#upap

We were warned that the drive to Dunche was similar to off-roading in southern Utah. Looking at a giant truck just inches away from one side of our jeep and, quite literally, multiple thousands of feet of vertical drop on the other, I would instead say that the best off-road Jeep enthusiasts in our state could not handle the main road into town. Littered with rocks, leftover landslide debris, and some of the most sheer cliffs that I have ever seen, the drivers that tackle two-way traffic on those roads (in manual vehicles, no less) are fearless. We had more than one bend pointed out to us where entire buses had tipped and rolled to the valley floor with no survivors.

After eight hours of being jostled in the backs of our respective vehicles, we arrived in the quaint little town of Dunche. Just 34 km from the China border, the residents here look and dress very differently from the dominant socioethnic groups in Kathmandu. Terraced fields rise up from the main street running through town, giving way to steep forested hills. This region in particular was close to the epicenter of one of the earthquakes in 2015, and the hospital we are working at was only finished a few months ago. The dedicated doctors and staff have been operating out of field tents for the past three years, through snow, monsoons, dust, and variable electricity and supplies.

Tomorrow, we start at the hospital rounding with two doctors, Prabal and Kamal. Both are recent MBBS graduates, which is a close equivalent of the medical doctor (MD) degree in the US. As part of a scholarship program, both have been assigned to practice a rural clinic (Dunche) for two years. Much like in the US, rural areas are chronically short on providers, and scholarship programs (or loan repayment in the US) are some of the only incentives that governments have found to fill those slots. For the communities, this is a double-edged sword: they have providers available, but they rarely stay longer than 2-3 years and provide longstanding continuity of care.

Just as it was a whirlwind in Nepal, returning back to the States has been just as chaotic! I landed at 12:30 AM last Sunday, and had to re-pack everything from my bags to my car by Tuesday morning to drive down to Monument Valley and start my next clinical rotation! For the next month, I have the privilege of continuing to work with rural healthcare – this time in rural Utah on the Navajo reservation. Health statistics on the reservation (life expectancy, rates of certain diseases, etc.) are often compared to similar rates of mortality and morbidity in developing countries, so there are a lot of medical parallels with my last rotation in Nepal.

Much like Nepal, the scenery coming down here is spectacular (though red rock monoliths and endless blue sky have replaced the lush green and white mountains of the Annapurna). Also much like Nepal, my accommodations are humble – I am living out of my tent at the Monument Valley Tipi Village, which is adorable! There is a central kitchen (with a fridge!), and a HOT shower anytime I want it (so, actually, even more glamorous than Nepal!). Another similarity to last month is the diversity of the community around me. From Navajo to French to German to Swiss to Hindi, the myriad languages I hear each evening at the campground is a lot like travelling internationally.

Transiting back to clinic was a bit difficult on the first day. Though I learned a lot about what to do with little to no resources in Nepal, it took me a few patients to remember all that we have available in the States! Even in a place as comparatively remote as Monument Valley, we still have the luxury of a lot of point-of-care lab testing (or the ability to send it out for a patient, without sending the patient themselves to the nearest city). I had to re-learn to change my default thinking from, “that’s not available here,” to “that’s something we can do!”

The biggest lesson from Nepal, however, is still true here: these patients have given up hours of their days to travel long distances to come to this clinic. In the US, where we put such a high priority on getting patients in and out quickly, I’m grateful to my time in Nepal to remember to put myself in the patient’s shoes. I still need to be efficient, but not at the expense of giving the patient enough time to be heard and honored for the effort that they put into coming to see me for care.