Advancing Neurological Care in Nepal
Madeline Fields, MD, and Lara Marcuse, MD, Professors of Neurology at the Icahn School of Medicine at Mount Sinai and Co-Directors of the Mount Sinai Epilepsy Center, recently traveled to Nepal to expand neurological care for underserved communities.
Their mission was to collaborate with the Intensive Care Unit at Dhulikhel Hospital to establish a self-sustaining EEG program and to provide advanced EEG education at two other hospitals in the region. An EEG (electroencephalography) is a test that measures electrical activity in the brain and is used to diagnose conditions such as epilepsy and brain tumors. This initiative aims to improve access to timely neurological and epilepsy care for communities across Nepal.
The AMPATH Nepal Partnership
The effort is part AMPATH Nepal, a partnership of Dhulikhel Hospital, Kathmandu University School of Medical Sciences, and a consortium of global academic health centers led by the Arnhold Institute for Global Health at Mount Sinai. The partnership focuses on improving access to high-quality health care for underserved populations in rural Nepal.
The work to establish continuous EEG services in Dhulikhel Hospital’s ICU is part of a collaboration with Cappi Lay, MD, Assistant Professor of Neurosurgery and Emergency Medicine at the Icahn School of Medicine at Mount Sinai, Co-Director of the Mount Sinai NSICU, and Director of the Institute for Critical Care Medicine’s Global Critical Care Program. Dr. Lay has been working with the Dhulikhel Hospital team to improve ICU services.
A Warm Welcome and Hospital Collaboration
Dr. Fields and Dr. Marcuse were warmly welcomed and treated with great hospitality from the moment they arrived at Dhulikhel Hospital. They joined the hospital’s morning report, where physicians gathered to discuss details of hospitalized and overnight admitted patients. Sujata Phuyal, the lead nurse for the EEG program, guided them on tours of multiple units throughout the hospital including the Pediatric ICU, Neuro ICU, Medical ICU, maternity floor and dialysis unit.
Establishing the EEG Program
With the support from Dhulikhel Hospital’s IT team, especially Sushil Napit, a portable EEG machine and review station were set up in the hospital’s ICU. The training for nurses and physicians included demonstrating the steps involved in connecting a patient to the EEG machine. This process is both time and labor-intensive, requiring precise placement of the EEG wires to a patient’s scalp, allowing the doctors to observe brain waves and to identify and monitor seizure activity.
Dr. Fields and Dr. Marcuse calibrated all EEG machines to ensure accurate data collection and created EEG report templates for both adult and pediatric neurologists. These templates will help the Dhulikhel Hospital team learn how to write and interpret EEGs, ultimately enhancing their analytic skills and improving patient care.
“The most important part of this work is the people who make the machines and processes work,” Dr. Marcuse said. “The doctors and nurses in Nepal are highly skilled professionals who excel in patient care. They have a strong educational background, and there is an opportunity to further enhance their expertise with additional resources and knowledge.”
Dr. Fields added, “It is an honor to work with the physicians in Nepal and to use this essential tool to better serve their patients and communities.”
Educational Outreach and Training
During their visit, Dr. Fields and Dr. Marcuse delivered multiple lectures at Dhulikhel Hospital for nurses, physicians, and visiting medical students. They covered EEG basics, examining complex epilepsy cases, seizure analysis through patient videos and brain wave data, and EEG testing in the neurocritical care setting.
Beyond Dhulikhel Hospital, they presented on epilepsy surgery at the Annapurna Neurological Institute & Allied Sciences and conducted a continuing medical education (CME) course at the Kathmandu Medical College titled, EEG and Epilepsy CME. The session covered emergent seizure treatment, EEG fundamentals, advanced treatment options, and concluded with complex epilepsy case studies.
The heartfelt welcome and friendliness extended by people at all these institutions made their experience exceptionally rewarding and memorable.
Expanding Sustainable Epilepsy Care
Looking ahead, Dr. Fields and Dr. Marcuse aim to develop an epilepsy education and treatment program led by nurses and community organizers, expanding it through Dhulikhel Hospital’s 18 outreach centers. This would reach the rural populations unable to visit the main hospital campus, raise awareness, and reduce stigma associated with epilepsy, encouraging more people to seek epilepsy care.
Through the AMPATH Nepal partnership, Dr. Fields, Dr. Marcuse, and other Mount Sinai neurologists are developing programs to improve education and patient care. These initiatives include neurology training for residents at Dhulikhel Hospital and Kathmandu University School of Medical Sciences, EEG technician training, and establishing an infrastructure for sustainable educational initiatives.
Dr. Fields and Dr. Marcuse look forward to returning to Nepal to continue working with their colleagues on the shared vision of improving epilepsy care and equipping local physicians to provide equitable health care to their communities.
Ankita Kureel is a Program Manager for the Department of Neurology at the Icahn School of Medicine at Mount Sinai.
Madeline Fields, MD, is a Professor of Neurology at the Icahn School of Medicine at Mount Sinai and Co-Director of the Mount Sinai Epilepsy Center.
Lara Marcuse, MD, is a Professor of Neurology at the Icahn School of Medicine at Mount Sinai and Co-Director of the Mount Sinai Epilepsy Center.