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“From Zero to Transplant”: Nephrology Services in Pokhara, Nepal, Develop With Support From the ISN SRC Program

Hemodialysis nurses attend an advanced hemodialysis course at CMH in Pokhara, Nepal, during a visit from staff from Barts Health NHS Trust in London as part of initiatives developed through their partnership in the ISN sister renal Centers Program

The renal unit at Barts Health NHS Trust in London, UK, and the Charak Memorial Hospital (CMH) in Pokhara, Nepal, have graduated from the ISN Sister Renal Centers (SRC) Program after an eight-year partnership from 2015 to 2022.

When the SRC partnership started, Dr. Klara Paudel, the SRC liaison officer at Charak Memorial Hospital, was the only nephrologist in Pokhara, which is in the Gandaki Province in the western region of Nepal and has a population of around 2.5 million. The support CMH received through the SRC program began just as Dr. Paudel returned home from spending a year training in peritoneal dialysis as an ISN Fellow at the supporting center, Barts Health NHS Trust.

The main goal of the collaboration was to advance kidney services in Pokhara. The SRC partnership helped train technicians, doctors and nurses from the center.

Previously, kidney transplantation had only been available in the capital, but now several kidney transplantations have already taken place in Pokhara at the government hospital. Dr. Paudel comments, “It is a great achievement and a milestone for our region, and we could only achieve it with the help of a great team in Pokhara!”

According to Dr. Paudel, nephrology in the region developed “from zero to kidney transplant” during the SRC partnership. At the outset of the program, CMH had just begun hemodialysis and peritoneal dialysis services, outpatient and inpatient nephrology services, and percutaneous kidney biopsies. From a handful of initial patients, the hospital now treats some 60 hemodialysis patients (limited by the number of available machines).

The partnership organized several regional activities and programs, including three regional dialysis conferences, workshops, and CMEs for nurses, doctors and medical students. The SRC pair also participated in community projects and awareness programs focusing on kidney disease prevention.

A kidney foundation, the “Jeewasha Foundation,” was set up by Dr. Paudel and her team to support the patients most in need. The local Rotary Club agreed to collaborate, and as a result, a community dialysis center with 20 dialysis machines will soon be ready to open.

In addition, the team at CMH trained nurses from other centers in the region in peritoneal dialysis, and nephrologists were taught percutaneous peritoneal dialysis catheter insertion, helping other institutions to start peritoneal dialysis and facilitating kidney care expansion in the area.

The two healthcare centers continue to collaborate through regular contact; the team at Barts remains on hand to help with any questions from staff at CMH. Conferences to help advance nephrology practice in Nepal are planned with speakers from Barts.

Dr. Paudel concludes, “During these eight years, nephrology care in the city and the region has progressed so much! I can confidently say that our SRC program played a great part in strengthening this objective!”

“The excellent help we got from ISN is difficult to describe. [The] ISN is so wonderful in helping with all these programs and helping to develop nephrology in the neediest places. I would like to express my sincere gratitude for all the work that you are doing for us.”



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