Emergency Neurological
Life Support Courses in Nepal
By Gentle Sunder Shrestha, MD, FACC, EDIC, FCCP, Neurointensivist, Assistant Professor, Department of Anaesthesiology, Tribhuvan University
Teaching Hospital, Maharajgunj, Kathmandu, Nepal
Nepal is a landlocked South Asian nation,
bordered by China on the north and India in
the south, east and west. Nepal has the
population of around 26.4 million, with the
land area of 147,181 km2. The GDP of Nepal
is USD 837 per capita. Countries like Nepal
and other low- and middle-income countries
(LMICs) have a high burden of neurological
emergencies. The burden of disease may be
higher than in the Western nations, and the outcome is dismal.
Several factors contribute to this scenario, including the difference
in disease epidemiology, poor pre-hospital transport and care,
healthcare infrastructure, poor awareness among public, scarcity of
resources and limited trained healthcare workers. There is a
chronic shortage of human resources for health in Nepal, with the
density of seven per 10,000 populations. Moreover, as compared
to other specialties, the trained people in the fields of neuroscience
is very limited. Most of the neurological emergencies are dealt
with by the healthcare workers with minimal expertise in the field
of neurosciences. Training these first line healthcare workers is of
paramount importance to enhance quality of care and thus to
improve outcome for the patients with neurological emergencies.
The first ENLS course was conducted on Feb. 21, 2015, at
Tribhuvan University Teaching Hospital, Kathmandu, Nepal
with Dr. Victoria McCredie as the course director. Dr. Alberto
Goffi, Dr. Antonio Bellini and Dr. Gentle S Shrestha served as
the trainers (Figure 1). The landmark course was also the first
course conducted in Asia. The course was attended by the doctors
from various specialties involved in managing neurological
emergencies, like emergency medicine, critical care, anesthesiology,
internal medicine, neurology and neurosurgery.
Knowledge and effectiveness of the course was assessed among the
34 participants, at baseline, post-course and six months following
completion of course. The course was found to be effective to
enhance knowledge, decision-making skills and clinical practice,
which persisted at six months following the course. The findings
of this prospective observational cohort study was published in
an international journal. Following the landmark course, there
was increased interest among the local experts to become the
ENLS trainers. At present, we have eight certified ENLS trainers in
Nepal. The landmark course was followed by three other courses
in Nepal. All the courses were very well attended and were focused
to train the first line healthcare contact with good involvement of
medical officers and nurses.
ENLS was well perceived by the national medical societies. One
of the courses were conducted on May 2017 as the pre-conference
workshop during the international conference of Society of
Internal Medicine of Nepal (SIMON), the largest medical society
of Nepal (Figure 2). We had the gracious presence of Professor
J. Claude Hemphill III during the very course. The need of the
course was perceived outside the capital city Kathmandu, as well.
We conducted a course at Biratnagar, a metropolitan city, located
400km east of Kathmandu, on April 2016 (Figure 3). The course
was hosted by Birat Medical College and Teaching Hospital. In
another course conducted at Kathmandu in December 2015,
which was attended by over 75 participants, we conducted a
questionnaire survey, just before starting the course, to explore the
knowledge about acute ischemic stroke among the participants.
The overall knowledge about the risk factors, diagnosis and
management of acute ischemic stroke was poor, thus highlighting
the need of training programs and courses like ENLS.
First ENLS course in Asia, conducted on Feb. 21, 2015, at Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
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