In England we have the dawn chorus. Sitting here in Nepal, in a room home to various insects and gheckos, on a bed that belongs to the man hosting my stay in his town, I am being night serenaded by a whole choir of foxes yowling.

Like the bus horns on the streets of Kathmandu, it is unnaturally loud. The foxes occasionally tire and give up, the air startled with silence then slowly refilling with the quieter music of the crickets.

It is hot, and I am sweating into clothes that are not clean, with the prospect of waking up tomorrow to wear clothes that are also not clean. There was not enough water from the well in our black plastic water barrel yesterday, so my clothes will wait, and the people of this town will once again marvel at how dirty this rich foreigner is.

I am on a gap year between a science and a medicine degree, and chose to come to Nepal about one month before I left, inspired by tales from my friends who had been here. I am staying in Trisuli, a small town just over 3 hours west of Kathmandu, volunteering at a health clinic. It is actually far more like work experience as I arrived here with only a science degree and a first aid course so cannot really contribute except with simple tasks.

I chose Volunteer Nepal (volunteernepal.com) because the spiel by the founder, Michael Hess, seemed genuine and the prices were comparatively low: I am quite poor and when an organization charges amounts averaging a local person’s annual salary it makes me question their motivation.

The clinic is run by Raju, a paramedic with a social conscience from Kathmandu. Check-ups are free; patients pay only for the medicines and other supplies they take away with them. Also working here is Gogana, a pathologist, and Laxme, a young nurse, both from local villages. There is a local ‘district’ hospital up the hill and on Saturdays specialist doctors visit from Kathmandu.

The days in Trisuli seem very slow. Nepali people get up at 5-6am and the clinic opens at 7am. The trickle of patients from the street comes slowly but reliably throughout the day.

Many cases we see are of food poisoning resulting from bad meat or poor sanitation, the latter also causing fungal and urinary tract infections. There are no showers and people wash at the communal water source by the side of the street or with a bucket in their back yard. The lack of privacy and strict dress code means only young children get naked to wash and the poor quality soap adds to the problem.

In quiet times Gogana talks to me about Nepal and we discuss its differences from the UK. He tells me the main problem in Nepal is in rural areas, where the farmers are very poor. They often have only enough food for their family so are unable to afford much fruit and vegetables.

"The UK people have a very balanced diet, I think", he says. I talk about fast food and describe a case I read about of an American student presenting at a clinic with malnutrition because he always ate fast food. I also talk about the obesity epidemic and try to suggest we have the similar problems as Nepal for different reasons, but Gogana shakes his head. I am exaggerating, he knows; their problem is far more serious.

I have seen no serious cases of nutritional deficiencies in Trisuli, however, and there is no hint of starvation. On the contrary, older ladies will often become gloriously rounded, their extra fat adding curves that are accentuated by the beautifully colourful and intricately designed saris they wear.

On Saturday the gynaecologist visits from Kathmandu and I see the pregnant girls undo and redo this complex ensemble at close hand. They are young, usually between 18 and 25 years. Unmarried at 23 I feel old.

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