Not a migration story: Dr Rojina Shilpakar

Today’s episode is not a migration story; you could even call it a non-migration story. I’m chatting with someone successful enough in her field that you could easily imagine her skills being in demand in many other countries, and that she could leave Nepal if she wished. But of course she hasn’t. 

Like many Nepalis, Dr Rojina Shilpakar went to Bangladesh to study medicine, then returned to Nepal. Searching for a niche, she found it quite fast at Sushma Koirala Memorial Hospital, performing surgery on survivors of burns. Today she is deputy medical director at the hospital, a trainer of burns surgery at the regional level, and an advocate for training of health personnel working outside Kathmandu, so that burn survivors who arrive in the capital have a better chance of survival. 

As much as I enjoyed this conversation, I hesitate to draw any lessons from Rojina’s story that might apply to Nepal more broadly. The experiences she’s lived and the decisions she made are unique to her. What I do know from our chat, is that she has been able to find a job in Nepal that challenges her and that she is devoted to. I wish that more people will find themselves in such a situation. 

Thank you as always to Himal Media for welcoming me into their studio for this recording. And a warning: there are some graphic descriptions of surgery in this episode. Please take care while listening.

Resources

Sushma Koirala Memorial Hospital, Facebook page

Interburns network

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Music by audionautix.com.

Thank you to Himal Media in Patan Dhoka for the use of their studio.

Chapters

• 3:58 Newly graduated, searching for a niche
• 11:50 Developing a passion for burns surgery
• 20:36 Why doing training outside Kathmandu is imperative
• 26:20 3 ways Dr Rojina's job keeps her in Nepal

Transcript

0:00

I want to go out and learn and come back and see how they do it out there in developed countries, how they save the patient. Hi everyone, this is Marty.

Thanks for joining me for another episode of Nepal Now: 0:26

On the Move, where you'll hear from some of the huge numbers of people leaving this country wedged between India and China, as well as from the few who return to settle in their homeland. And occasionally we'll call in an official or expert to help us understand these movements. Today's episode is not a migration story. You could even call it a non-migration story. I'm chatting with someone successful enough in her field that you could easily imagine her skills being in demand in many other countries, and that she could leave Nepal if she wished. But of course she hasn't. Like many Nepalese, Dr. Rojina Shilpakar went to Bangladesh to study medicine, then returned to Nepal. Searching for a niche, she found it quite fast at Sushma Koirala Memorial Hospital, performing surgery on survivors of burns. Today, she is Deputy Medical Director at the hospital, a trainer of burns surgery at the regional level, and an advocate for training of health workers outside of Kathmandu, so that burns survivors who arrive in the capital have a better chance of survival. As much as I enjoyed this conversation, I hesitate to draw any lessons from Rojina's story that might apply to Nepal more broadly. The experiences she's lived and the decisions she made are unique to her. What I do know from our chat is that she has been able to find a job in Nepal that challenges her and that she is devoted to. I wish that more people will find themselves in such a situation. Thank you as always to Himal Media for welcoming me into their studio for this recording. And a warning, there are some graphic descriptions of surgery in this episode. Please take care while listening. And now my chat with Dr. Rojina Shilpakaar. Rojina Shilpakaar, welcome to Nepal now on the move. Thank you very much. It's really nice to be here. We want to talk about your work here in Kathmandu as a surgeon. I know that you've been affiliated with one particular hospital for a long time now, doing some really interesting work. But before we get there, let's talk a little bit about your background where you were born, went to school, that kind of thing. I just turned 40. Congratulations. Very young. Thank you. I live nearby in Manbhavan, you know Manbhavan. So I'm a resident of Patan. I love Patan. And I'm a third-born daughter of my parents. I have two elder sisters and a younger brother. And I went to San Mary School, which is also very near. All our relatives are in Patan. So Patan was basically, you know, the whole essence of my childhood. And then I went to Bangladesh after my schooling to study medicine, where I met my husband, now husband, Dr. Shikhar Swar. Who happens to be sitting here with us. Yeah. Hello, Dr. Sikhar. So yeah, life's been good. And I came back from there knowing that, you know, okay, I'm a doctor now, and so many people are, but I want to do something different. And then I ended up in Sushma Gwerala, memory hospital, where I work. And I ended up becoming a surgeon. I become a surgeon. And I'm loving what I'm doing. And talking about plastic surgery. So, you know, we had very little knowledge when we passed out from medical school, what plastic surgery was. It was interesting for me, because, you know, plastic surgery, even in medical school, we thought entails more of cosmetic. But later, as I was doing my internship, and I came back here, I found out it is more of a reconstruction work. And I've always been very excited and enthusiastic about creative work, like reconstructive projects and everything. So that's how I looked at reconstructive surgery, like this is so creative. And I looked for a hospital where there were doing plastic surgery in Kathmandu, and I found Sushma Koirala, Memorial Hospital. So I went there, and that's how my journey started. Okay. That's a really interesting way of looking at it, actually. I never thought of that before, because online also your profile is very much associated with burns, like doing burns, surgery after burns, and working on patients who have been victims of burns or survivors of burns. But I never thought of that more creative aspect, which of course it is — rebuilding anything is a creative act, right? So, that's very much part of it. To be really, really honest, I was not a great or student, or somewhere, I was a very average student. And from the very beginning, I knew that I would not top classes, or I would not excel in a lot of things that necessarily, the whole crowd does. But I always knew that I will do good in something I really want to do when I find my passion. So I was, I didn't waste my time looking at things that was not appealing to me, that was not, you know, making me alive. My father, who just recently passed away six months back, so he's a businessman, and my entire family looks after that business, my siblings, elder siblings, younger siblings, so everybody, and I always felt out of place there. And one thing I knew was I was not going into the business, and so it was something different I wanted to do, and my father also wanted me to become a doctor. So I became a doctor just like that, you know, not, you know, like it's a novel profession, and I want to help sick people and all that. And when I passed out, my last placement in internship was in pedriotic surgery. In the ward, there was a kid, he had this condition, what we call as burst abdomen, when there's a surgery done inside the abdomen, and there's an infection, you know, there's the, the essence of the wound, and you have to treat the infection and close it down, close it down in a way where you have to use skin or part of muscles or things from other parts of the body to close it down. So that was the first basic surgery case I saw there, and I thought, wow, this is different, and this is just like origami or, you know, something like that, and, and I was interested in surgery. So from that moment on, I thought that I wanted to become a surgeon. And so when I came back here, I did some homework and I found there are not many female surgeons in Nepal, just a handful, and that was when sort of a tick bark, tick in the box, like something not everybody has done. There was a handful of plastic surgeons themselves in Nepal, and when I just looked over like it was all, I didn't, I couldn't think, you know, what kind of cases they were doing, I thought maybe some cosmetic surgery, maybe some, you know, reconstruction, like where there's burst abdomen and something like that, and cleft surgeries, cleft lip and palate. So I saw this place, Sushma Koirala Memorial Hospital in Sankhu. So he and I, then boyfriend, we went in a bike, and we went and went and went, and that place never shows up, and we went and went, and villages pass by, and still that place doesn't come, and then it comes a small alley, and we go there, and there was this beautiful hospital, very quiet, beautiful hospital with beautiful garden, and I found out it was German funded by an organization called Interplac Germany. I saw the pictures there, and I was amazed, I was blown away by the kind of work, plastic surgery entails, and I was more interested. So I left my CV there, and they said, right now we don't need anyone, we don't have space, so if we do, we'll get in touch with you. And they did, after a month, and I got in there, and slowly I found out, you know, the burns was a very big problem, and the burns were so neglected in Nepal, and not only in Nepal all over the world, and that I came to know later, but first, you know, just seeing the burn patients was very surprising for me, it's one of the most painful conditions, and the parts of your body literally get cooked. During surgery we have to remove it, the procedure is called deep rightment, but somehow after getting rid of those dead tissues, dead fingers, cutting off, amputating, off feet, and everything, you know, if the patient survives, they're always able to reconstruct it to make their life better. So it was an amazing feeling to find out all these people who come, especially out of Kathmandu from low socioeconomic background. They come here with their life at stake. It's a death and life in death situation when they come with more than 30% for the person burned, and then we are able to save them and reconstruct them. That was really amazing, you know, it was sort of like enlightenment for me, and a lot of patients came years and years later after a burn incident, and they come with these deformities called post-burned contractors. You know, they would come with this chin attached to chest, their elbows attached to the axilla, the fuses together. And then we are able to release it and just, you know, fix it. It was really amazing, so I sort of started getting more passionate about it as I learned more about burns, and found out that burns is actually the very big part of plastic and reconstructive surgery, and this hospital is back then it was the only hospital which it did burns in plastic surgery, and I was like, I felt very special to be there, and I wanted to do more in there, and that's how I got stuck there. Well, that's very interesting. So I came here with the assumption that you went into it as this very idealistic person wanting to kind of change the world and, you know, be the doctor who saves people, but it almost sounds to me like you didn't do that. You went in as a creative person, but you've developed that passion afterwards. Yes, yes, that's correct, yeah. You can put it that way that I went there and learned about it, and then as I grew up as a doctor, I was learning more and more about burns, and I thought, you know, not a lot of people do this, this is like something where, you know, people need to be aware of, and more people need to be involved, because you know, ironically actually burns is, it is a very intense job. When patients come with 20, 30, 40% burns, they need multiple surgeries, and their dressings are time consuming, like very hard and very painful, and like at least two, three people have to be involved during the dressing and bandaging, and even we take them in surgery, it is a very hectic surgery. It takes about two, three hours from the start to the brine, into packing the patient, and especially when we are covering it with skin transplantation. It's a very, very physically demanding and mentally also you need patients, because until and unless you cover the wound of the patient and he or she walks out of the hospital, every day is, you know, plus minus for the patient. Patient can die of pneumonia, patient can die of infection, not necessarily burn injuries, and it is a very non-glamorous operation, non-glamorous discipline, and most of the patients are from low socioeconomic backgrounds, so they can't pay money, and unless somebody is funding them, you can't, you know, earn from them. So I thought, you know, this really needs people more and more people, and it was great for me because I was looking for something like that, you know, something not done much, but then I realized that this has to be done, but there are no people in it, and I found my passion as well as my motto of working for, you know, my career in the same discipline, so it was perfect for me. Yeah, I could see you by looking online that you are, you're very committed to it, and you seem, you seem ambitious in a way, in a good way, like you seem to want to do more and more, that's the sense I got, and so we can talk a little bit more about the other training and things you've done, but I want to ask you, being a burn surgeon, the survival rate in that surgery must be lower than many others, I would think, is that difficult? Yeah, of course it is, so if a patient comes with 90% as burn, let's say USA, or, you know, every Sunday, I would have a, you know, Germany, or even China, they would work very hard, and they are able to save even the 80, 90% as burn, but when patients come here with 40 and 50% as burn, we have to think, shall we do all to try to save this patient? Because if that patient is not going to survive, maybe we can use that resource as better, you know, patient who has better chances of survivability, so I know it doesn't sound humane, but that's how we have to decide, and in very, personally, in very few cases have been emotional, it was probably because, you know, day and day are doing, seeing these patients and seeing these cases, like, you sort of become programmed to it, and sometimes it hits me, oh, this is not a very human way to think, but, yeah, that's how it is. Yeah, coping mechanism, right? I mean, we all have it no matter what we do. Just switching, somewhat, let's talk a little bit about the work you did after your initial degree, and then you started working in the hospital, and like I said, you seem to be involved in different things, I know you're part of an organization called, "Interburns." Interburns, thank you. Interburns, I was looking at that online. Or Southeast Asia, you have a Southeast Asian lead, right? So you're doing a lot of different things, and you seem very committed to this work. Tell me a little bit about this extra, I don't know if you call it, training or exposure that you've had in different places. So this also came along, like you mentioned before that I look at me, but I'm not ambitious at all. It's not a personal negative thing. No, no, it is a positive thing. Actually, I'm not an ambitious person. I like to be in a quiet place, which is not very commercial. So I'm very happy in Sushra Karela, you know, and doing just the job. They're doing, you were like, treating, treating patients and people would come looking for the place because that was the only place where we did burn surgeries. Now there are others. One is in Kirtipur Hospital. It's been seven to eight years. It's open and we share loads, so that's been easy. After working for three years there, I got a chance to be in the training by inter-burns UK. So inter-burns UK is the only organization that is solely committed in the research training in burns. They had been coming to Nepal since 2010 and other low socioeconomic countries for training health persons there for burns because apparently not only in Southeast Asia, this burn is actually neglected all over the world. It's actually called for gotten global health crisis and they came, saw the hospital, they were very intrigued and they organized training in our hospital. So we were in that session. So it was training for us and also duty training to become trainers. And in 2012, so I became a trainer also for this organization and all of us became training. And then let's say I'm lucky enough to say that inter-burns has various levels of training, basic burn, essential burn, advanced burn care. And after getting the essential burn care, also after a few years after I became a surgeon, I got a chance to participate in advanced burn care surgery also. So in advanced burn care surgery, I was selected as top five participant and then I was invited to UK for further trainings. And then it just, I just played along, like, you know, I got the opportunity to be trained and all. So before I knew it, then they offered me that you should become a clinical lead. So now as I'm in Sushma Koirala and I'm the deputy medical director there doing burn surgeries and here the training. So I thought it was a perfect marriage between the treatment and training, which is actually required. It is not only important, I mean, essentially enough to treat the patient in our hospital or one or two hospital in Kathmandu. It is very important to train people outside the Kathmandu and I will tell you later why. So then we had this partnership of our hospital and inter-burns UK. So now Nepal is the regional hub for training for Southeast Asia and Sushma Guarala is the regional hub training center for our country and other countries. So whenever there are trainings in Kathmandu, we do it at Sushma Guarala and we go outside Kathmandu also along with the training part. I'm trying to advocate along with the help of all my colleagues that teaching other people about burns is very important. In the process trying to knock the door of health, ministry of health and population. So they see the importance of training health personnel for first aid of burns for at least about some introduction of the burns. So they can do a little and minimum health outside Kathmandu before they refer the patient. Trying to get the ministry to get involved more in this training and take the ownership. So we can regularly do this kind of training throughout Nepal in all the provinces without having to depend on the foreign resources. This kind of training is very important especially outside Kathmandu because in burns, once the patient gets burned like more than 20% like it's not only the burn injuries that is of concern. There are different systems in our body like respirator system and digestive system and homeostasis system where fluids get balanced and your nephro system, you know, concerning kidney and all. Everything gets upside down. You start losing fluid and important proteins and all those electrolytes from your body and your body becomes weak, you become immune to compromise. So it's not only the wound that gets concerned, the patient starts deteriorating from the hard point of view. I'll say this in layman language so people understand they'll be compromised in the fluid balance, they'll be compromised in the sodium potassium balance and protein balance. So there's a lot of, let's say, the dismantling of all the systems going on and people actually die of infection or kidney failure or heart failure rather than burn injuries. What happens is once a person gets burned, the first 24 hours is very crucial because we have to replace the amount of fluid the patient is losing from the wound. And because people do not have these trainings, it's a very simple thing to do, open a cannula and then join fluid but they don't know and they just send the patient and patient has to travel like for hours and hours before they reach Kathmandu and that golden 24 hours is gone and sometimes we receive patient, you know, on the doorstep, very, very on the verge of death who otherwise wouldn't have to die. Just these few steps also can save people's life. So that's why these trainings are very important and that's why I got very passionate. I'm passionate about it. Okay, well that's a lot. So you're doing the training, you're continuing your surgery and as you said, you're doing this kind of advocacy administration kind of work and you've reached a certain level where you've been quite successful. I'm not saying you're about to retire or anything, you're still young and you've got a lot to do, no doubt. But you've got a number of accomplishments now and you've been outside of Nepal and you've had different training and exposure. You talked about these hospitals in other better resource to richer countries. Have you ever been tempted to just say, I want to go work somewhere where I have everything where I don't have to worry about choosing between this patient and maybe the next one who comes in the door? Actually, no. I mean, the challenge here is very attractive or I don't know, it keeps me alive and I don't know, it's not a nice way to say that this challenge was attractive but you know, it gives you ample of opportunity to do something you are capable of and I don't know maybe at the cost of sounding a little bit arrogant. I can say that I see myself capable of doing that. I work very hard and I'm a very sincere and loyal person. And I started off working at Sushmakhwarala which is actually funded by inter-blast Germany. It is a foundation of plastic surgeons mostly but they are also intensivist and anesthesiologist like who made this organization in Germany and they also work in a lot of low socioeconomic countries. And one of their biggest projects is Nepal and this is the longest running project. This is Nepal is the only place they have this hospital. So this is entirely run by inter-blast Germany in partnership with Sushmakhwarala Memorial Trust. So for 27 years they have been running this hospital and particularly Mr. Hind style like I see him as a father figure. He is a very passionate person. He is actually an engineer but very passionate about making a difference in Nepal. So he has sort of become Nepalese. And his committed his life in building this hospital so that people of Nepal benefits from it. Like I said there are very few people who work in Burns and three of my colleagues we have been working there for 13, 14 years now. One is the current director of the Santhus, become one area and another is my colleague Dr. Monohara who is also a general surgeon. So we three have been together for 13, 14 years now working together and we have been brought up there by inter-blast Germany. We have been sponsored to study for surgery and plastic surgery and given a lot of opportunities. So we learn and be able to give back to the people. They also expect us that one day we become sustainable and stand on our own feet and run that hospital continue the work they have been doing. So I think given the opportunity and these opportunities and chances in our hands and skills in our hands I think it would be a little bit of betrayal to go away from our country where people actually really need in this sector. If it was I don't know cardio or abdominal surgery and other stuff, there are many, many people who are doing it. But I think in this one, if you leave this and go there are a lot of people who will be doing it. Number one that and number two because we have been like I said brought up there with an expectation that we will give back to the community one day. I think it is just morally sound to stay back. And third, I love it there. I enjoy every single day of my work. I look forward to it. I dream about surgery in the next day. How am I going to do it? And this one I want to do it and I will not let other people do this. I dream about it and I love being here. So I haven't been in that stage that I'm going to go. I want to go out and learn and come back and see how they do it out there in developed countries. How did they save the patient, you know, surgical skills and all that like we are able to do, maybe not very advanced but very able to cover the ones, very able to send the patient. But how do they save patient, you know, what kind of ICUs they have, what kind of critical services they have, what kind of advanced technology they have. I want to see that, learn that and bring it back. And again the same question applies to inter burns also. So they have been training people in low social and countries. So people learn there to help themselves. And I've been very lucky to be in various trainings to learn myself and now in the position to teach other people, train other people, actually make a difference now. And so it would also be very disappointing if I go away and you know, want to work somewhere else where there are already people who are doing it. Okay, that's great. I mean, I'm convinced you're very also very passionate about that. You said one thing which was in this particular field, in this area that I'm working in which is kind of a narrower specialization. I'm sure you hear about other doctors and nurses and we all do, who do leave the country for various reasons and it seems like the numbers keep going up. You understand what drives those people. Yeah, absolutely. Do you see people you work with doing that or? Of course, like we have other, three of us have stayed back and there are many other nurses and other staffs and administration also. They've been working there for 13, 14 years. But there are other colleagues who leave also. And it is entitled to choose what they want with their life and especially conditions in Nepal. It's kind of gets frustrating. It's not like I'm always like, you know, smiling and running around with rims in my head and you know, wrinkling eyes and saying, you know, oh, this is great and this is absolutely perfect. Of course, there are frustrating days. Of course, if you like, you know, oh, my God, there's nothing happening. This is like, like I told you, the work with ministry for this particular work just to convince them that this burn training has to be endorsed by the government. Me and my colleagues, we've been making rounds there for two years and there was a time. I was so frustrated. I was so frustrated. I told my colleagues, look, that's it. I fought with the director there. At the moment I came back and I said, maybe I'm not cut out for this. Maybe I don't know something, but I don't think I can do this. I was so frustrated. And I'm sure there are a lot of doctors and nurses who leave in spite of not wanting to leave for better opportunity, for better academic pursuits and I don't judge them because, you know, as a human, I think it is a smart thing to do. It does get quite frustrating sometimes and feel like, you know, what is even the point of doing this? You will, you went and then you move on. And this year also with good lobbying and good proposals, we are able to secure some fun from government and it will help us treat some patients, at least 56 patients for free. Good news about the training part also after two years of making rounds. Just a month back, a National Health Training Centre was also kind enough to see through it and they endorsed it. They contributed a part of fun and we did the first pilot training of basic burn care at Sushmagoyarala for them to evaluate. So we have to do it one more time and if they agreed that, they will fund other trainings in other provinces. So things are hard. We are working towards it, but it is also looking up. There are positive things happening also. So it is quite encouraging and scary at the same time. Okay, that is very good. I think we could talk for a long time, but this has been really interesting. I am really happy to have met you, to have talked to you and hear about all the work you are doing. Happy to hear that you are committed to staying where you are and best of luck. Thank you very much. For that, my family and my friends have been very supportive as well in what I do. I travel a lot, even inside the country, so even my daughter gets it and supports me. And I wanted to tell you about the story about Sushmagoyarala. People need to know that. So Sushmagoyarala, she is a late wife. She was a late wife of late Girusa Prasad Goyarala. So she actually sustained burn injuries with gas explosion from the refrigerator and she did not get good burn care and she succumbed to burn injuries. So her daughter, Sushmagoyarala, who we fondly refer to as Sushmagoyarala, when she got in touch with Interplacia Germany also trying to build a hospital here. So Sushmagoyarala, memory is trust and Interplacia Germany came together in partnership to build the hospital. So the story behind the hospital is also a very sad story of Sushmagoyarala. How old is the hospital now? 27 years. Well, I hope it continues for at least another 27. Thank you very much. And if I may, I don't know, I would dare to ask for some funds. If anybody is interested, please donate to our hospital. Thank you Marty for having me. Thanks again to Dr. Rojina for chatting with me today. Let us know what you thought. You can text Nepal now by clicking on the link at the top of the notes to this episode. You can also email me at NepalNowPod@gmail.com or leave a comment on any of our social channels we're @Nepal NowPod. I'm off on holidays for the next few weeks. Back in September, I'll talk to you then.(upbeat music)(upbeat music)(upbeat music)(upbeat music)(upbeat music)[BLANK_AUDIO]