Expanding rehabilitation residency training in Nepal
With a population comparable to Canada’s, Nepal has just one physician qualified as a Physical Medicine and Rehabilitation (PMR) specialist. With International Development, Aid and Collaboration (IDAC) funding, Claire Weeks, MD, FRCPC, and Peter Wing, MBChB, FRCSC, are working closely with two Nepal-based physicians, Dr. Raju Dhakal and Dr. Christine Groves, to build a residency training program in Nepal that will set at least two residents on the path to become PMR specialists.
A program with roots in British Columbia
Both in Vancouver, Dr. Weeks, a retired PMR specialist, and Dr. Wing, a retired spine surgeon, have been supporting Nepali specialists’ training since 2009 and, through their UBC-based program, the Nepalese Spinal Cord Injury Collaboration (SpiNepal), have paid for the training of one neurosurgeon/spine surgeon and one PMR specialist. The latter, Dr. Dhakal, is now the medical director of the Spinal Injury Rehabilitation Centre in Kathmandu, the only facility of its kind in Nepal.
“Unfortunately, Dr. Dhakal’s PMR training took place outside Nepal because there is no such training available within the country,” says Dr. Weeks. “For rehab training to be most effective, it needs to be done in Nepal, by Nepalis, for Nepalis who have conditions amenable to rehabilitation. This IDAC grant is the perfect vehicle for building a training program in the country.”
Out of country training is generic
Dr. Weeks explained that rehab training for Nepal should ideally reflect the disease profile seen in that country, rather than a generic profile. “A large number of people in Nepal suffer from conditions that could benefit greatly from rehab,” adds Dr. Wing. “This new training program presents an opportunity to promote the importance of building local capacity in the specialty.”
Until recently, PMR patient care was not funded in Nepal, but that is changing. In 2020, Nepal’s Ministry of Health and Population, working with the World Health Organization, noted that Nepal was underserviced in the specialty. While even now only a small amount of funding has been allocated to develop PMR capacity in Nepal, the country’s National Board of Medical Specialties has acknowledged that a PMR training program would be a significant asset.
A multiplier effect
Drs. Weeks and Wing said that a Nepal-based, Nepal-focused PMR training program will have a huge multiplier effect in the country. “We hope that this new training program will be the start of a network of specialty rehabilitation across the country,” says Dr. Wing. The team envisions a future where each of Nepal’s seven provinces has at least one inpatient/outpatient centre with interdisciplinary rehab and at least one PMR specialist onsite, “…providing the best possible outcomes for patients who have sustained spinal cord injury, stroke, brain injury, and the many others who will benefit from tailored, focussed rehabilitation services,” says Dr. Weeks.