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FORUM
HMS Students, Fellows Aid Nepalis Toward Medical Ed Summit
It's fairly uncommon for someone to begin medical school having already completed a PhD. And it's even rarer to find a first-year student who has previously taught at a medical school. But Jenise Wong, PhD '02, Division of Medical Sciences (DMS)- Biological and Biomedical Sciences (BBS), will be able to make both of these claims when she enters Stanford University Medical School this fall. Wong was one of 11 Harvard graduate students and postdoctoral fellows who helped establish Nepal's first Western-style medical school by volunteering to develop and teach basic science courses there in 2001-02, its inaugural year. Temporarily housed at a Seventh Day Adventist hospital in Banepa, about 26 kilometers from the Nepali capital, Kathmandu University Medical School (KUMS) opened its doors to 43 students in August 2001. "When I first heard about KUMS, I was immediately excited about combining my interest in teaching, background in basic science, and desire to work in the developing world," said Wong. "Never before had I come across an opportunity which so elegantly combined these interests." Doctor DearthThe enthusiasm of Wong and others to participate in this program invigorated the handful of Nepali physicians whose dream was finally becoming a reality. Recognizing that Nepal has one of the world's highest patient-to-doctor ratios--patients in some rural areas must walk for days before reaching a functional clinic--these physicians hope to train a new generation of competent and socially responsible Nepali doctors to meet their country's growing health needs.But this would require revolutionary changes in Nepal's medical education system. The nation has only 10 medical schools. Most of them have existed for less than five years, charge astronomical tuition, and use outdated teaching methods. Consequently, the best young students not only receive their medical training elsewhere--usually in China, India, or, to a lesser extent, Europe or the U.S.--but also settle elsewhere.
Steve Keller, PhD '02, HST-Medical Physics, delivers a lecture to Nepali students. (Photo by Jenise Wong) Fortunately this was not the path taken by Arjun Karki, who attended medical school in Nepal, completed residency training in the U.S., and then returned to Nepal, where he and other pioneering KU officials decided to do something about their nation's crisis in medical education. They wanted to open a new school that would attract a broader spectrum of students--not just the wealthy and elite--and offer a top-notch education. Naturally, initiating such a project in a developing country is fraught with challenges, but perhaps none greater than the dearth of basic science faculty in Nepal. So Karki was ecstatic when he learned that his American ophthalmologist friend had a brother at HMS with resources to help get KUMS off and running. That brother was Cliff Tabin, HMS professor of genetics and BBS program codirector. Tabin told Karki that although it would be difficult to recruit full-time HMS faculty to go on sabbatical and teach at KUMS, he probably could find postdoctoral scientists at transitional stages of their careers who would be able to capitalize on the opportunity. "In addition to doing good for the world, it gives them a chance to really learn how to operate within another culture," said Tabin. The Mother of InventionTravis Taylor, who earned his PhD (DMS-virology) in June and now continues at HMS as a postdoctoral fellow, had already thought seriously about teaching in a poor or underdeveloped country when he first learned of the KUMS opportunity. "I knew it was something I really wanted to do after the first meeting," he recalled.Having taught microbiology lab courses for three years as a University of Southern Indiana undergraduate and completed his doctoral research in a department brimming with world-class faculty, Taylor felt well prepared to coteach KUMS's four-week infectious disease/microbiology course with Connie Chow, an HSPH postdoc. What he wasn't prepared for was the discovery upon arriving in Nepal that KUMS had no shaking incubators, bacterial strains, growth media, or adequate glassware--all staples for starting up a microbiology lab. But Taylor learned that in situations like these, you either have to scrounge creatively or do without. "I had to get some of the bacterial cultures the old-fashioned way--my own samples," he said. "We eventually got most of the lab supplies, so not all was lost." Exacerbating these challenges, most of which are inherent in establishing a quality educational institution in a resource-poor country, the uncertain political and social climate forced KUMS faculty to make frequent, drastic changes in the school's curriculum and schedule. "At least every month or so, there would be rumors that the Maoists were going to call a general strike, and we would have to close our doors for a couple of days or, at one point, an entire week," explained Bevil Conway (PhD '01, DMS-neuroscience), who helped to design and teach the cardiovascular, pulmonary, and renal system blocks. "Moreover, the political situation has resulted in a state of emergency with a 7:30 p.m. curfew, locking students out of desperately needed library time." The Nepali PathIn hopes of boosting the educational quality of KUMS, the school's founders chose to implement a problem-based learning (PBL) structure. Similar to the New Pathway curriculum at HMS, the PBL approach requires students to rely heavily on self-directed learning to prepare for case-based discussion tutorials. Tabin and the school's officials originally feared that this would pose severe problems for students in a nation whose didactic system teaches them from a very early age that asking questions in class is considered disrespectful.But much to their surprise, "the Nepali students have taken to the New Pathway approach far better than we had thought," said Tabin. "It's been very gratifying to see that, by and large, the students love it." During its initial year, KUMS relied almost entirely on volunteer faculty to design curricula, teach classes, and run tutorials. In subsequent years, however, Tabin and school officials are hoping that more young Nepali faculty can learn from and work alongside the volunteers and eventually do all of the teaching at KUMS. "In the long run, we want this to be a world-class Nepali institution," said Tabin. Although the transition to autonomy is happening more slowly than anticipated, KUMS is already quite progressive. In addition to its successful implementation of problem-based learning, KUMS is the first medical school on the Indian subcontinent to offer financial aid to its students, and the first to offer a medical ethics course. In keeping with its mission to train physicians who will be able to serve in their home country, KUMS offers a unique community medicine course, which sends students out into rural areas to get them in touch with the real needs of their country. Because the PBL structure requires such a high degree of self-directed learning, it is vital for KUMS to have an ample supply of books and other learning materials. About 1,700 textbooks--donated by students, professors, institutions, and professional medical groups--were shipped to Nepal several months before the first classes began. Items that were more expensive to ship, such as computers, were purchased in Nepal. Additional Harvard personnel who participated as basic science faculty during KUMS's first year include Steve Keller, Christian Pfeffer, Christine Zanella, Terry Lechler, John Randell, Mark Hickman, and Mike Hansen. Hillary Liss, a clinician who recently completed her residency training in Seattle, also joined the team to assist in teaching the community medicine course and to provide some clinical correlations for blocks taught by volunteer faculty with pure science backgrounds. During the second year, the school's basic science faculty will include volunteers from the University of Massachusetts-Amherst, MIT, and Stanford as well as Harvard. Tabin is beginning to organize a team of volunteer KUMS faculty to teach during the 2003-04 school year. Interested students or fellows should contact him at tabin@rascal.med.harvard.edu. --Esther Landhuis, a seventh-year PhD student in immunology at HMS |
