CRAJ Fall 2017

Fall 2017 (Volume 27, Number 3)

The Canadian Connection to Rheumatology in Nepal

By Stephen Aaron, MD, FRCPC

In 1977, the CRA established the Metro A. Ogryzlo International Fellowship in tribute to the founder of the Journal of Rheumatology, and for his other accomplishments. From 1981 through 2008, 26 physicians from around the world were able to undertake advanced training in rheumatology, most returning to their home countries to improve patient care, including in Nepal.

Nepal is remarkable for having seven of the ten tallest mountains in the world, and for its mystical blend of Buddhist and Hindu spiritualism. It is a poor, landlocked country of 30 million, sandwiched between the plains of Northern India and the Tibetan Plateau. It is ranked 157th in the world for per capita gross domestic product (GDP).

Dr. Buddhi Paudyal was born in a small town in the western plains of Nepal. During his youth, he pursued work in a United Mission hospital, where he met Dr. Helen Huston from Edmonton. He was keen to become a physician and was able to attend medical school, and then pursue a medical residency in Kathmandu. Driven by his experience with his father’s rheumatoid arthritis, he applied for a position at the University of Toronto, and for the Ogryzlo Fellowship.

In Toronto, Buddhi was motivated by his teachers: Drs. Heather Mcdonald-Blumer, Peter Lee, Dafna Gladman, Art Bookman, Vivian Bykerk, and Simon Carette. He was to be the last Ogryzlo Fellow.

True to his word, Buddhi returned to Nepal and the Patan Hospital, near Kathmandu. He started the first public clinic in rheumatology in Nepal. Most doctors, including the only other five, part-time rheumatologists in the country, work in the private setting. Patan Hospital is a public hospital, with clinics that serve a wider population.

Patan Hospital soon became the site of a new medical school, the Patan Academy of Health Sciences (PAHS), supported by volunteers from around the world, including Canada. Its mission is to attract motivated students from under-served rural areas and encourage them to return to their home regions upon completion of their community-based training. Dr. Paudyal has been a leader in musculoskeletal (MSK) and Internal Medicine for this program.

I met Buddhi while volunteering for the medical school in 2011 and have returned regularly since. Through his efforts and encouragement, he has just been joined by Dr. Keshav Sigdel, who has completed his rheumatology training in China. Patan Hospital is starting its postgraduate programs in August. There is no certification for rheumatology in Nepal, but Dr. Paudyal has approval to begin the country’s first fellowship program in 2018, as a centre for education, care, research and advocacy. For the first few years, until there are sufficient faculty, this program will require outside assistance in teaching.

If you would like to join me in providing help for patents with arthritis in Nepal, please email me at stephen.aaron@ualberta.ca and I would be happy to tell you more.
For more information on Patan Hospital and the PAHS, you may visit: www.pahs.edu.np.

Stephen Aaron, MD, FRCPC
Professor, Department of Medicine
Division of Rheumatology
Faculty of Medicine
University of Alberta
Edmonton, Alberta

Drs. Keshav Sigdel, Stephen Aaron, and Buddhi Paudyal at Patan Hospital in Nepal.