Perspectives in international neurosurgery: neurosurgery in Nepal

Academic neurosurgery in Nepal: Present status and future directions

Introduction

The establishment of local neurosurgery training programs in Nepal has proven critical for the expansion of the discipline across the country. This paper aims to describe the evolution, current status, challenges, and future directions of academic neurosurgery in Nepal.

Research question

What is the current status and international standing of academic neurosurgery in Nepal?

Material and methods

Information related to growth and development in Nepal was obtained from universities and regulatory bodies in Nepal. Variables described are the current number of neurosurgeons, the number of neurosurgical centers and centers with accreditation for training, the description of existing training models, the number of graduates, and the contribution of Nepalese neurosurgeons to world literature.

Results

Formal neurosurgical training started in Nepal in 1999. Of 67 hospitals with neurosurgical facilities, 10 (14.9%) are accredited. Three training models (MCh, NBMS, and FCPS) currently exist. Of 116 neurosurgeons currently practicing in the country, 47 (40.5%) are homegrown. The contribution of the Nepalese neurosurgical community to the world includes the training of the first two Maldivian neurosurgeons and an increasing presence in world neurosurgical literature.

Conclusions

Although comparable to other countries with similar economies, Nepal still faces some challenges to the sustainability and further developments of Neurosurgery. Continued concerted efforts will help Nepalese neurosurgeons achieve the goal of securing self-reliance in neurosurgical education.

Neurosurgery in Nepal: Past, Present, and Future

Neurosurgery in Nepal is now more than half a century old. Though Nepalese neurosurgical roots can be traced back to ancient times, modern services began in Nepal only after 1990 following the arrival of Dr. Upendra Devkota-the father of Nepalese neurosurgery. Contributions from many reputable global advisors as well as local leaders have yielded many changes to the field ever since. Despite these advancements, neurosurgical care in Nepal is mostly limited to the capital city of Kathmandu, and there remains a deficit of qualified neurosurgeons. Geographical dissemination of neurosurgical care, reappraisal of residency training programs, and initiation of subspecialty-based neurosurgical practices are the next steps to further improve the field in Nepal.

Subspecialties in neurosurgery and its challenges in a developing country

Neurosurgery in developed countries is creating subspecialties. The introduction of such a concept in a developing country like Nepal is discussed. For the steady development of neurosurgery in developing countries, the concept of subspecialization must be introduced.

One year of neurosurgery in the eastern region of Nepal

BACKGROUND

This article briefly discusses about the present status, future strategies, and perspectives of neurosurgery in the eastern region of Nepal.

METHODS

B.P. Koirala Institute of Health Sciences, Dharan, Nepal, is the only tertiary referral center responsible for patient care as well as training of postgraduate students and paramedical staff including health care workers in the eastern region of Nepal. We analyzed the data from January 2006 to January 2007 regarding patient care and their outcomes. At the same time, we also evaluated our limitations regarding resources and their impact on patient care. Strategies are suggested to overcome the barriers to establish effective neurosurgical centers in developing countries.

RESULTS

At present in the BPKIHS, neurosurgical facilities are being provided as a specialty unit in the department of surgery. From January 2006 to January 2007, a total 1120 patients were treated for different neurological and neurosurgical conditions. At present, there are 8 beds allotted to neurosurgical services in the general surgery ward. In addition, there are 8 ICU beds catering to the needs, including neurosurgery, of the hospital. No vascular, epilepsy surgery or functional neurosurgery has been performed due to lack of resources. The only imaging facility for neurosurgery that is available in the hospital is CT scan.

CONCLUSIONS

The study concludes that in a developing country, the neurosurgical unit can be structured in a manner that will fulfill most of the objectives required for better clinical outcome. This structured program may also benefit substantially in training health professionals as well.

Neurosurgery at Tribhuvan University Teaching Hospital, Nepal

February 6, 2005, marks the 10th anniversary of the first neurosurgical procedure performed at Tribhuvan University Teaching Hospital, one of only a few tertiary-care hospitals in Nepal. Neurosurgery began at the hospital with the arrival of an American neurosurgeon to train Nepalese surgeons locally and, later, the return of these Nepalese surgeons to Kathmandu after subsequent fellowship training in the United States. This article traces the origins of neurosurgery in Nepal, outlines the specialty's development in Kathmandu at Tribhuvan University Teaching Hospital during the past decade from international education strategies, and describes the status of and challenges facing the provision of neurosurgical care in Nepal. The role of neurosurgical services in improving the health care status of populations in developing countries is considered. Neurosurgeons in developing and developed countries alike should continue to work to remedy the inequitable distribution of neurosurgical knowledge and services throughout the world.