Nepali Times
Missionary zeal


HERE AND HERE: Arjun Karki points to the 22 districts of Nepal that are classified as "remote" and where his students will go when they graduate to be doctors.

Despite the spread of new hospitals in towns across Nepal, doctors are still reluctant to serve in remote areas. The newly established Patan Academy of Health Sciences (PAHS) aims to change all that by training doctors who are committed to working in the districts.

The retention of doctors, especially in government hospitals in rural areas, has always been a problem in Nepal, and PAHS aims to change that by making a paradigm shift in medical school philosophy, a part of its curriculum.

"We have a clear mission to extend health care to people outside the Valley," says Arjun Karki, founder and vice chancellor of PAHS, "we select students by assessing their academic ability and humanistic qualities."

In this year's batch of pioneer students, for instance, 60 per cent of those enrolled are from underprivileged families. Their scholarships require them to work for two to four years in rural areas. If they don't, they won't get to graduate. The remaining 40 per cent are not obliged to go, but Karki hopes they will.

The students will be posted to remote area hospitals every six months for two weeks each so they get over their fear of the unknown, and get to see how they can make a difference right from the start of their training.

PAHS collaborates with the Ministry of Health for the placement of future physicians into rural areas after they graduate, and Karki is confident that his plan will work because inculcating a sense of motivation and commitment are an important part of the school's philosophy.

"We want to produce health care personnel with a social responsibility and a keen desire to work in remote areas," says Karki, "we want to help strengthen the national health system, but not create a parallel structure to the Ministry of the Health."

This year, PAHS selected 60 of the finest medical students from over 2,000 applicants, focusing on a holistic model that emphasised personal qualities that could potentially change attitudes in health care workers. The idea was to ensure that more compassionate and empathetic physicians will enter the public health system.

The students will face their first real test when they're posted as interns in rural hospitals as part of the course. "The hidden objective is to expose them to the disparity of opportunity and health care in this country," says Karki.

Nepal's private and government medical schools produce 1,500 doctors each year, but half of them migrate overseas and the ones that stay in Nepal choose to work in urban areas.

The six-year PAHS program will try to change this and more importantly combat the two-decade difference in life expectancy between people living in Kathmandu and those in remote districts like Mugu.

PAHS will also work on improving public health through awareness about communicable diseases in remote areas through their doctor placements. Karki adds: "Until people are prosperous and have the means to find a way out of the poverty cycle, people will be vulnerable to diseases.''


Telemedicine is about to take off in a big way with Patan Hospital and its affiliated Patan Academy of Health Sciences implementing a program to help in the diagnosis and care of patients in remote areas via the Internet. PAHS hopes that its interns and graduates will also be able to refer patients to Patan when they are placed in remote parts of the country. Patan already has five doctors assisting district hospitals with feedback on patients.

Telemedicine is already working through a prototype in 20 villages in Myagdi, Kaski and Parbat districts conducted by Nepal Wireless Network Project, a brainchild of Mahabir Pun. The project has also been extended to Makwanpur, Palpa and Dolakha. Doctors at the Model Hospital in Kathmandu regularly consult patients and health workers at the Gaurishankhar Hospital in Dolakha via webcam.

The Indian government announced this week that it would help Nepal with a Rs 30 million telemedicine project that will allow Nepali doctors to refer cases via the Internet to medical facilities in India.

Everyone's cup of tea, JANA ASENBRENNEROVA in DHANKUTA
A default state, BIBHAV ACHARYA

1. Prats Sharma
Arjun Karki is a very admirable and motivated person. The hope for our country lies in the individual like him.

Not that I doubt it, but the following sentence caught my attention:
"..combat the two-decade difference in life expectancy between people living in Kathmandu and those in remote districts like Mugu."

What is the source for this two decade difference data?

2. A Doctor
It's great that Patan has started this program. I hope all other med schools adopt similar policies. There are doctors who are willing to work in rural areas. Actually, the salary for freshly graduated government doctors are more than what you get working in cities. One of my friend told me how frustrated he was during his 2 years service in rural areas, when he had to run the hospital with less than minimal facilities and all he could do was to send the patients to a bigger regional hospital. It's a waste of time and money if you train a doctor who ends up doing a work that could have been possible with a Primary Health Assistant. If only there were basic medical equipments, labs and easy access to drugs, there won't be any shortages of doctors. That's for sure. 
P.S. Just wondering where Dr.Karki's doctor daughter is? I hope not in US.... or??? never mind.....
(Cheers to the doctors working in Nepal, Proud to be one of you)

3. R RAI

I totally agree with Dr Karki-it is not only academic/intellectual abilities that should be considered when med students are selected-are they really keen on healing and helping the fellow human beings? Are they able to empathise? Do they have capacity to feel for those who are suffering?

Or, are they pressurised into it by their family, or they simply could not resist the social pressure? 

Best wishes to Dr Karki on his mission.

4. Eddy

Sure it is great that Dr. Karki start with PAHS. I'm sure his goal is positif , not selfish and motivate other people. I wish him succes and I am sure that will be big. 

That you doubt a little bid about his intentions and ask for the place his daughter is living now, in the US or something ells, do not make that he have not the right intentions. Around 20 years ago Dr. Karki was also travelling around in Europe (I lodge him for a copple of days) and the US, but when you see now what he is doing, IN Nepal and FOR Nepal,  then you can only have respect for it.

Of course from me too the best wishes to Dr. Karki and hope his mission wil be a great succes.



5. Anonymous
Glad to read that the alumni of the Tribhuvan University Institute of Medicine, Mahajajgunj, where the original concept of 'doctors with social responsibility' was born, have cultivated the philosophy in yet another medical school in Nepal. The 'need-based approach' to medical eduction is still very much relevant today in Nepal, as it has been during the seventies and eighties of the last century. The country still needs the strategy of a "Comprehensive Primary Health Care" approach, a holisitc approach incoprating preventive, promotive, and curative dimenstions of illness and health, and, above all, the goal of empowering the local people, if the medical education leaders in Nepal truly want to bridge the gap in the disparity between the 'center' and the 'periphery'. Posting Interns to the rural district hopitals, as proposed by PAHS is an excellent idea, and hopefully, such move will prepare the Interns to take up a family medicine (GP) career to serve the rural populace upon graduation. Indeed, from a macro-level policy perspective, the issue goes even further. Can we develop an active 'organic' link between an academic center and the rural communities in the long run? What are the parameters to evaluate the long-term success of a medical school, (and eventually, down the road how should national resources be allocated based on the performance benchmarks)? The technology (e.g. ICT)  is already there to bring an unprecedented impact on the health and education of the rural and marginalized people; however, the question is still that of fostering a new culture and generating new values in the national health care system in Nepal. What we need is a new model of leadership in medical education.

6. Shah
About 6 years back, me and my best buddy prepared rigorously to study medicine in a reputed medical college. We tried for 2 years without any success. On our 3rd attempt, my friend's family got in connection with some political people and some insiders within the dean's office. A large sum of money was involved and viola!!! his name was there among the top..... He studied medicine, graduated with pretty good grades, studied for USMLE and is now specializing in Philadelphia. 
And me, I am working in a bank right now. :)

7. Nepali
I am  extremely happy to see the changes. I support his actions.Please post me in Mugu after I complete my MBBS ...It would be a honor to serve the rural community of my country!! Jai Nepal!

-4th year medical student.

8. Tara Niraula
Woderful stroy! I hope the initiative taken by PAHS under our great friend Dr. Arjun Karki, is able to succeed in its mission.  Health and medical services in rural Nepal are almost non-existing in many remote areas of Nepal. What is more troubling is that no medical and health professional, who often do not come from such areas, are willing to go to these places and provide service to the needy people. I hope this initiative changes the whole scenario so that Nepali people no matter where they live, rich or poor, have at least basically health and medical services available in their own communities and districts.

I wish PAHS and its team all the best

9. Krisna(NOT DOCTOR)
Once  I was in remote PHC, a snake bite case admitted in mid night , fortunately multi venom  injunction known to me due to friendship with the in charge of the PHC , the watchman injected the patient 3 files. Thanks god patient revive. This real case in remote.

(11 JAN 2013 - 17 JAN 2013)