Neurosurgery in Nepal: Professor Terence Hope on Global Surgery

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Cecilia, InciSioN UK representative for the University of Nottingham

Hey everyone!

This is Cecilia, InciSioN UK Representative at the University of Nottingham. I am flattered to be able to introduce you today to someone I greatly admire: Professor Terence Hope, a retired consultant neurosurgeon at QMC and senior lecturer and Professor of the Kathmandu Neurosciences Institute, Nepal.

First of all, thank you for agreeing to this (virtual) interview, Prof Hope!


Illustration by Lemon Scott illustrations

Could you tell us at which point in your career you decided to go to Nepal? What led you to make this important decision?

“I retired at age of 65 years and decided to devote myself to teaching. I was at a retirement party for Sir Graham Teasdale[1] in Glasgow (famous for the Glasgow coma scale), where on this occasion I met Professor Upendra Devkota[2] who asked if I could join him in Nepal. He was the first neurosurgeon in that country and had trained in Glasgow.

With a certain amount of Scottish water on board, I said yes! Such was the beginning of a fruitful friendship lasting fifteen years.”

Why did you choose Nepal specifically?

“Well, fate chose me!”

What did you find were the biggest challenges of working in a developing country?

“At the beginning in the first few years, there was civil war in Nepal between the Maoists and the Royal Government. This strife was terrible and led to problems. We for instance we found difficulty in getting the first CT scanner out of the customs shed.

No neurologists, no physiotherapists, no rehab, and a dire shortage of drugs. Tuberculosis was common but with no NHS the patient often could not afford months of drugs. The hygiene in the Bir general hospital was poor although our unit was very clean. At night the ICU nurses were of a poor standard. So remarkably, Prof decided to build his own hospital, a purpose-built neuroscience unit outside of the city.”

Would you be willing to share with us an instance or a particular case, which has stayed with you beyond your time in Nepal?

“One day a senior army General had a subarachnoid hemorrhage from a huge intracerebral aneurysm. This giant aneurysm would require temporary occlusion of major vessels supplying the brain.

Hypothermia can protect the brain for a time during occlusion. We went to the fish market and brought back large blocks of ice to cool him. A great if somewhat smelly result with no deficit. He attended outpatients and gave me an honorary Gurkha tie!”

What did you find to be the biggest difference between the UK and Nepal’s healthcare systems?

“In 1947 we in the UK had the new NHS providing carefree for all. Nepal has nothing in comparison. Some important public health measures have developed such as Polio eradication and now midwife care for all first-time mothers even in remote areas.

In neurosurgery, head injuries are a big part of the case load in poor countries. No ambulance service can lead to delay in referral with bad results. On one occasion a severe head injury arrived by rickshaw.”

What led you to your decision to return to the United Kingdom?

“Well I never left, in a sense. It was a case of many visits, often in my holiday leave for the NHS here in Nottingham.”

How do you think COVID-19 has impacted global surgery?

“Elective cases are piling up in every country. Malignant diseases are now being delayed in diagnosis and treatment. I am particularly concerned about the effect upon teaching at the bedside and in the operating theatre which affects trainees in all branches of surgery. Aspiring surgeons may not come now to the UK and Brexit adds to this.”

What do you think are the challenges that global surgery faces in the post-COVID world? What’s the direction global surgery will be taking?

“We need to be optimistic about vaccines and return hopefully to normality. I am a little wary of the new trend towards video consultations and as a dinosaur, robotics has a long way to replace a good pair of hands.

International video meetings can replace expensive travel, perhaps? I feel the surgical colleges are not doing enough to establish these links.”

Do you have any advice for aspiring surgeons with an interest in global surgery and global health?

“Yes, use your elective time wisely. Go to underdeveloped areas. I go to Gaza, what an eyeopener that is. Use the BMA who provide links as do the Royal colleges if you ask. Medicine sans frontiers for the brave, why not? Ring or visit the London school of tropical medicine also in Liverpool. Global health conferences are advertised in the BMJ, often huge and possibly not for younger doctors.”

Thank you so much for taking the time to read this, and special thanks Professor Hope for sharing his story of global surgery with the InciSioN UK network! See you all soon.

Cecilia

References [1] A 1963 graduate of the University of Durham, Sir Graham Teasdale came to Glasgow as a lecturer in Anatomy in 1967. He became the Head of the University's Department of Neurosurgery in 2003. He created the Glasgow Coma Scale along with William Bryan Jennet. In 2006, Sir Graham was knighted for his services to neurosurgery. [2] Born in 1953 in Gorkha, Prof Devkota established the first neurosurgical unit in Nepal at Bir Hospital. He was the founder of the National Institute of Neurological and Allied Sciences and he also held the post of “Minister for Health, Science and Technology” for the Government of Nepal.

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