Alfin “Didi” Vicencio, MD, left, and Sameera Thapa, MD, discuss an interesting chest CT finding in Mount Sinai’s pediatric pulmonology clinic.
When Sameera Thapa, MD, met Alfin “Didi” Vicencio, MD, they were both trying to improve care for children with lung diseases, but in very different ways.
Dr. Thapa, a pediatrician at Dhulikhel Hospital in Nepal, wanted to provide better care for children with lung diseases in the town of Dhulikhel without having to refer them to more specialized centers hours away. Dr. Vicencio, then a Professor of Pediatric Pulmonology at the Icahn School of Medicine at Mount Sinai and now Chair of Pediatrics at Hackensack Meridien Health, North Region, is part of a group expanding techniques used to treat children bronchoscopically—through a scope inserted into the airway that can be used to both diagnose the problem and treat it on the spot.
Dr. Vicencio describes meeting Dr. Thapa as “serendipitous,” occurring in 2022 when he traveled to Nepal as part of a delegation from Mount Sinai to explore potential avenues within the new AMPATH Nepal partnership. They bonded over their shared passion for pediatric pulmonology, and they began to work together with the goal of transforming care for Nepali children with lung disease. They hope ultimately to bring to Nepal the most advanced pediatric bronchoscopy techniques in the world.
In 2024, having learned more about how their goals for pulmonary medicine intersected, Dr. Vicencio asked Dr. Thapa to be an author on an editorial in the medical journal Pediatric Pulmonology arguing for wider implementation of the new bronchoscopy techniques. They and their co-authors used Dr. Thapa’s experience in Nepal as a case study, pointing out that these advanced techniques can be especially useful in managing complications related to tuberculosis, a disease more prevalent in Nepal than in high-income countries. It makes perfect sense, they argued, to expand the reach of these techniques to low-resource settings.
Also in 2024, Dr. Thapa and Dr. Vicencio received a pilot grant from AMPATH Nepal that will help advance pediatric pulmonary care at Dhulikhel Hospital. The grant enabled Dr. Thapa to come to Mount Sinai in the spring of 2025 to observe and learn directly from Dr. Vicencio and his team, including attending the advanced pediatric bronchoscopy course he taught. In her view, the most important aspect of her observership at Mount Sinai was witnessing what could be achieved when clinical expertise is supported by the right infrastructure. Reflecting on her experience on rounds in the newborn ICU at Mount Sinai, she remarked, “Everyone was so optimistic, discussing what can be done even in the most critical cases.” This spirit of possibility left a strong impression—one she carried home.
However, she is realistic about the limitations in Nepal. Despite meaningful progress in the medical field, Nepal continues to face structural challenges, including inconsistent electricity access in many communities, which renders some of the advanced interventions she observed in the United States currently impractical. There are some experiences, though, that she can immediately draw on to treat her own patients. She hopes to implement strategies to better manage ventilators for very sick babies and take lessons from Mount Sinai’s multi-specialty “aerodigestive clinic,” where specialists co-manage complex feeding and breathing problems.
As she begins the second phase of her pilot project, where she will screen children in her local community for respiratory conditions, she will also identify more patients with asthma and other respiratory conditions. She hopes to apply her experience at Mount Sinai when caring for them. She also hopes to learn bronchoscopy herself, to be able to make basic pulmonary diagnoses and increase the services available at Dhulikhel Hospital.
Alexandra Coria, MD, is Assistant Professor of Pediatrics and Global Health, and Senior Technical Communications and Research Translation Specialist at the Arnhold Institute for Global Health at Ichan School of Medicine at Mount Sinai.