Member Spotlight: Raju Dhakal
January 14th, 2019
Dr. Raju Dhakal graduated Kathmandu Medical College and Teaching Hospital in 2007, earning a MBBS degree. After medical school, he served as a house officer and tutor at the Medical College and Teaching Hospital. In 2009, he began work as a physician at the Spinal Injury Rehabilitation Centre (SIRC) in Kaavre, Nepal, while also finding time to gain additional spinal rehabilitation experience through a clinical observership at the spinal injury program at National Rehabilitation Hospital in Dublin, Ireland. In 2012, he began his formal residency training at Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh, with the support of the Vancouver-based SpiNepal group. His residency included 2 years of rotations in medical, surgical and pediatric specialities and 3 years of physical medicine and rehabilitation (PM&R). He did take some time off during his residency training to return to SIRC to volunteer following the devastating 2015 Nepali earthquakes, and to receive training at the Royal Melbourne Hospital (Melbourne, Australia), earning a title of Clinical Honorary Fellow. During his residency, he also had the opportunity to receive clinical training at the GF Strong Rehabilitation Centre (University of British Columbia; Vancouver, Canada) and the Toronto Rehabilitation Institute's Lyndhurst Centre (University of Toronto; Toronto, Canada). He completed his residency training at BSMMU in March 2017, then received further training at the Swiss Paraplegic Centre (Nottwil, Switzerland), before starting his current position on 29 May, 2017, as medical director and physiatry consultant physician at SIRC.
Dr. Dhakal is a member of ISCoS and the Asian Spinal Cord Network (ASCoN), the regional ISCoS affiliate. He has been highly active in the educational missions of these organizations, including presenting at conferences, chairing sessions, and participating in the initial editorial group that prepared E-learn SCI under the direction of Professor Harvinder Chhabra. He is also a member of International Society of Physical and Rehabilitation Medicine (ISPRM), where he serves as a member of the Rehabilitation Disaster Relief committee. He also serves as the Low and Middle Income Countries Representative on the advisory board for Cochrane Rehabilitation. Finally, he is a founder and president of the Nepalese Association of Physical Medicine and Rehabilitation.
Dr. Dhakal has received many awards during his education and career, including an ASCoN Fellowship Award, the Melbourne Health Award (from Melbourne University, Australia), an International Award for International Physiatrists (from the Canadian Physiatrists Research and Development Foundation) and a Kenes International and ISPRM travel grant award.
How did you become interested in becoming a physician?
Due to a lack of medical doctors, hospitals and vaccinations program in my village, I contracted polio at the age of two and developed paraplegia. Rehabilitation was not available at that time. I used to think: how could I develop medical care and rehabilitation for the people to have a dignified life despite impairment and disability? This is how I became interested in becoming a physician.
How did you become interested in becoming a specialist in rehabilitation medicine?
During my rotations in medical school, I found something was missing in health care. Later on, I realized that it was rehabilitation medicine that was missing. From the very beginning, I was not interested only in curative medicine. Rather, I was interested in the preventive, diagnostic and rehabilitative aspects of medicine. I saw many patients with spinal cord injuries and disorders, brain injuries and disorders, and polytrauma just lying in bed, suffering avoidable complications. Too often, they were dying prematurely. There was not a single rehabilitation physician in the country [of Nepal] to manage their issues. This was the driving force for me to become rehabilitation physician.
What were the challenges you faced to become a specialist in rehabilitation medicine in Nepal?
The challenges I faced were:
- There was no post graduate training available in Nepal to become a specialist in rehabilitation medicine.
- There was no funding to go abroad to obtain training and specialty certification in Physical Medicine and Rehabilitation (PM&R).
- PM&R was not even recognized as a specialty by the Medical Council of Nepal. (Fortunately, this has now changed.)
- There was no national level rehabilitation hospital in Nepal to work in after completion of training. Even now, none of the university/medical colleges and hospitals have a PM&R department or a rehabilitation medicine unit in Nepal.
Please tell us about Spinal Injury Rehabilitation Center and the work that is done there. When did it open? How many patients are seen there? How is it supported?
The Spinal Injury Rehabilitation Centre (SIRC) is a 51-bed non-profit, charitable inpatient and outpatient facility inaugurated in 2002. It is the only facility specialized in spinal cord injury (SCI) care in Nepal. We provide holistic and comprehensive rehabilitation utilizing an interdisciplinary approach led by a rehabilitation physician. SIRC has medical doctors, diagnostic facilities, physiotherapy, occupational therapy, nursing care, psychology, social service, peer counseling, recreational and sports activities, vocational training, wheelchair maintenance and an orthotic workshop, all under one roof. Until very recently, this was funded entirely by donations and fundraising activities, without government support. More recently, some government funding has finally been granted, but about 30% of the running cost comes from patient charges and we still have to have a fundraising program.
What challenges do persons with disabilities face when living in Nepal?
The challenges include:
- A lack of affordable, quality health care and education.
- Challenges in finding dignified employment opportunities (and training) and livelihoods.
- Environmental and attitudinal barriers (social stigma). In rural areas, there may be hills and mountains, with no roads. In urban areas, there can be rather unfriendly infrastructure as well.
What keeps you busy/busiest these days?
Being a medical director and consultant physician, I have been very busy with inpatient and outpatient consultant work, as well as multidisciplinary ward rounds. I am also very busy as a speaker or resource person in different SCI conferences at home and abroad – especially in this region. Now, I find myself becoming increasingly involved in research, training activities at SIRC, planning a PM&R residency, administrative work, and strategy and policy making for both SIRC and the SCI system of care in Nepal. In my very limited free time, I enjoy being with my wife, our one-year old daughter, and our families and friends. I also enjoy music and reading.
What are some of your goals, for your career and for the field of rehabilitation in your country/region?
My goals are:
- To continuously improve the quality of care for people with SCI in Nepal, including their meaningful reintegration into their communities.
- To help SIRC become a national and regional leader in SCI medicine and rehabilitation.
- To lead the Nepalese Association of PM&R.
- To start a PM&R residency training program in Nepal.
- To strengthen the role of rehabilitation in our health care system and at to have at least one specialized SCI unit in all seven provinces of Nepal.
- To strengthen collaboration and continued medical education in the field of SCI medicine and rehabilitation.
Tell us something about yourself that would surprise us.
I am the first and still the only registered PM&R physician in Nepal! I am not only a practicing physician, but also leading a 51 bed spinal injury rehabilitation centre with more than 300 inpatients with SCI per year. People can hardly believe that someone like me, who has a physical disability, could serve the country after a disaster like the 2015 earthquake.
Tell us about a memorable experience you have had as a doctor.
At the time of the 2015 Nepali earthquake, I was doing my residency in Dhaka [Bangladesh], but returned within three to four days after the earthquake with my wife and another colleague to serve the country’s needs. Every day, I managed around 150 patients with severe SCI with the team. In the evening and night time when we had electricity, internet and phone available, we used to discuss one or two cases everyday with ISCoS colleagues, especially from the SpiNepal group of Drs. Peter Wing and Claire Weeks. I particularly remember a 34 year old woman with a mild head injury and an unstable fracture-dislocation at L1-2, who was intact neurologically, but in severe pain and 34 weeks pregnant. After four weeks of careful management, the baby was successfully delivered by caesarean section and a spine fixation was done. Both mother and baby were healthy and safe. I still remember the crying and screaming of patients who had psychological stress with each aftershock, sometimes occurring every five to 10 minutes, when they were inside the building. We therefore took all the patients outside the building, provided temporary shade, and provided medical, nursing and rehabilitation care outside the building in the shade. I also remember that the doctors used to use an office in the building to view imaging, provide consultations or have meetings. After government officials visited and inspected the building, they did not allow us to return to this office because they had determined that it was a most unsafe place due to dangerous cracks caused by the earthquake. We never imagined that we could also become the victims of aftershocks, and we then changed our office to an area outside, under some shade.
Are there any places you have never visited that you hope to visit in the future?
I would still like to visit the major rehabilitation hospitals in the United States such as Spaulding Rehabilitation Hospital, Rehabilitation Institute of Chicago [now Shirley Ryan AbilityLab], Rusk Rehabilitation Institute and Kessler Institute. I would also like to visit the Stoke Mandeville Hospital in the United Kingdom. I would also very much like to revisit the University of British Columbia and GF Strong Rehabilitation Centre in Vancouver once again with my family.
Who are the person(s) and/or organization(s) you would most like to thank and why?
There is such a long list of people and organizations who have helped me throughout my career. I could not have achieved what I have without the support of my family and friends. The SOS Children’s Village family where I grew up supported me through medical school. Kanak Mani Dixit, a well-known journalist and editor in Nepal, who established SIRC in 2002, and many of his board members (especially Dr. Anil Bahadur Shrestha and the current board chair Prachanda Bahadur Shrestha) have been amazing sources of support and encouragement. Ms. Esha Thapa, the executive director of SIRC for many years, and who currently heads its parent organization, developed SIRC from its humble beginnings in borrowed space to the highly respected and still growing institution of today. Drs. Peter Wing and Claire Weeks, with the help of the SpiNepal contributors, supported me throughout my PM&R residency, and also showed me the field of SCI medicine and rehabilitation. My professors in the PM&R department at Bangabandhu Sheikh Mujib Medical University allowed me to return to Nepal following the 2015 earthquake. I am grateful also to Stephen Muldoon of Livability, ASCoN and ISCoS for financial and other material support, as well as for the encouragement that has come from so many of the leaders and members of these organizations. Many thanks are also due to the Canadian Physiatrists Research and Development Foundation for sponsoring me to visit two exceptional Canadian rehabilitation centres and to attend the resident review course they hold every two years. Finally, the team in Melbourne sponsored my visit to Royal Melbourne Hospital for further SCI medicine and rehabilitation training there after the Nepali earthquakes.