Non-communicable diseases are the leading cause of morbidity and mortality in the world, with alarmingly high rates in low- and middle-income countries like Nepal. Ilinca-Gabriela Radu embarked on a thesis project that took her all the way to Nepal in the midst of the COVID-19 pandemic to study two of the most prevalent chronic diseases, hypertension and type 2 diabetes. In a rural community of Nepal, she examined how these diseases are (self-) managed, perceived, controlled and treated, and what could be done to improve their prevention and management with existing resources. Next to her research, Ilinca made many other discoveries about Nepalese history, culture and society during her seven weeks abroad.
In the midst of a global pandemic, I was able to withdraw myself from the virtual classroom bubble in order to carry out fieldwork for my Master’s thesis in Nepal. This article is not a narration about trekking and climbing the highest mountains in the world, as most people would expect from a trip to Nepal. This is an account of my time spent at a tertiary hospital 30 kilometers east of Kathmandu, in remote rural areas near the epicenter of the 2015 earthquake and of my enchanting explorations of Kathmandu.
After months of uncertainty ignited by the COVID-19 pandemic, my plans started falling into place and my Master’s thesis brought me all the way to Nepal for my primary data collection. I was based at the Department of Public Health and Community Programs of Dhulikhel Hospital, an independent, not-for-profit tertiary referral hospital in Kavrepalanchok District, Nepal. The hospital provides services for 2.7 million people and serves as the university hospital for all medical study programs in Kathmandu. My research team consisted of doctors in community medicine and public health professionals, as well as two research assistants.
Ilinca with her local thesis supervisor, Dr. Abha Shrestha and local co-investigator, Mr. Dinesh Thapa at the Department of Public Health and Community Programs at Dhulikhel Hospital. All photos by the author.
My thesis focused on exploring challenges to hypertension and type 2 diabetes management in a rural area of Sindhupalchok District. The aim was to identify barriers and challenges in providing routine screening, treatment and care for people living with hypertension and type 2 diabetes in remote villages where healthcare facilities and staff are scarce and inadequately equipped to deliver such services. The research project involved a situation analysis from which recommendations could be proposed based on existing human, capital and financial resources. I carried out 29 interviews and two focus group discussions with patients, ward chairmen, medical officers, nurses and female community health volunteers (FCHVs). FCHVs are local married women who serve voluntarily in their communities within the government health system. To date there are approximately 52,000 FCHVs in Nepal. Non-communicable diseases (NCDs) are evidently on the rise in Nepal, as current global trends also suggest. My study explored the prospect of a community-based approach in the prevention, screening and care of hypertension and type 2 diabetes with the potential involvement of FCHVs.
Statistics and facts can be easily retrieved off the internet. However, the interpersonal connections, the ethnographic observations of customs, habits, behaviors and cultures, the dal bhat and momos (typical Nepalese dishes), the smell of burned incense engulfing hundred-year-old Hindu temples, the bumpy dirt roads swirling through lush greenery of interminable paddy fields and banana plantations, the endearing giggles and smiles of delighted schoolchildren in uniforms, the soft touch of cashmere goats, the friendly Namaste greetings and of course, the breathtaking panoramas of the mighty Himalayan range cannot be lived and experienced through a virtual sphere. Throughout my seven-week stay in Nepal, I experienced all that and more.
Ilinca with her two research assistants from Dhulikhel Hospital and five FCHVs at Bahunepati Outreach Center. Photo by Author.
Upon my arrival in Dhulikhel I was greeted by my research team and settled in at the international students’ guesthouse as the only international student of the year 2021 – or 2078 B.S. (Nepali year) – at Dhulikhel Hospital. My first week at the hospital consisted of daily meetings with my team and fieldwork preparations. For the first time in over a year, I rejoiced at being able to work face-to-face in an office. The emergence into the real world after a year of intermittent lockdowns and interminable teleworking was a relief that reminded me of pre-pandemic life. After the first week in Dhulikhel I packed my bags and headed off with my two research assistants and a driver to two outreach centers of Dhulikhel Hospital in Sindhupalchok District for ten days of fieldwork. We lived in one of the outreach clinics and with a local Buddhist family. Every evening after a day’s work of travelling to health posts, primary healthcare centers and patients’ homes for conducting back-to-back interviews, we would be greeted with a big portion of delicious dal bhat (rice with lentils). Working in the field was the highlight of my trip. None of this would have been possible without the involvement of my research team, who scouted our interviewees.
Ilinca with her two research assistants, their driver and the Buddhist husband and wife who hosted them near Manekharka Outreach Center. Photo by author.
Upon our return from the field, I spent several days in Kathmandu celebrating Nepali New Year and taking in the festivities, the hustle and bustle of this enchanting capital city filled with UNESCO World Heritage Sites. In Kathmandu, a mystical city with minimal Western influences, you feel transposed back in time to the Medieval Era where people in traditional attire, dogs and colorful rickshaws engulf the narrow streets shadowed by remarkable architectural wonders with exquisite wood carvings. Kathmandu and its surrounding cities and towns that make up Kathmandu Valley should definitely be relished when visiting Nepal.
Ilinca at Chilancho Stupa, a Buddhist shrine in the ancient city of Kirtipur, located 5 kilometers south-west of Kathmandu. Photo by author.
I ended my stay in Nepal back at Dhulikhel Hospital where we started the cumbersome task of transcribing, translating and coding our 31 interviews and focus group discussions. By that point, late April 2021, the COVID-19 epidemiological situation was deteriorating in Nepal at an alarming rate, fueled by imported cases from neighboring India with which Nepal shares an open border. I continued to work from the office until the government’s announcement to suspend all flights. After a 20 hour-long frenzy of arranging my return to Europe, I was able to fly home the next day. As I was driven out of Dhulikhel Hospital on my final day, a hearse pulled in to retrieve the body of a person who had fallen victim to COVID-19, a shocking reminder of the devastation caused by this virus. My departure was sudden and unexpected. However, as we had finished our data collection, I could leave feeling accomplished and with incredible memories that I will cherish for life. For that I say “Danyebadh”. Thank you, Nepal, thank you to my research team and thesis supervisor at Dhulikhel Hospital for the experience of a lifetime, and thank you to Dr. Tania Dræbel and my main supervisor, Dr. Bishal Gyawali at the University of Copenhagen for sending me on this remarkable journey with the generous funding from the Asian Dynamics Initiative.
Ilinca-Gabriela Radu graduated from the Master of Science (MSc) in Global Health at the University of Copenhagen in August 2021. While still a student, Ilinca interned for the World Health Organization Headquarters in Geneva, Switzerland for seven months before embarking on her thesis in Nepal. Before that, she was actively involved in EIT Health through Global Health Case Challenges, workshops and trainings across Europe. Next to the MSc in Global Health, Ilinca holds a Bachelor of Science in European Public Health from the Netherlands and is concerned with non-communicable disease prevention and treatment control.