Interview with Dr Sanjaya Karki: How the World Extreme Medicine Conference helped further his career
Dr Sanjaya Karki is the current Head in the Department of Emergency Medicine at Nepal Mediciti Hospital and main author of the recent paper entitled ‘Helicopter Emergency Medical Services During Coronavirus Disease 2019 in Nepal’ (Karki & Sprinkle, 2021).
The Nepalese health service, like most of the world, has suffered under severe pressure. But unlike much of the Western world, Nepal’s lack of critical care facilities, resources and trained personnel, traffic infrastructure issues and mountainous terrain are a huge challenge to overcome. Identifying these critical issues, Sanjaya and his team are working hard to help overcome these systemic shortcomings.
We caught up with him for a friendly discussion not long ago and it was then that he revealed how the David Weil Bursary (now defunct, but soon to be replaced by new WEM Fellowship bursaries) and the World Extreme Medicine Conference helped usher him towards his first job placement in Nepal.
Naturally, we wanted to find out more. So, we sat down with him (virtually, of course) to learn more about his work in the hope that it helps other aspiring extreme medics identify avenues where World Extreme Medicine can help give their career a boost in the right direction.
Read on to learn more about Sanjaya’s journey and experience – and then we encourage you to delve into the Air Medical Journal article itself for free.
How did being a beneficiary of a David Weil Bursary and attending the World Extreme Medicine Conference help you and your career?
The World Extreme Medicine Conference helped me to interact with many other people that are heavily involved in a similar field. I got to know many of the latest developments in our arena from around the world and it improved my communication skills.
Academic heroes whom I met there boosted my energy to work more in the field.
Were there any skills/insights that you picked up from the conference and have used/still use at work?
I met a young doctor there who’d graduated from Canada who also had the similar intention that matched mine to set up prehospital care. He later visited Nepal and the first time I intended to set up a prehospital care unit in a hospital he was also involved.
Where were you in your career when you first attended the conference – what job/position?
In 2013, I started my professional career in Nepal. In September 2014 I went to University of Leipzig as a Scientific Research Fellow for about a year, then went back to Nepal to carry on my career. I was working in the capacity of Scientific Research Fellow when I received the award.
What are your current job roles?
I am currently working in the capacity of Head in the Department of Emergency Medicine/Emergency Medical Service/Helicopter Emergency Medical Service at Nepal Mediciti Hospital.
Was there a particular reason behind writing your latest article for the Air Medical Journal?
Nepal is a country where we have extreme geography. Also, we have extreme weather variation dependent on place. When COVID-19 hit us, we came to understand that using only the road route is not easy to transfer patients with COVID pneumonia. A helicopter was a great choice, though expensive. So, we fitted Patient Isolation Units (PIU) inside B3e helicopters, and we started to transfer critically ill COVID patients via helicopter.
Carrying COVID patients in a helicopter is not a popular choice in every country. Nepal is a country where we do not have a single dedicated medical helicopter, even though we have been providing such a service to patients successfully.
That’s the reason why we wanted to publish a paper.
What has been your own personal experience of working in Nepal during the Coronavirus pandemic?
It was indeed great initiative that we took during COVID-19. Very few countries in the world have operated a helicopter medical service for COVID patients.
Though Nepal does not have a dedicated medical helicopter, we still shifted COVID cases even when they were under a mechanical ventilator. However, due to poor advanced ambulance services, it was not easy for the patients to transfer from low resources set up to higher centers.
You said in the article there is a shortage of critical care facilities, resources, and trained personnel – is this essentially what it comes down to, or are there other daily challenges that you come up against and how are you finding solutions to these challenges?
In Nepal, medical facilities are centralized. Not everywhere are highly advanced critical care facilities available. During COVID-19, huge numbers of patients were in need of ICU. On one hand, due to the unavailability of advanced EMS services, patients were facing difficulties in reaching higher centers – Helicopter Emergency Medical Service are expensive! On the other hand, due to the shortage of ICUs, patients suffered in some extent.
However, through the private and government level, rapid extension of ward beds and ICU beds brought some relief. At the moment, the number of cases is going down and things are trying to go back to normal, but from now we need to have a proper plan for if a third wave hits us.
You’re considered somewhat of a pioneer in establishing hospital-based helicopter EMS in Nepal, what is next on your career wish list?
HEMS is getting more popular in Nepal day by day. Now, Nepal consists of three hospitals with a proper HEMS system. Many hospitals have either a Heli-roof or ground Helipad. People are much more aware of the service and helicopter companies are also keen to provide such services.
Now, we need to develop the prehospital care course in the country. Paramedics’ proper education is not available either, so we need to develop that too.
Dedicated medical helicopters, if available, would be a great benefit for patients, as well as flight medics. A national level campaign is necessary to create awareness about the system.
Therefore, we are doing our best for all these developments.
Any tips or advice you would give to any aspiring extreme medics?
“When you want something, all the universe conspires in helping you to achieve it.” ― Paulo Coelho, The Alchemist.
It was not easy to start the proper HEMS system in Nepal. Lack of dedicated manpower, no dedicated medical helicopters and no relevant education of prehospital care were the factors barring us from operating the system. However, we started it and it’s going in a good direction.
To start with the difficult thing is not easy. In the extremes, things are extreme – but once we overcome those extremes with our extreme work, the happiness and satisfaction we achieve is also extreme!
We’d like to thank Dr Sanjaya Karki for his time answering our questions and wish he and his team all the best as they build on their work in Nepal.If you’d like to see how the World Extreme Medicine Conference could help your extreme medicine career, book your place today – you can either attend online or in Edinburgh this November.
If you’re interested in finding out more about our new upcoming bursaries, please head over to the Fellowship of Extreme & Wilderness Medicine website, where you can join up to be the first to know when they launch.