Emergence
Stories from the frontlines – family physicians around the world responding to COVID-19 - episode 9 - Nepal

Interview with Dr. Yagya Pokharel on June 16, 2020

The Country with Canadian-Trained GP Programs

GP training in Nepal is what they call Family Medicine, and the origins are deeply connected to Canada - in the 1980s the residents actually came to Calgary for training. More recently, the University of Alberta and west coast ER doctors helped them create a context-specific Emergency training for the GP’s.

The Patan Academy of Health Sciences is attached to Patan Hospital as a training site, so they are responsible for a clinical and resource response. They have a specific mandate to train medical students and residents to serve those most in need, those in rural areas and dealing with poverty, and incorporate 25% of the training embedded in community. Yagya is the Rural Program Coordinator who helps arrange the teaching in District Hospitals, following research that shows students who train in such areas are more motivated to work there afterwards. Many PAHS students have proven this theory correct.

“Our Department had decided to develop an epidemic disaster plan in 2017.”

Dr. Pokharel described how students in rural areas are visiting each household to do screening maneuvers. Patan Hospital developed a disaster management plan almost 30 years ago, to prepare for earthquakes but also infectious disease - the first epidemic disaster plan in Southeast Asia - and Yagya was in charge of this operation. He describes how they learned both from their successes and opportunities. He felt that the drills sensitized all staff, from physicians to sanitation. They developed training modules, from the wearing of PPE to maintenance protocols. When asked about stories of compassion, the housekeeping staff are the first he thought to mention.

“When all the health care workers in the world were begging for PPE, we had already stocked up 500 PPE, 100,000 surgical masks in our hospitals. We learned these things would not be enough, so we started making these things on our own.”

He shared some remarkable initiatives. Their pharmacy made hand sanitizer and disinfectant. They invented a waterproof material (from umbrellas, for their birthing centre) that can be autoclaved for up to 6 wears, and have made hundreds of these homemade hazmat-suits that use transparencies (those used with projectors for teaching) as face masks - true entrepreneurship.

The Emergency, run by GP with enhanced training, is running a triage system where any symptoms or people from the “red zones” are sent to a separate department. Those patients receive PCR testing and then it’s determined where they may be admitted - their separate floors divide these patients - positive cases go to the second floor. These kinds of deliberate choices meant that no services closed or stopped throughout the response, including maternity care and surgery. He even mentions how hard it is to wear full PPE all day during the hot, humid monsoon season!

Yagya is also involved in two research projects. They examined the ethical implications, having some background in how to make critical decisions around resource management. They also surveyed the health care workers, finding that most of them have deep intrinsic motivation to help in the pandemic response - that they want to help. Their GPs are the first responders in their community; their teamwork is intrinsic to their success..

Innovation. Planning. Excellence.

Thank you, Yagya, for sharing this world-class response to a global pandemic with the involvement of committed family doctors (GPs). PAHS’ mission of love in community truly shines in this pandemic response. Namaste, indeed.

Listen to the podcast here: https://cfppodcast.libsyn.com/covid-19-global-pandemic-and-family-medicine-ep9-nepal

Links to the Journal of PAHS: https://jpahs.edu.np/index.php/JPAHS/about/index

Link to news about Christine’s being caught in the earthquake while working at PAHS: https://globalnews.ca/news/1963469/calgary-doctor-in-nepal-describes-life-after-the-quake/

Dr. Yagya Pokharel is an Assistant Professor of General Practice and Emergency Medicine at Patan Academy of Health Sciences, where he is involved in their rural medical training for medical students and GP residents. He is also an Executive Member of General Practice and Emergency Medicine Association of Nepal.

Dr. Christine Gibson (www.christinegibson.net) is a family physician in Calgary, Canada with a background in justice work, medical education, and global health. A skilled facilitator and speaker, she is engaged in building individual and community resilience. Her writing creates the woven narrative between her interests – wellbeing, trauma recovery, and the power of story.