Providing surgical services to the poorest of the poor of Nepal
Shankar Man Rai
America Nepal Medical Foundation Convention
Atlanta, 10 June 2000
The great need for health care services in rural Nepal has been a great challenge for the government as well as for the people and organizations concerned with health. All the big facilities are concentrated in big towns especially Kathmandu and so are the specialists for obvious reasons.
For a great majority of the Nepalese, it is still the district hospital where they have any access. Even though there is a referral system to the more specialized and organized health facilities, it is beyond the realm of economic possibility for them. The slogan of ‘equal access to health care for all’ is purely rhetorical. Provision of specialized care like surgery by qualified and well trained surgeons in remote districts on regular basis is just no possible for a long time to come.
SCALPEL is a group of doctors who are making an effort to train general doctors working in the remote district hospitals of Nepal to carry out basic surgical and orthopedic operations in district hospitals since 1996 using the instrument and supplies available in their own hospitals. The nurses and other paramedics and support staff are also trained to work as active members of this district surgery team. We have conducted 10 of two-week long workshops in 9 different district hospitals of Nepal. The whole district hospital staff realizes how much can be done by them using their own instrument and supplies with the training they already have. These workshops were carried out by the generous fund from American Himalayan Foundation, Sweet Grass Foundation, and Sailung Foundation. More than six hundred people have been operated in the remote districts through this program. This program has prepared the district hospitals for the possible emergency surgeries of life saving nature e.g. c section, perforation peritonitis on people who would otherwise just suffer or even die.
Considering the huge number of the patients with cleft lip and cleft palate deformities, there is a great need to train more surgeons to do cleft surgery all over the country. Majority of our patients can not come to Kathmandu or other big towns for surgery increasing the need for the surgical team to go to hospitals nearer to their homes. Such a program was first envisioned and carried out by Dr Libby Wilson and Dr Roger Miller of ‘Karing For Kids’. Interplast followed the suite and started going out of Kathmandu valley to provide plastic surgical service to the poor people and train local surgeons of the peripheral hospitals. Both the teams have reached the poorest of the poor people who need surgery for correction of their deformities for functional rehabilitation. Since last July, a new program called ‘Smile Train Incubator Program’ started in Nepal which has been able to reach people in periphery, train surgeons in cleft surgery and provide some speech therapy to the operated cleft palate patients. More than five hundred cleft patients have already been operated since last July. In less than a year’s time, the program has gone to ten different peripheral sites for more than 25 times and has been training two ENT surgeons, three general surgeons and one generalist. The program was designed by Dr Dave Dingman of Interplast who also supervises it. In due course of time, the surgeons in the periphery will start providing the service independently on regular basis and train more surgeons. The program has also been successful in organizing two one week long speech therapy camps for the operated cleft palate patients. Patients together with one family member spent the whole week with other patients and family members learning speech therapy from Nepali and expatriate speech pathologists. Plans are being made to incorporate orthodontics, and ENT in the program.
We also trained a general surgeon from Bhutan for a year in plastic surgery through a program called ‘Orenstein Fellowship’ and have plans to get more international surgeons of this region in the future.
Slowly, we are making progress by the generous help and support from organizations like Interplast, Karing For Kids, Smile Train Incubator Program, American Himalayan Foundation, and individuals like Drs Libby Wilson, Roger Miller, Dave Dingman, Kristin Stueber , Joe Rosen, Earl Parrish just to name a few. We sincerely thank all these organizations and individuals.
Shankar Man Rai
P O Box – 2033
Kathmandu, Nepal
ShankarRai
hotmail.com