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About Nepal

Nepal is one of the poorest countries in the world. One consequence of its extreme poverty is that the country suffers a marked disparity in health care. Whereas the doctor/patient ratio in Nepal’s urban areas, 1 to 1,500, is comparable to that available in developed countries, that ratio in most rural areas, where 85% of Nepalese live, is just 1 to 30,000. This glaring disparity, among other social ills, has contributed to the civil unrest of the last decade. More equitable healthcare would not only alleviate much suffering in the rural parts of the country, but also promote social cohesion and a sense of shared identity, and in turn reduce the likelihood that conflict might reoccur in Nepal.

About the Patan Academy of Health Sciences

Working with the Patan Academy of Health Sciences (PAHS), Academics Without Borders (AWB) hopes to improve health care in Nepal. PAHS has a Medical School and a School of Public Health and is affiliated with the neighboring Patan Hospital, in which its students have their clinical training. It aims to bridge the disparity between urban and rural health care by educating doctors willing to provide medical care to disadvantaged Nepalese living in rural areas. Specifically, it recruits students from those rural areas — often from poor families and from lower castes – with the understanding that at the end of their six-year program of studies, they will commit to spending five years working in rural areas. From the beginning of their studies, they participate in rotations in rural villages, where they incrementally apply community-based primary health care

Gap and Upgrade Teaching:* 2011 – 2013

Courses on Cardiology and Human Biology

In 2011, Carol Ann Courneya, along with two other AWB volunteers, Jane Gair and Jason Waechter, delivered two courses in basic medical science to 60 students who had begun the program in 2010, the first group attending PAHS. Carol-Ann and Jason taught a course on cardiology and Jane, a course on human biology. In giving the courses they worked closely with their PAHS faculty counterparts, Ira Shrestha, Babu Rajha Maharjan, and Mili Joshi, and their teams. The apprenticeship model that was used incorporated teaching and curriculum development for the faculty. After finishing their assignment at PAHS in 2011, the volunteers continued their relation with PAHS, providing on-site support for the PAHS faculty in 2012 and supporting them on-line in 2013.

Teaching in Nepal is so rewarding—I love interacting with the students and learning so much about international educational differences. In this past visit, I learned far more from the faculty and students at PAHS than I think they learned from me.

–Jane Gair

*Gap teaching is filling in the gaps in the course offerings of a university which does not have the faculty to teach the course; upgrade teaching is teaching a course with a local faculty member to upgrade their ability to teach the course.

The Cardiovascular Courses: 2014

Bibiana Cujec, Kristen Lyons and Olga Toleva, cardiologists from the University of Alberta, spent a month at PAHS in January 2014. The project’s purpose was to upgrade the ability of some of the PAHS faculty members to teach cardiology. The AWB volunteers and these faculty members co-taught first-year medical students in the Cardiovascular block. Teaching activities included lectures, small-group problem-based learning, learning games, art contests, and workshops. The volunteers also taught the faculty members how to perform echocardiography. This bedside ultrasound examination is very useful in the management of patients who are critically ill or have heart disease.

Thank you very much for teaching us how to use the Vscan [portable echograph]. This is really helping us. Now we are using it every day on each and every patient in ICU.

–Dr. Gyan Kayastha, Chief of Medicine, Patan Hospital

I have visited and worked at the Patan Academy of Health Sciences for up to 4 weeks during four visits in the past five years. The resilience of the people and the resourcefulness and skills of the healthcare workers continue to amaze me. Whenever I return to Canada, I am grateful for our good fortune in having clean water and air as well as advanced medical technologies. Through my visits to Nepal, I also have come to appreciate the power of communities and families that help each other.

–Dr. Bibiana Cujec

Outcomes

Both faculty members and medical students deepened their understanding of cardiovascular physiology and disease. In addition, internal medicine residents learned how useful handheld ultrasound can be in clinical decision-making. And the Intensive Care Unit (ICU) staff and residents developed skills in echocardiographic image acquisition and interpretation. Moreover, they now have new access to on-line resources, so they can continue to employ echocardiography in the daily care of ICU and medical ward patients.

Anticipated Impacts

  • New capability on the part of the PAHS’ Medical School faculty members to teach cardiology and human biology to the Medical School’s students
  • Improved care for rural Nepali citizens suffering from cardiovascular disease
  • Decreased mortality from cardiovascular disease in rural areas of Nepal