RCPS(C) IDAC Grant “NPMR”
We are proud and grateful to announce our three-year grant from the International Development, Aid and Collaboration (IDAC) Funding Program of the Royal College of Physicians and Surgeons of Canada. The project is titled : “A Physical Medicine and Rehabilitation Residency by, in and for Nepal” and abbreviated as NPMR.
Nepal needs and wants more physiatrists trained for Nepali needs and this project, developing a resident training program in Physical Medicine and Rehabilitation (PMR) in and for Nepal, can provide them. In Nepal, a UN ‘Least Developed Country’, injury or disease is often far more disabling than in better-resourced countries. In addition to far greater mortality and medical morbidity, the functional outcomes of these conditions can be devastating. Interdisciplinary Rehabilitation Medicine aims to optimize the physical, psychological, social, familial, vocational and avocational lives of people with disabilities. To date, Nepal has only two physicians qualified as PMR specialists (physiatrists), Dr Raju Dhakal (RD) and Dr Jas Bahadur Gurung (JG).
The Spinal Injury Rehabilitation Centre (SIRC – our project partner) near Kathmandu was inaugurated in 2002 by Sir Edmund Hillary, who said: “From my work in the Solu Khumbu region, I know that this kind of facility is extremely important for this country. The hill people who injure their backs … require a rehabilitation centre such as this.” We have worked with them for 12 years on our primary goal of providing specialty training in the areas of medical rehabilitation and surgical care of people with spine and spinal cord injuries. We formed the Nepalese Spinal Cord Injury Collaboration (AKA SpiNepal), within the Orthopaedic Department of the University of British Columbia. The fund has paid for the training of two Nepal-educated physicians, one in neurosurgery/spine, the other (RD) in PMR. Unable to train in Nepal as no program exists there, RD trained in Bangladesh. Because some training needs were not available there, these were addressed by additional courses and observerships in India, Thailand, Ireland, Switzerland, Canada and Australia. RD has been the Medical Director of SIRC since 2017. SpiNepal also partially sponsored another PMR trainee who joined SIRC early this year.
Following its 2015 earthquake, the Nepal government published a Ten Years Action Plan on Disability Management, which noted the need to develop human resources for rehab. Dhakal and Groves (2019) emphasize that Nepal’s special situation warrants their cited WHO recommendations including the need for rehabilitation hospitals with specialized rehabilitation units for inpatients with complex needs.
In 2020 Nepal’s Ministry of Health and Population (MoHP), working with WHO and Handicap International, published “A Situation Assessment of Rehabilitation”, noting both underservicing and maldistribution of rehab professionals in Nepal. While minimal funding has been allocated to date for this important goal, the National Board of Medical Specialties (NBMS) has expressed interest in a PMR training program.
A Nepal-based, Nepal-focused PMR training program will have a huge multiplier effect in the country. We envision a future in which, at the very least, one inpatient/outpatient centre should have interdisciplinary rehab in each of Nepal’s 7 provinces with at least one physiatrist, working towards the best possible outcomes for patients who have sustained spinal cord injury, stroke, brain injury, and neuromuscular diseases as well as those needing general rehabilitation services, with re-integration into the lives they desire and a reduction of the Disability Adjusted Life Years lost.
For various reasons relating to signing of appropriate contracts with and establishment of fund transfer requirements through UBC, and regulations of Nepal’s Social Welfare Council, we were delayed in our first transfer of funds to our colleagues in Nepal. However, much progress has been made in meetings with the Patan Academy of Health Sciences (PAHS) establishing a curriculum, a linked syllabus and finally leading to a recently signed Memorandum of Understanding. There are advantages to initiating this program as a two year fellowship to be offered to two successful applicants who have already received specialty accreditation in a relevant specialty, and who will be trained concurrently. The Canadian Royal College is supporting this approach. Dates to start the curriculum, the timeline, the application process, and the detailed budget are still in the discussion phase between the Spinal Injury Rehabilitation Centre and the academic administration of PAHS but we hope to recruit our first two applicants before the end of our first year. Meetings are being held every two weeks.
Attendees at the November 21 2021 Zoom meeting included below (top row) Drs Claire Weeks and Peter Wing, Clinical Emeritus Faculty UBC, Vancouver; Patryk Krolikowski, Orthopaedic manager, UBC, Dr Christine Groves, Associate Professor of Physical Medicine & RehabilitationIndiana University School of Medicine; (second row) Dr Raju Dhakal, Medical Director, Spinal Injury Rehabilitation Centre, Dr Anil Bahadur Shrestha, SIRC Board vice-chair and founding Medical Director of the Nepal Orthopedic Hospital, Esha Thapa Dhungana, Executive Director of the Spinal Injury Sangh Nepal (SISN); (third row) Hari Adhikari, SIRC Adminstrative Director.
Spinal Injury Sangh Nepal (SISN) https://sisn.org.np/
Patan Academy of Health Sciences (PAHS) https://www.pahs.edu.np/pahs-fellowship-program/
Nepal Orthopaedic Hospital (NOH) https://www.noh.org.np/index.php/about-us/introduction
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UBC Department of Orthopaedic Surgery UBC GO Spotlight June 2023: Claire Weeks and Peter Wing