Ill and injured Nepalese villagers sometimes walk or are carried for days to clinics and hospitals to receive treatment. Often, when they get there, they're told they must go the country's capital for simple diagnostic tests such as a computed tomography (CT) scan.
Dr. Kalloo Sharma, a radiologist from Pokhara, 100 miles from Katmandu, knows the problem well. The country is so poor that the average annual per capita income is about $210. And the only CT scanners — about five in all — have been located in Katmandu hospitals.
Recently, Sharma was among 50 doctors and nurses who pooled their personal resources to purchase a CT scanner that they will place in Pokhara, a city of about 200,000 people that is much closer to many of the villagers. He has spent the past six weeks at University Hospital's radiology department, learning how to use the technology.
In the past, doctors in outlying areas have had only ultrasound and plain X-rays to make diagnoses — something that's virtually impossible if you're looking for brain, spine or organ injuries or irregularities, according to Dr. William Brant, professor of radiology at the U. Medical School.
Brant was in Nepal last November teaching a medical education conference for Nepalese doctors. The radiology in the country was actually "very good," he said, "but it depends on high-quality images, and for that you need high-quality equipment." Nepal has a shortage of both.
He invited Sharma to the United States to learn the technology. Sharma returns home Thursday.
"In our country, some person may fall from a mountain or the slopes or be hurt on one of the steep cutoffs. There are road traffic accidents. If you don't know the real diagnosis, you may lose him," Sharma said. "With a CT scan, you can operate immediately and save a life. There are also diseases like cancer we can treat under the guidance of CT scan."
Brant, used to working in a country where CT scans are readily available, shudders to think of doing his job without the sophisticated device. "It would be impossible to find hemorrhages in the brain, strokes, abdominal injuries and tumors, injuries to the bowel and bowel tumors," he said, adding that about half of the time his hospital uses a CT scan for trauma cases.
Pokhara has only a government-owned general hospital and a new, private medical college/clinic, as well as physicians in private practice. Though the hospital has 250 beds, it's not uncommon to stack up 400 patients using makeshift beds. And at least 20 of them a day would benefit from access to a CT scan, Sharma said.
Sharma received his medical training in the Crimea of the old Soviet Union, then did his residency in Nepal. At that time, there were no CT scanners for the doctors to train on.
Besides getting help from a large number of faculty members at University Hospital, technologists provided Sharma with protocols that he can take back and share with his colleagues. He, in return, provided them with a taste of Nepal's culture and customs in what he hopes will one day be a routine exchange program.