Oxford University Clinical Research Unit - Nepal
Oxford University Clinical Research Unit-Nepal (OUCRU-NP) is hosted by Patan Hospital and the Patan Academy of Health Sciences in Kathmandu Nepal and works in close collaboration with the Nepal Health Research Council at the Nepalese Ministry of Health and Population. Our mission within the Patan Hospital, the Patan Academy of Health Sciences and OUCRU-NP is to build a strong critical mass of young Nepalese clinician scientists who can help build Nepal's scientific and clinical future.
OUCRU-NP was initiated in the summer of 2003 following a visit to Nepal by Prof. Jeremy Farrar after an exchange of letters with Dr Buddha Basnyat (Consultant, Patan Hospital) in the New England Journal of Medicine, subsequent to a review article by Prof. Farrar and colleagues on typhoid fever.
Since 2003, the research collaboration has evolved and OUCRU-NP has become a respected and integral part of the work of both the Patan Hospital and the Patan Academy of Health Sciences. There has been considerable investment in upgrading the hospital laboratories including Microbiology and now Biochemistry, Heamatology and Pathology, in the Clinical Research Unit and in the training of young Nepalese clinicians and scientists. Our main research focus has been on the most common infectious diseases affecting patients at Patan Hospital and in the surrounding areas of Lalipitur. We have a major focus on enteric fever (Typhoid and Paratyphoid) and other causes of febrile illness including typhus, infections of the central nervous system and Hepatitis E. We plan in the future to expand this work to include viral causes of pneumonia, TB, emerging illnesses and other public health priorities in Nepal. High altitiude sickness in Nepalese and travellers has also been an interest of this collaboration over the last ten years.
The recent earthquakes in Nepal, on the 25th April and 12th May 2015, have caused a tragic loss of life and had a devastating impact on an already fragile infrastructure. The resilience of the people of Nepal is legendary but the challenges are enormous. The initial focus was on finding survivors and ensuring essential food, water and safe accommodation are available to all those affected. But there are also short to medium term risks of major epidemics particularly of water borne diseases such as cholera, typhoid and Hepatitis E, which are all endemic in Nepal.
Our Unit at Patan Hospital has been conducting journal club on a weekly basis for the benefit of the doctors and students for many years. For example On Sept 14th 2014 the topic for discussion was:
Typhoid Fever: A Massive, Single–Point Source, Multidrug-Resistant Outbreak in Nepal published in Clinical Infectious Diseases 2005; 40:554–6. This is much appreciated by the hospital staff.
In addition, we (Dr Amit Arjyal) have also been involved for almost a year in the live streaming of medicine updates at Patan Hospital for Nepali health professionals. The updates are from the Royal College of Physicians in Edinburgh, Scotland. The last one (on Sept 12th) was on renal medicine.
Tuberculosis is a big killer and endemic in Nepal. Our team in collaboration with recognized expert national and international institutions is now dedicated to understanding the prevalence, incidence of this killer disease within the population of Kathmandu. With the use of the GeneXpert within the laboratories of Patan Hospital we have been able to diagnose an increasing number of TB patients who would have otherwise gone home undiagnosed. With the installation of the GeneXpert, the diagnosis of Tuberculous meningitis has also been made easier for the clinicians within Patan Hospital.
Continuing on our epidemiological study on enteric fever, whereby we found high faecal contamination in water used within our study population, we are now in the process of designing an intervention study within the population. The biosand filter is an adaptation of the traditional slow sand filters and the local stone spouts, which has been used for community drinking water treatment for 200 years. The biosand filter is smaller (about 1m tall and0.3m wide on each side) and adapted so that it does not flow continuously, making it suitable for use in people’s homes. For this study we hypothesise that with the access to cleaner drinking water, the longitudinal prevalence of enteric infections and the asymptomatic carriage of enteric pathogens within children in the local community of Lalitpur will be significantly reduced.
A big change for the team with Dr Samir Koirala leaving for the Epidemic Intelligence Programme (EIS) with the Center for Disease Control (CDC) in Atlanta and the departure of our medical officers and nurses for their higher education. We wish them all a very bright and happy future.
Congratulations to Sabina Dongol for having successfully completed her DPhil programme from Oxford University passing her viva on the 22nd of July. After Dr Abhilasha Karki, Dr Dongol is the second person to receive a DPhil from Oxford University from our Unit.
The Nuffield Department of Medicine named one of our scientists, Abhilasha Karkey, as their graduate prize winner for 2011-2012. Abhilasha worked with Dr Stephen Baker’s team in Tropical Medicine and was awarded the prize for her efforts to learn and study epidemiology and transmission of enteric fever with limited resources while based in Nepal. Her phenomenal will and drive has led to several novel and useful findings. You can read more of her story at: http://www.ndm.ox.ac.uk/abhilasha-karkey.
Finally, the most recent paper from our Unit will be published in the open-access Scientific Reports (publishers of Nature) on August 8, 2013. The paper is entitled “Aetiologies of central nervous system infections in adults in Kathmandu, Nepal: A prospective hospital-based study”.
When you have time, please read the weekly (every Friday) health column by Dr Buddha Basnyat in the most widely read English language weekly in Nepal, The Nepali Times (www.nepalitimes.com) where for almost 3 years without fail this column (named Dhanvantari, after the mythical Vedic physician to the gods) by Dr Basnyat has addressed issues predominantly in tropical illnesses to public health to mountain medicine as it relates to Nepal and other countries in South Asia. Old columns are also easily available in their archives. The Oxford University Clinical Research Unit\Nepal is trying to do more in terms of public engagement and this is an example.