Kathmandu University Medical School Project
A Short Introduction & Invitation for Collaboration

Arjun Karki, MD
Project Coordinator
KUMS Project
Kathmandu, Nepal
kumswlink.com.np

America Nepal Medical Foundation Convention

Atlanta, 10 June 2000

Background:

Following the historical people’s movement in 1990, which resulted in the establishment of a multiparty parliamentary system of democracy, Nepal witnessed series of changes in social sector area. One of the key features of these changes was to encourage private sectors to get involved in the national development process. Visionary leaders of would be Kathmandu University (KU) exploited this opportunity to give a new shape, meaning and direction to higher education in Nepal.

Established in 1991 with the charter from the parliament of Nepal, it has grown significantly since then and has already been running several academic programs of undergraduate and postgraduate levels in different disciplines through its Schools of science, education, management, engineering and medicine. Because of its unwavering commitment for quality and excellence in education and efficient management system, KU has already made itself known as the model institution of higher learning. As a result, Kathmandu University run academic programs are heavily sought after by the overwhelming number of students anxious to get a worthwhile education within Nepal.

In its current organizational set up, the Prime minister of Nepal is the ex-officio Chancellor of the KU and the Senate, the highest policy making body of the KU, is composed of several key government officials including the Ministers and National Planning Commission members. It is being run not only on a not for profit basis, but its properties will belong to the government should there be a situation in which it gets dissolved. Given these characteristics, it can be said that even though managed privately, KU is rather an academic institution of public nature.

Kathmandu University and Medical Education:

One of the special features of post democracy Nepal is the unprecedented proliferation of educational institutions in the country. While initiated and run mostly by the native Nepali people, some outsiders (Indians) have also contributed in this proliferation. As a matter of fact, it is the later group who either own and / or promote most of the existing private medical colleges (Currently there are 8 medical schools in the country, 6 privates and 2 funded and run by the state. And there are few down the pipeline) in the country. Expensive though the business of running the medical school is, especially during the early years of its establishment, the amount of money the students have to pay to get admitted and complete the entire study in these medical colleges has been a point of criticism in public media. Given such high capitation fee, one cannot help but wonder whether their primary motivation was making profits rather than to impart quality education to the future physicians.

However, it is unfortunate that the KU ended up giving affiliation to 5 out of the 6 private medical colleges that we have today. This resulted mainly because of the undue political / administrative pressure exerted to KU by the government to give the medical colleges the needed affiliation even before it had the chance to assess their motive and performance. The medical colleges which are currently affiliated with KU are as following:

Name of medical colleges Geographic location Year of KU affiliation

• Manipal College of Medical Sciences Pokhara 1994
• College of Medical Sciences Bharatpur 1996
• Nepalgunj Medical College Nepalgunj ` 1997
• Nepal Medical College Kathmanmdu 1997
• Kathmandu Medical College Kathmandu 1997

Kathmandu University Medical School (KUMS) Project:

a) How KUMS started?

That decision of KU proved very costly. KU was harshly criticized not only by the medical establishment but also the academia and media. Fortunately, however, it did not take too long for the KU leadership to realize that giving affiliation was a hasty decision. Obviously, it was not possible for the KU to disown these colleges at that stage, for it would involve the future of so many young men and women. On the other hand, KU was not prepared to give up its mission of providing the highest possible quality education, including medical education, of course, for the nation. It was primarily to ensure the proper quality control in, provide necessary technical leadership for and bring new and appropriate innovation in medical education in the medical colleges under its jurisdiction that KU felt the need to accelerate its long worked out plan to establish its own medical school i.e. Kathmandu University Medical School (KUMS) and was on the look out for potential partners who would not only share their educational mission but would also have the willingness, capability and commitment to make this dream a reality.

It was around mid November 1999 that I came in contact with the KU leadership for the first time. Having been disappointed with the performance level, the pervasive lethargy and excessive politicization among the national medical institutions and having felt the need to act to improve the situation, a group of like-minded physicians, including myself, were also exploring realistic alternatives to focus our time, energy and expertise to create a model in the field of medical care and medical education. We therefore found a meeting point with KU and had a series of joint meetings in December 1999 and January 2000 where we discussed about several key aspects of this proposed new medical school. These deliberations, followed by the critical review of the available literature in the area of medical education, the country health profile, and national policies on health and human resources culminated in the production of the concept paper in February 2000, which most of you are familiar about.

b) What are its aims?

1. Broadly speaking, KUMS intends to do following 4 things:
2. Produce physicians who are not only technically competent but are also socially responsible. In so doing, it wants:
• To enroll academically capable and socially deserving students.
• To have a curriculum that attempts to maintain a balance between our current needs and the challenges of 21st centaury.
• To adopt the Problem Based Learning (PBL) as the methodology of instruction.
• To recruit well-qualified and academic minded faculties with demonstrated professional/scientific productivity who share the KUMS vision / philosophy and willing to contribute to its mission.
3. Provide quality medical care through its University Hospital (envisaged to be the National Medical Center of Excellence) with the state of the art facilities so that we no longer need to send our citizens abroad for diagnostic work up and / or therapeutic interventions for their medical problems.
4. Carry out independent and / or collaborative research work in clinical and public health area in the spirit of understanding and / or resolving the medical / health problems affecting our populations.
5. Engage in national dialogue in a proactive way to make the national health system equity oriented, need responsive, cost effective and efficient in the years to come.

Interestingly enough all these aims are quite consistent with the spirit of current national health policy of Nepal.

c) What is the organizational set up of KUMS like?

The KUMS is a plan officially endorsed by the Senate of KU. The executive council of the KU has formed the following committees to plan and launch the KUMS project:

1. Steering Committee: Comprises 4 members, chaired by the KU Vice Chancellor (VC). Reviews progress and provides direction to KUMS Project.
2. Planning Committee: Comprises 9 members, including the architect. KUMS Project Coordinator functions as its member secretary. Develops and recommends plans and programs regarding KUMS.
3. Project Management Team: Consists of 3 physicians and supporting staff led by the Project Coordinator. Responsible primarily for implementing KUMS project.

d) What is the present status of KUMS?

KU has already decided that KUMS will begin the academic session of first batch of students from August 2001. There will be about 50 students to begin with and the number may expand up to 100 along with development of needed infrastructures. The government of Nepal has allotted 500 Ropanis (? 28 Hectares) of land near Dhulikhel for the purpose of establishing KUMS. A Danish architect has been working out the plans for the buildings for over a year. The contract has already been awarded to the contractor and ground excavation is underway.

We are about to review and modify (as necessary) the existing MBBS curriculum of KU. We have also started exploring the potential faculties in an informal but active manner. Our preference is to recruit Nepal nationals provided they meet the needed criteria. Finding well-trained faculties seems to be the bottleneck in this process.

We have also initiated the dialogue with the several hospitals having the potentials to become an affiliated teaching hospital until the university hospital is built and operationalized. The responses received so far are very positive.

In addition to this, thanks to the generous support of our ANMF colleagues, we were able to get the help of Dr. Carol-Ann Courneya, Associate Professor of Physiology and experienced medical educator in PBL system from University of British Columbia (UBC), Vancouver, Canada from 16 – 26th of May. Her visit proved very fruitful not only to help the KUMS leadership to get a better understanding of PBL philosophy and techniques, but we also organized two mini workshops for our prospective faculties about the actual practice (or tutoring the students) of PBL in a small group setting. In addition, this encounter has also provided a solid basis for future collaboration with her, for example provided that UBC agrees to second her to KUMS program, she is committed to come back with a long-term assignment.

Establishing a new medical school is a daunting task indeed. Hence much remains to be done including setting up a good medical library, building and equipping the classrooms / laboratories, faculty recruitment, student selection etc. etc. Accomplishing these tasks require huge amount of fund and active efforts are underway to explore all the possible avenues to generate the needed resources, including that of taking low interest loans from the banks.

What can ANMF do to this initiative?

When we established the ANMF about four years ago, our overriding goal was to help Nepal in its effort to strengthen the technical capabilities of its medical institutions and thus enabling it to achieve a reasonable level of national self-sufficiency in the area of medical care and medical education. Because that was the raison d’etre of its very existence, it has initiated various concrete programs towards this direction. Organizing CMEs in Nepal and sending books and journals for the TUTH library are just some noteworthy examples. Despite the lack of timely communication and other shortcomings, the medical community in Nepal is gradually but increasingly appreciating these ANMF efforts.

It is in this context that KUMS is soliciting ANMF support as it struggles to come into existence. In addition to demonstrated track record of KU, KUMS has the right vision and leadership, has the interest of ordinary Nepali citizens in its mind and heart, and above all, has the potential to become an inspiring model and standard-bearer in the field of medical care and medical education in Nepal. I am saying this not because I am a part of this process. I am saying this because these are my convictions. As a matter of fact these were the prospects that inspired me to join and work for KUMS.

This being the case, on behalf of the Kathmandu University and KUMS Project, I request all the colleagues in ANMF consider the need of KUMS favorably and to extend its support as it plans to proceed ahead with its noble mission. Specifically, apart from the good will and general encouragement, we would like the ANMF to provide and / or facilitate the help in the following key areas that are of immediate concern of ours:

1. Human Resources:
   KUMS needs qualified faculties especially in the area of basic sciences (anatomy, physiology, pharmacology, pathology, biochemistry, microbiology, genetics, immunology, behavioral science etc). Please mobilize your members, well wishers and other appropriate networks to explore potential candidates willing to teach in KUMS program for short term / long term basis. We can not pay their salaries, but we will provide modest accommodation and meet their basic living cost while in Nepal. If there are training opportunities available to upgrade the knowledge base / skills of our faculties (basic science and / or clinical area) please let us know. If there are researchers interested to collaborate with us help us get hooked up with them. We welcome faculty and student exchanges.
2. Material Resources:
   KUMS needs to build up a good medical library with the adequate collection of various learning resource materials. This is especially important for us because we want to adopt the PBL system as the principal method of pedagogy, in which self-directed independent learning replaces the conventional didactic lectures. We would greatly appreciate ANMF’s support in this area. Once it arrives in Nepal, it will be our responsibility to deal with the custom authorities for clearance etc.
3. Financial Resources:
   We are aware of the fact that ANMF does not yet have a sound financial base. However, if anyone of your members or well wishers are interested in making some financial contribution to be used for a specific or any purpose of KUMS project, we would encourage and welcome that. If they would like to contribute towards a part of the building or construction e.g. conference room or library building etc. in memory of their loved ones, we are willing to consider to keep their names on that room or building.
4. Publication / Networking:
   Given that many of our prospective faculty members are in North America, and to some extent in Europe, Australia and Japan, it will be a great help if you could spare part of the cyber space of your web site for KUMS related information and / or cross connecting with our own web sites which is under preparation at present.