Visiting Fellow from Nepal Describes US Experience as “Dream Come True”

From Machhapuchchhre to Manhattan

Nepal is a mountainous and landlocked country between India and China, with a population of 30.8 million people as of 2023. The unique geographical landscape of Nepal, including the never summited Machhapuchchhre, presents both opportunities and challenges. Nepal is rich in natural resources, but the craggy mountains that dominate the terrain act as a barrier to the transfer of knowledge about and access to healthcare.

Despite sophisticated oncologic technology and earlier detection, the cancer burden in Nepal is on the rise. In addition, a lack of standard treatment facilities persists, largely due to the country’s poor economic status. Healthcare providers offer the best services they can, as far as they can.

I feel privileged to have been selected as one of New York Community Trust’s Mammadi Soudavar Traveling Fellows for 2023, which allowed me to spend 3 months at the renowned Memorial Sloan Kettering Cancer Center (MSKCC) in New York and interact with US colleagues who are also members of the American College of Surgeons. This experience stands as a pinnacle in my academic and professional journey.

As a scholar from a low-income country, visiting one of the world’s best cancer centers is a dream come true. I was particularly excited to join the hepatopancreaticobiliary (HPB) department at MSKCC, led for many years by the esteemed late professor Leslie H. Blumgart, MD, FACS. In fact, the bible in HPB surgery, Dr. Blumgart’s Surgery of the Liver, Biliary Tract, and Pancreas, was my textbook during my surgical residency in Nepal. Meeting with eminent surgeons and learning from their legacies allowed me to achieve one of my professional dreams.

My rotational fellowship started with 3 weeks in HPB surgery, witnessing intricate procedures such as liver resections and the Whipple procedure, whether performed through open or robotic methods. In fact, robotics captured my fascination—this was my first-ever experience, watching surgery from a robotic console. Engaging in multidisciplinary team (MDT) Zoom meetings and in-person academic sessions with other general surgical oncology fellows and friendly attendings also enriched my stay.

Subsequently, I joined gastric and mixed tumors surgery for the next 3 weeks, encountering complex cases like retroperitoneal sarcomas, melanomas, extensive metastases, and peripheral extremity malignancies daily. The MDT discussions on these topics were incredibly enlightening, with faculty members deliberating on the best procedural approaches for the best outcomes. The humility of the attendings, particularly Sir Murray F. Brennan, MD, FACS, impressed and inspired me. 

Breast cancer surgeries were mainly performed at Josie Robertson Surgery Center, which has breathtaking views of the Queensboro Bridge over the East River along with Manhattan’s skyline. I observed various breast cancer surgeries, mainly axillary dissections, radical mastectomies, and breast reconstruction surgeries.

Later, I spent a day with Neil M. Iyengar, MD, a breast medicine oncologist, to witness the complete continuum of care at his outpatient clinic. I spent the following 2 weeks in radiology, where I was accompanied by an international fellow from Mexico, Gustavo Barraza, MD—a radiologist specializing in oncologic imaging, who was very kind and expanded my horizons in the oncological aspects of CT scans and MRIs.

My journey at MSKCC concluded with colorectal surgery, where I observed robotic and open procedures, such as total colectomies and hemicolectomies, along with active participation via Zoom meetings and MDT sessions. Overall, my dream visit to MSKCC ended with beautiful memories.

During weekends, I explored Boston, visiting and making new friends while touring the prestigious Harvard University and Harvard Medical School. My short excursion to Maryland and exploring Johns Hopkins University marked another memorable chapter. I am also glad I visited Washington, DC, and enjoyed every moment scenic America offers.

Kathmandu University to The University of Kansas

As I bid farewell to MSKCC, with 22 days to spare before returning to Nepal, I traveled to Dallas, Texas, to reconnect with my cousins and share the warmth of family during the Dashain festival.

Later, I accepted an invitation from the honorable dean of The University of Kansas (KU) School of Medicine-Salina, Tyler G. Hughes, MD, FACS. Dr. Hughes and his wife Mary graciously received me at the airport, and we proceeded to McPherson, where they reside.

The following day, Dr. Hughes introduced me to the KU-Salina campus, nestled in the rural landscape of Kansas. The campus hospital serves around 50,000 residents, and I was impressed by the well-managed Emergency Department and overall facilities provided to the local population in such a rural community. Drawing from my experiences in a resource-challenged part of Nepal, I could empathize with the difficulties of geographic diversity and financial constraints.

During an honorary presentation at the campus, I highlighted these challenges and engaged in fruitful discussions with medical students, including Samir, a Nepali MBBS student who migrated to the US. We could all agree, that despite the physical distance between rural Kansas and rural Nepal, fostering collaboration and exchanging ideas between the two communities was essential. Dr. Hughes then kindly dropped me off in Topeka, where I was received by a friend. I concluded my journey on October 22, 2023, with beautiful memories. 

Now, I am equipped clinically and academically in the field of surgical oncology, and I am committed to dedicating myself to this sector in my home country. The conclusion of my tenure at MSKCC marks the beginning of my surgical career in the realm of surgical oncology.

I extend my heartfelt appreciation to MSKCC, and especially Dr. Brennan, for their efforts in developing oncological health in low-resource settings and providing opportunities for clinicians like me. Additionally, I am very grateful to Dr. Hughes for the invitation and chance to share my experiences serving rural Nepal.

Meeting friends and fostering new relationships in person was a wonderful experience.

Disclaimer

The thoughts and opinions expressed in this viewpoint article are solely those of the author and do not necessarily reflect those of the ACS.

Dr. Suman Baral is a consultant general surgeon in one of the private hospitals in Pokhara, Nepal, and assistant professor of surgery at Kathmandu University in Dhulikhel, Nepal.