Madeline Fields, MD, and Lara Marcuse, MD, Professors of Neurology at the Icahn School of Medicine at Mount Sinai and Co-Directors of the Mount Sinai Epilepsy Center, recently traveled to Nepal to expand neurological care for underserved communities. 

Their mission was to collaborate with the Intensive Care Unit at Dhulikhel Hospital to establish a self-sustaining EEG program and to provide advanced EEG education at two other hospitals in the region.  An EEG (electroencephalography) is a test that measures electrical activity in the brain and is used to diagnose conditions such as epilepsy and brain tumors. This initiative aims to improve access to timely neurological and epilepsy care for communities across Nepal.  

The AMPATH Nepal Partnership 

The effort is part AMPATH Nepal, a partnership of Dhulikhel Hospital, Kathmandu University School of Medical Sciences, and a consortium of global academic health centers led by the Arnhold Institute for Global Health at Mount Sinai. The partnership focuses on improving access to high-quality health care for underserved populations in rural Nepal.  

The work to establish continuous EEG services in Dhulikhel Hospital’s ICU is part of a collaboration with Cappi Lay, MD, Assistant Professor of Neurosurgery and Emergency Medicine at the Icahn School of Medicine at Mount Sinai, Co-Director of the Mount Sinai NSICU, and Director of the Institute for Critical Care Medicine’s Global Critical Care Program. Dr. Lay has been working with the Dhulikhel Hospital team to improve ICU services. 

A Warm Welcome and Hospital Collaboration 

Dr. Fields and Dr. Marcuse were warmly welcomed and treated with great hospitality from the moment they arrived at Dhulikhel Hospital. They joined the hospital’s morning report, where physicians gathered to discuss details of hospitalized and overnight admitted patients. Sujata Phuyal, the lead nurse for the EEG program, guided them on tours of multiple units throughout the hospital including the Pediatric ICU, Neuro ICU, Medical ICU, maternity floor and dialysis unit. 

Establishing the EEG Program 

With the support from Dhulikhel Hospital’s IT team, especially Sushil Napit, a portable EEG machine and review station were set up in the hospital’s ICU. The training for nurses and physicians included demonstrating the steps involved in connecting a patient to the EEG machine. This process is both time and labor-intensive, requiring precise placement of the EEG wires to a patient’s scalp, allowing the doctors to observe brain waves and to identify and monitor seizure activity.  

Dr. Fields and Dr. Marcuse calibrated all EEG machines to ensure accurate data collection and created EEG report templates for both adult and pediatric neurologists. These templates will help the Dhulikhel Hospital team learn how to write and interpret EEGs, ultimately enhancing their analytic skills and improving patient care.  

“The most important part of this work is the people who make the machines and processes work,” Dr. Marcuse said. “The doctors and nurses in Nepal are highly skilled professionals who excel in patient care. They have a strong educational background, and there is an opportunity to further enhance their expertise with additional resources and knowledge.”  

Dr. Fields added, “It is an honor to work with the physicians in Nepal and to use this essential tool to better serve their patients and communities.”  

Educational Outreach and Training 

During their visit, Dr. Fields and Dr. Marcuse delivered multiple lectures at Dhulikhel Hospital for nurses, physicians, and visiting medical students. They covered EEG basics, examining complex epilepsy cases, seizure analysis through patient videos and brain wave data, and EEG testing in the neurocritical care setting. 

Beyond Dhulikhel Hospital, they presented on epilepsy surgery at the Annapurna Neurological Institute & Allied Sciences and conducted a continuing medical education (CME) course at the Kathmandu Medical College titled, EEG and Epilepsy CME. The session covered emergent seizure treatment, EEG fundamentals, advanced treatment options, and concluded with complex epilepsy case studies.  

The heartfelt welcome and friendliness extended by people at all these institutions made their experience exceptionally rewarding and memorable. 

Expanding Sustainable Epilepsy Care 

Looking ahead, Dr. Fields and Dr. Marcuse aim to develop an epilepsy education and treatment program led by nurses and community organizers, expanding it through Dhulikhel Hospital’s 18 outreach centers. This would reach the rural populations unable to visit the main hospital campus, raise awareness, and reduce stigma associated with epilepsy, encouraging more people to seek epilepsy care.  

Through the AMPATH Nepal partnership, Dr. Fields, Dr. Marcuse, and other Mount Sinai neurologists are developing programs to improve education and patient care. These initiatives include neurology training for residents at Dhulikhel Hospital and Kathmandu University School of Medical Sciences, EEG technician training, and establishing an infrastructure for sustainable educational initiatives.  

Dr. Fields and Dr. Marcuse look forward to returning to Nepal to continue working with their colleagues on the shared vision of improving epilepsy care and equipping local physicians to provide equitable health care to their communities. 

Ankita Kureel is a Program Manager for the Department of Neurology at the Icahn School of Medicine at Mount Sinai. 

Madeline Fields, MD, is a Professor of Neurology at the Icahn School of Medicine at Mount Sinai and Co-Director of the Mount Sinai Epilepsy Center. 

Lara Marcuse, MD, is a Professor of Neurology at the Icahn School of Medicine at Mount Sinai and Co-Director of the Mount Sinai Epilepsy Center. 

Mount Sinai CEO Brendan Carr, along with members of the Mount Sinai team, meet with the Right Honorable Prime Minister KP Sharma Oli and representatives from Nepal.

Brendan Carr, MD, MA, MS, Chief Executive Officer and Professor and Kenneth L. Davis, MD, Distinguished Chair, Mount Sinai Health System, recently visited Nepal to see firsthand the work of the AMPATH Nepal partnership—a collaboration between the AMPATH Consortium of academic health centers led by Mount Sinai, Kathmandu University School of Medical Sciences, and Dhulikhel Hospital.

Over the course of the visit, Dr. Carr delivered the keynote address at the 30th Convocation of Kathmandu University, met with the Right Honorable Prime Minister KP Sharma Oli to discuss health priorities, and toured multiple community and hospital-based programs engaged in the AMPATH Nepal partnership. Dr. Carr’s visit highlighted the depth and impact of this unique collaboration, which is advancing health care delivery, education, and research in Nepal.

Convocation Address Highlights Compassion and Collaboration

In recognition of Mount Sinai’s contributions to health in Nepal and Dr. Carr’s leadership, he was invited to serve as the Chief Guest at Kathmandu University’s 30th Convocation. In his keynote address to graduating students, Dr. Carr reflected on the strength of the partnership and the power of shared learning across borders.

“Mount Sinai has a strong and impactful partnership with Kathmandu University School of Medical Sciences and Dhulikhel Hospital, built on a solid foundation of mutual respect, shared goals, and the understanding that we, as institutions, grow stronger through collaboration,” Dr. Carr said. “We are learning and growing together, adapting solutions to local realities, and strengthening health care systems in both Nepal and the United States. This exchange of ideas and expertise is not just improving care; it is broadening our perspectives, empowering both societies, and laying the groundwork for a healthier future for all.”

Dr. Carr also emphasized the importance of compassion in one’s professional life. “While collaboration is vital, there is another essential quality I want to emphasize today: compassion,” he said. “I truly believe the world does not simply need more experts—more physicians, more engineers, or more lawyers. It needs people who lead with compassion…The best science, the best medicine, the best technology—they can change the world. But to truly make a lasting impact, you must lead with compassion, humanity, and authenticity.”

At the ceremony, Professor Achyut Wagle, PhD, Vice Chancellor of Kathmandu University, affirmed the importance of the partnership. “Dr. Carr’s presence here is also to recognize the invaluable contribution of the Mount Sinai Health System in the advancement of medical education and health care system in Nepal in general, and at the Kathmandu University School of Medical Sciences and the Dhulikhel Hospital-Kathmandu University Hospital,” he said.

Click to watch the slideshow

Meeting With the Prime Minister to Advance Health Equity

Dr. Carr, along with the Mount Sinai team, also had the distinct honor of meeting with the Right Honorable Prime Minister of Nepal, KP Sharma Oli, at his residence. The meeting provided an opportunity to share updates on the AMPATH Nepal partnership and reaffirm Mount Sinai’s commitment to advancing health equity in collaboration with local institutions. The conversation focused on how the government and AMPATH Nepal can work more closely together to scale innovations, strengthen the public health system, and ensure long-term impact and sustainability for communities across Nepal.

Visiting Community-Based Health Programs

Dr. Carr also toured Dhulikhel Hospital and its Baluwa outreach center, where he observed several key community health initiatives, including efforts to strengthen the emergency care system, as well as hypertension and diabetes screening programs. In Panauti, he visited sites where the partnership is conducting comprehensive cervical and breast cancer screening and follow-up care for all women in the municipality—an effort to improve early detection and reduce cancer-related mortality.

Another highlight of the visit was observing the growing critical care partnership between Mount Sinai’s Institute for Critical Care Medicine and the Dhulikhel Hospital ICU teams. Together, they are working to elevate the standard of critical care in Nepal through clinical collaboration, shared learning, and infrastructure development.

Dr. Carr’s visit concluded with words of appreciation from the Right Honorable Prime Minister Oli, who expressed gratitude to Dr. Carr and the Mount Sinai team for their enduring commitment to strengthening Nepal’s health sector.

Dr. Carr’s visit to Nepal further strengthened the AMPATH Nepal partnership, deepening institutional ties and showcasing the meaningful impact of our collaborative work. It helped raise national awareness of how sustained, equitable collaboration is improving health systems—and lives—throughout Nepal and beyond.

Rose House, MD, MS
AMPATH Nepal Partnership Director, Arnhold Institute for Global Health
Associate Professor of Emergency Medicine, Pediatrics and Global Health
Icahn School of Medicine at Mount Sinai

Mary Ott, MD, MA, the Arnhold Institute for Global Health, and partners at the ribbon cutting of the Adolescent Health Clinic at Dhulikhel Hospital in Nepal

Dhulikhel Hospital and the AMPATH Nepal partnership recently launched an Adolescent Health Clinic at the hospital. The clinic was the culmination of months of work and training that brought adolescent health experts from Mount Sinai’s Arnhold Institute for Global Health to Nepal to train and support Nepali health workers in providing world-class care to adolescents.

The clinic provides comprehensive, integrated care every Thursday for young people ages 10-19, aiming to improve access to adolescent-centered health services at Dhulikhel Hospital and its surrounding rural communities. Through a collaborative approach involving doctors, nurses, psychologists, and other health professionals, the clinic offers holistic care across key areas such as reproductive health (including family planning, menstrual health, and adolescent gynecology), mental health, and chronic disease management, with a focus on supporting youth in transitioning to adult care. This integrated approach reflects a deep commitment to meeting the diverse and evolving needs of adolescents in a safe, supportive, and inclusive environment.

AMPATH Nepal is a collaboration of Dhulikhel Hospital and Kathmandu University School of Medical Sciences in Nepal, and the AMPATH Consortium of academic medical centers led by the Arnhold Institute for Global Health at Mount Sinai.

Medical and nursing students trained to roleplay as adolescent patients celebrating the first adolescent clinical training at Dhulikhel Hospital

A Growing Need for Adolescent Care

The need for the adolescent clinic was initially recognized at multiple levels. Dhulikhel Hospital pediatricians saw that their adolescent patients often had mental health issues and other concerns that medical providers weren’t equipped to handle. School nurses in the community shared the concern that they weren’t sure where to refer adolescents, especially young girls, who asked for reproductive health services, or who needed mental health care.

Prithuja Poudyal, MD, a pediatric neurologist and Assistant Professor of Pediatrics at Dhulikhel Hospital, was one of the concerned providers. She noted that her patients with chronic illnesses didn’t have experts to turn to when they needed to navigate the transition to adult medical providers, a transition that can be scary and intimidating. Adolescents may also be seen as “challenging” patients because they are asserting their independence and testing boundaries.

Dr. Poudyal and others saw an urgent need for specialized training for Dhulikhel Hospital providers to help their patients navigate this tricky developmental stage by providing adolescent-friendly services and “transition” care: services that help youth with chronic diseases bridge the transition to making their own medical decisions, without their parents and with new, non-pediatric health care providers. Dr. Poudyal joined several faculty members to advocate for their patients and establish an adolescent clinic at Dhulikhel Hospital. The Arnhold Institute for Global Health provided the expertise, through the Global Youth Health Program, to plan, develop, and launch the clinic.

Dhulikhel Hospital’s First Adolescent Health Training

In March 2024, a team from the Arnhold Institute traveled to Nepal to conduct the first adolescent health provider training at Dhulikhel Hospital. The program began by training youth to roleplay as adolescent patients, followed by two, four-day sessions of provider training. The course combined evidence-based lectures with interactive sessions where clinicians practiced communicating and counseling with the youth in various scenarios. More than 50 health care providers from nine departments across Dhulikhel Hospital participated in the training, gaining practical experience in delivering youth-friendly, respectful, and confidential services.

The Adolescent Clinic Launch

Building on this momentum, Dhulikhel Hospital launched its Adolescent Health Clinic on Thursday, April 24. Many of the faculty and staff members who had participated in the training attended. The youth who had acted as patients were excited to see that the training they helped provide would be put to good use.

Dr. Poudyal and Mary Ott, MD, MA, Associate Director of Global Youth Health Programs at the Arnhold Institute, both spoke at the inauguration, along with Ram Kantha Makaju Shrestha, Dr. med. univ., the founder of Dhulikhel Hospital. In her speech, Dr. Ott said, “We hope to build on young people’s strengths and capacities and involve young people themselves in creating new and innovative solutions. The clinic represents a shift in how Dhulikhel Hospital sees adolescents—not as a big risk, but a huge opportunity.”

Vhari Forsyth, MBBS, MRCPCH, is Program Manager of Adolescent Health Programs at the Arnhold Institute for Global Health.

A youth standardized patient working through scenarios with clinicians

To improve health care for youth in western Kenya, the Arnhold Institute for Global Health at Mount Sinai and our AMPATH Kenya partnership held a pivotal clinical training for health care providers who work with adolescents.

The Institute leads the adolescent health initiative of the AMPATH Kenya partnership, a collaboration between Moi Teaching and Referral Hospital and Moi University in Eldoret, Kenya, and a consortium of global academic medical centers. The need for this training was identified at the AMPATH Kenya Youth Summit held in January 2024 and became a strategic priority of the partnership.

Hands-On Skills-Based Learning: About Youth, With Youth

The training, held in Eldoret, Kenya, brought together nurses, doctors, clinical officers, and other health care professionals from Moi Teaching and Referral Hospital, USAID AMPATH Uzima, and community clinics across Western Kenya that frequently interact with adolescent patients. Over five days, clinicians participated in a rigorous 30-hour course focused on developing youth-friendly interviewing skills and counseling techniques, earning continuing education credits upon completion of the course.

Participants of the adolescent health clinical provider training in Eldoret, Kenya

Youth played an essential role in the course’s success. In the days leading up to the course, which was held in January, a group of young people received two days of training to serve as “standardized patients.” These trained youth acted in the role of the adolescent in common clinical scenarios corresponding to the lecture content. This allowed clinical providers to immediately practice the skills they learned in the lecture portion of the training with the youths themselves.

Content lectures were delivered by faculty from the Arnhold Institute, Moi Teaching and Referral Hospital, Moi University, and adolescent medicine experts from East African countries. Topics included the HEADDSS interview (a psychosocial tool for assessing adolescents); motivational interviewing; consent and confidentiality; pubertal assessment, sexual history and family planning; mental health and substance use; and adolescent transitions.

The training paired one hour of skills lab practice session for every hour of content. Each skills lab group included four to five participants, a facilitator, and one youth standardized patient. Clinicians took turns practicing scenarios with the youth standardized patient while the facilitator and other participants provided structured feedback at the end of each scenario. Youth participants also gave feedback on how providers could be more youth friendly.

Scaling Up and Looking Ahead

This training is part of the Arnhold Institute’s broader effort to strengthen adolescent care within our global partnerships.  An upcoming educational quality improvement project will focus on implementing locally the World Health Organization’s guidelines for adolescent health and refining the clinical provider training model to improve providers’ knowledge, attitudes, and confidence in adolescent care.

Additionally, key implementation outcomes of the clinical training—including reach, feasibility, acceptability, and sustainability—will be evaluated to further implement and scale the training.

In March, the Arnhold Institute and our AMPATH Nepal partnership culturally adapted and delivered a similar clinical provider training in advance of launching an adolescent health clinic at Dhulikhel Hospital in Nepal in April. With these early successes, the Arnhold Institute hopes to implement this training across all of the Institute’s partnership sites.

Sakshi Sawarkar is an Associate Researcher at the Arnhold Institute for Global Health, where she supports the Adolescent Health initiatives.  

Roberto Posada, MD, second from left, attends antibiotic stewardship rounds with Nepali colleagues at Dhulikhel Hospital.

At my first meeting with the staff at Dhulikhel Hospital in Nepal, Suman Shahukhala, a pharmacist, showed me bacteria growing from a urine sample of a patient who came in very ill. The bacteria was E. coli, and it was resistant to all antibiotics available in Nepal except colistin.

Discovered in the 1940s, colistin fell out of favor in the 1980s because it caused dangerous side effects in some people, and by the 1980s there were less risky alternatives available. However, in this case the pharmacist had no option but to advise the treating physicians to use colistin, despite its serious side effects.

The next bacteria he showed me, from a different patient, was even worse. In that case the organism was resistant to all antibiotics available; there was no drug at all that could be used. That patient had little hope of recovery from their serious infection.

Antimicrobial resistance is a growing global crisis, and Nepal is no exception. The misuse and overuse of antibiotics have led to drug-resistant bacteria, making common infections harder to treat. With limited health care infrastructure and increasing infection rates, Nepal faces a serious public health threat from antimicrobial resistance. Luckily, I am privileged to partner with a dedicated team at Dhulikhel Hospital, committed to reducing antibiotic resistance,  and to keeping their patients and communities safer.

Why Antimicrobial Resistance Is a Major Concern

When antibiotics don’t work, infections last longer and become more severe. Conditions like pneumonia and urinary tract infections, which were once easily treatable, are harder to manage, leading to higher mortality rates.

Patients with drug-resistant infections often need extended hospital care, additional tests, and more expensive medications. Many medical procedures rely on antibiotics to prevent infections. When antibiotics fail, the success of surgeries and treatments like chemotherapy is at risk.

These issues put a strain on both families and Nepal’s already overburdened health care system. In addition, drug-resistant bacteria can spread quickly in hospitals and communities, endangering vulnerable groups like newborns, the elderly, and those with weakened immune systems.

How Dhulikhel Hospital Is Combating Antimicrobial Resistance

To tackle this crisis, Dhulikhel Hospital, in collaboration with the Arnhold Institute for Global Health at Mount Sinai and the AMPATH Nepal Partnership, has launched an Antimicrobial Stewardship Program. This initiative ensures responsible antibiotic use to prevent resistance while providing the best possible treatment for patients. Key strategies of the program include providing more resources to clinicians to support their decision-making and creating systems to monitor antibiotic use. The program was created by the team from Dhulikhel Hospital, with Mount Sinai experts joining as advisors as they roll it out.

As a result of the program, one new resource available to Dhulikhel’s clinicians is an antibiogram—a report used at Mount Sinai’s hospitals and many others, that tracks local antibiotic resistance patterns—to help clinicians make informed treatment decisions and monitor changes in resistance over time. Dhulikhel Hospital is also developing guidelines for treating common infections like pneumonia and urinary tract infections. These guidelines help doctors select the most effective antibiotics while avoiding unnecessary use of drugs that we need to save for complex or very serious infections. Regular training sessions are also being held for doctors, nurses, and pharmacists to promote responsible antibiotic prescribing and use.

The hospital also has started an antibiotic stewardship committee that conducts weekly hospital rounds. This team of experts—including doctors, nurses, pharmacists, and microbiologists— helps physicians choose the right antibiotic, in the right dose, for the right duration, preventing unnecessary antibiotic use and slowing down resistance development.

To monitor and regulate antibiotic use, the hospital now classifies certain powerful antibiotics as “restricted,” meaning they require approval before use. This ensures these lifesaving drugs are only prescribed when absolutely necessary, reducing the risk of resistance.

The Team Behind the Initiative

The Antimicrobial Stewardship Program at Dhulikhel Hospital was established by Prakash Sapkota, MD, and is led by Nabin Simkhada, MD, both from the Department of Internal Medicine. The team includes specialists from anesthesiology, obstetrics and gynecology, pharmacy, microbiology, and nursing. Sujan Pathak, MD, serves as the research assistant for the project. Key collaborators from Mount Sinai include myself, Roberto Posada, MD, and my colleague Mary Boyle, MD, MPH. We are both pediatric infectious disease specialists.

Why This Matters

Antimicrobial resistance is a serious threat, but with immediate action, we can slow its spread and preserve the effectiveness of lifesaving antibiotics. The Antimicrobial Stewardship Program at Dhulikhel Hospital is a crucial step toward responsible antibiotic use, improving patient outcomes, and safeguarding future generations against untreatable infections.

Roberto Posada, MD, is Professor of Pediatrics, Medical Education, and Global Health at the Icahn School of Medicine at Mount Sinai.

A child receives a health screening in school in Guyana.

The Arnhold Institute for Global Health is proud to present Inside a National Healthcare Collaboration, a compelling documentary highlighting Mount Sinai’s groundbreaking partnership with the Government of Guyana and Hess Corporation to strengthen the health system across Guyana.

The film’s trailer premiered during a milestone signing ceremony in Georgetown, Guyana, where His Excellency Dr. Irfaan Ali, President of Guyana, announced a five-year extension of the National Healthcare Initiative. This renewed commitment aims to transform Guyana’s public health system with world-class health care services accessible to all citizens, especially those in vulnerable communities. Following the ceremony, President Ali officially launched the full documentary.

Inside a National Health Collaboration chronicles the first phase of this ambitious effort—from the rollout of school-based health screenings to the launch of a cutting-edge pathology lab that has significantly reduced the time it takes for patients to receive a diagnosis and begin lifesaving treatment. The film also highlights advancements in community-based diabetes care, improvements in the quality of care at the country’s largest hospital, and progress toward developing new digital health systems, including a national electronic health record system.

Produced by Mount Sinai, the documentary features interviews with President Ali, Mount Sinai experts—including from the Arnhold Institute for Global Health and Mount Sinai International—along with Guyanese partners. It tells the human stories behind this health transformation and offers a powerful look at how the collaboration is reshaping health care in Guyana and improving lives for generations to come.