Association of Medical Doctors of ASIA, founded in 1984, Consultative Status with UN ECOSOC since 1995

On 14 February 2021, AMDA board member and endoscopy expert Dr. Takushi Sato had an online meeting with AMDA Damak Hospital in Nepal. The discussion was held with a focus on endoscopy on which Dr. Sato and the hospital have collaborated for the last few years.

AMDA Damak Hospital is located in the city of Damak in the eastern part of the country which is 700 kilometers away from Kathmandu, the capital.

For the purpose of uplifting endoscopy techniques at the Damak hospital, AMDA has been continuing training efforts for Nepalese doctors in both Japan and Nepal since 2016. The hospital was initially established as a secondary medical care facility for the Bhutanese refugees in 1992. Ever since, it has grown to one of the hub hospitals in region whose annual visitors tops 78,000 (including emergency outpatients). 


As part of 2016 Okayama Prefecture International Contribution Local to Local Technology Transfer Project, Dr. Diwash, an endoscopist at AMDA Damak Hospital, underwent a three-month training course at Okayama Saiseikai General Hospital in Japan.

This led Dr. Sato to visit the Damak hospital in 2018 and 2019 to provide technical guidance on an upper gastrointestinal endoscopy and the diagnosis of lesions.

However, due to the COVID-19 pandemic, the training in 2020 was postponed. As there has been no prospect of Dr. Sato going to Nepal for the time being, an online workshop was held on 14 February this year to make up for the inconvenience.

This time, Dr. Prakash (AMDA Damak Hospital Director), Dr. Nabin (former AMDA Damak Hospital Director) and Dr. Diwash took part in the online session from Nepal.

From AMDA Japan, Ms. Tae Namba (Director of GPSP) and Dr. Archana Shrestha Joshi (officer in charge of Nepal-related projects) also joined the session.
 

The online meeting began with Dr. Diwash giving latest updates on the hospital activities. He reported there were only 317 cases of endoscopy conducted in 2020 due to the novel coronavirus although thorough precautionary measures were in place.

For this year (2021), 80 upper gastrointestinal endoscopies have been performed so far, diagnosing gastritis, oesophagitis, gastric ulcers, oesophageal varices, duodenal ulcers and cancer.

Five of the above cases were handled by Dr. Diwash himself who performed ligation of the bleeding associated with the rupture of esophageal varices. He was under constant supervision of Dr. Sato when he diagnosed duodenal stricture and gastric cancer.

All five cases were advanced gastric cancer detected in elderly patients. In addition to the lack of equipment and medical skills of the staff which makes it difficult to respond to emergency cases, Dr. Diwash said it takes a lot of effort to promote endoscopy in the region where the treatment is still not very popular.
 

After responding to a number of questions from participants, Dr. Sato gave a lecture on diagnostic endoscopy. He pointed out problems regarding images used for diagnosis which Dr. Diwash sends in and gave detailed instructions on how to take photos effectively.

Dr. Sato also promised to bring Indigo carmine and Lugol's iodine solution (used to increase image resolution) from Japan next time as they are not available in Nepal.

Furthermore, they discussed what to do about the colorectal camera donated by the Ministry of Health of Taiwan in November 2019. Originally scheduled for February 2020, its training has been put to a halt due to COVID-19.

Dr. Nabin expressed his hope for the earliest possible installation of the device in a practical setting, while Dr. Sato emphasized the importance of understanding risks which colonoscopy entails.

  The Nepalese side said the earliest resumption of Dr. Sato's hands-on training would help improve the quality of their endoscopic services in a wide spectrum, which brings benefit to the local people’s well-being.
 
Dr. Sato concluded the meeting by stating that the local doctors have a huge responsibility because of the high expectations people have on them. He himself earnestly hopes to resume the training course as soon as he can to deliver safe and quality endoscopic diagnosis and treatment for allowing the early detection of cancer and other diseases.