Medical Electives

Research, data collection and the creation of public information and awareness programmes are essential to the promotion of pre-hospital emergency care among populations long accustomed to the belief that medical help is available only in a hospital setting.

In 2016, two undergraduate medical students from the University of Liverpool and a final year medical student from Barts and The London School of Medicine pursued medical electives in Pokhara, Nepal’s second largest city. The medical electives, in part supervised by Dr Nick Wilson of Friends of NAS, were conducted at Manipal Teaching Hospital, the largest hospital in Pokhara, and at Gandaki Medical College.

The electives had three main objectives:

  1. to assess the current state of emergency and pre-hospital healthcare provision in the Pokhara Valley;
  2. to identify key factors requiring consideration in the implementation and optimisation of future EMS in the Pokhara Valley; and
  3. to investigate the current clinical need for EMS in the Pokhara Valley.

Recent data collected by Friends of NAS medical students during their electives in Pokhara have shown that 10% of patients in one Pokhara emergency department had initial oxygen saturations below 85%, with two patients recording 72% on arrival. This is a condition easily rectifiable with pre-hospital oxygen.

In fact, all of the initial emergency department interventions observed and recorded in Pokhara by Friends of NAS medical elective students could have been provided in the pre-hospital phase. The most common interventions – fluids and oxygen, if given by a professional emergency medical service provider, have great potential to improve the clinical course of a patient.

Also observed was a long lag in time of onset of illness or injury to presentation in emergency departments. In a small sample, 40% of patients with a variety of conditions were unwell for at least 24 hours before attending the emergency department. Some of these were sub-acute conditions, for example infective exacerbations of COPD (Chronic obstructive pulmonary disease), while others were fractures or even acute coronary syndrome.

The causes of the delays in reaching the emergency department are multiple and include lack of access to healthcare, poor health literacy, poor access to transport, and the use of traditional medicines.

Addressing these issues will be key to Friends of NAS’ public awareness and education programme in Nepal.

If you would like to apply to undertake a medical elective with Friends of NAS in Nepal, please email the FoNAS Chairman.


Nepal Ambulance Service is the first and only fully professional pre-hospital emergency medicine provider in Nepal. It is the only ambulance service that operates a 3 digit toll-free phone number and screens incoming calls in its telephone dispatch centre.


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