Today began my journey to Bharatpur. Located in the southern part of Nepal near the Nepali-Indian border, Bharatpur is located in what is known as the Central Terai region. Surprisingly (or perhaps not) it is not very easy to get to. My travels took me through an obligatory day in Delhi. Somewhere during the flight, it sadly (and embarassingly) occurred to me that this layover is actually my first time back to India in 20 years.

So I made it to Bharatpur after three days of travel. Though the travel advisory from the US Embassy and the Lonely Planet made it a foregone conclusion I would encounter political unrest, to date there has been no sighting. Fortunately, the disturbance appears to have moved away west.

My stay in Nepal is to extend my understanding of neurosurgery, and more generally medical care in developing regions. Nepal in contradistinction to Ethiopia has a well established neurosurgical base, thanks in great part to the work of Dr. Bagan and FIENS. There are fourteen neurosurgeons caring for this country, of which two reside outside of Kathmandu in Bharatpur.

Here in Bharatpur, I will be working with Dr. B.K. Thapa, the lead neurosurgeon at the government supported BP Koirala Memorial Cancer Center . Having grown up slightly east of Kathmandu, Dr. Thapa pursued his neurosurgical training in Bangladesh, prior to returning to Nepal to pursue a career. In 2004 he had spent a couple of months at MD Anderson; now I have the opportunity to experience a cancer center with not quite the resources of our venerable MD Anderson Cancer Center.

In the latter half of my journey, I will move on to the capital city of Kathmandu. There I will join Dr. Shilpakar at the Tribhuvan University Teaching Hospital (TUTH).

I landed into Bharatpur at 4:00 on Sunday. By 4:30 we made it over to Dr. Thapa's private clinic at the Chitwan Hospital (upper left). Here he sees all his non-oncologic patients - a general neurology/neurosurgery practice. I have now had the priviledge of experiencing and practicing medicine in four continents. One of the appeals of practiving in developing regions is that here, a physician remains a general physican. A neurosurgeon cannot simply treat only surgical disorders of the nervous system. They must be able to recognize and treat most problems that come their way. This has somewhat been lost in the specialized system of medicine back home.. After clinic we had a short OR case, then to enjoy some momo (a Tibetan dish similar to dumplings) and the hotel.

Below the Chitwan Hospital is the B.P. Koirala Memorial Cancer Hospital (BPKMCH). A joint effort between the Chinese and the Nepalese government, the hospital continues to be supported by Chinese volunteers. The hospital is the dedicated cancer center for Nepal. We currently have a 4 bed neuro-unit and 2 operating days per week (Wednesday and Sunday). Clinic runs on the nonoperating days where new consultations and followup patients are seen.

As a government hospital, BPKMCH provides an essential service to indigent patients in Nepal. Whereas in other parts of the country, hospital bills may range up to 6000USD. Fees at BPKMCH are capped at 100USD. In country where the per capita income is around 180USD, this is invaluable.

Monday we assisted in the operating theater for a large sacral mass (chordoma) along with the orthopedic surgeons and the general surgeons. Fortunately, the anesthesiologists here have access to a host of monitoring which was not found in Addis, enabling more complex cases to be performed safely.