You must be thinking, what on Earth can the U.S. health care system learn from a poor, developing country like Nepal? Isn’t the U.S. known across the globe for its latest innovation and advanced procedures? Well, I was thinking the same thing. Until my seven-week trip this summer to rural Nepal. As a Nepali-American Emergency Medical Technician-Basic (EMT-B) studying medicine in the U.S., I learned more than I could imagine about health care. I spent time volunteering in a rural village clinic and a health camp. As one of the world’s poorest countries, I knew Nepal struggles with health care, but maybe they are doing some things right.
From my experience, I observed five things that U.S. health care can learn from Nepali health care.
1. Everyone is considered family. No matter where you go in Nepal, whether in a remote village or the capital city, Kathmandu, everyone addresses each other with affectionate terms like dai (big brother) and bahini (little sister), even when there is no blood relation. This happens even in the medical setting. When an 80-year-old patient presented with back pain, the doctor caringly addressed her as ama (mother) as he welcomed her into the office and listened to her complaints. The doctor saw this patient as his mother. I saw how this small phrase comforted her in her most vulnerable state. Even as I gathered the patients’ vital signs, the health care staff referred to me as bahini (younger sister). I felt that I was an important part of the health care team. Sometimes, in our fast-paced U.S. health care arena, we overlook the easiest way to connect with our patients. Many times, we may not even know our patients’ names. Now, I’m not saying that we should start calling everyone “grandma” or “big brother.” But, perhaps we can learn from Nepal’s family-based culture and get to know our patients better.
2. Doctors come from the same culture as their patients. When a 54-year-old laborer came in with back pain, the doctor immediately knew why. The laborer had just spent the last week hunched over in the fields during the peak of rice planting season. When a 21-year-old came in with a 6-month-old attached to her hip wheezing, the doctor knew why. She prepared all of the meals for her family in their indoor fire cook stove with little air circulation, which triggered chronic obstructive pulmonary disease (COPD), common in rural villages. When a 37-year-old came in with epigastric pain, the doctor knew why. She had eaten spicy peppers with her dal-bhat for lunch. Doctors in Nepal deeply understand their patients’ lives because they live in a similar culture. In the U.S., we could benefit from learning more about our patients’ cultures. Perhaps we could provide more personalized care by paying more attention to our patients’ social history.
3. Daily physical activity is a part of life. Nepal’s jobs rely heavily on physical labor: planting and picking rice, carrying bulky loads, and farming. Everyone is physically fit. I mean everyone. I saw an 86-year-old man with a blood pressure of 100/60 mmHg. I saw a new mother who was back in the rice fields, working only one week after giving birth. I hardly met anyone who was even slightly overweight. I saw very few patients taking blood pressure medications or getting tests to rule out heart disease. Exercise was built into everyone’s daily routine. Sometimes, in the U.S., exercise is more of an option rather than a means for survival. As a result, diabetes, cardiovascular disease, and high blood pressure rates are rising. Perhaps, encouraging exercise as much as taking medications should be stressed more for patients.
4. There is a high level of respect for doctors. Nepal is mainly an agrarian society; there is a high level of respect for the educated. I frequently saw patients thank the doctor over 20 times for something as simple as prescribing antifungals for a rash. I saw both women and men wearing their most distinguished clothing, Nepali topi (traditional hat) and golden pote (beaded jewelry), to their doctor’s appointments. They wanted to look their best for the doctor. I saw how Nepali patients sat on the edge of their seats, clinging to each word coming out of the doctor’s mouth. It seemed that people respected the expertise of medical professionals and followed their recommendations. Sometimes, in the U.S., we are faced with more skepticism from patients who may equate their Google searches with our medical expertise. Perhaps, patients could be reminded about our qualifications to take care of the sick.
5. Sicker patients tend to be heavily prioritized by the community. In Nepal, many families live in inter-generational households and are highly connected with their neighbors. There is a strong sense of community among all people. During a rural health camp, I noticed a commotion brewing at the end of a long line. A young man with a prominent limp and a gash to his forehead carried a frail older woman. She stood, or hunched, at 4 feet 9 inches and weighed 70 lbs. The man told us how he ran into this ama (mother) who was hobbling along and wheezing on his way to the clinic. Though he was sick as well, he carried her to the front of the line, knowing she needed more help. These types of selfless acts were the norm. Sometimes, in the U.S., patients regard their own medical problems as more urgent than others. Perhaps, we can encourage a sense of civic responsibility in our communities in the U.S.
Nowadays, everyone has an idea of how to improve health care with fancy technologies and complicated systems. But, from what I learned in Nepal, I think it is time for us to start returning to the basics. Simple, little things go a long way to improving big problems.
Simona Adhikari is a premedical student.
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