Plastic And Reconstructive Surgery In Nepal

Written evidences of reconstructive works by utilising the skin grafts date back to 4000 years.  However, the modern field of plastic and reconstructive surgery flourished only in the 1960s. The aim of such surgical interventions at the beginning was primarily inclined towards cosmetic enhancements. Today, plastic and reconstructive surgery encompasses a broad spectrum of medical procedures that are helpful in restoring congenital and acquired deformities and functionalities. Plastic and reconstructive surgery is largely used to repair and reconstruct missing or damaged tissue and skin so that it is as close as possible to the normal to restore and/or improve body function. 

The spectrum of plastic and reconstructive surgery is steadily gaining traction in Nepal that is offering hope and transformation to individuals affected by congenital and acquired anomalies, trauma and other deformities. However, this facility is limited only to very few specialised medical facilities and hospitals concentrated mainly in Kathmandu and other main cities. Despite this limitation, plastic and reconstructive surgery is emerging as a vital component of Nepal’s healthcare sector. 

Functional challenges

According to the World Health Organization (WHO), the prevalence of cleft lip and palate is comparatively high in South-East Asian countries. In addition, Nepal has one of the highest rates of these deformities (approximately 1.64 cleft deformities per 1000 births). The cleft and palate deformities are known to pose functional challenges as well as social stigma that adversely affects the quality of life of the sufferer. Hence, the WHO data indicate a pressing necessity for plastic and reconstructive surgery in Nepal. Surgical corrections of deformities through plastic and reconstructive surgical interventions as well as evidence-based patient care is known to support the individuals to lead fulfilling lives.

Nepal is prone to persistent severe trauma that include injuries from road accidents, criminal undertakings, and high rates of suicides. These incidents lead to a considerable number of injuries, burns, fractures, and soft tissue damage every year.  Moreover, natural disasters such as earthquakes, landslides, and other natural calamities are frequently observed in Nepal. Hence, the significance of plastic and reconstructive surgery is utmost in Nepal. 

The history of plastic and reconstructive surgery in Nepal dates back to 1980s when international volunteer teams carried out these surgical procedures for the first time, while Nepali doctors remained under-equipped. Plastic and reconstructive surgery was included in routine surgical procedures after the inauguration of Cleft and Burn Center at Kirtipur Hospital in 2014. However, already in 2002, an American textile retailer and social activist Jim Webber had organised financial support from other rug importers from Nepal to help fund the initiation of the plastic and reconstructive surgery project at Kirtipur Hospital. This initiative had formally laid the foundation of plastic and reconstructive surgery in Nepal. Since then, the Cleft and Burn Center at Kirtipur Hospital has established itself as Nepal’s first and leading centre specialising in deformity-correction surgeries.

During last few years, various surgical techniques and technologies have steadily progressed in Nepal. This advancement has also enhanced the capabilities of plastic and reconstructive surgery in few specialty health facilities in Nepal. Surgeons at different hospitals are increasingly utilising innovative approaches such as microsurgery, tissue expansion, and 3D printing to achieve optimal surgical outcomes for their patients. Moreover, collaborative efforts between local healthcare providers and international organisations have facilitated knowledge exchange and skill development, further elevating the standard of care in the country. 

In this regard, I recently had an opportunity to know and understand about a collaborative initiative of Carl-Thiem Hospital, Germany in providing continuous professional development and knowledge exchange in plastic and reconstructive surgery for patients with tumors and deformities at Nepal Cleft and Burn Centre. The project funded by Hospital Partnerships, a global medicine programme supported by German Agency for International Cooperation (GIZ), particularly promotes that the disadvantaged patients with disabilities, deformities and disfigurements at the centre receive improved care and treatment. In addition, the medical and health care staff at the centre and Kirtipur Hospital are provided with regular trainings regarding the state-of-the-art surgical technologies and evidence based patient care. Furthermore, the enduring aim of the project is to ensure that Nepali plastic and reconstructive surgeons are trained in this special area of surgery within Nepal thereby improving and improvising the country’s health care structure in the long run.

Expensive service

Despite the steady progression of plastic and reconstructive surgery in Nepal, the challenges in providing pertinent service to the patients are persistent. The main limitation is that these facilities are available only in selected hospitals, mainly in urban areas. The second factor refraining a large section of the patients from availing the plastic and reconstructive surgical interventions is the financial constraint. Plastic and reconstructive surgery is a comparatively expensive service and hence, is mostly unaffordable for the majority of the patients. 

In addition, lack of skilled plastic surgeons and inadequate infrastructure are also limiting the boundaries of plastic and reconstructive surgery in Nepal. This is supported by the fact that, as of August 2023, there were only around 40 reconstructive plastic surgeons throughout the country, out of them eight at Kirtipur Hospital. Hence, addressing expertise and infrastructure deficits in this special field of surgery requires a concerted effort from policymakers, healthcare professionals, and community stakeholders to ensure equitable access to quality surgical care across the country.

(The author is senior scientist and independent opinion maker based in Germany pushpa.joshi@gmail.com)