A global perspective on rural medicine

(Edmonton) Before the civil war in Nepal ended in 2006, a group of physicians banded together with the aim of creating a medical school that would focus on delivering medicine to badly underserved rural areas.

The founding physicians knew that urban-rural disparities were a main issue in the civil war. They also knew they would need help from medical schools abroad to develop and deliver the curriculum. They required varied expertise and, with any luck, a post-secondary partner willing to provide a large base of volunteers.

Kim Solez of the University of Alberta’s Faculty of Medicine & Dentistry heard about the need in Nepal and became involved with establishing the Patan Academy of Health Sciences’ medical school in the early 2000s. After Solez had a “chance cafeteria discussion” with medical educator David Cook, the duo realized they were both volunteering their time to the same cause.

There are now 15 members of the Faculty of Medicine & Dentistry who donate their time and expertise to the Nepali medical school, which came into existence in 2008 and accepted its first medical students in 2010. The volunteers span numerous departments and divisions—laboratory medicine and pathology, family medicine, pediatrics, nephrology, cardiology, endocrinology, rehabilitation medicine and community engagement. The efforts of the Faculty of Medicine & Dentistry to provide a strong base of varied expertise to the Nepali school were recently highlighted in the peer-reviewed Global Journal of Health Science.

Two faculty members are in Nepal right now, and numerous educators travel there each year to teach learning blocks, coach faculty and develop learning opportunities for faculty and students there. This year marked the first time U of A medical students and residents were involved in the effort, with four medical students and two residents making the trek overseas—an opportunity that has enhanced their medical education and given them a way to give back.

“We have a collective presence there rather than an individual presence,” says David Zakus, director of global health with the Faculty of Medicine & Dentistry. “It brings us together from many departments, and provides a multidisciplinary collaboration within our own faculty.

“Not only is this effort important in a humanitarian and collegial aspect, it also provides great learning opportunities for all of us. What we have learned here about rural medicine is applicable in Nepal and what physicians in Nepal have learned about the same issue there is applicable here in Alberta.”

Solez, a professor in laboratory medicine and pathology, adds, “It’s very empowering for people in Nepal to see their leadership efforts acknowledged in the published paper. I was Skyping with the vice-chancellor of the medical school in Nepal so we could wrap up the paper and it was 1 a.m. there.”

“It’s also good for people here to see the results of our collective efforts,” he says. “The interesting thing is there was never an organized, proactive effort to attract a bigger volunteer base. I never gave a sales pitch to anyone—yet we’ve gone from one to two to 15 in a very natural way.”

Each year, about 2,000 new physicians graduate from urban medical schools in Nepal. However, many choose to pursue further studies or practise outside the country. Very few opt for rural medicine or family medicine. This is a critical issue because about 83 per cent of the country’s 28 million citizens live in remote rural areas. 

The Patan Academy of Health Sciences was a necessity for rural residents and is now “a gateway to Nepal’s most needy communities, where global innovations in health education are taking root,” note the paper’s authors.

The Patan Academy has already become a leader in enteric fever research, triggering a worldwide change in how typhoid fever is treated. The school has also demonstrated leadership in education, health policy and telemedicine, and has published several top-tier research papers.

Opening the medical school was the first step; now it plans to educate nurses, midwives and other health-care practitioners on how to effectively deliver rural medicine and public health.

“We want to ensure the Nepali medical school’s aims remain, and we look forward to many more years of this partnership and sharing knowledge,” says Solez.

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