"Namaste sir!"
 
That's how most mornings would start at Kanti Children's Hospital.  After a gripping journey from my host family - through cows, police checkpoints and Nepalis with unimagineable loads on their backs - to the epicentre of Nepal's child health service, a sumptuous feeling of optimism greeted me every morning at the 300 bedded building.  Despite the fact that each and every family had a remarkable and often tragic story behind their visit to Kanti, they believed it to be their duty to give an unjustified level of respect to their Western visitors.

Such is the terrific nature of Nepali hospitality.  Nepal is a friendly place, with warm welcomes awaiting in the most unlikely of places.  Of all the memories I have of Nepal, it is the smiles, cups of "chia" and being generally accepted as a visitor that I remember most fondly.  Nepal is stereotyped for its stunning landscapes and its friendly people - and it is a great pleasure to discover that these perceptions are held for good reason.

Yet Nepal is not standing still; basking in pride of having such a good reputation for travellers.  It is also a place where volatile politics and rapid economic development is to be witnessed.  Since the massacre of the royal family in 2001, Nepal has has continued to endure significant instability, with all the corruption, injustice and poverty that such "progress" demands.  The majority of Nepali citizens live in extremely basic conditions, and the capital - Kathmandu - contains a wide spectrum of wealth.  Trying to make sense of this seems impossible - especially to the Western visitor who doesn't have the same appreciation of cultural boundaries such as the caste system - but even a short visit can offer a fascinating glimpse of a country going through a cultural, industrial and political revolution.

I travelled to Nepal in July 2004, for a 5 week elective at Kanti Children's Hospital, which provides specialist paediatric medical and surgical care.  Two years previously, I had completed another elective at Great Ormond Street Hospital in London, and so the two experiences were designed to be completely contrasting.  My planning began in October 2003 with an email to Bishop Joshi, one of the hospital administrators who runs the entire elective programme at Kanti.  10 months later, with the Qatar Airways flight touching down in Tribhuvan Airport, it seemed unreal that I had actually arrived in Nepal.  The trip into central Kathmandu was nothing short of an assault on all 5 senses, and something told me by my first meal, that I would really enjoy staying in the country

Medically, Kanti Hospital provided the opportunity to learn about the importance of basic clinical skills in assessing children - and the importance of simple measures of care.  An inspiring oncology unit is run by an equally inspiring consultant at Kanti, and it was amazing that such advanced medicine could be practised against the backdrop of a third world country.  However, the Oral Rehydration Unit Vaccination Centre were responsible for preventing much more mortality and morbidity through far less sophisticated treatments.

Exposure to the realities of a pay-as-you-go health service were difficult to observe comfortably.  Far from the "free" model of the NHS, it was heartbreaking to watch families spend their last rupees on venflons in order to adequately rehydrate children admitted to the emergency ward.  Thanks to people like Bishop, a basic service does exist to cater for situations when the money completely runs out.  However, the demographics of those children being brought to Kanti means this service is forced to cater for the most desperate of situations.

In terms of the elective experience, doctors were helpful in providing teaching when possible (the turnover of a typical morning clinic is something to be witnessed!), and were equally keen to speak to us about methods of medicine back in our countries.  Given the wide range of students who attend Kanti, this included experiences from the UK, US, Netherlands, Germany, Spain, Malta, China and more.  However it needs to be noted that most Nepalis do not speak English - and this includes patients and nursing staff.  On the flip side, the Nepali medical exam requires fluent English, and so there are usually plenty of Nepali students who are happy to translate, in return for improving their English and discussing cases with Western-based students.  Besides, it is quite amazing how much can be diagnosed by asking about "duccha" (pain), "ragat" (blood) and basic clinical examination.