General Information

Treating cancer 9,000 miles away

Dec 3, 2010

Prakash Neupane, MD, uses telemedicine to treat cancer patients in Goodland, Kan. -- and in Nepal.
The rugged South Asian country of Nepal is 9,000 miles and 11 time zones away. It might seem remote and inaccessible to many Americans, but Prakash Neupane, MD, routinely visits Nepal without ever stepping away from his desk.

Neupane left his homeland of Nepal nearly twenty years ago. He arrived at the University of Kansas Medical Center (KUMC) in 2008 by way of the Bronx, NY (where he was a resident at Barnabas Hospital), then Shreveport, La. (where he had a fellowship followed by a faculty position at LSU Medical Center), and Jefferson City, Mo. (where he ran a private oncology practice). Neupane came to the Midwest because he enjoys patient care. "The private practice in Jefferson City allowed me to get closer to patients than I did at LSU," he says, but he missed teaching. "I missed the interacting with colleagues and discussing choices for patients."

His search for a dual clinical and teaching opportunity brought him to KUMC, where he became an assistant professor in internal medicine. Now, he devotes part of his time to patients with head, neck and genitourinary cancer, and the other part to academic pursuits and peer interaction.

Shortly after arriving at KUMC, Neupane was introduced to fellow faculty member and oncologist Gary Doolittle, MD, medical director for the Midwest Cancer Alliance -- the outreach arm of the University of Kansas Cancer Center. As an active provider of teleoncology services for nearly 15 years and medical director for the KU Center for Telemedicine and Telehealth (KUCTT), Doolittle was quick to introduce Neupane to the convenience of providing patient services over great distances using interactive tele-video technology. In June 2009, Neupane began using telemedicine to visit with patients at Goodland Regional Medical Center in Goodland, Kan., 380 miles away from his office.

Now, once each month, Neupane makes that lengthy trip to meet in person with new patients and maintain rural relationships. It requires a full day to travel to Goodland, but after the initial visit patients generally meet with him via telemedicine. "Patients receiving active [oncology] treatment sometimes need to be seen as frequently as weekly," Neupane says. "If we had to travel great distances weekly, it would become difficult."

He's also made numerous return visits to Nepal, where his parents and other family members live. He combines the social visits with speaking engagements at Nepalese hospitals or meetings with professionals in Nepal's active medical community.

A few months ago, Neupane became convinced that if he could connect so easily to Goodland, he should investigate the possibility of a telemedicine connection to Nepal.

"I found that Katmandu Model Hospital has a lot of rural connection to mountains through telemedicine, and they were interested in communicating with us to manage cancer patients," says Neupane. "I felt that a cancer management teleconference could follow the tumor board model, with presentation of multiple cases and discussion between doctors about possible diagnosis and treatments."

With support from KUMC's Outreach department and the KUCTT, he was able to make it happen with a series of monthly, interactive video conferences connecting his KUMC office with a team of physicians in Katmandu.

When a team of doctors at Katmandu Model Hospital was first able to present patient cases directly to Neupane and interact with a group of cancer specialists located on the KUMC campus, one Nepalese newspaper called it "a medical revolution." KU doctors were able to suggest possible diagnosis and treatments for each case. The newspaper's editors wrote that the technology holds great promise for Nepal, offering access to medical expertise from specialists outside the country and to remote populations in the rural, mountainous regions outside Katmandu.

The technology has also allowed Neupane to assist the Nepalese medical community beyond monthly tele-video conferences. In March, he traveled to Nepal as course director for a multidisciplinary cancer management course that was offered to 120 oncology professionals in Kathmandu. The course was jointly organized by the American Society of Clinical Oncology and the South Asian Association for Regional Cooperative Federation of Oncologists-Nepal Chapter (SFO-N) and held in conjunction with the second Annual SFO-N Conference. Neupane and the Nepalese organizers were able to coordinate the multidisciplinary cancer management course program with an international faculty from five organizations presenting fundamental training information based on a variety of oncology programs.

A second multidisciplinary cancer management course at B.P. Koirala Memorial Cancer Hospital in Bharatpur, Nepal, included two oncology nurses from The University of Kansas Cancer Center: Peggy Murphy, RN, BSN, and Debbie Bass, RN, BSN.            

As Nepal advances technologically, Neupane hopes he and KUMC will be there to assist. "Telemedicine, I think, is going to help Nepal gain access to the expert opinion and consultation needed to improve levels of care, as well as enhance training," he says. "The reason for selecting the tumor board teleconference model for our monthly conferences was that it is based on a 'present and discuss' format. While helping to manage patient care, I am simultaneously sharing my knowledge with the other doctors so they will be better equipped to deal with similar cases."

Like Kansas -- and many areas of the U.S. -- most of Nepal is rural. Health services are limited outside the main cities. Eighty-six percent of Nepal's population lives outside the capital city of Katmandu.  

In both Kansas and Nepal, the physician shortage is particularly acute for those trained in medical specialties. As a doctor of internal medicine with a specialty in hematology and oncology, Neupane can use telemedicine to share his expertise with more people in more places.

He feels fortunate to be able to impact the lives of critically ill people 9,380 miles away without leaving his office. "I arrive in my office at KU Medical Center and my Internet connection is a given," he says. "Not everyone has that, particularly in Nepal."

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