Nepal is a geographically breathtaking country in South Asia and home to majestic Mount Everest and about 240 other peaks that rise more than 20,000 feet above sea level—magnets for mountain climbers worldwide.
As a trio of doctors visiting the country with the RSNA-hosted International Visiting Professor (IVP) Program recently discovered, those mountains—and the victory experienced by those who scale them—serve as a metaphor for the healthcare challenges faced by this country of 29 million, and the resourceful practitioners who are overcoming them.
Young Kim, M.D., was among the doctors who traveled to Nepal, located in the Himalaya Mountains and bordered by China to the north and India to the south, east and west, for nearly two weeks in February 2012. RSNA annually sends teams of North American-based professors to lecture at national radiology society meetings and meet with radiology residency training programs at selected host institutions in developing nations.
"The medical community in Nepal was hungry to learn more about technology and procedures they can use now," said Dr. Kim, an associate professor of radiology at the University of Massachusetts Medical School, Worcester, participating in his first IVP trip. "Faculty members remarked often that hearing about advanced technologies such as MR enterography motivated and inspired them to continually learn and advance in their profession."
A top priority for the IVP team was attending the South Asian Association for Regional Cooperation (SAARC) Fifth Congress of Radiology in Dharan, a major city in eastern Nepal. IVP team members lectured at the congress which was originally established by the Radiological Society of SAARC Countries, whose member countries are Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.
"It makes you appreciate the advantages that we have here," said Anne Roberts, M.D., chief of vascular and interventional radiology at the Thornton Hospital/University of California San Diego Medical Center and a member of the RSNA Public Information Advisors Network, on her second trip with the IVP program (she previously traveled to Nigeria). "I know it sounds cliche, but until you have seen what other countries make do with—and without—it is hard to really understand how lucky we are."
The doctors’ visit began with the SAARC congress, its fifth and largest gathering so far, held on the 700-acre campus of B.P. Koirala Institute of Health Sciences. The complex features a hospital, medical school, nursing school, technology training and housing for medical students, residents, faculty and staff.
The doctors lectured and gave case presentations to an audience that included almost all of Nepal’s radiology residents, many residents from India and numerous radiologists from SAARC countries. A demonstration by the third IVP participant, Kambiz Motamedi, M.D., an associate professor of musculosketal imaging at the University of California, Los Angeles, included what he considered an unusually successful demonstration of hands-on ultrasonography on actual patients.
"The audio-visual equipment was excellent and the projection of ultrasound images—which, from my past experience is not so easy—was superb," Dr. Motamedi said.
As team members toured the medical institution’s grounds, including the surgical, pediatric and OB/GYN areas, they observed the institute’s Department of Radiology, which has basic resources but clearly needs more advanced equipment.
"They have a 0.5 Tesla MR imaging scanner that is about 20 years old," Dr. Motamedi said. "There are several up-to-date ultrasound machines and a multi-detector CT scanner, but there is limited availability of fluoroscopy and regular diagnostic radiology mammography machines."
In Kathmandu the IVP physicians lectured at the National Academy of Medical Science, Bir Hospital and the Tribhuvan University Institute of Medicine and toured their radiology departments. Most are equipped with one older, low-field (0.5 T) MR imaging scanner and a multi-detector CT scanner. None of the institutions they visited owned PACS equipment and high-resolution 3T MR imaging wasn’t available anywhere in the country, the doctors said.
The IVP team’s next stop, the Universal College of Medical Sciences in Bhairahawa was better equipped than other facilities, Dr. Motamedi said. Located in a brand new wing in the private college, the radiology department has a 0.5 T MR imaging scanner, a new multi-detector CT scanner, three ultrasound rooms and several general radiology rooms.
Funding for the mostly public hospitals and medical institutions visited by the RSNA team comes from various sources. The B.P. Koirala Institute, for example, receives funds from the government and the Indo-Nepalese Medical Association. India also plays a large role in funding Nepal’s medical system, which draws a large percentage of its radiology residents from India.
Nepal has five radiology residency programs with a total of 25-30 residents in training and these spots are very much in demand. "Although the equipment, with few exceptions, is quite old, the staff and residents still are able to provide invaluable service to their patients," Dr. Motamedi said.
Despite current challenges, Nepal holds the promise of future radiology advancement by tapping into an ever-expanding pool of resources, including those offered by RSNA, he added.
"Although the state of medicine and, in particular, radiology in public institutions is very basic, the speed and availability of the Internet and support from India are promising and may aid advancing radiology in Nepal," Dr. Motamedi added. "RSNA can also play a crucial role in advancing radiology in Nepal by continuing to provide access to medical journals and online tutorials. With the exception of India, the other SAARC countries are really in need of help in terms of radiology training."
While the team spent a lot of time working, they were also able to enjoy some of the amazing Nepalese sights, including a temple in Kathmandu, a bird reserve at the Nepalese/Indian border and a view of the Himalayas and Mount Everest by air.
A visit to Lumbini, a United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage site that was the birthplace of the Buddha and where many temples have been built over the centuries, was a trip highlight for Dr. Kim. "On first glance, the area seemed empty and undeveloped with nothing but trees and vast fields, but it offered a remarkable sense of comfort and calmness that is rarely felt," Dr. Kim said.
In contrast with its magnificence, seeing the areas where Nepal is lacking—infrastructure, medical technology—had a profound impact on the IVP team, who felt privileged to give of their time and training. In fact, the Nepalese trip fulfilled a dream Dr. Kim has had for many years.
"Having grown up in South Korea, I was able to experience the transformation of a country from a poor and undeveloped nation to a modern, high-tech society," Dr. Kim said. "I was always very appreciative of the medical education I received. Many of my teachers trained in countries such as Japan, Germany and the U.S., and returned to Korea to help develop the medical profession. I have always felt the need to give back in the same fashion, and going to Nepal was simply a dream come true."
In addition to Nepal, 2012 IVP teams traveled to Vietnam, Mexico and El Salvador. Destinations for 2013 are Tunisia, Russia and Kenya. Other recent trips have included Myanmar, Lithuania, Estonia, Nigeria and Malaysia.
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