Below is a collection of articles written by past students about their experiences at Tansen Mission Hospital:

 “…the reality of doing a medical elective course in Nepal was a real challenge…”    writes Jin Hyun Kim, a final year Medical Student from South Korea                    

Namasthe! My name is Jin Hyun Kim from Konkuk University School of Medicine in the Republic of Korea.

 Since I started studying medicine, I have wanted to help people in foreign countries in the future. However, this was more in my thinking than anywhere else. Before going to Tansen the reality of doing a medical elective course in Nepal was a real challenge, however I believed that it was time to go. 

Studying / working in Tansen was challenging due to the differences - culture, customs and language. You need determination to continue to learn and work when so much is new. To be truthful, yes, it was different than medicine back home, but I was well briefed before and after arrival in country as to some of the cultural / work differences I would find. 

In terms of my clinical work, I was able to do many procedures that I wouldn't have a chance to do in my school back in Korea, and see cases / diagnoses that I had never seen before. The doctors always gave great supervision and chances to join in the decision-making. The variety of cases that I met with meant there was plenty to read up on, and discussions with colleagues, as well as some of the practical teaching given, built on my theory.

In addition, there was a nice library to study with books and journals that helped me a lot. Moreover, I met many people who serve their life in Tansen community. That was the most precious thing in Tansen Mission Hospital. They came from all over the world to help Nepali people. They showed me who is a man of action.I'll never forget them. Also, I made good Nepali friends in Hospital. They are Nurses, Anesthetists, Interns and nursing school students.They joyfully welcomed the visitor. No better opportunity will ever come to me.  

I thank God for giving me valuable moments in Tansen Mission Hospital. 

Jin Hyun Kim

Medical Elective Student in 2008

Hospital, heights and hearts

 by Helen Begbie, UK Medical Student in 2008 

Fresh out of Finals, I travelled bleary-eyed yet excited to Tansen for my medical elective. Arriving at Tansen, you are immediately struck by the beauty of this hillside town. I was warmly welcomed by a fellow medical student and promptly informed of my social calendar for the next few days! Indeed, I was immediately introduced to the international missionary doctors working at Tansen, who became inspiring friends and colleagues during my time there. Being shown around the hospital, I was touched by the friendliness of everyone - even if that extended to being told my skirt looked like a petticoat by a giggling nurse!  

My first lesson was to throw away any previous naïve expectations of ‘making a difference’ in Tansen. The hospital is well staffed with highly skilled and knowledgeable Nepali doctors. Although initially disappointed at my evaporating visions of single-handedly saving ten lives a day, I quickly came to enjoy my privileged position. The morning ward rounds were spent helping to assess patients with the aid of translating student nurses. Then after a quick ‘chia’ (Nepali tea i.e. essential social event of the morning) and PowerPoint tutorial (yes – even in Nepal!), there was time to examine patients with signs or help with jobs. After lunch, the afternoons were usually spent in outpatients learning from the senior doctors. I also took Nepali language lessons each week - a particular highlight for me.  

Whist at Tansen, I had the chance to work in all hospital departments day and night, deliver babies, observe many operations and visit a remote health clinic. There were patients with diseases I was less familiar with (rheumatic fever, malnutrition and tuberculosis) as well as some unexpected old friends (diabetes, depression and COPD). Life outside the hospital was seen as equally important, and I have wonderful memories of leading worship, celebrating Easter Nepali-style, learning to make Nepali food, and lots of Nepali dancing!  

I would thoroughly recommend doing your medical elective in Tansen unless you are hoping for an elective where your medical skills are indispensable. However, if for example this would be your first time in a developing country or you just want a supportive, challenging yet social time, you wouldn’t be disappointed! 

I was a final year med student from Australia, who knew little about Nepal (it has big mountains, right?) and less about Tansen. So I went with a fairly open mind about what to expect during my time there. The arrival process gave a fair indication of what to expect for the next 2 months; a 9hr bus ride that mixed beauty and terror with the great views, and shocking drivers! That pretty much sums up my time as a student in Tansen, many times great fun and learning and occasional moments of complete uncertainty and terror, like when a large traffic accident is coming in, and ALL the doctors are at emergency waiting with gloves at the ready.

Medically, there were a lot of the classic diseases mixed in with the exotic, so I never got too bored of the clinics – because I never knew what was going to walk in the door next. However, as language is such a crucial part of a consult and my Nepali was rudimentary at best I was mainly an observer in these clinics. Socially, I had trouble keeping up with what was going on, because of the many visitors passing through, and numerous dinner engagements along the way. It was a real inspiration for me to be able to sit at the feet of those have been in mission for a while, and to listen to what they have to say.

If you go you will have a very eye-opening time, there will be periods of boredom, mixed with a few moments of terror, but you won’t be on your own!

Lyndsay McLellan from the UK describes her time at Tansen in April 2009: 

Tansen Mission Hospital is a 137 bed hospital in the Western Hills of Nepal which opened in 1954. Tansen itself is a lively old town with a population of around 25,000 and is the capital of Palpa District. The hospital serves a population of up to 5 million people, with some people travelling from India to get there. Frequently, patients will have travelled there on foot or by bus for several days.

Wards include general medical and surgical, paediatrics, maternity and orthopaedic and a new A&E department. The hospital is constantly expanding, with the current development of a new laboratory and an ENT department that is looking for a long-awaited ENT surgeon! Development at the hospital is mainly limited by finances and staff. Patients pay for every clinic they attend, every procedure and all their medication. They often have to sell livestock or land to afford it. There is a pastoral care team at the hospital whose role it is to assess the poorest of patients financially to discern whether they require financial aid for their medical care.

Incredibly, Tansen Mission Hospital does about 16% of all the surgery carried out in Nepal. A surprising number of the orthopaedic surgical cases are middle-aged women who have had a fall from a tree following attempts to pick leaves to feed their goats!

In order to become involved in life at the hospital and communicate more effectively with patients, I decided to have some language lessons. The language barrier was an initial limitation to my role as a medical student, but I quickly gained confidence and was able to take basic histories and examinations of my own patients during ward rounds that I would follow up until they were discharged. It was a real encouragement to try out something I had learned in a language lesson and have the patient respond! The interns and doctors around were most obliging and were often helping me out with my language!

I started my elective on the general medial ward for three weeks. The day stated at 7.45 with prayer and a handover from the interns who had been on call that night. Ward rounds would then commence. I was able to take responsibility for a number of patients and present them to the consultant as we did the round every day. It was good to follow patients through from admission to discharge as I was able to see the effects of the treatments on each patient.

One malnourished 16 year old girl had been on the medical ward for over 180 days because her oxygen saturation levels had to be maintained. She didn’t have a definitive diagnosis, and although the working diagnosis was ARDS, investigations were ongoing to look for heart defects or chronic pulmonary emboli as her diagnosis could not be confirmed. It was surprising that her family had kept her in hospital for so long because in Nepal, girls are usually not cared for as well as boys, and it cost the family a lot of money to keep her in hospital. Many families would have given up and taken her home to die.

One thing I found difficult was that often the vital signs were recorded inaccurately by the nurses. It seemed they were influenced by previous records and didn’t understand the need for accuracy. It was frustrating not being able to trust these recordings and having to double check everything. I checked several patients whose pulse had been recorded as <100 when it was actually >150 beats per minute.

After ward rounds there was often tutorials ran by the interns and supervised by consultants. The quality of teaching there was excellent. In the afternoons, I attended clinics or stayed on the wards where I saw a variety of tropical diseases, including many cases of TB and other rare conditions, often more advanced due to the cost of treatment and distance to hospital. Procedures were often required and I was able to improve my practical skills in lumber punctures and ascetic taps. This will equip me better for start my job as an F1 doctor in August as I will have confidence to perform these tasks without supervision.

The treatment regimes were simple, affordable and appropriate to the local situation. Statins, for example, were uncommonly prescribed as they were seen as unnecessary for patients who had little money to afford them. This has given me an appreciation of the comprehensive free care within the UK National Health Service, leading to greater equality between the care of patients.

I spent the last two weeks on the paediatric ward. Again, I took responsibility for my own patients and formulated treatment plans after reviewing them each day under the supervision of amazing consultants. Some of the cases were very different from conditions I have seen in the UK. One 3 year old girl had ingested 50mls of paraffin oil and had subsequently developed a chemical pneumonitis. There were no ventilators at the hospital to maintain her respirations. Her family had to take her on the long, windy 6-hour bus journey to a hospital in Pokhara before she deteriorated. I found it hard that so many children died over the time I was at the hospital, when in another situation with greater resources, they may have survived. However, this is held in tension with finances of patients, training of staff and funding to run such facilities.

I cannot recommend Tansen Mission Hospital enough as a prospective elective destination. Patients attend with a huge variety of pathologies at differing stages and it is a great opportunity to see the rarer conditions that we miss out on here in the UK. There is a huge amount to get involved in, whether it is inserting a chest drain or assisting in a massive bus accident and if you’re willing to learn a bit of the language, the patients warm to you a treat! I loved being involved in the team of doctors, including ex-patriot consultants and Nepali interns who made us feel so welcome. I would choose to go there all over again!

Tom Donaldson was here in July 2009 and writes to give prospective medical students an idea of what to expect:

United Mission Hospital Tansen was a great place for a medical elective. I was provided with plenty of information before coming, which was really helpful in getting prepared. In Tansen there is a good guesthouse, the chance to have Nepali lessons, which are really helpful on the wards, and lots of support. The placement provides a great chance to see a variety of rare and interesting conditions and the hospital staff are a very friendly and welcoming team to be part of. It was also a good opportunity to live as part of a mission community and learn about the challenges and opportunities involved in medical mission work. Tansen is also a beautiful part of the world, with the Himalayas in view (as long as it isn't the monsoon!).