1. UT MPH Field Practice Report
Kathmandu, Nepal
BreeAnna Dell, B.S., MPH (candidate), DVM (candidate)
University of Tennessee, Knoxville
yjf729@vols.utk.edu
2. Background
• My interests
– International public health
– Infectious disease management and epidemiology
• The original plan
– Patan Academy of Health Sciences
– CDC affiliated influenza surveillance
• But things don’t always go as planned
– Major earthquakes
3. Patan Hospital
• Mission: Apart from clinical
services, Patan Hospital's
community oriented program,
health education classes and rural
networking have helped thousands
of Nepalese to live a safer and
healthier lives.
• Teaching hospital for medical
students
• Research laboratories for disease
surveillance
4. Rampur Institute of Agriculture and
Animal Science
• Mission: design and implement
educational programmes
balancing between established
and emerging needs in the
agricultural sector, introduce
innovative ways of instruction,
research and technology
dissemination, and encourage
research and studies catering to
the needs of the people engaged
in agriculture in the country
• Research studies focusing on the
priority areas as emphasized by
the Nepal Agriculture Perspective
Plan (APP)
5. Kathmandu Animal Treatment Centre
• Mission: non-profit registered charity
organisation dedicated to improving
the welfare of Nepal's animals. We are
humanely creating a healthy, rabies-
free, sustainable street dog population
in Kathmandu.
• Several programs
– ABC & Vaccination
– Public Education
– Rescue and Treatment
7. Retrospective Analysis of Antibiotic
Resistance
PROJECT RATIONALE
• South Asia represents
highest rate of resistance
• Underrepresentation of
Nepal in scientific
literature of antibiotic
resistance
• Resistance poses
enormous and imminent
threat to medicine
8. Retrospective Analysis of Antibiotic
Resistance
CONCLUSIONS
• Patan Hospital data is
consistent with reports
from India
• Publishing data might
provide impetus/hard data
to rethink drug delivery
• Must adopt a One Health
and cooperative solution
9. Dolakha Foot and Mouth Disease Relief
Camp
• Nepali Veterinary Association
– Relief camps to earthquake-
affected districts
• Immunosuppressed cattle
populations after earthquake
• WHO reportable disease
– Production losses
– Severe consequences for
sustenance farmers
10. Dolakha Foot and Mouth Disease Relief
Camp
PROCESS
• Sterilization of environment
and carcass removal
• Medical
treatment/disinfection of
affected buffaloes
• Recommendations to
farmers for containment of
virus
• Bonus: medical treatment of
villagers
11. Public Health Core Competencies
• Analytic Assessment Skills
– Makes relevant inferences about patterns of health
and potential causes from quantitative and qualitative
data
• Cultural Competency Skills
– Appraises the role of cultural, economic, social, and
behavioral factors in determining the delivery of
public health services
12. Veterinary PH Core Competencies
• Assess health related risks to individuals and
communities with special attention to zoonotic and
emerging disease, foodborne illnesses and injuries
related to animals.
• Communicate health risks to individuals and
communities with special attention to zoonotic and
emerging diseases, foodborne illnesses and injuries
associated with animals.
13. Impact of Internship & Future Plans
• Reinforced my interests in international
medicine
• Broadened scope of interest to include
sustainable food resource development
• Applications for externship
– CDC Hubert International Medicine Fellowship
– Food and Agriculture Organisation
– NGOs?
14. Acknowledgments
• Marcy Souza, DVM, MPH, DAVBP (Avian), DACVPM
– VPH Advisor
– Associate Professor and Director of Veterinary Public Health
• Julie Grubaugh, MPH, CHES
– Academic Health Department Coordinator
• Nabin Rayamajhi, BVSc, PhD
– Preceptor at Patan Hospital
• Dinesh Singh, BVSc, MS
– Mentor at Rampur Institute of Agriculture and Animal Science
• Pushkar Pal, BVSc
– Project Manager and Senior Veterinarian at KAT Centre
BVSc, MVSc, BSc (Agriculture)
a 20-year agriculture development plan which has been in effect since 1995
Evaluate and document current treatment strategies used by veterinarians
Go on farm calls and document public health concerns on subsistence farms
More than 22,500 dogs live on the streets of Kathmandu, Nepal
Every year, around 200 people in Nepal die of rabies (most of whom are children), and 35,000 are treated for dog bites.
The Kathmandu city government used to poison more than 10,000 street dogs each year with strychnine, in an attempt to control the street dog population. This is a horrific form of death, throwing the dogs into violent seizures for up to nine hours before they die. The poison is scattered on the streets in lumps of meat, where it is a danger to children (who often play in the streets) and people's pets.
The dog carcasses are dumped in piles and left to decompose in the river beds. As many Kathmandu residents depend on the river for their drinking water, this creates a serious health hazard. Furthermore, this method is ineffective because the remaining dogs breed and the dog population returns to its original size within a year.
Through an agreement between the KAT Centre and the government of Kathmandu,the government no longer poisons stray dogs in the areas where KAT works.
Infrastructure and transparency of organization
We presume Nepal is included but don’t know
Inability to use first and second line medications- expensive
