Spine Surgery Fellowship in London Ontario
Prakash Paudel MD FRCS (Pakistan)
A Stressful but Successful journey from Nepal to Canada:
Thank you SpiNepal for giving me this opportunity!!
In 2021 I was accepted for a one year Spine Surgery Fellowship Program in London, Ontario Canada to start on March 1, 2022. My flight to Toronto from Kathmandu was scheduled for 13th of February 2022 on KLM Airlines. I was super excited! Thrilled! Full of anxious anticipation, I had already shared this news with all of my friends, colleagues and family.
I had all the documents ready in my hand, printed and packed in a clear plastic bag! I had a letter of approval from the High Commissioner of Canada for a Canadian work permit, a Canadian Visa, full itinerary, some Canadian and American dollars, my ArriveCan card, Vaccine certificate (three doses of Covishield vaccine), recent negative PCR test for COVID 19, my baggage already packed and locked with a padlock and a backpack with laptop in it. ArriveCan is an online app which verifies and stratifies the foreign travelers into different categories. My documents were accepted, and I was provided with an ArriveCan receipt with an “I” beside my name, meaning that I was immunized. And what else could be needed to kick-start my much-awaited dream-trip to Canada?
Then a major and unnecessary stress hit me: despite all the planning done so far, and just as I was prepared to leave my home and family for a year (itself enough stress), suddenly KLM told me I could not fly.
I have been associated with SpiNepal since 2009. I met two amazing people at the 2009 ASCON (Asian Spinal Cord Network) meeting in Kathmandu: retired orthopaedic surgeon Prof. Dr. Peter Wing from University of British Columbia and retired physiatrist Dr. Claire Weeks from GF Strong Rehabilitation Center in Vancouver. Since then, they have been my very good personal and professional mentors. I completed my Neurosurgery residency training in 2016, and I am very grateful to the supporters of SpiNepal for their support during my residency. I was hoping to do a spine fellowship in Canada somewhere down the line. Finally, that day had come and I was accepted by the fellowship program in London Health Science Center in Ontario. It was a long-awaited dream to be realized. I had a flight at 8 PM on February 13, 2022 from Kathmandu to Toronto via Amsterdam. I had uploaded my travel documents including clearance from ArriveCan to KLM’s online portal at around 2 PM but, in an utterly surprising way, I received a rejection letter from KLM mentioning that my vaccine is not approved by Canadian Government, and I had to arrange a valid vaccine document. Here is the reply from KLM:
Dear Prakash Paudel,
You recently uploaded COVID-19-related entry documents in preparation for your trip to Canada. Thanks a lot for submitting them in advance!
We would like to let you know that the following COVID-19 entry documents are not approved: the COVID-19 proof of vaccination is invalid because the vaccine is not approved by the Canada government.
Please make sure to arrange valid documents before your departure.
It was a complete shock to me as I was prepared to call a cab, take my baggage, say good bye to my family and go to the airport to catch my flight. I was mentally frozen, nervous, anxious, worried, and running out of time, and what else can I say? I had already packed my baggage, had already informed my friends and family and was continuously receiving best wishes text messages and calls!
Feb 15, 2022: Before saying good bye to my family. In Picture: Laxmi (my wife) and daughters Ritika (elder) and Ishita (younger). N.B. Only one person was happy when my flight was cancelled on Feb 13. It was Ritika who was super excited!!!
“A valid vaccine document.” This appeared to be KLM’s misinterpretation but that phrase is what cancelled my flight at the last moment. Except for Covishield, none of other vaccines reportedly (by KLM) accepted in Canada were available in Nepal for my age group. I kept googling the information and looked at the specific names of Covishield vaccines approved in Canada. I found that the vaccine which I had (Covishield- Serum, produced in India) though approved by Canadian government, had not been used in Canada since September 2021. Since I was running out of time, not able to talk with Peter in Vancouver (it was middle of the night and his mobile was on do not disturb mode!!), and there was a clear message from the airline saying that I was holding an invalid document in my hand, I had no choice but to take a decision. The level of panic and anxiety was steadily rising in my head. Considering the rising third wave of COVID and the risk of possible repatriation from immigration, I called Regency Travel in Vancouver (who issued my air tickets) and cancelled my ticket. I was at least relieved for a few seconds by the fact that I had at least made a decision though still not knowing if it was a right one. Mentally drained and physically tired I took a deep breath, sat on the couch and gulped down my tea. I got a call from Peter in the evening, discussed the issue with him. He was so gentle and reassuring to me. Thank you Peter. He discussed this issue with the health authorities in Canada and managed to get a letter confirming that my Covishield vaccine is still accepted in Canada and I am allowed to enter Canada provided I met all other requirements (which I already had). KLM had completely misinterpreted the rules!
Finally, my flight was rescheduled with Qatar Airway (not KLM this time) for February 15 (2 days late) and I was again ready to fly with the same vaccine document! I landed in Montreal on the 16th of February, collected my work permit from Immigration, and checked in again for Toronto. I took a bus from Toronto airport to London and reached my apartment by 11 pm. I was welcomed by my landlord Lucas. He helped me walk through the slippery icy road!!! ( People often think of Mountains and Ice and Snow when they think about Nepal but so sorry to say that I have never been to Mountains and never got a chance to play and walk on snow!!) It was an awesome feeling that finally I reached London and was about to start my training within a few weeks.
Feb 17: Beautiful London and the Snow
By now, I am well settled in London. It took me about 2 weeks to get over jet lag. I have a cozy one- bedroom apartment (which is close to hospital, takes 15-20 minutes on foot) with a well-furnished kitchen. I got my educational license from College of Physicians and Surgeons of Ontario (CPSO), and I have my SIN number and Ontario Health Card. I started my training on March 1 on the exact date it was supposed to be!! Staff and colleagues are very helpful and friendly. I am now gradually learning and adapting to a new system and hope to learn a lot in the days and months to come.
March 1, 2022: Hospital ID card and in Operating room with Dr. Parham Rasoulinejad (Spine Surgeon)
I am very grateful to Peter and Claire and all the supporters of SpiNepal for their generous support and continuing guidance, helping me to realize this dream. I am very thankful to Dr. Supriya Singh and Dr. Parham Rasoulinejad from London Health Science Center for arranging my fellowship placement in their hospital. I am especially thankful to my wife Laxmi who is now taking care of all the house chores and also looking after our two lovely daughters Ritika (7 years) and Ishita (4 years)- I miss them a lot!
FINALLY IN CANADA!!!!!
THANK YOU ALL.
Below: At the local golf club for dinner, June 23, 2022. Left to right: Drs Farwaz Siddiqi, Priya Singh, Prakash Paudel, Chris Bailey, Claire Weeks, Peter Wing and Parham Rasoulinejad.
Some Months Later: Merry Christmas and a Happy New Year ……………….. 
Left: checking out the instrumentation sets.
The year 2022 has been a remarkable year to me. This is the year my long-awaited dream came true. I started my spine surgery fellowship in Victoria Hospital, Western University, London, Ontario, Canada in March 2022. It has been nine months since I joined and I have already been actively involved in more than 200 spine surgeries. This is an important and wonderful opportunity for me to learn and become totally involved in spine care. With this fellowship completed, I am going to be the first fellowship-trained spine specialist with neurosurgery background in Nepal. All this has been possible because of persistent guidance and the generous support from SpiNepal. I am very grateful to all the people who have been continuously supporting me in this endeavor. I have no words to express but would like to say thank you to all of you from the bottom of my heart.
As a fellow, I am involved in clinical care of patients with spinal disorders. I actively participate in seeing patients in clinic where I evaluate the patients and discuss treatment plan with staff surgeons and attendees. (Right: careful assessment of the postop imaging in the follow up clinic.) Seeing patients at follow up clinic gives me the opportunity to evaluate the outcome of patients who were operated on. It’s very encouraging to see how their functional status changes after surgery. “I am feeling way better now”, “wo ya I am very happy with the outcome” these are some of the expressions by the patients when they come in follow up.
I now realize the real value of a dedicated spine service. Spine surgery really helps gain function and give them better life to live ahead without pain and difficulty in walking. However, it’s not the same all the time! There are instances when patients do not respond as expected by us and hoped for by them, and there may be complications from surgery. Most of these can be managed well and though sometimes frustrating, it gives us opportunity to ponder on, reevaluate and reassess ourselves and provide opportunity to improve next time.
Active involvement in surgery is the major part of this fellowship training. I usually have 3 OR (operation room) days per week. Mostly, two to three patients are operated in a day on elective basis. The staff surgeons are very kind and helpful: technically excellent surgeons and in addition great teachers. I have learned a lot of surgical principles and techniques which I was not familiar with before. Cases vary from degenerative spine diseases to tumor to infection. We have a wide range of exposure here. I hope I will be able to utilize all these principles and surgical skills in helping patients in Nepal in the days to come. Although Nepal is a small country, it has the same population as Canada. There are lots of patients with spinal disorders who needs both acute and long-term care. For patients with spinal cord injury, it is still a farfetched dream to live the kind of life that a patient here does.
We have much work to be done in the field of spine care in Nepal. Besides improving care, we have a major role to create a disability-friendly environment so that patients with disability can live their life with minimal hassle. To this end, SpiNepal is helping in both acute care as well as in Rehabilitation medicine. With support from SpiNepal, a residency program in Physical Medicine and Rehabilitation is going to be started first time in Nepal which will be a great milestones in improving the lives of patients with spinal cord injury and other disorders. With my training as a spine surgeon, now my whole effort would be toward this goal and I hope we can streamline spine care as a subspecialty in Nepal in future.
Finally, I would like to thank Peter, Claire and all the sponsors of SpiNepal for your support. Without your help, it was virtually impossible for me to make this journey. Thank you for your incessant company in my professional and personal life and as a big support to my family. This fellowship not only provided me an opportunity to gain surgical experience but also an important platform to build and create network with spine surgeons which I believe will be helpful in the days to come to improve spine care in Nepal. As the year 2022 is coming to an end and Christmas around, I wish you all very happy New Year and Merry Christmas!!
Thank you all, with lots of Love!
Prakash
Below: two famous Canadian neurosurgeons in London’s Canadian Medical Hall of Fame – Drs Penfield and Tator.
