Kathmandu: Shortly after connecting on Google Meet, I inquired of Dr Binod Khadka: “Did you always aspire to become a doctor?” He responded with a smile. “Absolutely! Ever since my childhood.”
Following a concise review of his journey into the medical field, he took me back to his formative years when becoming a medical doctor seemed to be the only path for him. He spoke fervently about his adolescence, with a continuous flow of anecdotes.
Talking to him, one could feel how passionate he is for his profession. He spoke unwaveringly, and I listened to him attentively without any interruption.
Dr Khadka currently works at Apogee Physicians as a Hospitalist Internal Medicine Physician and holds the position of System Program Director at ProHealth Care System, Waukesha Memorial Hospital, an affiliate of ProHealth Care, located in Wisconsin, United States of America. He is also the president of America Nepal Medical Foundation(ANMF), which is an association of people from all sectors wanting to contribute in advancing health care in Nepal. The foundation has been supporting millions of rupees to strengthen the Nepali healthcare system along with sharing of technical knowledge in Health Care since 1997.
For Dr Khadka, achieving what he has achieved today did not come easy. Born and raised in Itahari, an eastern part of Nepal, his father was in Agriculture Development Bank Ltd. As a part of his job, Dr Khadka spent his childhood in different parts of eastern Nepal until his father completely settled in Itahari.
An ace student since school days, Dr Khadka completed his School Leaving Certificate (SLC) from Secondary Boarding School Itahari, topping the erstwhile Eastern Development Region. He then moved to Kathmandu for higher education, and joined St Xavier’s College for ISC. He stayed in Kathmandu with his brother Manoj. After completing ISC in 1997, he joined MBBS at BP Koirala Institute of Medical Sciences, and completed the five and a half-year medical course and internship in 2004.
According to him, life was relatively easy being amidst friends, colleagues and teachers until the completion of MBBS studies. However, things took a U-turn afterward, and as he describes it, a series of challenges began to impact his life. During our conference call, he shared various anecdotes from his life that highlighted these difficulties.
“The lawmakers in Nepal should adopt a patient-centric perspective when formulating laws, envisioning themselves as recipients of medical treatment.”
In contrast to most young medical graduates, Dr Khadka opted to teach at NAME Institute for Medical Education, which focuses on preparing students for medical school. Dr Khadka also joined a
Polyclinic during that time.
I found it intriguing why he chose this route over working at a hospital. “Why NAME? Why not a hospital?” I interrupted him, curious to know more. “I loved teaching and inspiring curious minds wanting to pursue medical education.”
“The primary goal was to attain the finest medical education and expertise inspired by witnessing my seniors succeed in the USMLE examination. I was steadfast in my belief that I should receive top-tier medical training. I devoted two years to intensive preparation for the United States Medical Licensing Examinations (USMLEs),” he explained. While at NAME Institute, Dr Khadka assisted medical hopefuls in preparing for the pre-MBBS examination.
Simultaneously, he utilized his leisure time to study for the USMLEs. Given his status as a recent graduate, he had to secure an income while also managing the costs associated with preparing for the USMLEs, which was substantial.
Driven by inspiration of his mother, Dil Maya Khadka, for him to be a doctor, and bolstered by the backing of his father JB Khadka, brother Manoj, and sister Bhawana, his path gained clarity. The unwavering support, according to him, also motivated then young Khadka to push the limits.
During that period, Nepal also had a scarcity of available residency seats. Specifically, there were only 10-12 seats allocated for internal medicine. This limited opportunity in Nepal also inspired young Khadka to prepare for foreign education.
Dr Khadka prepared for USMLE for two years, and in July of 2005, he moved to Chicago. He thought of preparing and applying while being in Chicago. But then, solely dedicating time for preparations was not possible as he also had to gain experience before getting a residency match. Dr Khadka worked as a research volunteer for HIV/AIDS studies in Cook County Hospital. The experience he had gained and three-year-long preparations paid off as he matched for residency for internal medicine studies in the same hospital.
Dr Khadka remembers the time when he was a newbie in the United States. Arriving in the USA in 2005, he found himself in an entirely unfamiliar environment. Armed with just two suitcases, he set foot in Chicago, embarking on a new chapter of his life. With only a few acquaintances in the States, he had the intention of sharing accommodations with a friend from his school days, even though the area was uncharted territory for him. The cost of living was notably high, and even a simple McDonald’s burger priced at USD 5 felt substantial. He would always convert the cost into Nepali rupees, always wondering about the disparity in monetary value. The biting cold was another challenge, with temperatures plummeting as low as minus 27 degrees. This harsh climate reminded him of the extreme conditions at the Everest Base Camp in Nepal, creating a sense of difficulty and struggle during his early days in the US.
“Had I not succeeded in cracking the USMLE, I would have lost everything, notably the invaluable three years of my life. In hindsight, moving to the States before securing a residency match feels like a gamble,” he reflects.
Dr Khadka’s daily routine became more demanding during his time as a research volunteer. He was required to be at the hospital by 7 o’clock in the morning, a commitment he upheld despite the unforgiving cold weather. His daily journey commenced from his residence, involving a series of commutes that included reaching the bus station and transferring to another station. The challenges of his routine were further amplified by the biting cold, which posed an additional layer of difficulty for Khadka due to his upbringing in one of the hottest regions in Nepal.
Following the completion of his residency, he ventured into a new chapter by relocating to Milwaukee in the same year. Here, he assumed a role at Advocate Aurora Health Care as a hospitalist internal medicine physician. This transition aligned with his aspirations, as he had always nurtured a desire to explore the globe. His role as a hospitalist involved demanding 12-hour shifts, with a weekly workload totaling 80 hours.
However, the nature of the schedule led to the accumulation of over 80 hours in a single week, given the alternating one-week-on, one-week-off pattern. Capitalizing on his week offs, Dr Khadka made the most of his free time. He embraced his passion for travel, extensively exploring new destinations. Simultaneously, he devoted substantial hours to enriching his knowledge through diligent study. The perseverance has paid off.
In Harvard Business School, he has already completed seven courses and three specializations in Leadership and Management, Strategy; Innovation and Entrepreneurship in the last seven years.
In addition to these pursuits, he also invested his time in various social initiatives, demonstrating his commitment to making a positive impact beyond the medical realm.
Given his profound interest in hospital management and the abundance of free time at his disposal, he decided to pursue an Executive Master of Business Administration (EMBA) program in 2015. It was fueled by a passionate drive to delve into academic pursuits and broaden administrative knowledge base to practice evidence-based management to excel whatever he pursues.
At Aurora, Dr Khadka held several significant roles, including the Chair of Blood Management and the Chair of Infection Control. Also, he became an integral part of the Leadership Council, contributing to strategic decision-making within the organization.
After working for a decade at Aurora, Dr Khadka, in 2019, got a leadership opportunity at ProHealth Care. He was hired by Apogee Physicians as System program Director in a community hospital that needed help as it was struggling in multiple areas–recruiting, creating positive work culture and excellence. The leadership training and hard work paid off as the hospital he led was awarded the best program in the United States with excellence in quality and multiple initiatives among 80 Apogee Programs within two years in the National Summit at Arizona. This healthcare organization comprises 80 hospitals and an array of clinics. Within this framework, he assumed the role of System Program Director while continuing to fulfill the responsibilities as an attending physician and hospitalist.
Currently, Dr Khadka leads a team comprising over 50 doctors and Advanced Practice Provider (APP), all of whom operate under his guidance. His aptitude for leadership has been clearly demonstrated, as the hospital under his direction attained the notable distinction of being the finest within the Apogee network last year and this year too. This accomplishment underscores the collective commitment and concerted endeavors of the entire team, consistently delivering healthcare services of the highest caliber, he says.
“You have closely seen the medicine sector of both Nepal and the United States. Where does Nepal stand in terms of quality?” I asked.
“A lot needs to be changed. For example, in the United States, everything related to medicine is well organized. This includes doctors, administration, and pharmacists all working together. Unlike in Nepal, where medical records are often written by hand and doctors’ handwriting can be hard to read, the US hospitals use softwares to send doctors’ instructions directly to pharmacies,” he said.
“Nepal is just starting to use these systems, and it’s still in the early stages. It’s headed in the right direction and I look forward to seeing progress on electronic records with collaborative efforts from the government and all sectors.”
According to Dr Khadka, the foundation of healthcare practices, whether in the United States or elsewhere, is based on four essential pillars–quality care, safety, patient experience, and financing. In terms of quality care, Dr Khadka highlighted the importance of treating patients as valued customers, ensuring their utmost satisfaction throughout their healthcare journey. “The lawmakers should adopt a patient-centric perspective when formulating laws, envisioning themselves as recipients of medical treatment. The critical aspect of safety, wellbeing of patients, healthcare facilities, and all stakeholders should be safeguarded even before potential risks arise.”
Dr Khadka contrasts this with the reactive approach observed in Nepal’s healthcare system, advocating for a proactive stance to prevent incidents such as the unfortunate oxygen cylinder blast that recently happened in Nepal. On the matter of financing, Dr Khadka stresses the prudent allocation and utilization of the healthcare sector’s budget.
“Ensuring transparency and efficiency in budget utilization can significantly contribute to enhancing healthcare services. Currently, the budget to the health sector in Nepal is being freezed in many cases. It should be utilized to make a difference in health care for the rural communities in Nepal.”
Before talking to Dr Khadka, I had studied about the work of ANMF and their projects in Nepal. Since its inception, the foundation has provided millions of rupees to strengthen the Nepali health care system, and in the presidential term of Dr Khadka, the support has increased further as he was elected in the midst of the Covid-19 pandemic.
“How do you see your presidential term?” I asked. Dr Khadka smiled and said, “It is all about teamwork. I, as a president, am nothing without my team members. It is teamwork that makes a dream work.”
The ANMF is facilitating skill transfer to Nepal via doctors employed in the United States. A significant number of doctors of Nepali origin have expressed a willingness to volunteer their services in Nepal. For the same, Dr Khadka, and his team, is holding constant meetings with the Nepal Medical Association to explore strategies for sending doctors of Nepali origin in the US to work in Nepal.
This initiative has garnered strong support through collaborative lobbying efforts by both ANMF and NMA. The once-lengthy process of completing necessary paperwork, which used to take 4-5 months, has been notably streamlined through the efforts of ANMF, Nepal Medical Association, Nepal Medical Council and the Ministry of Health and Population, says Dr Khadka.
According to Dr Khadka, the ANMF organizes regular teleconferences on a monthly basis, specifically designed to facilitate case discussions and enable the exchange of technological insights among Nepali doctors with a collaboration committee.
“The Education and Research Committee of ANMF is committed to actively addressing proactive approaches to practicing safe medicine and wellness. These discussions are strategically geared towards enhancing medical practices and raising the overall quality of healthcare delivery.”
Reflecting on the challenges imposed by the Covid-19 pandemic, Dr Khadka acknowledged the pivotal role played by webinars and telecommunication. “When the first wave of the Covid-19 pandemic hit Nepal, the United States had already faced a serious health crisis. Through webinars and conference calls, Nepali-origin doctors in the United States played a valuable role to transfer knowledge and techniques to tackle the threats of the pandemic.”
When Nepal witnessed the second case of Covid-19 and imposed nationwide lockdown from March 24, 2020, the United States had already recorded 52,976 cases and 704 deaths related to the pandemic.
In the face of the Covid-19 pandemic, the ANMF demonstrated remarkable initiative by assisting in the establishment of oxygen plants, oxygen concentrators, and sending ventilators to Nepal. While the United States grappled with the pandemic earlier, ANMF facilitated valuable knowledge-sharing through meetings and webinars, disseminating Covid-19 treatment insights to Nepali medical professionals.
During this period, Dr Khadka served as vice president and the ANMF team extended a significant financial contribution of USD 500,000 to aid the response to Covid-19. The organization’s efficacy stems from its collaborative ethos, translating shared aspirations into tangible impact.
Now that the pandemic is ‘over’, the ANMF, according to Dr Khadka, is undertaking a few initiatives in rural areas of Nepal. The foundation is helping oxygen plants at Bayalpata Hospital, Kathmandu Institute of Child Health (KIOCH), AMDA Damak Hospital and Rapti Medical College to establish ICU units. And in Bhojpur, ANMF is helping with digital X-rays, and in Khotang, they are contributing baby warmers. According to him, the ANMF has undertaken more than 300 projects in Nepal since 1997.
Dr Khadka first became acquainted with ANMF during his residency in 2006, and he acknowledged the organization’s commendable initiatives. Intrigued by its endeavors, he became a member but wasn’t initially active within it. ANMF, he emphasized, is not exclusively composed of medical doctors; rather, it welcomes individuals with an interest in healthcare. Lawyers, IT experts, management professionals, and various other specialists contribute to the foundation, he says. It is the organization for all wanting to contribute to healthcare in Nepal.
Dr Khadka’s leadership role in ANMF began in 2017 when he assumed the role of Chair of the Membership Committee. This marked the inception of his active involvement at ANMF, leading him to participate in conferences and engage more extensively. His commitment continued to deepen as he progressed from secretary in 2019 to Vice President and, the current position of President. The ANMF has a presidential term of two years, and Dr Khadka’s tenure is set to conclude next May.
The ANMF, according to him, bridges the past, present, and future. The past leaders convene meetings, fostering idea exchange and knowledge transfer. The present members in the leadership committee undertake collaborative projects with Nepali doctors to advance healthcare. The future involves the mentors helping USMLE aspirants, solidifying ANMF’s role in nurturing a continuum of medical excellence; and attracting talents from all fields to help in advancing healthcare in Nepal.
He then talked about his family. A steady pillar of support, his partner Aditi fills his days with joy. His two children, Abinav and Aayansh, consistently renew his spirits, reminding him of the shared moments that illuminate their familial journey.
Before wrapping up, I asked, “When will you come back to Nepal for good?” “Not now! I have two kids aged 9 and 4. It is not like I will not come back to Nepal. I will, definitely.” “But when?” I asked again.
“The primary reason for me to come to the United States was to pursue a better education, and I hold the same aspiration for my children too. As they progress towards their college years, I envision myself entering a new phase of my life. That is coming back to Nepal.”