• A person is limited to what they can afford. In all aspects other than maternity and WHO funded programmes for sickness like TB (Tuberculosis) and Leprosy, its a private healthcare system. This is not so obvious in the physiotherapy department, but on the wards and in Accident and Emergency, you pay for everything. If you can’t afford the test, you are not getting the test. Obviously, this is very different to the UK where the NHS is funded by tax payers. If you require a test, it is completed.

  • Outdated treatment methods- electrical modalities are king in the outpatient department, and a treatment without one is not seen as a ‘valid’ treatment. An interesting use of time and an interesting development of patient expectations. I am curious to know how this came to be. Whilst Ultrasound machines are still used commonly in private physiotherapy in the UK, it is not a treatment that is offered any more through the NHS, due to limited efficacy.

  • Limited medical supplies in the villages. More often than not a simple solution given from the health post with strong advice to get to the hospital if symptoms did not improve. You have a few basics to hand, ibuprofen, antihistamines, vaccinations and antibiotics. Antibiotics were, according to my medical colleagues, far overused, but with the understanding that if nothing is given, then the local community will no longer use the health post. A challenging relationship, and again the interesting issue with managing expectations.

  • A hierarchical medical team. The doctors word is the law. Your word means much much less, even if their ideas are outdated or downright dangerous the culture is to follow the leader. I cant speak for an MDT (multidisaplinary team) approach as I wasn’t on the wards to see one. In the NHS a patients treatment plan is a joint descision with the MDT and the patient.

  • No joint decision making with the patient. They do what they are told and don’t ask questions. Even if it goes against basic instinct as a new parent. No plans are discussed with them or education about their conditions. It was frustrating to see no posters on the wall of basic anatomy in order to educate and advise patients. Unnerving, when you have been taught a patient-led, holistic approach, it became a clearer reason to me why Shaman ceremonies would still thrive, with their person led, individualised approach.


Physiotherapy department Neck Stretching Machine
A machine used for all persons with neck pain



  • Low cost treatment for physiotherapy: coming in at approximately £1.20 a session, this is a service the local population can utilise, and many travelled from days away to receive this support. I was told this cost is lower at the government run hospital than at private establishments. However, as with all areas of life, this is still presents a large limitation to the low wage worker. Having looked online, the lowest wage a person can legally be paid in Nepal is 418 NPR a day which comes in at £2.50. Physiotherapy wouldn’t come high on my list of priorities at this wage level.


    Physiotherapy in Nuwakot Health Post
    Nuwakot Free Health Post


  • Patients can come daily if they can pay. This can help things recover reasonably fast and people can come in earlier at the first signs of a problem. What waiting lists? It was incredible to have this level of flexibility when making treatment plans. When you are unsure if someone has taken on board the homework or needs post surgery input, as long as they can pay, they can be seen as often as needed. At its worst, I remember my outpatient waiting list in the UK topped to ten weeks for a follow up appointment. It was usually between four to six weeks.

  • Health post treatment is free: A massive plus. I’m almost certain that the villagers would not have been able to afford treatment if it was cost based. In Nuwakot, the villagers are predominantly subsistence farmers. Although the health post can’t solve more complex issues, as a Nurse Practitioner ‘GP style’ practice, they do a great job of sorting the daily issues that arise, from childhood colds, MSK (musculoskeletal) complaints, work related injuries, respiratory related illness (everything is cooked on open fires) and required vaccinations.

  • People always come to the hospital or outpost with family or a friend. No one is alone. This helps to ensure the advice given is hopefully remembered by one party. The downside to this is if they are alone, it is very difficult to get anything done. Family are porters. In the UK people mostly come alone, unless they require support.

  • Low cost solutions are always sought, nobody has a high budget, nobody is asked to obtain something they cant afford like equipment. A make do attitude is utilised at all times and this is great as a physio as the homework given utilises the home environment, just like in the UK.


Nuwakot Health Post Team
Nuwakot Health Post Team