We identified two exceptional young physicians to support their specialty training.
We hit the jackpot when we met Drs Raju Dhakal and Prakash Paudel. They are two exceptional and dedicated young doctors whom we not only mentor but with whom we have forged enduring bonds of friendship. Both have now successfully passed their exams – on their first try.
Polio afflicted Raju as a child. To this day, crutches restrict him physically but his spirit and determination are unquenchable. Raised in a remote village three days’ walk to the nearest bus, his parents must have recognized his ‘specialness’ for they had the perspicacity to send him to live at the SOS Children’s Village near Kathmandu. His parents’ sacrifice was his salvation. In Raju’s own words:
In the core of my heart…I wanted to be a doctor…. It was first time the SOS Children’s Village…had received such a request, and no disabled person had ever dared to study medicine. Full of doubt and uncertainty, but with a determined heart, I went to Village’s national office and explained my interest. National Office was positive about my proposal. It was the second time my eyes filled with tears, BUT this time it was tears of joy and celebration! It was the most memorable moment in my life….
When we met Raju in 2009, he had just begun practising at SIRC, and was also working two other jobs – teaching anatomy and covering night call in a local emergency department. That meant that he could only work part time at SIRC during his first months there. He had placed well in his medical school class. At SIRC, he cared for about forty patients with the assistance of two nurse clinicians. We began teaching sessions with him and found his brain was like a sponge, thirsty for knowledge. He attended two Asian Spinal Cord Network (ASCON) conferences (one in combination with the annual meeting of the International Spinal Cord Society (ISCoS), visited the Indian Spinal Injury Centre twice and in early 2011 won an observership position at the National Rehabilitation Hospital in Ireland.
We discussed various options with Raju for credentialing in Physical Medicine and Rehabilitation or other specialty, and carefully explored the options for out-of-country and out-of-region training. North American training was prohibitive in cost and we realized that there are some other benefits to regional training: the likelihood of return to work in the home country is greater and the management technique taught are based in an economy similar to that of Nepal. He was accepted by the PM&R program at Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, and began his residency training in March of 2012, qualifying as a specialist in PM&R in the spring of 2017. For this training, we provided tuition expenses and a monthly stipend for five years, as well as money for airfare for periodic visits home. We have worked closely with the Spinal Injury Rehabilitation Centre in Nepal to ensure his financial support through his five years of training and back into practice in Nepal – he began work as Medical Director in May of this year. We will also explore with him opportunities for additional SCI training. He has done consistently well on examinations, and maintains great enthusiasm for his studies.
Raju and Sheela were married on October 16th 2012 and were together in Dhaka until she successfully completed her Master’s degree in public health. Sheela returned to work in SIRC in the fall of 2015 and is looking for opportunities in her field. We talk with them every few weeks.
Raju and Sheela returned to Kathmandu in May 2017. Raju is now the medical director of SIRC and is the senior doctor. Raju has already begun discussions with the SIRC administration and board on the topic of founding a rehabilitation training program. SpiNepal will assist as needed in this development.
Prakash’s story is no less inspiring. As he tells it:
Having been born…in one of the most remote parts of the nation, even a notion of acquiring a good education was a farfetched dream…. My father can barely read and write, whereas my mother was illiterate…. It was in…my ninth grade, when the concept of medical school was introduced to me…. I lost my mother…as a result of a crossfire between armed rebels and security forces right outside my doorstep…. I got to know about it a day later, amidst friends discussing the prospect of medical school.
Prakash was working at the Kathmandu Model Hospital as a neurosurgical medical officer when we first met him. He placed well in the qualifying exams of the Pakistani College of Surgeons (commonly used in Nepal) but was unable to afford the training and exams beyond that would qualify him to proceed with neurosurgical training. With our encouragement and backing he began this residency with the support of the local neurosurgical head. He completed eighteen months of general surgical residency (which carries a stipend) at the end of June 2012 prior to entering the three years of neurosurgical training (which carries no stipend). He has received credentialing as a neurosurgeon and is now a fellow of the College of Surgeons of Pakistan, a qualification accepted in Nepal. He is in the planning stages towards a spine surgery fellowship under the guidance of Drs Scott Paquette and Peter Wing.
Prakash worked in the community prior to developing his interest in spine work. At Kathmandu Model Hospital he undertook a research project focussing on the role of folic acid in prevention of spina bifida. His paper “Awareness of periconceptional folic acid supplementation among Nepalese women of childbearing age: a cross-sectional study” was published in the journal Preventive Medicine. Congratulations, Prakash and coauthors!
Prakash, worked in Bir Hospital in Kathmandu for about one year after passing his specialty exams. He was awarded a three-month fellowship in neuroendoscopy in Greifswald in Germany (fall 2017) and is now working in Mediciti Hospital in Kathmandu. He is still enhancing his qualifications and will seek a spine surgery fellowship. The subspecialty of Spine Surgery, which is open to neurosurgeons and orthopedic surgeons with (usually) a one-year fellowship, is evolving in Nepal and in due course it is likely that a major trauma centre will develop a focussed spine program.