Local Voices: Surgery and Research in Nepal

Dr Sagar Devkota is a physician from Nepal. He completed his medical degree from BP Koirala Institute of Health Sciences, Dharan, Nepal .He has worked as a medical officer in Nepal and recently was a study coordinator in  the Surgeons Overseas Surgical Assessment Survey (SOSAS)-- Nepal countrywide epidemiologic survey.  His interests are global health, internal medicine and promoting research skills in low and middle income class countries. He can be reached at @1devSagar.

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Walking down the streets of Hetauda, I came across a 46 year old female who had the complaint of recurrent bleeding while passing stool. She was not willing to seek medical attention mainly because of the fear of getting under the knife. Her lack of knowledge regarding her treatment options was preventing her from getting surgical treatment for her condition, even though we all knew it was completely curable.

 This encounter made me aware of the situations where people with morbid medical and surgical conditions are still unaware about the availability of treatment options.  It really highlighted how people who have all these conditions are still unaware that treatment is possible and also the dearth of surgical treatment options in Nepal.

“You can’t start the next chapter if you keep re-reading the last one.” Having heard and talked a lot about TB, HIV, and many health issues, I was wondering whether there was anything left to be discovered. This was perhaps the perfect time to have come across the idea of assessing the surgical needs in my country which still lacks basic healthcare facilities.

“An idea can make the difference”. #nepalSOSAS is in true sense an idea aimed at reaching out to the people of Nepal and knowing the ease of access to surgery. It is in fact the perfect way of knowing the actual picture of surgical problems in Nepal when most of the research has been focused on other medical issues or epidemiological studies. SOSAS (Surgeons OverSeas Assessment of Surgical Needs) takes into account the ease of access to health facility, a community's perceived need for surgical treatment, the availability of surgical care, and women’s health and surgical problems.  We interviewed individuals in 1 one urban and 2 rural "clusters" in each of the 16 randomly selected districts across the country.

Putting forward the idea of #nepalSOSAS was one thing--but making this dream a reality was a different picture altogether. We began with a pilot study in Pokhara in January and we finally started training team leaders and volunteers on May 24th. The idea of an online portal was new to us and we were excited about using it. The survey started from Kathmandu which is the capital and the urban center of Nepal. The job of completing surveys for 270 households in the most dense district of Nepal in 3 days seemed like a distant possibility. Finding each household was tough and the deflating heat and the rain didn’t help either.  But this herculean task was achieved with the help of all the dedicated and well trained volunteers.

We headed from Kathmandu to Chitwan, where we trained and commissioned a team of 8 to conduct surveys across the district. We then headed to Makwanpur in the south of the country. Makwanpur which was a completely new place for me and I being the team leader was worried whether I could get the job done. But as things panned out I didn’t do that bad a job either. Basamadi, one of Makwanpur's rural clusters was the most tiring and difficult experience. I really felt sad knowing the problems faced by the people who thought of seeking medical attention for health related problems. I was surprised to know that people had to travel on foot for nearly 30 minutes to the nearest health facility. I was left wondering what they actually did when they had serious health related problems. Heavy hearted, we started our journey towards Kogate. I seriously had doubts over this cluster due to the rain. The doubts shown by the drivers about reaching there didn’t help either. But as things unfolded, it turned out to be the most beautiful one. The urban cluster was cakewalk, I realize now.

With so much talk focusing on a better Nepal in the recent times, it was really frustrating to see people suffering so much due to a lack of access to health services needed to treat surgical problems.

A female with recurrent anal fissure was interviewed by us during the survey and although she was not willing to seek medical attention, with our constant efforts and counselling, she has now undergone surgery. The dream of reaching out to the people was perhaps fulfilled.

It was really disheartening to see the people suffering so greatly with easily fixable health related issues, be it due to lack of awareness or to geographical and financial constraints. With so much talk focusing on a better Nepal in the recent times, it was really frustrating to see people suffering so much due to a lack of access to health services needed to treat surgical problems. The lack of qualified health personnel and the rampant rise of quacks in rural Nepal really astonished me. It was really disappointing to see the concerned authority being so ignorant about this issue. The increasing trends of drug resistance and the increasing mortality associated with injudicious use of drugs could have been curtailed with proper monitoring. I really hope that making the surgical problems of the people and other health related issues heard with #nepalSOSAS will have a significant impact on generating attention of the concerned authority. I wish that this effort put in by the Surgeons Overseas and the all its interns in reaching out to the people won’t go unnoticed and will lay a solid platform for better and healthier Nepal.

What are your experiences or opinions about surgery in low and middle income countries? Do you feel it's necessary/possible to make surgical facilities available to everyone, regardless of their ability to pay? How should it be done? Sound off and discuss with other diaspora at our new Forum: http://my.diasporahealthnetwork.org/forum/surgery-at-home-a-discussion