Neurosurgery at NINAS – Stories from Nepal

Inspired by his mentor Dr Gongal, Professor Upendra Devkota left his hometown of Gorkha, Nepal to pursue a career in neurosurgery at Glasgow institute of neuroscience. He was first mentored by Sir Graham Teasdale before moving on to the Sir Atkinson Morley Hospital. This prestigious site was made famous by Jimmy Ambrose and Sir Godfrey Hounsfield in 1971 who took their first CT scan of a patient there.In 2002, Professor Devkota decided to take his expertise back to Nepal and founded the country’s first Neurosurgical unit at the Bir hospital, Kathmandu. In 2006 he opened Nepal’s first Neuroscience institute (NINAS), which has now celebrated it’s 11th anniversary.

The national institute of neurological and allied sciences; a sleek, modern green building set amongst beautiful flowers
National Institute of Neurological & Allied Sciences

At the time of professor Devkota’s return to Nepal it was a struggling nation, oppressed by its powerful neighbours, plagued with illiteracy and infant mortality. There were a mere 400 physicians for a population of 15 million, most of whom lived and worked in Kathmandu leaving the provinces struggling to survive and people dying of diseases they simply should not die from. Malnutrition and gastroenteritis were common place and viral infections, parasites and tuberculosis contributed to most deaths with reported infant mortality rates as high as 209 per 1000 live births in 1980.

makeshift hospital beds lined up outside NINAS after the 2015 earthquake
Post-earthquake relief efforts by the staff at NINAS

By 2016 when I travelled to Nepal there had been dramatic changes in Healthcare; life expectancy now stands at 68 years and under 5 mortality has fallen to 40 per 1000 live births. Expenditure on health per capita has risen exponentially from $15 in 1995 to well over $70 in 2012 and death from lower respiratory tract infections and diarrhoea illness has reduced significantly. Infant mortality rates have reduced from over 200 deaths per 1000 live births to under 40 and expenditure has increased exponentially, much of which can be accredited to Professor Devkota during his time as health minister. 

I was lucky to spend a short period of time with Professor Devkota alongside Professor Henry Marsh as his guest in Bansbari, north of Kathmandu and whilst I can by no means comment on the overall healthcare situation of Nepal with any expertise, nor will I try too, I can give a small insight into my experience.

Professor Henry Marsh overseeing a trainee Nepali surgeon perform microvascular decompression with a scrub nurse
Professor Henry Marsh overseeing microvascular decompression for trigeminal neuralgia

I found there to be a huge contrast between the healthcare available to those living in Kathmandu and people living in the provinces. At the National Institute for Neurological and Allied Sciences (NINAS) they have three operating theatres all complete with the latest in neurosurgical technology. The have an excellent radiology department, CT and MRI scanner, 15 bed intensive care unit, a semi-ICU ward with 18 adult beds and 3 paediatric beds wards, 2 more wards and a buffer ward for national emergencies. They have daily consultant outpatient clinics, a 5 bed emergency department and use of an emergency helicopter. In contrast to this, Gorkha, the epicentre of the 2015 earthquake has just 8 doctors spread across two underfunded district hospitals and 3 primary healthcare centres serving a population of 260,000.

NINAS staff members are anaesthetising a child after the 2015 Nepal earthquake
Post-earthquake relief efforts at NINAS

During my stay in Nepal, NINAS put on a three day health camp in Gorhka. Over 3000 patients were seen and more than 40 operations performed using donated equipment brought all the way from Kathmandu in a dilapidated post-earthquake building. The team of 40 included doctors, physiotherapists, pharmacists, dentists and nurses who all provided completely free care and medicine to all who attended. In return, the locals provided food and accommodation for the team and we had cultural events each night. Some patients travelled for up to three days to be seen by the specialists as they would otherwise have no access to healthcare at all, it being too far to travel to the major cities and too expensive.

3 vibrantly dressed local women and an elderly Nepali are sat on the stone floor selling snacks to health camp visitors
Local women at the Gorkha health camp

The range of pathology was impressive, there were patients with large fungating tumours, which we sadly could not do anything for, breast lumps, cysts, syndactyly and polydactyly, hydroceles, varicoceles, varicose veins, diabetic ulcers, dental abscess’, back ache, the list goes on. Pregnant mothers were able to hear their babies heart beat for the first time with the ultrasound machine and people were able to take medicine home free of charge.

A Nepali gentleman is having his teeth examined by a young dentist at the health camp
Gentleman with a large fungating oral tumour

I spent the majority of my time in the three operating theatres, diathermy was sparse so inguinal hernia repairs, saphenofemoral ligations and lipoma resections were all performed without it. I learnt how to perform all these operations alongside performing a spinal anaesthetic, intubation, hydrocele repairs, incision and drainage of abscess’ as well as surgery for polydactyly and witnessed a polyp removal in a 2 year old child.

A young beautiful Nepali girl in a bright red and yellow dress has her right arm in a make-shift sling
Local child attends the Gorkha health camp

Back in Kathmandu at NINAS I had the privilege of watching Professor Henry Marsh perform microvascular decompression for a patient suffering from trigeminal neuralgia, saw exotic cases of neurocysticerosis, large intraventricular tumour excision, patients with extensive TB and severe spina bifida. I performed a subdural haematoma evacuation under local anaesthetic, witnessed patients with phenytoin toxicity and saw endless cases of severe head injury following road traffic accidents.

CT brain scan showing a large hemispheric bleed

Our new project escapemedicelectives offers the opportunity for others to experience healthcare in Nepal, visit our website now for more details & fill out the application form to be contacted with more details.

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Inspired by his mentor Dr Gongal, Professor Upendra Devkota left his hometown of Gorkha, Nepal to pursue a career in neurosurgery at Glasgow institute...
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