job, and with kids keeping to glue or steri-strips, suturing is a skill that had been relegated to my past life. I was prepared to suture if needs be, though in truth debridement and dressings were sufficient for almost all of our patients.
There was one boy with a particularly nasty toe infection who we hummed and hawed over. He had cut the bottom of his big toe with some broken glass, and had come to our campsite looking for help. He was 5 years old. His wound was 2 days old and wrapped in leaves and rags. Olivia, one of our team, unwrapped and started the debridement process. As she cleaned, it became obvious that it was a fairly nasty wound with some dead skin and slough already evident. Our fears, of course, were infection. ‘Get that dog away from here!’ I yelled as a nosy mongrel approached for a sniff. Our Nepali doctor, who had joined us from a neighbouring NGO, and I had a discussion regarding whether it would need closed. Cleaning, irrigation and sterility were key. My personal preference was to remove the dead skin, leave it open and dress it well, with follow up dressings recommended (though the question of where rang in my mind - Melamchi? Kathmandu? Local health post in Chitre? Next group?). We had one vial of 2% Lignocaine, several sterile size 8.5 gloves (I am 5 foot tall, these were almost the size of my face), and some suture instruments which we sterilised in boiling water. The same suture instruments I had practised on lemons and bananas.
There are many things that make Expedition Medicine and volunteer work difficult, but this was one of the times where I really felt the lack of language skills necessary to calm and reassure this poor little boy. In the end, I called a halt to operation suture and spoke a combination of English, Hindi and random Nepali words in an attempt to regain his trust.
Children are not like adults. Their fear shows in their eyes and falls as tears. They cannot be reasoned with. They must be coaxed and cajoled. I say this and I laugh in my mind. Adults are exactly the same. Slowly, somehow, I regained his trust. But I was not willing to hold him down and put a needle in him. We were already risking the sterility of the debridement process by his not unfounded anxiety. In the end, Olivia and Jess (the good cops), wrapped and dressed it in Betadine and Lignocaine impregnated gauze and by the end he was laughing at my silly faces, chewing happily on biscuits and wielding a new toothbrush. I call this a win.
Our team (Olivia, Sam, Jess, Steph and Lee) were excellent and I cannot thank them enough for their hard work and professionalism throughout the trip.
‘Gestalt’. We had a feeling things were getting out of control and at that point stopped and thought again. Gestalt is a very important part of many clinical decisions, do not ignore it, for it is the summation of your knowledge and experience. It is your gut instinct and your gut rarely lies.
If your gut is telling you this may be the trip for you, I strongly suggest you follow it.
‘No matter how your heart is grieving
If you keep on believing
The dream that you wish will come true…’