Preparing A New Generation Of Cancer Surgeons

Dr Manohar Lal Shrestha (center, with Dr Y Singh and Dr Surendra Shrestha) serves on the advisory board of INCTR .

Dr Manohar Lal Shrestha has particular expertise in general and cancer surgery. He has demonstrated considerable leadership in national and international medical affairs, but the essence of his character as a physician in Nepal is demonstrated by his outreach to youngsters and the succession of doctors and healthcare workers who are following in his footsteps.

Working through a branch of the Nepal Cancer Society, he meets personally with about 200 adolescent boys each year, educating them about cancer—what can cause cancer, the importance of early detection, and what can be done to prevent and treat the disease. Through programs in the schools, students learn how they can become responsible citizens and advocates for good health.

"In any developing country, there is an enormous health burden," he says. "If you want to build up the nation as a productive society, the health of the individual must come first. In my country, it is a question of developing manpower and building medical teams that will take up this challenge."

It is not an easy challenge where basic facilities, physicians and properly trained health workers are in short supply. Dr Manohar is director of the Bir Hospital in Kathmandu, a government teaching hospital in Nepal where medical oncologists and oncological nurses are available to care for patients. Unfortunately, he says, patients too often present with cancer in severely advanced stages.

"My mission is to reorient our approach to medical care, to make local health workers competent, to integrate the medical profession into the communities," he says. "Illiteracy of the population is a huge problem. So is poverty. We have to train people to take care of themselves in their own communities."

The frequency of cancer in Nepal is increasing as a result of changing environmental and dietary factors, he notes. The Ministry of Health in Nepal is directing more funds to support cancer treatment. Recognizing the health risks associated with smoking, the government has directed that taxes collected from the sales of cigarettes be used for healthcare programs.

Yet cancer awareness is on the rise as well. "People are becoming more aware; our facilities in rural areas are being used more. People are asking questions and seeking answers. This is because of our efforts to make people aware of what cancer is, how it can be treated, and how a healthy life can be ensured."

The Nepal Cancer Relief Society, of which Dr Manohar is a founding member, is endeavoring to improve education and cancer screening facilities in the villages of Nepal. The national breast screening program has attracted 1.5 million women between the ages of 19 and 60 to local facilities. Another government initiative has trained 2,400 village workers who now are sharing their newfound knowledge about cancer, AIDS and tuberculosis with their communities.

"These are the individuals who are carrying the message to each and every corner of the country. I believe one person can make a difference. There are sincere people working in the field, and it gives me a great deal of satisfaction to know that I am governing a program that will reduce the disease burden in my country and that will make people happier."

Affiliated with the Nepal Medical College, of which he is a founding member, and as a surgical tutor and examiner at the Royal College of Surgeons of Edinburgh, UK, and College of Physicians and Surgeons of Pakistan, Dr Manohar has played an important role in training and educating young surgeons. He still is involved in post-graduate teaching (PGMECC, Nepal), striving to share his surgical knowledge and skills with a new generation of health care professionals. A more personal contribution to the medical advances in his country are his two sons, both of whom are doctors, and both of whom are members of the Nepal Cancer Relief Society. One wants to be a surgeon, the other a radiologist, he says.