Sangina Ranjit Malla, MD, left, and Bhawana Regmi, MSc
Sangina Ranjit Malla, MD, and Bhawana Regmi, MSc, trained and visited Mount Sinai through the Arnhold Institute for Global Health’s global health education program in September 2023 for one month.
Dr. Ranjit is an Associate Professor, Department of Anesthesiology and Critical Care, at Dhulikhel Hospital and Kathmandu University School of Medical Sciences in Nepal. Ms. Bhawana is a lecturer for the Department of Medical Surgical Nursing and Nurse Manager, Adult Intensive Care Unit and Surgical Intensive Care Unit, at Dhulikhel Hospital in Nepal. They work closely together in Nepal and are both very passionate about global health.
In this Q&A, they discuss what they hope to learn from their visit to Mount Sinai.
Can you both please tell us a little bit about yourself and your work?
Dr. Malla: I am an anesthesiologist, currently working in the operating room as well as the intensive care unit. I joined Dhulikhel Hospital in 2003 and since then, I am committed to the principle and objective of my Institute: “quality health care for the poor.” I completed my anesthesiology residency in 2008 in Nepal and, over the years, I have developed a special interest in critical care, cardiac anesthesia, trauma, and resuscitation. My team and I provide perioperative care for specialized surgeries like neurosurgery, gastrointestinal surgery, cardiothoracic and vascular surgery, trauma, obstetrics, and pediatrics. Since we are growing and have more specialized surgeries, procedures, and disease conditions, we are encountering more sick patients. This inspired me to learn more about critical care and bring programs that will help my patients to have better outcomes. I also teach students earning a Bachelor’s Degree in Medicine/Surgery (MBBS) and an MD in anesthesiology.
Ms. Bhawana: I have been working in the adult intensive care unit and surgical intensive care unit of Dhulikhel Hospital as a nurse manager since September 2018. I am basically responsible for the staff, patients, and students in the adult and surgical Intensive care unit. I have also worked as a lecturer in the department of medical surgical nursing since September 2015. I teach critical care nursing and adult nursing.
What do you both hope to learn from your time visiting Mount Sinai and the Institute?
Dr. Malla: I would like to learn about specific procedures used in intensive care, as that is rare and inaccessible to learn in Nepal. For example, I want to observe how slow real replacement therapy is performed in the ICU. Since stronger broad-spectrum antibiotics are often used in the ICU, I want to learn how antibiotic stewardship has been practiced in Mount Sinai. I would also like to develop a rapid response team/critical care outreach, so I would like to observe how it is done in Mount Sinai. In addition, I would like to learn more about overall treatment and how critical care pathways are followed in the ICU. These pathways could be guideline, protocol, or a specific care plan for a specific disease.
Ms. Bhawana: I would like to observe nursing care being provided to the critically ill patients and the use of nursing process. I am interested in the involvement of nurses in the planning, implementation and evaluation of patient care and the involvement of nurses in the doctor’s round. Also in the different protocols being used for patient management; infection prevention policies and protocols; different diagnostic and treatment modalities for patients admitted in ICUs; and simulation regarding critical care procedures for students.
How do you both think you can apply what you learn from the visit to your work in Nepal?
Dr. Malla: The skills, techniques, and approaches that I will observe at Mount Sinai, I shall apply them to my daily practice with the critically ill patients back home. In addition to changes in my own practice, I shall develop protocols and guidelines in my ICU so that my colleagues, students, and nurses will be able to follow a better critical care medicine. Also, I shall develop small critical care training packages for my nurses and residents so that ongoing teaching and learning activities will multiply and propagate the skills I have gained to better care for our critically ill patients.
Ms. Bhawana: I will incorporate the knowledge, skills, and approaches learned there for myself, my staff and student’s practice. We will focus on improving patient care by developing different standards for providing nursing care and on making policies and protocols regarding critical care. As nurses are the most important members in the critical care, their inclusion and visibility can be shown in patient care.
What do you both like about working in Nepal and in medicine?
Dr. Malla: I love my country and my people. This is the place where I can be myself and be happy for the rest of my life. We have the responsibility to make the country worth living. If we don’t do it, who else will? This is my home and I love working to make this home safe and beautiful. Since health and medicine is the basic need of any citizen, I feel proud to be working in this field. Medicine is a noble profession that involves life-saving care. Anesthesiology and critical care is all about acute care and life-saving care, and this is what makes me content.
Ms. Bhawana: Nepal is a beautiful paradise on earth. It has a variety of landscapes, cultures, traditions, and friendly people. The people here have greater health needs because of ignorance, poverty, and lifestyle. The health system is very expensive in Nepal, as most of the health expenditure is out of pocket. So working with and for our own people has always been a matter of pride. We have so many learning opportunities in medicine in Nepal. On my team, all my colleagues are motivated, hardworking, and dedicated to their work. So it has always been my pleasure to work with them.
What is some advice you would give to someone wanting to work in global health and medicine?
Dr. Malla: Every human being deserves optimum quality health care. By working in global health medicine, one can participate in this revolution of improving the health of people globally. One can find tremendous opportunities for research and innovations that involves quality and equity in health care. Working in global health and medicine will definitely keep you proud and gratified.
Ms. Bhawana: Global health facilitates a broader understanding of global health challenges that rise above international borders. So the people who want to work in global health and medicine should not be restricted by society, economic, geopolitical, or security implications. Health care should be affordable and accessible for all.
Ashante R. Patterson is the Communications and Marketing Manager at Arnhold Institute for Global Health and the Department of Global Health and Health System Design at Mount Sinai.