For three years my wife and I lived in Nepal. Those years included some months studying language and culture, a half year in a rural mission hospital and two years in a large university government teaching hospital. We’d been inspired to work in Nepal by life changing experiences as undergraduate medical students and a brief stint later as volunteers. At the end of three years, we hoped our connection to Nepal was not over. Having accumulated some knowledge of the language, culture, medical diseases and treatments, it seemed wise to continue. But could we emulate the expats who had been our mentors in this journey with their decades of continuous presence in Nepal? Were the only two options ‘finish up’ and ‘settle in for decades’?
The rural mission hospital had been a better fit for us than the large government teaching hospital, especially given the former’s ability to care for those that could not pay for their treatment, so we made a plan to return regularly to it, if it suited them, for one year terms. Fourteen years ago, we started the pattern of alternating from Newcastle, NSW for a year to a rural town in Nepal for a year, moving to ‘the other home’ after each 12-month term was up. Only Covid put a small dent in this pattern.
“What have you learned from swapping regularly from the two very different contexts? How can you just leave your job in Australia every 12 months? And what about your roles in Nepal; how are you covered when you leave there?” These are questions we have often been asked.
At the end of three years, we hoped our connection to Nepal was not over ... Were the only two options ‘finish up’ and ‘settle in for decades’?
Seeing with Nepali Eyes
We have new terms in our household lexicon: Nepali Eyes and Australian Eyes. We are especially conscious of their influence on how we see things after each arrival ‘somewhere’. After a year in Nepal we return to Australia and see afresh with our Nepali Eyes the wealth, the speed of life, the hyper-individualism, the infrastructure, and the widespread emotional ill-health of depression and anxiety. In the face of so much help, so much wealth, and so much health, how is it that so many Australians are barely coping? With so many ways to connect, why does connection seem to be difficult and loneliness so common? Our fresh-from-Nepal eyes see all this again in focus.
Why are some of my Australian medical colleagues so stressed about money? How did that happen? Sometimes the answer is simply that debts for homes, vehicles, holidays, schools, and ‘good’ food mean their books are only just balanced and there is stress to work longer and more lucratively. With Nepali Eyes, this looks like a self-inflicted wound. In Nepal we hear more about the very poor being burdened by debt, paying unjustified interest to the local loan sharks. How did the Australian rich end up so stressed about money?
Seeing with Australian Eyes
And after arriving again in Nepal, our Australian Eyes see afresh the poverty, the broken or missing infrastructure, and the harsh challenges of a life where young death, exotic diseases, long and hard work, and social dislocation are the norm for so many. But we also see the dogged dedication to family members, which for us will be on display daily in the hospital as the family provides food and nursing care to the patients—and sleeps on the concrete floor by the bed of their sick relative—day after day, week after week. With Australian Eyes we are confronted anew by the culture where the birth of a girl is tolerated quietly and the mother is judged a failure by some relatives, because it is her role in life to produce a boy. We see some fathers consent to medical care for their sons, but not their (sicker) daughters. It’s not a sight we fully understand, but we know it sits uncomfortably with us.
A village life
Our Nepali town is not small, but it feels like a village. It’s not really possible to walk more than a few minutes without stopping for some small talk. Our work, our play and all our routines are in walking distance. We can go a few months without stepping into a car, and it’s a year before we will have to drive and look for our own parking places. We relish this.
Some advantages of alternating each year
Our Australian Years allow us to recharge our batteries, and refill our coffers. In Australia, we both work part time and have more spare time to reconnect with family and friends, enjoy a slower working pace and get ready for the next Nepal Year – where work is full time. The Australian Year also allows us to keep up to date with Australian medical developments and meet the criteria for staying registered as Australian doctors, which is the basis on which we can re-register each year as Nepali doctors. Our Australian Years also fund our Nepali Years.
We can go a few months without stepping into a car, and it’s a year before we will have to drive and look for our own parking places.
Teaching and doing
It is a bit of a sacred cow of development work that the volunteer/westerner should teach and not do. It occasionally causes knitted brows when we confess we both ‘do’ and ‘teach’ in rural Nepal. Medicine is an apprenticeship and cannot be learnt by books, lectures, and online tutorials. Bedside and classroom teaching are enhanced by working with other practitioners. The other reality is we have learned far more than we have taught anyway. This only makes sense when you are in a new place with new diseases and limitations in investigation and treatment options.
Coming and going
How are we able to leave every year? The fact is, in both countries, for both of us, we are part of a pool of workers which grows or contracts all the time due to many factors. Sometimes we arrive in Nepal at just the right time when the staffing has seen an unanticipated loss. Our departure is not a surprise in either location, being open about our departure plans from the start of each year. Our public hospital jobs in Australia these days are ‘zero hour contracts’ that neither oblige nor guarantee work. In either place we slot back into the pool after arrival.
Changes over the years
For all the changes we have seen since we first showed up to the mission hospital unexpectedly 17 years ago, the most exciting change has been in the makeup of the hospital’s senior doctors. In our first year, there was a single senior Nepali doctor and a large group of very junior doctors. After three years away in the Nepali government hospital and Australia, we returned to find two senior Nepali doctors, and the usual band of expat seniors and Nepali juniors. Now, every department is headed by a Nepali senior, and there are many more departments than there used to be. Expat numbers have been decreasing and our role is changing. Nepali doctors who were once shy and timid interns are now the leaders and administrators of the hospital. Others who spent time with us are now in charge of district hospitals in remote parts of the country. The new equipment is an improvement, but it is trivial compared to these changes.
Same same but and not so different
Sometimes the gross differences in the two lives do not seem to be great at all. In either place we work, we eat, we sleep, we relax, we answer or ignore our emails, we catch up with friends, we are part of a Christian community and a wider community; but only in one of them do we swim regularly.
The mantra from the politicians and commentators on the Australian airwaves is that ‘Australians are doing it tough these days especially’ […] is very hard to hear after a 12 month stint in rural Nepal.
Further reflections
Nepal has taught us much about flexibility and unpredictability. Local people have to adapt to unforeseen changes and cannot be ‘masters of their destiny’ like the western myth we easily swallow. Early death, landslides, floods, earthquakes, harsh climates, road deaths, sickness, and limited financial resources to handle everyday life have appeared to have toughened Nepali people both physically and mentally in a way that we do not see in our protected western life. When we return from each year in Nepal, we see afresh the wealth, comfort, and greater predictability of life in modern Australia. In contrast to this, the mantra from the politicians and commentators on the Australian airwaves is that ‘Australians are doing it tough these days especially…’ and the way it is put, we are somehow included in this. This is very hard to hear after a 12 month stint in rural Nepal.
The western obsession with the individual and the individual’s ‘freedom’ is also in our faces on return to Australia each time. In Nepal, it is your family or your society that determines who and when you will marry. All operations, even those performed on doctors, are consented to by the family, not the patient themselves. Where you live after marriage is determined by cultural norms. The sense of financial superiority that is real for westerners spills over into other kinds of feelings of superiority and judgements of inferiority of different cultures in ways that are not real or justified. The commitment to family, the ability to laugh at the smallest provocation, and the ability to adapt to the harsh and unpredictable events of life all tell me there is no justification for our superior feelings in the west.
In Nepal, as I walk home for lunch (I can’t do that in Australia) I walk past a bank of walk-in cage-like structures – this one for gloves, the next for glass, the one after for IV fluid bottles… These are all to be picked up and recycled. Here, in rural Nepal with its low income, its busted roads, its difficult terrain, and its multiple obstacles, this hospital is recycling its waste! Australian hospitals bury tonnes of waste or incinerate it at high temperature and great cost every day; but here, there is enough common sense, responsibility, and energy to figure out a way to recycle. I am ashamed.
We note that Nepali people love to have a laugh, to tease, to giggle, and guffaw and it only takes a tiny prompt to see their faces break into smiles and then bend over in whole-body laughter. I hate the ‘they are poor but happy’ throw-away obligation-relieving appraisal that has been used to describe financially poor people across the world. But somehow the ‘very low threshold to laugh’ is a real thing here in Nepal. In Australia, I see in some groups a low threshold to swear, or argue, or hurl abuse out the car window over bad driving – I wonder how these two different emotions have ended up so close to the surface of two completely different groups of people. I don’t know how it happened.
I see Australia encouraging the immigration of the wealthy and the well-educated. Let the financially poor countries produce the children, see them through school and university and when they are finally financially productive, at no cost to Australia, get them to immigrate to save us all the expense of raising children and educating people. After all, we’re ‘doing it tough’ and those poor countries should be helping us out through these especially difficult times. I struggle to listen to it with an open mind.
I am not sure there is a point in ‘recommending’ this alternating life to anyone. It’s hard to imagine that the circumstances would line up uniquely as they have for us. I doubt I would live this way with children, but I am not a parent and maybe it would be great. I do know that I feel privileged to live such a life: to belong, in some sense, in two vastly different locations and cultures, and to have a sense I am allowed to be part of something that achieves a lot with very little.
Steve and Ana are doctors who studied and trained in Newcastle, NSW. Ana is a general practitioner and Steve an anaesthetist. In the last 17 years, they have spent a little more time in Nepal than they have in Australia.
