Being able to shadow in the Tansen United Missions Hospital has been an eye-opening experience and blessing. The physicians were extremely welcoming and willing to take the time to translate, explain, and inform on various cases and methods of treatment. We’ve been able to witness cases, conditions, and diseases that are not prevalent in the United States, and get a new perspective on treatment options and progressions. There have been a couple of main differences I’ve noticed in Nepal compared to the States, such as the confidence of patients in physicians, the humility of physicians, methods of diagnosis, and the role of a communal culture present in the hospitals rather than an individualized one as we see back home. 

Back home in the States, I’ve noticed patients can often be weary of doctors. I have had numerous patients back home at work dislike doctors, question their motives, and overall be distrustful of certain physicians they have come in contact with. However, in Nepal, all the patients I have encountered on rounds with physicians or in the clinic appear to put all their trust in the physicians they are seeing. They are quick to agree with physicians and appear to have profound respect for those treating them. From what I have experienced, this could be due to a more hierarchical system in health care that is prominent in Nepal, or the fact that they do not have a sense of entitlement many Americans contain. Although a hierarchy does not always promote the most cohesive work environment, the trust that patients have in the hospital staff seems to cause an overall smoother experience and treatment. 

The confidence of patients in the physicians of the United Missions Hospital could possibly be induced by the immense amount of humility the physicians here contain. Many doctors I’ve met in the States are very confident and hold themselves in high regard, which is not necessarily a bad thing. However, the physicians here take time to talk to patients and family members, taking time with each one, offering greetings and comfort. They are also very quick to confide in other physicians for guidance on cases and treatments, and even ask for help in the OR. I think the idea of being a physician in Tansen is more communal and reliant on others than the notion in the States, which is something I believe we could learn from those here.

A main normalcy of the United Missions Hospital that took me by surprise was the lack of certain technologies and lab tests. For example, the hospital does not have a CT machine; endoscopies and echos for most patients are only performed two days a week. On top of these complications, the power constantly goes out throughout the hospital. Despite what we would consider inadequacies in a hospital, these physicians are still able to diagnose and give exceptional care. Often patients will present with a certain condition that back home we could prove with one singular test such as a lab or CT scan. That is not available at the hospital in Tansen, so physicians diagnose by performing available tests that rule out the potential of alternative causes, indicating the diagnosis they originally believed but could not directly test to prove. Although to many of us this would seem inefficient, it often ends up cheaper for patients who tend to be financially unstable because they do not receive the most expensive, fancy tests. Choices on diagnostic methods are largely influenced by the financial ability of patients, as many of those who come to the hospital are from poorer communities, and treatment is usually avoided due to the cost.

Overall, the hospital has a larger sense of community within, not only in the sense of the cooperation of the physicians but also among patients. Here in Tansen, there can be anywhere from 3 to 12 patients in a room, and each of these patients has a family member or neighbor who stays with them the entire time to aid in their care. While this was a huge shock at first, there have been numerous times I’ve seen those who are complete strangers who happen to be in the same room offer support and comfort to one another, or to just be a friend during difficult times. The community aspect of the hospital appears to bring such a high morale for a hospital that we tend to not experience in the States. At home, patients are consistently isolated in their rooms by themselves, stripped of the community that we so desperately need as the social creatures God made us to be. Although cases can be as severe, or even more so, as those in the States, the people here seem to be quite more at peace and overall in better spirits. 

As a whole, I think the United States’ main focus is efficiency, and while there is still efficiency in the United Missions Hospital, it is not the most important quality of the hospital. When the excessive efficiency that can plague the Western world is set aside, such thorough, beautiful connections and networks can be made between patients, family members, and physicians. The experience here has been priceless in how I hope it molds me into the physician who reflects God’s love and the fruit of the spirit just as the physicians in Tansen do.