Kathmandu: Week 1
A resident’s introduction to Nepal proves exciting, chaotic, and rewarding.
It was my first day in Kathmandu and I remember feeling a bit overwhelmed as my tiny taxi weaved through the dusty congested streets of the Himalayan capital.
We were competing for space with just about every other motorized and non-motorized sort of vehicular traffic, with a suitcase full of donated interventional radiology equipment destined for Bir Hospital strapped to the roof of the cab. I couldn’t help but wonder if it would still be there when I arrived.
With some creative maneuvering and seasoned cab driver cunning (not to mention lots of honking), we arrived at the hospital safely and on time. When I stepped out
of the taxi, I was met with a flurry of activity, as every square inch of sidewalk surrounding the hospital gates was occupied by some kind of street peddler inviting you to come take a peek at whatever sundry assortment of goods for sale. I made my way through the hospital gate, into the hospital lobby, and up to the fourth floor. I proceeded to the hospital director’s office and was ushered in by the secretary. Dr. Swoyam Prakash Pandit (the hospital director), Dr. Saroj Sharma (head of radiology), and several of the other doctors from the hospital greeted me warmly and welcomed me to Nepal. As I took a seat, I immediately found a hot cup of chai (Nepali tea with milk and spices) in my hand. I took a deep breath. I had arrived.
In many ways, this first day would mirror my entire experience in Nepal. On the surface, there is a sense of chaos, but waiting behind every door is a big smile, a quiet refuge, and a hot cup of chai. The Nepalese people are some of the most welcoming and friendliest people I have ever encountered.
After the initial greetings, I presented Dr. Pandit and the department of radiology with the donated equipment. They were very pleased with the large assortment of stents, balloons, wires, catheters, sheaths, micropuncture kits, drainage catheters, etc. I explained that the generous gifts were from an aid organization called Supplies Over Seas from Louisville, Ky., and from Dr. Jorge Lopera, an IR attending in my radiology program in San Antonio.
Afterward I was given a tour of the department and introduced to some of the radiology residents. The radiology department at Bir operates in all imaging modalities and has two radiography machines, one 16-slice CT scanner, one ultrasound machine, a fluoroscopy room, mammography units, and (as of about 2 weeks ago) a 1.5 tesla permanent magnet MRI.
Over the next few days, I attended resident conferences, sat in on multidisciplinary tumor boards, and gave a lecture on MSK bone lesions and tumors to the residents. As physicians care for their patients in this developing country, they face many obstacles. One of the biggest challenges for patient care and resident learning is a lack of a PACS system. As I’ve worked with the residents, it’s been difficult to take out film copies of interesting cases and try the get them to project clearly using a standard overhead projector, especially CT and MRI cases in which the individual slice images are small. This made me even more excited about my upcoming effort with RAD-AID, when we will be installing a new PACS system at Bir.
So far I have been able to prepare two computers in the resident room for the installation process and enabled remote access to these machines. Dr. Andrew Kesselman of RAD-AID informed me yesterday that he was able to start some of the PACS installation remotely. I look forward to meeting Dr. Kesselman and completing the PACS installation next week! It will be a tremendous step forward for the residents and patients at Bir.
Follow along with Dr. Kapalczynski’s project in Nepal through his weekly Bulletin updates.
By Wojciech J. Kapalczynski, MD, University of Texas Health Science Center at San Antonio