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Studying medicine at the foothills of Himalayas, Kathmandu valley

Hello all! My name is Madushika and I completed my MBBS in Pokhara, Nepal, following which I entered a 365-day compulsory rotational internship. Internship was hard albeit an interesting experience. The hospital I worked at was a tertiary hospital in a town, Pokhara, situated about 250 kilometers from Kathmandu. It was an 800 bed hospital with about 1500 staff members (including doctors, nurses, technicians). Doctors, mainly interns who worked there, used to describe the experience as unique. If I had to pick one department and call it a favorite I would pick the emergency room. Then next I would pick the Medical ICU. Why those two departments? I was given the opportunity to handle patients in the emergency room from start to finish. In the medical ICU I was able to stay awake the whole night and monitor 14 cases (capacity of ICU). I was supervised and was always reporting to a senior, but the ability to take full control of most emergency situations was an experience I will never forget. We had two consultants in the emergency room, critical care consultants, they were ready to teach at any given moment and everything I learned from them, I apply to this day. That is the time I learned to think on my feet and always improvise and adapt. Everyday there would be at least one patient, who was poverty stricken and unable to afford medication or care. The hospital was able to provide as much allowance as possible for most patients. The students of the university ran a charity fund called the ‘PPF: Poor patient fund” where each student donated a set amount every month until they leave the university. This was able to help many patients. Experience I gained, gave me the insight to difficulties faced by people of low economic households. This insight, taught me the importance of being able to access affordable healthcare. During this time, was when it dawned on me, that I wanted to open a free clinic in Sri lanka, in a remote location for underprivileged people, one day.

If I was to talk about experience I gained over one year, I could talk for days on. I remember one particular incident. A 55-year-old man, presented to the ER, with signs of a hemorrhagic stroke and this was quite early on in my internship. He had to be taken for a MRI in another hospital about 20 minutes away. I was going in the ambulance with him. Throughout the journey, he arrested several times and it was just him, the driver and myself. I had to perform CPR and keep him alive to the best of my abilities. To top that, it was a hailstorm and there was no phone signal. Rugged terrain included, it was quite a difficult journey. MRI was done, stroke was confirmed and he was returned to the base hospital. He made a near full recovery. I am glad I was the doctor in that ambulance and such experiences molded me into the doctor that I am today. Nepal is a beautiful country with loving, patriotic people, despite many challenges, they seemed to cope well. While I was in 4th year of medical school, 8 Richter scale earthquake struck Nepal in 2015, which resulted in a lot of displacement, deaths, electricity and water supply was disrupted. There is a well-known tower in Kathmandu, call the Dharahara tower, which is a heritage sight and it was severely damaged by the earthquake. Several other historic sites were damaged as well. As all medical students do, we had good times too, I tried many different Nepali cuisines, went on treks and kayaking. I have a collection of photos with the picturesque Himalayas as a backdrop, made friends for life and learnt two new languages. Most importantly, I learned to take care of myself and live on my own. Working as a doctor in Pokhara, definitely taught me teamwork, compassion and dedication. I believe all the experience I gained during this time, laid the perfect foundation on my journey onwards, as a doctor. I learned about true love and real problems people face, but I also learned to prioritize and compartmentalize so that I could focus fully on a patients’ wellbeing. I realized that the patients best interest depended on unbiased medical decisions. I will always fondly remember Nepal and be grateful for it being the place where I graduated as a doctor, to serve humanity for the rest of my life.

Dr. Madushika Rajapakse

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