It has been a year ago almost. We met on a rainy Friday evening, at the entrance of the University Hospital in Ghent. It was December 27th and you could tell from the activity in the hospital that everyone was eagerly preparing for the year end festivities. And so was Dr. Mangal Gharti Magal. After a three months fellowship at the department of Plastic Surgery, led by Prof. Dr. Phillip Blondeel, he was about to travel back home, to his lovely wife and family in Nepal.
The offices were closed and the hospital restaurant was waving its last customers goodbye. We ended up in a small corridor for what happened to be a very interesting and warm conversation; a conversation with a doctor that had such an incredible story about Nepal, his home country, its challenging healthcare system and about why he was so happy with the fellowship he had obtained at the department of plastic surgery of the UZ Gent, a fellowship co-funded by our organization.
‘Why did I decide to become a doctor and plastic surgeon? Because I want to make a difference for people in need’. He did not need much time to reflect on this question. ‘Did you know there are only 30 to 35 plastic surgeons in Nepal?’ And I understood that healthcare in Nepal is far from how we know it in the Western world.
Lack of social security and insurance coverage, means that surgery goes out of pocket and hence becomes a financial burden for the patient. Community hospitals are run by Public Health Concern Trusts, and the government is providing only a minimum of guarantees and service. Plastic surgery in Nepal therefore focusses on priority areas like cleft lip surgery and acute burn and hand surgery (trauma). When confronted with breast cancer, surgery is mainly done to remove the malignant tumor in the breasts or to perform a mastectomy, but not to perform breast reconstruction, which is considered a cosmetic surgery and hence not a priority concern. Many patients lack financial resources and cannot even afford basic cancer treatment in many cases. That is why breast reconstruction surgery is not performed in Nepal and surgeons are not trained in this type of specialty.
‘Why was I so interested to do a fellowship at UZ Gent, Belgium, in microsurgery and breast reconstruction? Because I have always been very interested in microsurgery. Through a Microsurgery Group on Facebook I learned about the Stephen S. Kroll fellowship sponsored by The Beautiful After Breast Cancer Foundation. Such fellowship is performed under the leadership of Prof. Dr. Phillip Blondeel, who is world renowned for his pioneer work in breast reconstruction.’ There was this happy smile on his face and the enthusiasm by which he talked. It showed his gratitude for this fellowship and for the opportunity to learn so much from Prof. Blondeel and his team on DIEP Flap breast surgery and other type of microsurgery. He was most impressed by the professionalism, the efficiency and the teamwork between surgeons and nurses during the surgery.
Having studied and being trained in Nepal, it was his first time outside his home country.
‘Do I like Belgium? Certainly. Actually do you know that Ghent, is ‘greener’ than most cities in Nepal’? It is so nice to bike around, something that we hardly ever do in Nepal. Nepal mainly has high mountains (border of Tibet/China) and lakes (border of India), and in the cities there are basically no cycling lanes. It is not as clean as here in Belgium and much more hectic in traffic’. ‘And I like your beer’, he added. It is apparently much stronger than the strongest beer from Nepal (4%). Of course!
‘I have plans back home’ he continued with enthusiasm. ‘Plans to share my experience with colleagues back in Nepal. Plans to show how to build in more efficiencies during surgery by referring to the teamwork I have witnessed here in Belgium. Plans to talk to other surgeons and create breast reconstruction awareness in Nepal, both towards the medical community as towards the general public.‘
I did not realize that many people in Nepal do not have the ability to study and cannot even read, reason why reaching people and creating awareness in the country is representing a big challenge. There is a minimum of coordination between centers who have implemented a very basic outreach program to remote areas, but a lot of work is still to be done.
The hour went by very quickly and I ended the conversation with a lot of admiration for this very person and his mission. I realized once more how lucky we are in this Western world and could not feel but proud that we, as an organization, had been able to contribute at least a tiny bit to a hopefully better future and treatment of breast cancer patients in Nepal. Women deserve the best treatment everywhere, don’t they.
We hope to hear more about your future work in your home country Dr. Mangal Ghati Magar! And we certainly hope to see you back in Belgium again one day to drink a ‘real’ beer to your success.