Day 1 of the conference was live surgery demonstrations. This took place at Grande Hospital, a recently built private around the corner from the Teaching Hospital. Facility wise it felt far more like a western hospital than the teaching hospital. I was later told that rich people leave the country for healthcare, upper middle class would go to a private facility like grande hospital, lower middle class to TU Teaching hospital, and the poorest to Brie (sp?), another teaching hospital in the city.
Main Enteance
Presentation hall
Day 1 agenda was live ERCPs. ERCP is for gallstones and is normally done by gastroenterologists in Canada (and most of the world). Here the surgeons do them. After the ERCPs there was supposed to be a laparoscopic bowel resection but the scheduled surgery was done emergently the night before and, being a private hospital, there wasn't a waiting list from which to schedule a different patient.
Throughout the live cases I was reminded of this article (), which argues live surgery is performance theatre, compromises patient safety, and that the principles taught are better done via video highlights. After my experience here, including the audience clapping the surgeon, I'm inclined to agree.
Evening of day 1 was the opening ceremonies at the Radisson Hotel. Like the Grande hospital, It felt very western. The opening ceremonies were attended by Nepal's Vice President and filled with a lot of pomp and circumstance. It went one for 2.5 hrs!
Hall at the Radisson
Vice President of Nepal
Day 2 was presentations at a local business tower. The day was divided into several sessions scheduled with a keynote speaker, then other papers. Keynotes were generally well done - I especially enjoyed one on surgical education in SAARC countries, as well as the talk from a Pakastani neurosurgeon. He discussed the changing face of trauma in the area: terror now causes more trauma cases than motor vehicle collisions. He also apparently treated the man who fired the SAM missile at te US SEAL helicopter during the bin Laden raid
The papers themselves were interesting. By and large they duplicated work previously published in the Western literature but in a SAARC setting. Many were done as part of the graduation requirements for the 3rd year residents (final year of MS). Studies were generally prospective case series. Discussion of statistical power was absent, as we're attempts to match patient backgrounds etc. Mention of ethics approval for research was rare and I don't know if that is a requirement for studies here. The discussion section generally focused on a review of the literature and how the presented paper compared. Limitations were inconsistently cited. Overall the papers felt more reflective on individual practices in SAARC nations than the novel papers advancing the field found at the American College of Surgeons Congress. This work is no doubt important, especially reproducing scientific results, but made for less interesting papers. I'm reminded of the recent Economist article highlighting how major studies are no longer checked for reproducibility and negative studies harder to publish. It certainly is more interesting to read / watch novel papers.
Along with the presentations, there were the usual vendors / advertisements. Vendors tended to be local distributors rather than manufacturers. There were even ads for antibiotics!
Vendor with even basic surgical instruments profiled.
Antibiotic ad!
Day 2 ended with a cultural program of formal traditional dances. After there were snacks and drinks. Some of the residents also started dancing on stage - a mixture of traditional and western. I joined in but have no photo proof. I'm sure someone does though - I was the only Caucasian in the room!
Traditional dance
Day 3 of the conference was on the Saturday, the only weekend day as the work week is 6 days. Consequently I skipped attending more paper presentations and went touring. But that is for another post.
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