Nepal

Nepal Medical Project
(2013 - Present)

During the final stages of the Nepal Ambulance Service EMT training program, the condition of Nepal's rural medical infrastructure was presented as in dire need of modernization. In the summer of 2013, following the two year combined effort of Stanford EM faculty, Nepali community leaders, and the charitable work of the Fletcher Thompson architectual firm to develop blue-prints for modern rural medical clinics in Nepal, a team of Stanford students and faculty travelled to the Solukhumbu region of Nepal to commence a community health volunteer education program to staff the first clinic.

The program was modeled after the successful Papua New Guinea Medical Project; focusing on the primary health care needs of the region and developing a region speciifc training program to educate the local population and develop preventive and early identification treatment processes. The community health volunteer training program follows USAID education curriculum standards but also features new teaching techniques and development of Stanford based visual learning modules.

When funding is complete, the new clinic will be built by Nepali workers with Nepali resources and will be fully staffed and supported by locally trained community health volunteers, along with government trained community health care workers, nurses, and physicians.

A Sherpa women’s medical education fund, Global Medical Outreach, lead by Dr. Kelly Murphy, has been set up to promote higher medical education opportunities for girls and support them during their training in Kathmandu.  

 

 

 

Patan Academy of Sciences Epidemiology Research
(2011)

Prospective Evaluation of Patients Presenting to an Emergency Department in Kathmandu

Due to the struggling economy of developing nations such as Nepal, healthcare budgets are often not sufficient to serve the entire population. The minimal healthcare infrastructure, along with the burden of disease, both infectious and chronic, exacerbates the poor health of the population, especially among the most disadvantaged populations. Due to the need to allocate limited healthcare resources, developing countries such as Nepal have been unable to invest in the establishment and maintenance of an effective emergency medical system.

Morbidity and mortality due to trauma and injury are high in Nepal- annually, 530,000 DALYs are lost to injury in Nepal. Since most injuries occur within the economically active population, this high burden of injury directly impacts the nation’s development by depleting the already scarce human and monetary resources available. Studies have shown that many conditions that contribute to the burden of disease in low and middle-income countries can be improved through prompt emergency care. For many patients in developing countries, the emergency room often also serves as the first point of contact with the medical system. However, there is often a gap between the need for emergency services and the resources available in providing the needed services , including facilities and trained personnel.

As such, collaborative emergency projects are emerging in several countries in the developing world. The Stanford Emergency Medicine International (SEMI), under the leadership of Dr. S.V. Mahadevan, has developed short-term projects that build emergency medical capacities in several nations, including the establishment of India’s first advanced prehospital care program as well as the development of Nepal’s first EMT program.

A prospective study demonstrated that while an emergency medical framework in fact exists in the Kathmandu valley, service and quality of care was found to be lacking . In 2010, the Nepal Ambulance Service, in collaboration with SEMI, developed Nepal’s first EMS system and its first pre-hospital training program for paramedics. This is an important step towards strengthening the emergency medical system in Nepal.

Further training programs for emergency physicians need to be established in order to improve an emergency department’s capacity to care for patients sustainably. A residency training in emergency medicine does not currently exist in Nepal. However, Patan Hospital, a major tertiary-care hospital in Kathmandu, has expressed an interest in developing such a program in collaboration with SEMI. The first step towards this goal is to evaluate the epidemiology of patients presenting to the emergency department, since a comprehensive and effective curriculum cannot be developed without knowledge of the types of patient profiles and cases most commonly seen at the hospital. A baseline of the population and conditions served by Patan Hospital’s emergency room as well as information on the quality of care that was provided is important in the design and implementation of quality improvement programs such as a residence in emergency medicine curriculum.

 

 

 

Nepal Ambulance Service EMS Development
(2009 - 2011)

The Department of Emergency Medicine is once again taking its expertise around the world. Representing the Stanford Emergency Medicine International (SEMI), Drs. S.V. Mahadevan and Paul Auerbach were in Nepal in November to attend the graduation of the very first Emergency Medical Technician (EMT) class in the country, as well as assist with technical issues before the launch of Nepal’s first emergency medical services (EMS) system in early January.

Prior to SEMI’s involvement, Nepal has lacked both a formal prehospital emergency care training program as well as centralized EMS. After learning about the successful launch of a the Stanford-GVK EMRI paramedic-training program in Andhra Pradesh, India, the Nepal Ambulance Service (NAS) approached SEMI to assist with the development of their own pre-hospital training program as well as creation of an EMS system for the Kathmandu valley, home to nearly one million people.

In partnership with NAS, Stanford emergency medicine faculty have successfully created, coordinated and taught Nepal’s very first EMT (Emergency Medical Technician) training program. During the summer and fall, 18 physician instructors and two undergraduates have traveled to Nepal to provide instruction to Nepal’s very first EMTs. The instructors included Aditya Mantha, Nathaniel Lee Coggins, Scott Bradley, Charlene Kiang, Uta Shimizu, Jennifer Kanapicki, Jessica Pierog, Rebecca Walker, Dwain Coggins, Rebecca Smith-Coggins, Phil Harter, Colin Bucks, Peter D’Souza, Laleh Gharahbaghian, Lori Rutman, Ian Brown, Paul Auerbach, Kelly Murphy, Matt Strehlow, and S.V. Mahadevan. The twelve-week course commenced on August 8th and finished on November 13th. Fifty bright, enthusiastic Nepali EMTs graduated on November 17th, 2010, in an historic ceremony.

Prior to their work in Nepal, SEMI put together India’s first successful advanced prehospital care program, a two-year course that lead to the development of a prehospital care training institute in Hyderabad, India. Their success in India provided SEMI’s director, S.V. Mahadevan, with the confidence to expand their program to other countries. Nepal is site of the Division of emergency medicine’s second pre-hospital educational program, and other countries, such as Ethiopia, are waiting in the wings. “We like to align with countries and organizations that are passionate about providing emergency care to those in need,“ Dr. Mahadevan said, when asked how the Division chooses the countries to assist.

Though many countries are eager for assistance, cultural differences and language barriers are some the challenges that must be faced and surmounted. “In Nepal, before beginning the EMT course, we taught a one week leadership course to instill the typically reserved Nepali students with confidence,” Dr. Mahadevan said, explaining how it was important for the emergency medical responders to take charge of emergency situations.

“We are sowing the seeds of emergency medicine in countries that haven’t traditionally had access to emergency care, both in the prehospital and hospital settings. With our collective expertise, and prior experience, we strive to help developing nations build educational programs and EMS systems from scratch.”

For more information, please visit the website for the Nepal Ambulance Service.