The Himalayan country of Nepal has a population of 33 million and yet there are less than 20 medical oncologists in the country to treat the rising rates of cancer among the Nepalese people. If you compare that to Canada, there is quite a difference. We have about 620 oncologists available to treat our population of 37.5 million.

For a Nepalese cancer patient, this disparity means that access to care is not as simple as going to the local hospital each week for chemotherapy. There are only two public cancer centres in Nepal that offer treatment: one in Kathmandu and the other in Bharatpur. And in a country characterized by mountains and variable road conditions, those centres can be difficult to get to. Living expenses in Kathmandu are prohibitive, leaving some patients to travel more than 500 km to get 45 minutes of chemotherapy on a weekly basis.

Dr. Bishal Gyawali, an assistant professor in the Department of Public Health Sciences, is acutely aware of the strain the lack of oncologists places on individuals and on the Nepalese healthcare system. After completing his speciality training in oncology in Japan, Dr. Gyawali – who was born in Nepal – returned home and spent six months working in a public hospital in Kathmandu.

There, he witnessed the challenges facing cancer patients.

“One of my young male patients was from the far western part of Nepal and he needed chemotherapy every two weeks,” he says. “It would take him more than 36 hours to come to Kathmandu for chemotherapy. This disrupted his job, on top of the cancer diagnosis and hassle of travel.”

With the burden of childcare often falling to Nepalese women, they face particular challenges.

“A woman from rural Nepal stayed in Kathmandu with her relatives for more than three months to complete her chemo. She had two little kids back home who needed her care, but she had to complete the chemo first,” Dr. Gyawali says. “A weekly commute was impossible.”

But Dr. Gyawali sees a way forward.

He has a plan to import an initiative that has been successful here in Canada to Nepal. It’s a training program for primary care doctors, which builds their capacity to deliver basic cancer treatment in rural settings. Here in Canada, this has dramatically increased the number of patients who can receive care close to home. Upon completion of the training, the Canadian physicians gain the designation of General Practice (GP) Oncology, and go on to provide rural cancer treatment.

When Dr. Gyawali came up with the vision for this project, he lacked the resources to make it happen.

“I had thought about doing this for a long time but had no money or ability to implement it,” he says.

That changed last month when Dr. Gyawali received a prestigious award from the American Society of Clinical Oncology (ASCO) which will allow him to lay the groundwork for a training program modelled on the Canadian one.

The $50,000 award will be used to perform a needs assessment and to collaborate with Nepalese doctors to develop a training curriculum in basic oncology care. The training will be delivered to primary care doctors who practise outside the two main cancer centres in Nepal, thus increasing the capacity of GPs throughout the country. Ultimately this will make cancer care more accessible to patients, regardless of geography.

In some cancers, chemotherapy needs to be administered once a week for 12 weeks. With that frequency, Dr. Bishesh Poudyal, Associate Professor and Chief, Civil Service Hospital in Kathmandu, agrees that a training program is much-needed.

“If we can train GP oncologists, then patients can be treated locally and they don’t have to travel just to show bloodwork reports,” he says. “This will save lives and make treatment more affordable and efficient.”

Dr. Bishal Gyawali joined Queen’s in March 2019. In addition to his appointment to the Department of Public Health Sciences, he is a clinical fellow in the Department of Oncology at Queen’s.

What attracted him to the university was the global focus within the Department of Oncology under the leadership of department head, Dr. Scott Berry. He is thrilled to have Dr. Christopher Booth as a colleague, an oncologist who has worked extensively in India.  

“The Queen’s Global Oncology team is made up of similar-minded people,” he says. “I am fortunate to have this career path.”

As with our other Global Health initiatives in the Faculty of Health Sciences, Dr. Gyawali’s work is premised on building local capacity to address a specific need within a community. I am pleased that his work will be added to the slate of partnerships and projects that we have across the globe and I look forward to hearing about the impact that it has.

This article was first published in the Faculty of Health Sciences Dean's Blog.