Dr Punya Kharbuja's experience in the UK

As a Visiting Clinical Fellowship at Royal Preston Hospital, UK from 13th Feb 2023 to 24th Feb 2023, I had a wonderful experience of learning, observing, and some clinical involvement. Firstly, I really liked the amazing academic culture in the hospital. Literally, every senior consultant was guiding the junior fellows and registrars on their surgical skills. Morning Pre-op assessments by registrars, then personal assurance by operating consultants, then at theatre case briefing, sing in and sign out, super nice theatre staffs, scrub and circulating nurses made every patient feel that they were in safe hands.  Secondly, in Cancer  MDTs, each and every cases are discussed in the best of interest the patient's benefit. I really wish this could be replicated in Nepal as well. Special thanks to Mr.Jeremy Ward for the clinical and theatre arrangement and for taking an effort in introducing me to different sub-specialties specialists. Robotic Surgical experience is something very new to me. Hopefully, the government of Nepal would bring this machine to Nepal. Just to name a few,  I would like to thank surgeons Mr.Bhowmick, Mr. Pursnani, Mr.Chris Ball , Mr. Alan Beveridge, Mr. Singh , and Mr. Dhilwayo Blessing for their excellent surgical show. Last but not least, Dr. Ramesh Khoju for wonderful hospitality in Wales and the kind donations of anesthetics instruments ( Monitor, Disposable Laryngeal Masks, Bronchoscopes) to Bhaktapur Cancer Hospital. Cheers!

Nepali Health Mela, Manchester

HExN conducted Nepali Health Mela at Manchester Geeta Mandir on 29th January 2023.

We screened 42 people with BMI, BP, ECG, Cholesterol and sugar and provided advice on healthy lifestyle. It was conducted by 20 NHS Doctors for Nepalese diaspora in Manchester. This is the fourth such event conducted by HExN in the UK.

HExN plans to conduct such events in other part of the UK with Nepali communities, where access to NHS is not good due to language and cultural barrier.

Dr Irfan Chaudry on 22nd Congress of APACCM, Nepal

I was honoured to be invited to provide a talk at the 22nd Congress of APACCM which was held in Kathmandu this year. This was only made possible with support from the Health Exchange Nepal (HEXN) charity. The talk I provided was on Patient Safety systems within critical care, very much a UK based experience and how we implement systems within our local critical care unit at Lancashire Teaching Hospitals. I was also fortunate to chair several breakout sessions and workshops for various critical care topics including patient safety.

Credit must go to the organising committee of the Nepalese Society for Critical Care Medicine, for the standard of scientific and clinical content which promoted widespread debate across the whole spectrum of the Multi disciplinary team within Critical Care. There was good attendance ( approx 1000 delegates), and a varied national and international faculty including speakers from Canada, New Zealand and India as well as the UK. Delegates came from across the Asian Pacific  and I was fascinated by the unique challenges faced by critical care medicine in many different regions. The organising committee held various social occasions on each night of the conference which provide valuable opportunities for networking in a relaxed environment.

I was fortunate enough to have a day of sight seeing with a guide and driver that was kindly arranged by the organising committee. Kathmandu is beautiful, the buzz and the people are what make it and is something I will not forget. I was able to visit the temples at Pashupatinath  which dates back to 400 A.D and Boudhanath a UNESCO world heritage site. The weather was kind and allowed us to see the peaks of the Himalayas in the distance.

The societies can be justly proud of the conference they have managed to achieve after the difficult years of the COVID 19 pandemic and some of the unique challenges faced by the critical care communities across the Asia Pacific. I hope in future to build on the links made to increase the knowledge sharing and improvements in practice relating to quality and patient safety. I wish the APACCM and NSCCM well for the future and thank them again for inviting me to speak at the conference.

 Dr Irfan Chaudry, MB ChB, FRCA, FFICM, FFMLM

GIRFT NW regional Ambassador

 Divisional Medical Director, Lancashire Teaching Hospitals NHS Foundation Trust

Faculty of Intensive Care Medicine Professional Affairs and Standards Committee; North West Clinical Senate; Lancashire and South Cumbria Critical Care Network; Independent Reconfiguration Panel

Honorary Senior Clinical Lecturer Manchester Medical School

Dr Pankaj Pant on HExN Fellowship in ILD

HExN International Fellowship was a great learning opportunity for me, when I was an observer in Respiratory Medicine at Lancashire Teaching Hospital in the subspecialty of Interstitial Lung disease (ILD). During my training, I got broader vision about ILD care, a multidisciplinary approach in management of ILD, which include Respiratory Physician, Chest Radiologist, Pathologist and ILD nurse. I also got opportunity to discuss CT reading about various patterns of ILD. OPDs visit was equally fruitful learning experiences. With my eye opening experience about ILD diagnosis and management, I hope to start ILD clinic in my hospital back in Nepal. I would like to thank, my mentor Dr. Yussef Haider, who is leading ILD services at Lancashire for accepting me and guiding me.

My heartfelt thanks goes to Prof.Satyan M Rajbhandari, one of the founder of HExN, without whom this training would not have been possible. Finally I would like thank Health Exchange Nepal for providing me a greater learning experience and support during my stay in UK.

Jeremy Ward on HExN / NDA / RCSEd Nepal visit Sep-Oct 2022

In late September we travelled to Nepal to run a series of surgical courses and engage with surgeons there to discuss future potential collaboration. 

The UK team consisted of:

 Mike Griffin OBE, President of the Royal College of Surgeons of Edinburgh (RCSEd)

Stuart Clark, Consultant Maxillo-facial Surgeon in Manchester and Council member of RCSEd

Kamal Aryal, Consultant Surgeon and Chairman of the Nepalese Doctors’ Association (NDA).

Ken Walker, Consultant Surgeon

Jeremy Ward Consultant Surgeon and Chairman of Health Exchange Nepal (HExN)

Chris Ball Consultant Surgeon

The team kicked off with a one day course at the Nepalese Army Institute of Medical Sciences where approximately 30 senior students and interns attended a Future Surgeons course where they learned and practised basic skills such as suturing, knot-tying and excision of skin lesions.

Following this we moved to Dhulikhel Hospital where we run our well-established RCSEd-endorsed three day laparoscopic surgery course. It was great to be back amongst friends after a 3 year gap due to the Covid19 pandemic.  We had a day of interactive lectures and case discussions before two days using laparoscopic simulators and spending time in theatre, giving our delegates experience in laparoscopic cases.  During this time Stuart also took the opportunity to visit a charitable maxillofacial hospital in Janakpur.

On returning to Kathmandu Ken, Stuart, Kamal and Jeremy ran a RCSEd NOTSS (non-technical skills for surgeons) course in conjunction with the Tribhuvan University Teaching Hospital.  There was great engagement from delegates and feedback was excellent.

Mike Griffin arrived that afternoon and RCSEd held a roadshow to engage with surgeons from Nepal, attended by approximately 60 surgeons. Mike talked about the work of the College and other discussions included the college international Deanery in the UK, use of simulation in training and what the College could do to support surgeons in Nepal.  There appeared great enthusiasm for further collaboration.

The following morning we flew to Pokhara and travelled to Ghandruk for the first of four wonderful days trekking in the Annapurna region, culminating in an ascent of Poon Hill for magnificent views of the Annapurna and Dhaulagiri ranges as the sun came up.

Back in Pokhara we were delighted to attend an evening meeting of the Society of Surgeons of Nepal and then run our second two day laparoscopic surgery course at Manipal Medical College, again with great engagement from delegates.

Mike Griffin also took the opportunity to meet stakeholders including representatives of the  Nepalese Medical Council and the British Ambassador to discuss Healthcare and training in Nepal, and potential further College involvement.

After a very busy two weeks we departed in different ways: Mike and Stuart to the RCSEd conference in Chennai, Kamal to spend time with his family, Ken to visit old colleagues in Tansen, and Chris and Jeremy back to Kathmandu before heading home.  This two week trip was extremely busy but equally rewarding in terms of educational activity achieved, discussion of potential future collaboration and RCSEd involvement.  Most of all it was great to be back amongst friends and to enjoy each others’ company in part of the world that we love.

Thanks to all our friends in Nepal who made us so welcome, and to Chris, Ken, Stuart and Mike who made such great travel and work companions.  We very much appreciate the support of the Royal College of Surgeons of Edinburgh in developing further links.  Thanks also to Satyan Rajbhandari for unstinting work behind the scenes in planning the trip, but most of all, thanks to Kamal Aryal who worked tirelessly throughout to ensure that everything went smoothly from start to finish.

Jeremy Ward

Dr Agya Shrestha on HExN Fellowship

It was a pleasure and learning experience to get an attachment at LTH. At first I was a little nervous as this was my first time in UK. But as I reached the medical workforce,  things started to seem good.  I joined the department and met with Dr. Sadath. I was given an attachment with a trainee (Dr. Fran) and was free to choose whatever sub speciality I wanted to.  

Everyone in the department was always ready to help me. I would most of the time be with Fran where she would be doing the cut ups under consultants. The consultants were very kind and helpful and would save the intresting slides to look for. I got the chance to attend the MDTs which was a new thing for me.  I was really impressed with the way of document and record keeping system at the hospital,  which I intend to practice at my workplace here at Nepal.  

I had a wonderful learning during my stay at Royal Preston Hospital. Other than learning,  I made few wonderful friends too. I would always cherish my beautiful memories made there. At last,  I would like to thank HExEN, for providing me the opportunity to work at LTH. 

Child Protection, Recognition and Response’

‘Child Protection, Recognition and Response’ a 2 days Training course organized at Kanti Children’s Hospital, Kathmandu

Dr R Chapagain, Consultant Paediatrician, Kanti Children Hospital, Kathmandu

Dr D Upadhyay, Consultant Paediatrician, Community & Child Health, North Cumbria Integrated Trust, UK

Background: The Child Protection: Recognition and Response (CPRR) Course was developed by the Royal College of Paediatrics and Child Health (RCPCH), Advanced Life Support Group (ALSG) and National Society for the Prevention of Cruelty to Children (NSPCC), UK in mid-2000.  This one day child protection training course is designed for healthcare professional including doctors and nurses and is run in several centers in the UK as well as in some overseas countries including Nepal. The aim of the course is in Nepal

1. To raise awareness of child abuse and neglect in Nepal. 

2. To encourage effective response including referrals to the appropriate agency.  

3. To support the development of a multiagency response in the Nepalese context when child abuse is suspected

This report is a summary of training at the Kanti children’s  Hospital on 9th  and 10th December 2021 .This is  a part of an ongoing child protection training programme supported by So the Child May live (STCML) and Health Exchange Nepal ( HeXN) UK and organized by Nepal Paediatric society (NEPAS) and Paediatric Nursing Association Nepal (PNAN). It is aimed to increase the awareness of child safeguarding among doctors and nurses mainly working with the children and the young people.

NEPAS had developed a manual with reference to RCPCH module which is being used for this course.  These session were organized by Nepal Paediatric society (NEPAS) and Paediatric Nursing Association Nepal (PNAN). This course is aimed for the pediatricians, nursing staff, post graduate residents and post graduate nursing students   working in Paediatric OPDs and Wards of the different hospitals of Kathmandu and Dhulikhel.

 The workshop/Training was financially supported from ‘So  The Child May Live (STCML)’ and the ‘Health Exchange Nepal (HExN)’ UK. The local arrangements and resource people were managed from Nepal Paediatric Society (NEPAS), Paediatric Nursing Association Nepal (PNAN) and Kanti Childrens Hospital

Facilitators: Dr Deepak Upadhyay, Consultant Paediatrician, UK.

The NEPAL team

·         Dr. Ram Hari Chapagain,  Consultant Pediatrician, KCH/ Associate Professor NAMS /course Director

·         Dr Samana Sharma, Consultant Paediatrician,  Sreecheer Memorial Hospital,   Banepa

·         Dr. Smriti Mathema,  Assistant Professor of Paediatrics,  Kathmandu Medical College

·         Dr. Jasmeen Maa: Consultant  Child Psychiatrist, Kanti Children’s Hospital

·         Advocate  Mr. Kedar Chalise,  NCRC ( national council for Right of children), Nepal

·         Ms. Apsara Pandey, Associate professor, Nursing Campus, TU

·         Dr Moon Thapa , HOD and Associate professor,  Nepal Army Hospital

·         Ms. Sita Karki, Associate Professor,   KU school of Nursing

·         Dr Anshu Jha  , Consultant Paediatrician, Kanti Childrens Hospital

Course:  Twenty five participants each day (total 50) took part as trainees consisting of pediatricians, Paediatric nurses and resident doctors from Kathmandu Medical College, Kanti Children’s Hospital, NAMS, Nepal Army Hospital, and Dhulikhel hospital.

The pre training meeting (virtual) of the faculties\ facilitators was hold 2 day prior to the training date. The faculties discussed the content as well as few additions to the training materials. On the 9th December 2021 Dr Ganesh Rai, President of NEPAS and Dr Deepak Upadhyay joined and the faculty meeting took place at 9.00 AM and the training started on time.

Feedback/Recommendation from trainees and the trainers: This training is good and gives holistic idea of Child protection in Nepal with global prospective. NEPAS has to take lead role in distribution of this material and also for the continuation of training. The training was highly valued by the trainees. The materials will be useful resources for the training conducted by the government agencies. Till now, the Government, medical universities, NMC and other organization were the potential parties to use this training module.  We should incorporate this material in Nepal Health Training centers and Ministry of women and children’s for wide acceptance and for intensification in large scale, till the government institutions, medical and nursing universities own and recognize this training.

Conclusion

This joint program highlights an example of effective collaboration between professionals from high –income and low-income countries for the best interest of children worldwide.  The aim was also to identify the Named doctors and nurses in each hospital which has been achieved in many centers. It also aims for the establishment of an effective multi-agency referral and management pathways for the children presenting with suspected abuse or neglect.