Introduction

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Friends of Nepal Ambulance Service (FoNAS) have recently focused their charitable efforts on supporting the Nepal Ambulance Service (NAS) in providing an Emergency Medical Service (EMS) in Pokhara, Western Nepal. 

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In 2016, Emily Giles and Lucy Urbas, both medical students at the University of Liverpool, visited Pokhara for their ‘medical elective’ – a period of undergraduate medical training designated to experiencing healthcare in a setting away from the United Kingdom. They collected data regarding the health, geographical and social infrastructure of the city, and sought to ascertain the requirement and feasibility of a pre-hospital care service. They collected data from patients admitted to the critical care area of the Emergency Department (ED) at Manipal Teaching Hospital, the largest hospital in Pokhara. 

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For 6 weeks from late March 2017, James Lambert, a final year Medical student from Barts and The London School of Medicine, London, went to Pokhara on a medical elective. James had the intention of continuing to collect data on ED attendances at Manipal, however a 4-month doctors’ strike at the hospital had led to drastically reduced ED attendances. Although some patients did still attend, it was decided that data from Manipal would be unrepresentative of normal conditions, and therefore was not the focus of data collection. 

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For one week James attended the ED of Gandaki Medical College (GMC), a large hospital in Central Pokhara. During this period data was collected from patients that presented to the department and benefitted from gaining the perspectives of clinicians from a different institution. 

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There were 3 main objectives:

I.To assess the current state of emergency and pre-hospital healthcare provision in the Pokhara Valley

II.To identify key factors requiring consideration in the implementation and optimisation of future EMS in the Pokhara Valley

III.To investigate the current clinical need for EMS in the Pokhara Valley

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Part I 

The current state of emergency and pre-hospital healthcare provision in the Pokhara Valley

Pokhara is Nepal’s second largest city which in 2011 had a population of 255,465. (1)Recent reports that take into account suburban and rural communities, suggest a population of over 400,000.(2)As Pokhara has the most developed healthcare provision for over 100km in any direction, its sphere of influence likely extends much further, suggesting an even larger catchment population. Many of these communities are inaccessible by road, which poses major logistical issues for an EMS provider.

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Hospitals

Within Greater Pokhara, there are twenty hospitals, most of which have an ED. The level of care available varies considerably between hospitals. For example the seniority of medical personal – with some departments providing ED consultant led care, whilst in others; interns and medical officers (middle grade doctors) are the most senior clinicians present for most of the day. 

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*** to be continued if agreed***

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