Monday, April 26, 2010

Pune, India and Kathmandu, Nepal

By: Ravi Bashyal

As part of our residency training experience, we have the privilege of taking part in an international experience that allows us to participate in orthopaedic care overseas. I was fortunate enough to spend time with wonderful orthopaedic surgeons in India and Nepal.
The first week of my experience took me to the Sancheti Institute for Orthopaedics & Rehabilitation (SIOR) in Pune, India. Pune is a vibrant city of about 5 million people about 163 km (101 miles) east of Mumbai. I had the pleasure of spending much of my time with Dr. Parag Sancheti, the current chairman of SIOR.

SIOR has made a strong commitment to orthopaedic resident and fellow education, and many of my experiences there paralleled my training experiences at Washington University. Just as we do here in St. Louis, we began each morning at 6:30am with a morning conference on a specific educational topic, followed by an interactive "board rounds" where ER admissions, pre-operative cases for the day, and post-operative cases from the day before were presented by residents and discussed by the entire group. During my time there, we had a lot of interesting case discussions on treatment options of fairly common orthopaedic injuries. I found that in my situations, our thoughts and algorithms were almost identical. However, in some cases, we found that treatment philosophies, hardware availability, and even differences in patients' cultural/social standards led us down varied treatment paths. This all made for very lively debate, and I learned a great deal from participating.

I was able to participate in the OR and clinic as well. Most of my time was spent observing and assisting in various total joint arthroplasty cases. I enjoyed my time at SIOR, and remain thankful for the gracious hospitality extended to me by everyone there.

From India, I made a short 2 hour flight to Nepal, the rooftop of the world, and home of Mount Everest. The flight itself was spectacular, with amazing Himalayan vistas in every direction. Upon arrival in Kathmandu, I was greeted by Dr. Binod Bijukchhe, who was my main host during my time in Nepal. I had arranged my trip with Dr. Ashok Banskota, one of the co-founders of B&B Hospital in Kathmandu. In addition to founding one of the leading teaching hospitals in Nepal, Dr. Banskota spearheaded the creation of the Hospital and Rehabilitation Center for Disabled Children (HRDC) in nearby Banepa. Established in 1992, HRDC is a unique collaboration between Nepali physicians, the Nepalese Government, and domestic and international donors to provide care to Nepali children while also training future orthopaedic surgeons.
Nepal ranks 115th in the world for adjusted GDP, and the economic hardships faced by many of its rural citizens are extreme. For children, this translates into limited access and availability to adequate medical care, including orthopaedic treatment. HRDC attempts to address these issues by offering access to low or no-cost quality orthopaedic care for Nepali children.
During my time in Nepal, I was able to spend tie at HRDC as well as B&B Hospital. At HRDC, I was able to observe and participate in the pediatric orthopaedic care of indigent Nepali children. At B&B, I was able to work with orthopaedic surgeons in a high volume acute trauma setting. Both provided me with valuable insight into the similarities in education and dedication of the residents and staff, as well as the disparities in resources between the US and Nepal.

The most striking memories I took from my experience in Nepal were from HRDC. Everyday, I interacted with patients with orthopaedic issues that are rarely, if ever, seen in America. The lack of access to care can result in neglected injuries that present significant challenges to both surgeon and patient. Though the hurdles to proper treatment may have seemed insurmountable, I found that both the physicians and patients had boundless enthusiasm, patience, and dedication to help them achieve their goals.

My entire international experience was enriched by the fact that my hosts in both countries were so welcoming and hospitable. The lessons learned from my interactions with patients, staff, and residents were one of a kind, and could only be gained by spending a significant amount of time with them. It also became clear to me how much more can and should be done to help advance orthopaedic care for patients in less advanced health care settings. I am grateful that I had the support to be able to participate in such a program during my residency, and I am sure that I will be returning overseas numerous times in my career.