The Intensive Care Unit

My first week started with a city introduction and my first shift in Tribhuvan International Teaching Hospital's Intensive Care Unit (ICU).

After settling into my home for the next month and unpacking, meeting room/housemates and delving into my first Nepalese dish (delicious chicken momos) I explored Thamel, the tourist district. Chaotic traffic, cars overtaking each other left, right and centre and police on every corner introduced me to this country that lacked the infrastructure I am used to back in England. 

Tiny streets lined with shops, restaurants, cafes and several very large potholes paved a maze of culture and Nepal's biggest income - tourism. After getting a new SIM card, withdrawing some Nepalese Rupee from a local bank and trying some local tea I went back to the house to prepare for my first day of placement.

Before placement I came up with several objectives that I wanted to achieve during my month in Nepal. These included:

- Understanding the difference in holistic care provision between the UK and Nepal

- Understanding critical care policy/procedure differences and assessing whether there were obvious cases of patient harm.

- Looking into the culture and environment for learning, if present, and analyse how patients are kept safe.

- The availability of certain drugs and whether cost was prioritised over efficacy.

My first day of placement started at 7am, followed by a small breakfast and a 10p bus ride to the hospital. Upon entering the hospital I was greeted with dark concrete hallways, filled with people in every direction. Queueing for outpatients, radiology, pharmacy and local appointments faces blurred into each other and I found myself ascending to the first floor and meeting the friendly nursing director.

I was greeted warmly, and the director showed great interest in ensuring I had a good experience in the hospital. I was issued an ID badge and shown my way to the ICU, meeting the charge nurses and supervisors. The staff were extremely welcoming and eager to show me around the ICU and their different procedures.

Over the next 3 weeks I looked after a range of patients, including those with diseases not often seen in the UK including tetanus, tuberculosis, dengue fever, Japanese encephalitis and CJD. I was able to meet several of my placement aims in the ICU, 

The biggest culture shock I received throughout my entire time on the ICU was how different holistic care was perceived and delivered. Most wards and areas within the hospital have relatives providing personal care and having an active part in how a patient is looked after. This is different on the ICU, with visiting restricted to just 30 minutes a day even when a patient is in the last days or hours of life.

Nurses provided exceptional care that was responsive to the needs of our patients, and they were all trained to an expert level in their field. However, there was one thing not present in the UK that put a stop to this. Finance.

When a family has no money it means they cannot afford ventilator treatment, medications and procedures that are life-saving to a person of any age. There were countless times in my three weeks where patients, who if situated in the UK could have had a very positive outcome, unfortunately passed away due to a family driving themselves to bankruptcy to pay for treatment. Money has a limit in Nepal, and in an economically developing country many families from rural villages many hours away from Kathmandu did not have the facilities to pay for some expensive treatments.

A specific experience plays in my mind, involving a 29-year-old woman suffering with respiratory sepsis. She was requiring ventilator and organ support alongside very specialist antibiotics due to the source of her sepsis being extremely drug-resistant. A week and a half ago this patient and her relatives were living together in a house in a village in the outskirts of Kathmandu. A week and a half later, her relatives had no house, money and even more painfully, no daughter. People in Nepal were desperate to do anything to preserve life of those they loved, driving themselves to homelessness when required. 

I spoke with my allocated nurse after this patient died as it played repeatedly on my mind, and she unfortunately confirmed it was an all-too common occurrence.

It struck me how unique a position I was in to have been given the opportunity to take part in this experience, and my three weeks on the ICU will undoubtedly make me a better Registered Nurse when I qualify. This wouldn't have been possible without support from the Santander Scholarship I received and the Turing scheme which covered several of my placement expenses and allowed me to increase my depth of knowledge.

In conclusion to my three weeks in the ICU, I have had some incredible exposure, the opportunity to take part in several different procedures and was made to feel part of the team. The nurses were intrigued to learn from my own experience back in the UK as much as I was interested to learn their perspective. It would appear wherever you go in the world; nurses follow the same mindset of evaluating their practice and ensuring they remain safe.