Medicosnext
Dr. Neil Pande
He is a Kathmandu-based dental surgeon with nearly three decades of clinical experience and an early adopter of digital dentistry. He is an active member of ek-ek paila, the organization that is known to reach the far flung areas of Nepal and provide essential medical care to people who otherwise would not be able to avail such services.
It began with a 55-minute flight from Kathmandu to Dhangadhi. The rest of the journey revealed everything that statistics cannot. A 10 to 11-hour bus ride along narrow, winding roads carved into the hills. Roads that left no room for distraction. Our driver was 23, calm and composed, navigating sharp bends with an ease shaped more by necessity than training. And yet, he was frequently on his phone while driving. It was unsettling. On one side, rock. On the other, a steep drop. In those moments, the fragility of the journey became very real.
Beside him sat his 17-year-old assistant, an age when he should have been in school, now part of a system defined by circumstance. At several points, silence filled the bus. Not out of calm, but awareness. That it would not take much. In many parts of Nepal, even reaching healthcare begins with risk. By evening, we reached Gokuleshwar, a small town at the border of Baitadi and Darchula. It felt like a threshold. Beyond this, infrastructure thins, and access becomes uncertain. The next day, the journey continued. Two hours by bus, followed by two hours by jeep, and finally a four-hour climb of nearly 1000 meters uphill. This is what it takes to reach Khandeshwari in Darchula.
And it raises a simple but uncomfortable question. If this is what it takes for us to reach them, what does it take for them to reach essential medical care? Imagine a patient with a grave illness seeking medical help, we understand how frail our system is.
For the people living here, healthcare is not a routine visit. It is a decision. Seeking care means lost income, travel expenses, physical strain, and real safety risks. As a result, many delay medical care until symptoms become severe. By then, disease is advanced, treatment becomes complex, and outcomes are compromised.
Over three days, more than 1500 patients were seen. But this was not a routine health camp. It was a fully functional, multidisciplinary healthcare system temporarily established in one of Nepal’s most remote regions.
Specialists from across disciplines came together. Ophthalmology, ENT, dentistry, pulmonology, general medicine, gynecology, orthopedics, pediatrics, dermatology, pathology, and radiology, including ultrasound and serology services. Preventive education and awareness were integral to the effort.
Collaborations amplified the impact. Teams from Geta Eye Hospital performed cataract surgeries. The Himalayan ENT Program established by Ek Ek Paila Foundation conducted surgical procedures, carrying portable microscopes into the hills. Dental teams addressed acute and chronic tooth ailments including 254 extractions over three days, with one clinician performing more than 100 extractions in a single day. This was not efficiency. It was the visible burden of unmet medical needs of the people there.
Biopsies were performed. Suspicious lesions were identified early. Conditions that might have progressed silently for years were brought into clinical attention. For those few days, a mini hospital existed where none otherwise could.
For most of these patients, accessing similar care would require days of travel to Kathmandu or even crossing borders into India, often at a cost they simply cannot afford.
By taking medical care to the community, this burden was significantly reduced. Time was saved. Costs were avoided. Disease was intercepted earlier. Outreach, in this context, is not charity. It is economically and clinically sound healthcare delivery.
A critical strength of this model lies in its integration with local governance. These initiatives are conducted in partnership with the Gaunpalika. Existing facilities are utilized. Local health assistants and in-charges are engaged, trained, and supported.
Non-profit organizations like Ek Ek Paila have quietly and consistently worked alongside government systems, complementing their efforts and helping close the gaps where care is yet to reach. The goal is not to replace government services. It is to complement, strengthen, and accelerate them. This approach creates continuity beyond the duration of the camp. The ground reality, however, is clear.
Dental disease was widespread, driven by increased consumption of packaged foods and lack of preventive awareness. Night brushing was uncommon. Early intervention was rare. Across specialties, undiagnosed and untreated conditions were prevalent.
The burden of disease was not surprising.The predictability of it was. At the same time, delivering high-volume care in such settings places significant strain on healthcare providers. Long hours, intense workload, limited infrastructure. While impactful, this model alone is not sustainable.
The fundamental question is not what happens during a three-day camp. It is what happens after. If we already understand the burden, geography, and patterns of disease, then the future of healthcare in Nepal must move beyond episodic outreach.
Every ward should have access to a basic telemedicine unit. A structured system where patients can connect with trained personnel during working hours. A platform where initial history, triage, and guidance can be provided without the need for immediate travel. With the increasing number of healthcare professionals in the country, this is achievable.
Artificial intelligence can further strengthen this ecosystem. Acting as a first layer, it can assist in structured history taking, identify red flags, generate differential diagnoses, and support documentation. The clinician remains central, validating decisions and delivering care. Over time, such systems can generate meaningful data. Disease patterns, regional needs, and service gaps can be identified proactively. Healthcare can shift from reactive to predictive.
Nepal stands at an important moment. With evolving governance and openness to innovation, there is an opportunity to reimagine healthcare delivery. The lessons from Darchula are not isolated. They reflect a broader national reality.
Multidisciplinary outreach shows what is possible. Technology can make it continuous. Policy can make it scalable. The path forward lies in integrating these elements. As we made our way back, descending the same paths and crossing the same roads, one thought remained. The challenge is not just distance. It is a disparity. And bridging it will not happen in a single effort.
