Dr. Koike and Dr, Barnhorst at the Tribhuvan University Department of Psychiatry. Dr. Koike and Dr, Barnhorst at the Tribhuvan University Department of Psychiatry.

In May of 2017, Alan Koike, M.D., and Amy Barnhorst, M.D., embarked on their first trip to Nepal.  Their journey was part of the Global Mental Health Program's mission to provide a set of educational and research opportunities for medical students, residents, and faculty who are interested in mental health in international settings.

Nepal is famous for its friendly, hospitable people, rich history and stunning natural beauty. Although its population approaches 29 million, there are roughly 125 psychiatrists in Nepal, most of whom work in urban areas. There are 18 outpatient facilities as well as 17 inpatient facilities with a total of about 400 beds in the country. With assistance from the Hand and Hands Volunteer Society (a non-profit organization in Nepal), we were able establish a relationship with the Department of Psychiatry at the Tribhuvan University Institute of Medicine in Kathmandu, Nepal. We had the pleasure of meeting with Dr. Saroj Prasad Ojha, the head of the Department of Psychiatry. The psychiatry department is comprised of 6 faculty psychiatrists, 3 faculty psychologists, and 22 residents. The residents come not just from Nepal, but from other nearby countries as well, such as Maldives and India.

Dr. Koike and Dr, Barnhorst at the Tribhuvan University Department of PsychiatryDr. Eidson-Ton and Dr. Koike at a school health camp in Kathmandu.

During our trip, we visited an outpatient clinic and the inpatient psychiatric unit at the IOM at Tribhuvan University.  On the inpatient unit, the patients were there voluntarily, and the hospital provided no mental health worker staff to monitor them. Instead, a family member was required to be present at the bedside of every patient 24 hour a day to help and support them. This was a striking cultural difference from our inpatient units in Sacramento.

There were lots of non-psychiatric medical opportunities for us to learn from as well. Along with the second-year medical students and Suzanne Eidson-Ton, M.D. from the UC Davis Department of Family Medicine, we participated in a health camp at the local school in Kathmandu.  We performed basic medical screening and well-child checks for elementary school students.

We also visited the Anandaban Hospital-Leprosy Mission, where patients with chronic leprosy infection, antibiotic reactions, and gangrenous limbs stayed for treatment. It was very different from what we expected — the patients seemed happy and well-cared for and had open contact with family and friends. They had formed a community with fellow patients, and played chess and chatted together on the porches of the hospital, which overlooked beautiful jungle-covered hills. The doctor was warm and familiar with his patients, seemingly unconcerned about transmission of the mycobacterium. We learned a lot about the disease, and more about compassionate, humane patient care of people with stigmatized illness.

We also visited the Friends of Shanta Bhawan Clinic, a charity hospital for patients, where it costs $0.40 for a new patient appointment and $0.30 for a follow-up appointment. Yet, many patients utilize the sliding scale of payment because they cannot afford those rates.

View of Dr. Koike and Dr. Barnhorst’s homestay neighborhood from the hills.View of Dr. Koike and Dr. Barnhorst’s homestay neighborhood from the hills.

This year, we plan to send a resident to Nepal in May for a one month rotation in the Department of Psychiatry at the Tribhuvan University Institute of Medicine to learn from their faculty and residents. We hope to coordinate this trip with a medical student trip as well so we can take advantage of the language classes and other cultural experiences provided by the homestay program through Hand and Hands.

Also, in the near future, we hope to have child and forensic faculty interested in travelling there to provide some didactics for the Tribhuvan University Psychiatry Department’s specialty areas. We are really excited about our new relationship with the Department of Psychiatry and the community in Kathmandu, and hope to forge a lasting collaboration.

Marketplace near temples in Bhaktapur
Marketplace near temples in Bhaktapur.

Dr. Koike with Dr. Ojha and some Tribhuvan University residents in their call room.
Dr. Koike with Dr. Ojha and some Tribhuvan University residents in their call room.