The Internship in Nepal Helped the Residents of the Faculty of Medicine to Appreciate What We Have in Lithuania

Poverty, a different kind of healthcare system to what we are used to, the breath-taking Himalayan mountains and the people of Nepal, are ever ready to come to your aid. This perhaps sums up the experience of residents of the Faculty of Medicine at Vilnius University during their time in Nepal. After the break caused by the COVID-19 pandemic, third-year students Vytautė Žukauskaitė and Mantas Jodinskas and fourth-year student Donatas Stauskis from the Department of Orthopedics and Traumatology, undertook their 3-week work experience in Nepal, at the Madhesh Institute of Health Sciences and the local hospital.

During our conversation, the students expressed their gratitude to the Head of the Centre for Orthopedics and Traumatology orthopedic traumatologist Prof. Valentinas Uvarovas. As a result of his acquaintance with the orthopedic traumatologist Prof. Ram K Shah in Nepal, this exchange, allowing residents to gain knowledge and experience abroad, was possible. These exchanges have been taking place for a decade now.

Nepal struggles with hygiene, order and rules

“Poverty is the word that best describes what we saw in Nepal. Widespread poverty,” Vytautė said. According to Vytautė, the healthcare system in Nepal is different from that in Lithuania – state compensated medical services are absent there. “This means that there are far fewer surgeries because people simply can’t afford to pay for them. Sometimes the entire village collects the money to provide help to one person. Consequently, doctors have less opportunity to practise. Prosthetics and other similar surgeries for them are very rare! However, they perform quite a few reconstructive surgeries to repair the effects caused by a lack of timely medical assistance when a fracture first occurred.”

The students noted that there was hardly any difference between public and private healthcare facilities. In some cases, public hospitals were even better equipped. The host country struggled with hygiene, order, structure and rules. “The town of Janakpurdham, where we had our work experience, is near the border with India, so almost everything is imbued with the Indian spirit. At home in Lithuania, for example, it is customary for us to maintain order on the streets and throw rubbish in the bins, but in Nepal’s cities, everything looks the opposite completely. Cows and wild dogs roam the streets. The hospital itself also did not seem to be subject to any sense of “order.” The notion of sterility is very different,” Donatas said.

Interestingly, during their work practice in Nepal, residents also visited a leprosy hospital. Although it is a forgotten disease in Lithuania, many people still suffer from this disease in Nepal. This hospital receives support from the United Kingdom, the United States and Switzerland, and is like another world – both the buildings and the infrastructure are of Western standards. The hospital not only treats patients but also provides educational services explaining how to care for one’s hands and feet to avoid complications.

The impressive grandeur of the Himalayas and the goodwill of the locals

Describing their adventures during this trip – an inseparable part of sharing one’s travel impressions – the students spoke of their climb in the Himalayas. Donatas explained, “At the altitude of almost 4 kilometres, I started showing all the symptoms of altitude sickness. So I had to return in a helicopter”. Travel insurance purchased before the trip was very helpful for covering contingency expenses. According to Mantas, the students always joked about it, explaining to the Nepalese that the highest mountain in Lithuania is just under 300 meters. In Nepal, the mountains are 8-9 kilometres high, “the difference is, therefore, huge and we didn’t know how our bodies would respond to such altitudes.”

Despite the incident, the beauty of the Himalayas, and the goodwill of the locals, were the most memorable things. “Being surrounded by the mountains, you understand how small you are, and how insignificant your supposedly huge problems, really are. I was also impressed by how very warm the people of Nepal are. Although they live in absolute poverty, they are content with what they have and don’t complain,” Vytautė said. Donatas and Mantas were impressed by the willingness of people to help. Even if the travellers encountered small problems, a few phone calls by the locals solved everything. Of course, they were also happy with some financial gratitude for their help.

Work experience taught gratitude

Vytautė noted that work experience in Nepal provided an opportunity to see how healthcare works in an impoverished country and how doctors manage to find solutions working with only what is available. It also illustrated that not only skills are important for a doctor, but also leadership and the ability to work in a team. The student gained the motivation and ambition for making a change in Lithuania: “Conditions in Nepal are incomparably worse, but doctors working in Nepal are still trying to take action and achieve something. It reminds us that a contribution from just a single person can make a big difference.”

Mantas added that although Nepal is a much poorer country than Lithuania, the Nepalese do not feel inferior. On the contrary, they are doing their best, going for work practices and internships abroad, and viewing the future positively. This experience allows us to re-evaluate what we have: “In Lithuania, we complain about the things we want to be fixed. But when you go to Nepal, you realize that everything is fine with us – we have many opportunities, we just have to do something about it. Sometimes it seems we are evaluating everything within European terms – we travel and go to conferences in Europe. But outside of Europe, the world is often completely different! It is very healthy to broaden your horizons regarding how people live, work, and are treated in other healthcare facilities.”

According to Donatas, when looking for places to improve their knowledge and skills, doctors are looking at Switzerland, the United States or other powerful states: “Nobody goes to poorer countries because they think they will not learn or see anything there. But I think getting to know the healthcare structure of any country broadens your understanding. Notably, in Nepal for example, most doctors have a great deal of knowledge and have studied or done internships in different parts of the world. So the discussion with them becomes very fulfilling – they can compare and contrast different experiences.”

At the end of the interview, the students encouraged their peers to take the opportunity to have work practice outside Europe. “I think we will remember this journey for the rest of our lives. It’s a really great gift, thanks to Prof. Uvarovas and Vilnius University!” Vytautė concluded.