Our story begins in Nepalgunj, located in the southern-mid west region of Nepal, right on the Indian border.  After a long day and our usual nightly debrief session I headed back to my room not knowing that the most primary research I would gather on health was about to happen…you know what they say? Be careful what you wish for.

One of our colleagues was in need of medical attention.  I rushed into the main office to find the hotel owner to find out where exactly we should go to get her proper treatment.  I met Pushpa and the girls back in the bus and relayed what I was told: that there was a good hospital just down the street.  What in the world is going on right now? I thought to myself. Barely hours before I had been asking organizations about what they are doing for people in their community in terms of health services and was coming up with nothing! Now we have to take one of our own to a hospital here? The only saving grace I remembered was what a UN official had told us earlier- that compared with other districts in Nepal, Nepalgunj had a decent grasp on healthcare in terms of number of facilities and their quality.  This calmed me on the bus ride with the others.  Pushpa, myself, our sick friend, and two other girls went to the hospital.  We pulled up to a tall(ish) building blocked off by a large gate.  After the drivers got the attention of the gate keeper and we pulled inside we walked our friend into the ’emergency room’ where I was shocked by what we saw.

In retrospect, I am not sure why I was so stunned to see a dirty room with 6 beds, no curtains. I am surprised I was taken aback by the lack of lab coats and equipment in the room.  We passed a small room where many men were congregated around a few desks, all dressed in normal street clothes and turned the corner into the one room emergency room.  As we laid our friend on the bed I looked down to see an open bucket with bloody syringes just laying inside. By American standards this is NOT ok. As soon as we laid her down I got into defense mode. I was officially out of my comfort zone.  I was focused on observations: what is going on in each corner of the room, what are the doctors saying, who is touching her, how many people are in the room? I realized not only was I feeling quite protective of my colleague who was in pain, I was also needing to research.  For me this was the experience that would define a lot of my research and assumptions about healthcare in Nepal.  I didn’t need to hear about it from others that night…we were living it!

Several things struck me that I will write about not only here but in my later papers.  While the cost of getting our friend into the hospital and treated was relatively low by our standards, registration costing around 200 rupees (less than $5 US), we had to buy all the medicines she needed up front.  Obviously this trip to the hospital didn’t dent our wallet much but if you think about it in terms of what an average Nepali makes a month (we heard a good salary was 5,000 rupees a month but many people do not make even close to that) this isn’t as affordable as it looks.  If you are poor and you bring your loved one into the hospital you have to not only pay the registration fee up front, but  you also have to buy all the medicine you need at the time of service, there are no supplies held in the emergency room itself.  So if you don’t have the money up front, you don’t get the medicine you need. There isn’t this concept of get the care now, pay later like there is here in the US. I can only imagine how many people are disenfranchised by this system.  We can also assume the low cost of service is why the hospital’s condition was relatively poor.  They don’t have the money to get more advanced technology, hire someone to clean the floors every hour, get fancy buckets to dispose of the syringes, ect.  There was also very little privacy…wait there was no privacy.  I already mentioned the lack of curtains around beds in the open emergency room, but even just the mannerisms of people were interesting and new to us coming from our American background.  Several people came around us when we walked in, others came and said everything will be ok-it was just very different then the mindset in the States where people’s medical issues are very private.  In the beginning we didn’t even know who exactly our doctor was because of the lack of lab coats identifying who was who.

I journaled that night about just how dirty the hospital was, but seeing as though this was a city and people were saying how good medical institutions were in Nepalgunj, I wondered just how bad other more rural hospitals were.  I remember thinking to myself, this was bad in my perspective but surely it was better than many other hospitals in this country…this upset me.