As the only permanent physician in Jiri, Dolakha, a remote area on the trekking route to the Everest region and near the epicenter of the April 25th earthquake and aftershocks that killed 8,000, Dr. Roshan Khatri says that the experience following the quake shaped his life.
Headwaters Relief Organization had the privilege of working with Roshan during its work in Nepal in 2015 and 2016. He also joined Headwaters as one of our volunteer medical team members in Greece in June and November of this year. A rural doctor with a passion to provide adequate health care for those in most need in his native Nepal, Roshan recently won a Fulbright Scholarship which he intends to use to study public health in the U.S. with an emphasis on global heath.
Tell us a little bit about you and your work and how you got to where you are today.
I was born as the eldest son to a family of four, from Jumla, Karnali. This region was and still is remote. It is inaccessible and challenged by food shortages and the quest for basic services such as health care and schools. Amidst the harshness of poverty and isolation, my family always taught me to respect hard work, commitment and positive attitude as my only religion. Honoring these principles has steered me to accomplish my achievements so far.
After graduating from Kathmandu University School of Medical Sciences then taking the demanding series of exams, I was appointed Medical Superintendent of Dolakha District Hospita in Jiri, Dolakha. As manager of a district hospital, I lead a small army of 43 staff members and as the only permanent doctor I have clinical responsibilities and 80 nursing students and paramedics to train every year. Together, we care for a population of almost 25,000 in our catchment areas. This job as a medical superintendent has taught me more than I could ever have gained at a university. It has exposed me to both the best and the worst of situations. It has been made more challenging by the constraint of resources and the ever-increasing patient load.
You managed a hospital in an earthquake when it was totally destroyed. Tell us about that experience, your struggles, and what you learned.
The most memorable and unfortunate experience I have had there was the massive April 25th earthquake and its aftershocks. Dolakha was one of the Nepalese districts most severely affected by the earthquake. Because the Dolakha district hospital serves as the primary and the only referral site for health centers in the periphery, there was a huge influx of patients. Even though we had no shelter to cover our heads and while earth beneath our feet was still tumbling, I had to manage more than 300 patients in the first day. Of these, 12 needed urgent referral and had to be airlifted to Kathmandu. My greatest challenge as a clinician was to take care of all the wounded and injured while still coordinating my panic-stricken staff, ensuring their safety, and arranging for their food and shelter. Luckily, I managed to handle the situation and come out of it with no loss of life.
When a community has lost everything, where do you begin in helping people with their medical needs?
Attaining health for rural people in Nepal is like searching for the Holy Grail. At a time when medical science and technology are advancing rapidly and providing effective prevention and treatments for illness, we are still struggling to provide basic health care such as full immunization coverage, iodized salt and safe maternal care. Every day in my clinic, I treat patients whose main problems arise from poor hygiene and unhealthy living conditions. As a result, I am very aware of the importance of illness prevention and health promotion and a system wide effective approach to these aspects of health care.
I believe that simple health care measures such as provision of safe, clean drinking water can prevent hundreds of patients and children from getting sick. Following the 2015 quake, with almost all housing destroyed and people living in the temporary, make-shift tents, I initiated a campaign of safe drinking water in my area. I mobilized my small number of medical staff and volunteers. With the help of different organizations, we cleaned the water sources, built temporary latrines as far as possible from water sources and installed water purification plants at strategic locations. These simple health care measures proved to be very effective: very few patients with diarrheal illnesses presenting to us. Indeed, at the same time of year, there were fewer cases after the water was cleaned than before the earthquake.
You met Headwaters staff immediately post-earthquake. What made you interested in becoming involved with this volunteer group?
There were many different organizations coming in and through during the post-earthquake phase. However, my meeting with Headwaters staff remained to be the most fortunate and it arose from the necessity. All of the post-earthquake assistive teams were either focused on immediate rescue and relief or physical rehabilitation on the latter phases. As a clinician working in rural areas, I greatly perceived the need of psychological aid not only to the public but to my hospital staff or even myself as well. This is when Headwaters staff, specially Rebecca came to aid.
We were arranged an appointment in the middle of their busy schedule via a common friend. Though the meeting was very short, the impact the Headwaters team left on me and my staff was phenomenal. I realized how small team of volunteers who have the zeal to ‘volunteer’ can make great impacts.
Both the groups, our hospital and Headwaters realized the necessity of further elaborate meetings in days to come, and I was in constant touch with them later. During this course of time, I was able to observe or assist in some of Headwaters’ activities in Nepal. For instance, writing of a story book for children. These ‘thinking out of box’, ideas of Headwaters impressed me much, and I was very much happy to be further involved with this group.
Tell us a bit about how Nepal Shakes was met by students and teachers? Why do you feel this book is important?
I have been involved in distribution of children book Nepal Shakes, in schools of Dolakha district. This book has received a mixed kind of response from teachers and students here. To begin with, our students have never been taught to read anything besides text books, and the concept of drawing conclusion after reading such story books- with hidden agendas is a far cry! Even the teachers after skimming though the book were skeptical, however later on when they read the manuals, that is when they realized the book’s essence. Since then, the book has been widely accepted, it has been put on the libraries of 9 different schools in and around Jiri, Dolakha region.
What do you intend to do with the Fulbright Scholarship?
Schools of Public Health in the US are renowned for their extensive research and excellence in teaching and learning methods. I dream to be a part of this vast pool of knowledge, procure some life changing frameworks that schools there have to offer. I want to learn to identify and adapt simple, effective measures that can be applied in the context of my situation in Jiri and its specific health problems. With the help of teaching staff, who have experience in designing and implementing health policies in many different nations, I will make a critical study of Nepal’s current health policies, analyzing its successes and failures. I want to learn from our mistakes and the experiences of others in order to be equipped to improve health services in Jiri and in Nepal in general.
My goal is to involve myself directly in the planning and design of national health policies. I will be able to identify need and will be able to work in a bottom-up manner to encourage practical, effective solutions to emerge. I strongly believe that health policies and services should be planned and implemented in collaboration with the communities for which they are destined – by the people for the people.