Surgery in Kurdistan considerable value to a doctor who already has a wide clinical and operative experience; the range and responsibility of the work may be beyond the capabilities of the more recent graduate, whose need is for larger numbers of routine cases. In any case the authorities will grant work permits only to those with a specialist qualification (for example, FRCS) and 5 years' postgraduate experience. Apart from the dedicated few for whom this can be a lifetime's work, most doctors who consider such a post would commit themselves only for a year or two; in either case thorough preparation is advisable, both
by supplementing one's training in unfamiliar specialties and if possible by direct contact with a doctor or nurse who has worked there. The pressures on expatriate medical and nursing staff are considerable, and despite journals and mail from ex-colleagues one is bound to feel isolated from professional surgical contact. But the objective of the work is service to a deprived community and we would suggest also that the experience gained by the surgeon, not only in clinical skills but in shouldering responsibility and developing resourcefulness, will help to equip him for his future work in the National Health Service.
The Britain-Nepal Medical Trust Sandwiched between China to the north and India to the south lies the Hindu Kingdom of Nepal. Five hundred miles long and ioo miles from north to south, with a population approaching twelve million, this fascinating country was virtually closed to outsiders until 1950. In 25 years it has emerged from obscurity, opening its borders to the many who want to wander through the streets of Kathmandu or stride off into the mountains to gaze at the ice giants of the Himalayas. Problems facing a developing country such as Nepal are legion and none the least is the health of its scattered population. When I first visited Kathmandu in I966 there were only 200 doctors in the country and most of these were situated in the Kathmandu valley and a few of the larger towns. Later that year the Britain-Nepal Medical Trust was registered as a charity in Britain, its aims being to provide personnel and supplies to augment the Nepalese health services. By i968 the first team of I I doctors and nurses was in Nepal working alongside Nepalese staff. During the past 8 years over ioo doctors and nurses have been employed by the Trust, mostly from the United Kingdom but also from the United States, Holland, and Canada. In a country where 4 out of every Io child-
ren die in the first year tuberculosis reaps a heavy toll throughout the population and the incidence of the disease could be as high as
We set about tackling the problem in two ways: by treating the patients with the disease through a network of clinics in the plains and the hills and by initiating a BCG campaign. The latter involved giving BCG vaccine to children from one day old up to I5 years, thus providing protection from the disease and limiting its spread in the years to come. Gradually expanding outwards from our base in the plains, ward by ward, district by district, we are now involved in covering the whole of Eastern Nepal-a third of the country. Publicity has spread before us to such an extent that in one district more children were given BCG than were shown to exist in the latest census. Two months ago we gave our millionth injection. To achieve this figure our doctors and nurses and our Nepalese trained staff have walked Ioo 000 miles across some of the most difficult terrain in the world. With a bit of luck and with continued support they will walk a similar distance in the next 5 years.