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

AMDA Damak Hospital (run by AMDA Nepal) is a secondary medical facility located in Damak, Jhapa in the eastern part of Nepal. Serving as the region’s core hospital, the number of outpatients totaled 66,620, while handling 5,586 childbirths in 2021. 

The facility operates its intensive care units thanks to the support from Japan. However, the environment surrounding endoscopy has yet to be enhanced. To strengthen its capabilities, AMDA Headquarters launched a training program on upper gastrointestinal endoscopy and legion diagnoses for local doctors in February 2018. 

Until it was temporarily suspended in 2020 due to the COVID-19 pandemic, in-person training had been conducted every year by Dr. Takushi Sato, a Japanese endoscopist and AMDA board member. In 2021, the training session was held online to make up for the suspension.
 
 This year, Dr. Sato returned to Nepal for the first time in four years to hold training sessions from 7 to 13 March, as the coronavirus situation calmed. He accompanied Dr. Diwas, an endoscopist at AMDA Damak Nepal, to instruct local doctors on lower gastrointestinal endoscopy without anesthesia. Dr. Diwas completed a three-month training program at Okayama Saiseikai General Hospital in Japan in 2016. He has also received guidance from Dr. Sato over the years.

During this year's workshop, Dr. Sato used an endoscopic simulator that he brought from Japan to inspect a number of patients who were alleged to have intestinal problems. After conducting 19 cases of both upper and lower gastrointestinal endoscopy and 13 cases of upper gastrointestinal endoscopy, patients with rectal cancer, ascending colon cancer, sigmoid volvulus, Crohn’s disease, and polyps were found. 

Among those who wished to be seen by Dr. Sato were people from areas outside Damak as well. A total of 32 patients (15 males and 17 females) underwent diagnosis and treatment. They ranged in age from those in their 20s to their 80s.

Some of the patients said they were happy that the procedure was “not unbearable at all” compared to what they had experienced in other medical facilities. 

A patient with sigmoid volvulus was deeply moved by the fact that one’s pain went away after the treatment. “I used to hear from others how physically tough endoscopy was and that put me off many times,” the patient said. “However, I was right in my decision after learning that it was a Japanese specialist who would take care of it.” 

Another patient could not believe at first that it would be done without anesthesia but changed one’s views after receiving the actual diagnosis and treatment. “I was impressed by the level of skills the Japanese doctor had,” the patient said. “I am glad his expertise has been passed on to our local doctors.”

For now, endoscopy has not been widely practiced outside Kathmandu, the capital. However, it is fair to say that more lives will be saved if doctors in remote regions learn the techniques to respond to the local needs. This will surely make endoscopy all the more meaningful.

On the last day of the training session, the participants held a wrap-up meeting to report what they had gained during the past few days. Also present at the gathering was Mr. Ram Kumar Thapa, City Mayor of Damak. During the meeting, Dr. Diwas elaborated on the cases he handled. Dr. Sato gave the detailed explanation on the detection and removal of early-stage cancer and polyps, while stressing the importance of having appropriate facilities and equipment.

On one hand, local doctors and nurses expressed their wish for this workshop to continue, as they believe the spread of endoscopy is vital in improving the standard of medical care in remote areas. In response, Dr. Diwas emphasized that his role as an educator is paramount, and that the cooperation of every concerned party is a must in strengthening the capabilities of AMDA Damak Hospital.

Showing gratitude for the technical transfer from Japan, Mr. Ram said people will travel to Damak from different parts of the country to receive endoscopy. “This is something that our city should be proud of,” he added, saying that he himself wants to give endoscopy a try.

From 2018 until now, more than 2,500 people have received upper gastrointestinal endoscopy at the Damak hospital, of whom 75 people were diagnosed with cancer. In fact, some of them lost their lives at a young age. However, those whose cancer was detected at an early stage have been treated at a cancer treatment center in Kathmandu.

Local medical practitioners say that ever since the Damak hospital has started offering endoscopy services, many people have come to receive the checkup, thereby making them more conscious about their health. 

One of the nurses who has worked with Dr. Diwas since endoscopy was introduced to the hospital said, it is by word of mouth that an increasing number of patients have been visiting the hospital. 

The nurse is confident that Dr. Diwas is a good endoscopist who has learned all the great techniques from Dr. Sato. “I really want everyone to receive endoscopy regularly, because early detection of problems is what really counts,” the nurse said. “Nothing was sadder than losing some of our patients just because they came in too late.”

As endoscopy services become more prevalent at AMDA Damak Hospital, there are hurdles to overcome aside from the continuation of special training for doctors and nurses. For instance, the endoscope at the hospital (which has been used for the last five years) is usually washed by hand by the nurses. Because this method damages the device rather quickly, an automatic endoscope washer may be required for better handling of it.  

The endoscope (colonoscope) was originally donated by Taiwan International Health Action (Taiwan IHA), a humanitarian wing of the Ministry of Health of Taiwan. The organization, which has long been collaborating with AMDA, said in its message that it hopes to contribute to the improvement of endoscopic procedures at the Damak hospital. 

(The author would like to thank Taiwan IHA for their heartfelt assistance. Thank you!)

On 15 March, Dr. Sato, Dr. Nabin (who used to head AMDA Damak Hospital), and the author, paid a courtesy visit to His Excellency Ambassador Yutaka Kikuta at the Embassy of Japan in Nepal. 

Dr. Sato explained the background of the endoscopy training and how successful it went this time. Whereas, Dr. Nabin thanked the ambassador for the fact that more than 500 people have received treatment in intensive care units of the hospital, a facility which was constructed with the support of the Japanese embassy. 

Hearing from Dr. Nabin that the donation from Japan has played an important part in the hospital operation, Ambassador Kikuta said, “I am very happy to learn that the Damak hospital has been making the most of what our people have offered.”
 
AMDA will continue to provide what it takes to enhance endoscopy at AMDA Damak Hospital. Your continued assistance would be deeply appreciated.