In the immediate aftermath of last year’s earthquake in Nepal I took part in an emergency mission. A few weeks later we returned for an aid and education mission. And now, here we are again, in Dharan, East Nepal for another mission to support local doctors and empower them to implement change and drive healthcare and medical education forward. This is part of a project led by the British Association of Oral & Maxillofacial Surgeons (BAOMS) and its international education subcommittee, the Norman Rowe International Education Foundation (NRIEF).
We arrived in Kathmandu on 12 March 2016, met with local surgeons, and stopped overnight. Then our group of five maxillofacial surgeons made the trip to Dharan to set up our base at the BP Koirala Institute of Health Sciences. We had already been working in collaboration with the local faculty over the past few months. We put together a two day acute trauma care workshop and a further two day symposium on head and neck oncology.
We have also been helping the local faculty with management plans for challenging surgical cases. It is rather wonderful that technology has brought us together and made such collaborations across the world a reality.
So far we have performed four surgical procedures, making sure to involve the local team and take them through a step by step approach to each operation. Although we were acutely and frustratingly aware that what we helped them deliver may not be our first choice if we were faced with the same cases in the UK, we had to make sure that we strike the balance between what we would like to achieve and what is realistically achievable given the limited resources of the Nepalese economy.
For instance, my colleagues Andrew McLennan and Cellan Thomas (pictured with other UK colleagues on arrival) were faced with a challenging case of advanced oral cancer that left them with a treatment dilemma. While there would be no debate that free tissue transfer and a complex bony microvascular reconstruction would be the treatment of choice in the UK, things are not as straightforward here.
After careful consideration of the patient’s general health, the limited resources available, and the experience of local staff in looking after such complex cases, they had to improvise and use simpler reconstructive methods. Primum non nocere, or “first do no harm.”
Going back to our educational endeavours, my colleague Sean Laverick and I concluded our trauma workshop and we were both exhausted and delighted. The engagement of local staff was refreshing and the way they embraced simulation and role play was very encouraging. They took things in their stride and really delivered. We thanked and congratulated them in our closing remarks, pleading with them to keep the momentum, and adopt this interactive approach to medical education as staff and faculty.
We are almost halfway through our mission and team spirit is very high with many achieved positives so far. The hospitality and graciousness of the local people is overwhelming. It is hard to find more proud and generous people than our Nepalese hosts. They are truly amazing.
Shakir Mustafa is a consultant oral & maxillofacial surgeon at Cwm Taf University Health Board, South Wales. His areas of interest are maxillofacial trauma, skin cancer of the head and neck, and reconstructive facial surgery for developmental and post traumatic deformities. He is an honorary senior lecturer at Cardiff University School of Medicine and is heavily involved in undergraduate and post graduate medical education. He is the chair of the Norman Rowe International Education Foundation.
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Competing interests: None declared.