Interview | “The primary challenge in Nepal is limited training centers for doctors,” says Prof. Dr. C. Palanivelu

"Nepali doctors need to understand that training is just the beginning of a lifelong journey. Continuous learning is the key to staying abreast of medical advancements and evolving with the changing times."

NL Today

  • Read Time 4 min.

Kathmandu: Prof. Dr. C. Palanivelu is a pioneer in the field of laparoscopic surgery in India. His training and qualifications as a surgical gastroenterologist, combined with his natural skills and genius, enabled him to expand his repertoire of minimal access surgeries to include advanced procedures and even radical cancer surgery. He has several firsts and innovations to his credit, such as the first totally laparoscopic pancreaticoduodenectomy for cancer (Whipple’s operation) and the prone position tharacolaparoscopic radical esophagectomy.

In the field of hernia surgery, against the prevailing sentiment at the time, he was one of the earliest advocates of the sutured closure of defects for laparoscopic ventral abdominal wall repair with sac excision—a procedure that has since become the standard operating protocol. He also described, practiced, and taught the triangulation placement of ports when performing totally extraperitoneal (TEP) groin hernia repair. This approach allows for an extended view and ample space creation to manage even the so-called ‘difficult hernias.’

Recently, Palanivelu, who is also the founder president of the Association of Minimal Access Surgeons of India, visited Nepal to attend a conference organized by the Society of Surgeons of Nepal. This center offers training to surgeons from India and foreign countries. While in Nepal, a team from Swasthya Khabar, sister publication of Nepal Live Today, caught up with him to discuss various issues. Excerpts:

What is the purpose of your visit to Nepal?

Over the course of the two-day conference, individuals from Bangladesh, Pakistan, and various other countries convened, presenting a valuable opportunity to exchange experiences and gain insights into developments across borders. The visit proved to be quite enriching, offering a platform to learn about ongoing initiatives and challenges faced by professionals in different nations. Personally, I found it particularly enlightening to listen to the experiences shared by Nepali surgeons, allowing me to better understand their unique situation.

I found that the Nepali surgeons, while dedicated and skilled, could benefit from additional support. I had a chance to broaden my perspective and contribute to the collective knowledge shared during this event.

How would you assess the state of the surgical process in Nepal?

The surgical landscape in Nepal has a commendable enthusiasm among Nepali surgeons to enhance their skills and knowledge. The primary challenge lies in the limited availability of training centers within the country, hindering their professional development. Recognizing this gap, surgeons from Nepal seek opportunities to expand their expertise by attending training programs at external centers, including mine, where we conduct regular sessions.

The cultural similarity between Nepali and Indian societies facilitates a smooth learning process. Technological advancements, particularly in fields like robotic surgery and the integration of artificial intelligence in medicine, have revolutionized surgical procedures. Procedures such as hernia repair, gallbladder surgery, and colon cancer treatment now leverage cutting-edge technology, often controlled through keyboards. This technological progression has significantly elevated the quality of surgical interventions. Given these advancements, the need for ongoing training remains crucial to keep Nepali surgeons abreast of the latest techniques and technologies. My keen interest in supporting and training Nepali surgeons stems from a shared commitment to advancing surgical practices and ensuring that they can provide the highest quality care to their patients.

What measures have you taken to successfully implement advanced technology in India, considering the potential for the cost of treatment to be perceived as too expensive?

We must not blindly adopt new technology and advanced procedures. The success of any scientific or medical treatment is only meaningful when it becomes accessible to the majority of people. Coming from an ordinary agricultural background, I am well aware of the challenges faced by common people. I focused on developing cost-effective techniques that are affordable across all socioeconomic strata. Also, I provided training to rural surgeons, making these technologies accessible even in remote areas of India. This approach ensured that our methodologies were followed not just in urban centers but also in Western countries.

What should be there to improve the health system in Nepal?

To enhance the health system in Nepal, a multifaceted approach is needed. The introduction of a comprehensive health insurance system is essential, providing financial security for citizens and enabling broader access to medical care. This initiative should be coupled with robust education and awareness programs, emphasizing preventive measures and healthy lifestyles.

Is there any message from Nepali doctors from your side?

Nepali doctors need to understand that training is just the beginning of a lifelong journey. Continuous learning is the key to staying abreast of medical advancements and evolving with the changing times. So Nepali doctors need to learn and train more. In this way, we can ensure that the healthcare landscape in Nepal evolves in tandem with the ever-changing demands of modern medicine, ultimately leading to improved health outcomes for all.

What is the major difference of Nepali and Indian health systems?

In the Indian context, the healthcare system operates under the purview of state governments, while education receives substantial support from the central government, reflecting a national commitment to both sectors. India has made commendable strides in health and education. However, challenges persist, particularly in the realm of insurance services, where there is a recognized need for improvement. Premium insurance services have yet to reach their full potential.

Despite these challenges, the healthcare scenario in India has seen significant positive shifts. There is a perceptible decline in the fear of diseases like cancer, attributed in part to increased awareness, improved diagnostic capabilities, and advancements in medical treatments.

Are there any specific programs for Nepali doctors?

A few months ago, we successfully conducted a training program in Nepal. Building on this momentum, we are now signing a Memorandum of Understanding (MoU) to further collaboration and extend our efforts. The focus of our upcoming initiative is to organize training programs for young Nepali doctors in minimal access surgery, specifically emphasizing advanced techniques. Our aim is to empower Nepali doctors with the necessary skills and knowledge to perform complicated surgeries confidently.

While basic laparoscopic surgeries are common in Nepal, our current goal is to elevate their expertise to encompass advanced procedures. By doing so, we aspire to equip Nepali medical professionals with the capabilities to undertake intricate surgeries, ultimately contributing to the improvement of healthcare standards in Nepal. Through collaboration and focused training, we believe we can significantly enhance the proficiency of Nepali doctors, enabling them to provide high-quality healthcare services and make a lasting impact on the medical landscape in the region.