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VSO/Peter Caton

Life as a public health nurse volunteer in Nepal

Women suffer disproportionately from access to quality health services in rural Nepal. Although the frequency of maternal deaths in Nepal has significantly reduced, pregnancy related complications remain high, especially in rural areas. VSO volunteer public health nurse Cath Nixon has taken a two year career-break from the NHS in the UK to work alongside health workers in a district hospital and across villages in mid-west Nepal to improve standards of care and raise awareness of health issues affecting women.

Volunteer public health advisor Cath Nixon and auxillary nurse and midwife Bharatkumari Sijapati, Nepal VSO/Peter Caton

VSO volunteer Cath Nixon advises a local midwife in Nepal

What are you doing with VSO in Nepal?

I’m working at the district hospital in Dailekh, which is in the foothills of the Himalayas, as a public health nurse. My work involves improving standards and raising awareness of the care vulnerable women receive before and after pregnancy. I also work with an organisation called Women’s Empowerment Action Forum (WEAF) as a community mobiliser educating communities about women’s health rights and trying to involve village women in decision-making.

Women in rural Nepal face challenges throughout their lives. They start working very early and finish late at night, doing much of the heavy labour. This, combined with early marriage and home births, contributes to a spectrum of gender-specific health problems in Nepal, like uterine prolapse.

How did you manage to take two years out of your career to volunteer with VSO?

I first heard about VSO when I was at university studying adult nursing ten years ago. After becoming a community public health nurse in 2009 I felt I had the relevant skills to do VSO and I was keen to put them into use in international health.

When I told my employers I was thinking about doing VSO, they asked me if I’d like to take a two-year career break which meant I didn’t have to give up my job. I didn’t know the NHS offered that before, so it’s important to talk to your employer to find out your options. It made a big difference in my decision-making because it mitigated any concerns about finding a new job when I came home.

So you work in clinics and in the community?

Yes my placement is quite varied. In the hospital I’ve been working alongside nurses in antenatal and post-natal clinics to improve patient care.

When I first arrived, I saw how there was little privacy or confidentiality for women and how it was putting them off coming to the clinic, so I suggested that nurses try to talk to one patient at a time. Also when I started working nurses were distributing medication to patients without explaining what it was for, like calcium tablets to help prevent preeclampsia and iron tablets to help prevent anaemia. If patients don’t understand why they need the tablets, they’re unlikely to take them, so I’ve encouraged nurses to explain more. These are just a couple of examples of the small but high impact changes we’ve been making.

In the community I work with WEAF to help women speak up about problems they experience.   Many of the women I’ve been lucky enough to work with are pioneers of women’s development and are campaigning for equal rights with men, which is not an easy subject here. We also work with some men, creating role models of those who defend women’s rights and promote the benefits of women’s participation in decision-making.

My two roles complement each other; enabling women to engage with their health rights at the community level and ensuring they receive quality care at clinics too.

What is a typical day like for you?

My day starts very differently here than it does in the UK, where I have a long commute to work and I am always rushing around in the mornings. Here I wake up early, around 5am, and I don’t go to work until 10am so I have time to go for a cycle, wash some clothes, or chat with a neighbour.

After arriving at the hospital I meet with the nurses in the antenatal clinic. We discuss any problems we might have identified the day before and then we usually do some training, which involves observing how the nurses interact with the patients and feeding back to them afterwards. The clinic closes around 3pm, so then I cycle back home or go to the WEAF office.

What are some of the challenges you have faced?

In the UK you’re always working as part of a team, so you have people to bounce ideas off and you’ve all had the same training. It’s different here; everyone’s had different training and has different opinions. Challenging those opinions can be quite daunting, but I’ve actually found that when you do challenge them, people are happy to listen.

That’s the great thing about volunteering, you’re the agent of change and people want you to say things and make changes that they may not necessarily be able to say or make themselves.

What’s it been like working alongside local people?

Things happen differently in Nepal to the UK, and that takes some getting used to. You have to build relationships with the people you work with and realise that some things take longer than they would back home, but I’ve met many amazing people and everyone has been friendly and welcoming.

Even without knowing the language at the beginning, you can connect with people and make friends. Learning Nepali seemed like a challenge because I didn’t have much experience learning a new language, but living here and sharing ideas with other volunteers, like preparing a few sentences before going out each day, really helped... and now I am almost fluent in Nepali!

What is living in Nepal like?

The social life is focussed around meeting up with friends and having tea together, but there are lots of festivals with dancing and singing too. I often go for bike rides; the scenery here is amazing. There’s a big volunteer community in Nepal too and we get together during holidays to celebrate and share stories.

How has volunteering in Nepal affected you?

Doing VSO has given me a different perspective on life and I’ve experienced new ways of approaching situations and thinking about things. I’ve gained leadership skills and learnt how to be assertive when I need to be, but most of all I’ve met some incredible people who have lived truly inspiring lives.

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