Wednesday, March 16, 2005

At Ang Rita’s request…

Ang Rita visited our floor the other night – he does this every other day or so just to check we are all right and have everything we need I guess. We were watching some film on HBO and again he offered for us to go downstairs and watch it on the bigger telly. We decline, more for fear of being plied with millet whisky again than anything, explaining that this is more than adequate, and that we should really be working anyway…

He then proceeded to ask us a favour, and, as is often the case, it was difficult to tell exactly what he meant (his English, while being infinitely better than my Nepali, is self-learnt and heavily-accented), but the gist of it was that he’d like us to visit a school he sponsors in the north of the city. Well of course we were more than happy to do him a favour to thank him for his generosity, and it would be interesting to see some more local culture. Keen for it not to interrupt our hospital placements, he agreed for it to take place on Saturday afternoon (after our mountain flight).

When he left us to our film, Nhish turned to me and we both simultaneously asked each other what we had just agreed to!?

On returning from our mountain flight, Ang Rita asked if we could take our white coats and stethoscopes to the school with us, and Nhish and I decided to “dress up” for the occasion and both donned ties with our regular hospital shirt-and-trouser combinations (a tie in the hospital would look very much out of place next to the jeans-and-t-shirt-under-white-coat attire of the local docs)!

Still non-the wiser about our activities on reaching the hospital, Ngima accompanied us there and we were introduced to the principal: Mr Chinawa (or something like that). It is then that we asked what we were to be doing, and were told the kids were coming in especially for us to “teach them something about medicine” – we had no idea and hence had nothing prepared!

After the initial shock and fear had subsided, I quickly wrote a list of topics to cover: strategies for preventing illness (basic personal and food hygiene); home management of simple illness (fever, colds, etc); basic first aid (management of cuts, scrapes, bleeding, fractures); recognising an unconscious patient and opening an airway; and the recovery position. We thought we could then fill some time with playing with the steths and pen torches by listening to each others’ heart and breath sounds and looking at tonsils. We had from 1300 – 1600, and I reckon we could pad out what we had to maybe 2 hours at most…

There were about 40 kids, ranging in age from 2 or 3 up to about 18. While they are taught English very early on in their schooling, it is by no means their first language, and it was apparent that throughout the theory section (never the favourite with kids) that most of it was above their heads.

Nepali kids differ significantly from the English kids I have taught (CPRiS project, etc) in that there are much more shy. There were 2 or 3 really bright kids asking questions and writing notes, but even these keen ones took about half an our before they were brave enough.

We tried to make the theory interactive by asking the kids what experiences they had had with the various things we were talking about, but it seemed that none of them had ever been ill and never witness illness nor injury!

After about 15 minutes or so, I decided enough was enough, and moved swiftly on to some more practical stuff: we had asked for some simple props from the school infirmary/shop and had been given some bandages, tape and a small bottle of dettol. So I asked for a volunteer (had to pretty much pick one of them – but tried to steer away from the really timid-looking ones) and we went through a big, dramatic enactment of them cutting themselves and me getting covered in blood. I was amazed, however, when I asked for suggestions on how to managed the ‘patient’ that many of the kids not only had understood out ramblings for the past 10 minutes, but had remembered it too and were able to put into practice. I think my silly acting encouraged their involvement a little too and soon they were calling out: “apply pressure”, “clean the wound” and “put on a bandage”. We had some fun with bandaging a couple of the kids up and stealing their shoes and things. That went down well.

Then I moved on to the recovery position, which I demonstrated on Nhish. We were out in the dusty playground in the heat of the day and he got a little mucky – but that was all part of the fun! It brushed off – was only dust! So I showed them how to call out an instruction, to open the airway (I encouraged gentleness, but didn’t go on about c-spine protection – it only confuses and scares them off actually helping at this level), to check for breathing and then to put the patient into the recovery position. I used my “SUPERMAN!” technique, which involves putting both the patient’s arms straight out above their head like they are flying, which only serves to remind the kids what order to do things in.

After I had finished my demonstration, I asked for another volunteer and had three had shoot into the air – finally I was engaging them! Then I insisted that Mr. Chinawa get involved and be the patient – they loved that! I got the smallest volunteer to do it, to demonstrate that you don’t have to be big or strong to save someone’s life. Again, I was impressed with their recall as the other kids helped the volunteer with suggestions.

Then we spilt the kids into groups of three or four and got them to take turns practicing it on each other. Nhish and I wandered around critiquing and making sure everyone was having a go to the occasional background calls of “SUPERMAN!”. It is truly gratifying to see that the children actually learnt something – that they can recall what you have told them and put it into practice is rewarding indeed.

We then spent a further half hour or so, after a much-needed brief interval for soft drinks, passing around our medical toys and getting the kids to listen to each other’s chests. During this, I’d pick on kids at random and “test” them with a scenario from earlier (bleeding, fracture, fever, unconsciousness, etc) and see if they could remember what to do. They were very good, and required little prompting – much better than the English kids I’ve taught.

Eventually, by 1500, we had run out of things on my list and explained to Mr. Chinawa that we couldn’t think of anything else to talk about right now. I told the kids how impressed we were with them and how much better they were than the English kids and got them all to clap each other. An awkward ten minutes or so then followed during which the kids all silently stared at us, expecting more. Eventually, one of the other teachers called for a group photo and the group then split up.

Mr. Chinawa thanked us repeatedly and offered to meet us for dinner in Thamel that evening. It being rude to refuse we agreed and met him at 1800. We went to a Chinese buffet place, which was pretty good, and had a fun evening. It turns out he lived in Worcester (near my home town) for two years doing his masters degree!

So, all together a daunting but enjoyable afternoon. J

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