On May 4th, our team set out to visit the local health post in Dang. As many healthcare services in Nepal are concentrated in urban areas, health posts were created to increase access to those in rural villages. These clinics are typically run by health assistants, but the health post that we visited was quite unique in that it had received funding for a physician! We were fortunate enough to have the opportunity to sit down and discuss with this physician, Reagan, named by his father after the American president!
Originally trained in Bangladesh, Reagan is a Nepali doctor who has been working at the health post for the past two years. He previously worked in a larger urban centre in Kathmandu, but moved his practice to Dang District to gain experience working in rural areas with limited resources. We were stunned to learn that he is the only physician in a region of approximately 60,000 people! Common conditions that he manages include diabetes, chronic kidney disease, and hypertension (high blood pressure). Depending on the acuity and complexity of the situation, he either virtually consults specialists from nearby larger centres or sends patients directly there. Services provided by the health post are of no cost, but according to Reagan, transportation and hospital fees are often barriers to accessing care. He showed us a notebook that he uses to keep track of patients who he wants to follow-up with to know whether they were able to access referral services. Reagan finds it difficult to see his patients suffering because they cannot access care due to financial barriers. He shared with us a story of a young boy from the mountains who had made the trek to the health post with a serious infection in his leg. When Reagan realized that the boy would not be able to afford the treatment, he paid for it with his own money.
When asked about the challenges that he faces as a physician working in a rural setting, he identified five key problems:
Antibiotic overuse
Difficulties with knowledge transfer and patient compliance
Overuse of over-the-counter anti-inflammatories (such as Advil), which can have numerous adverse effects (including worsening of kidney disease and stomach bleeds)
Overuse of medical services- Reagan described how he often sees patients without any signs or symptoms of disease, but who request medication to keep “just in case”. This creates a difficult scenario in a setting where publicly funded medication is limited. Reagan finds it particularly frustrating when patients who require more acute or complex care are left to wait in long queues behind those who are not sick.
Lack of funding and low prioritization of adolescent health services- From what Reagan described, these services essentially do not exist at the health post. We were shocked to learn that women and girls seeking abortion care require the permission of their father or husband.
As we listened to Reagan’s experiences and perspectives, it struck us how many parallels there are to the healthcare challenges in Canada. Given that physician burnout rates are on the rise in Canada leading to greater emphasis on mental health, we asked Reagan how he was coping. He paused for a bit, and it was clear that there were so many things he wanted to say. But he quickly composed himself and replied, “There is no time for that when I have so many things I need to do.” He explained that he tries to focus on the positive and the people whose lives he’s been able to change because as he described it, that’s what he came here for. As we said our goodbyes, we couldn’t help but wonder what would happen to the people here at the end of the year when Reagan is scheduled to pursue further training elsewhere.
Reagan’s immense dedication to his patients, as well as his kindness and perseverance, are incredibly inspiring to us as future physicians ourselves. We are incredibly grateful that we had this opportunity to speak with and learn from him.