Aoife O’Sullivan speaks to Nepalese neurosurgeon Professor Upendra Prasad Devkota, whose dedication to patient care and the advancement of surgery was recognised by the College at a ceremony in September

In the nomination for Professor Devkota to receive the College’s Fellowship ad hominem, Mr Nihal Gurushinghe, Chair of the Neurosurgical Surgical Specialty Group, praised him as “the founder of modern neurosurgery in his native Nepal” and “an outstanding emissary for neurosurgery who has made an enormous contribution to the discipline he serves”. Professor Devkota is one of South Asia’s most well-known and respected surgeons; there can’t be many surgeons who have a Facebook fanpage dedicated to them, let alone one that boasts over 800 fans.

Professor Devkota came to the UK in 1983 to begin training at the Glasgow Institute of Neuroscience under Professor Sir Graham Teasdale. He became a Fellow of the Glasgow College in 1985, gaining training placements as both registrar and senior registrar at two premier institutions of neurological surgery in London – the Atkinson Morley’s Hospital and the National Hospital for Nervous Diseases.

Reflecting on the opportunity of training in neurosurgery in the UK, Professor Devkota said: “It might not be an overstatement to say that British neurosurgery was leading the world from the 1960s to the 1990s and therefore, for a trainee in the 1980s, the UK was by no doubt the ultimate destination. As a young trainee from a developing country, to train under two globally acclaimed academic professors of neurosurgery, Sir Graham Teasdale and Bryan Jennett (who invented the Glasgow Coma Scale) and then to move on to other similarly famous British units at Atkinson Morley’s and the National Hospital Queen Square were, undoubtedly, grooming in the best of neurosurgery that Britain could offer. I imbibed everything around me, got thorough grounding in all aspects of neurosurgery and, above all, got the inspiration to dream for higher ideals.”  

In 1989, Professor Devkota returned to Nepal to set up the first neurosurgical unit at the extremely busy Bir Hospital in Kathmandu. Despite the responsibilities of a huge workload in a developing world location, he organised and led the training of the majority of Nepal’s neurosurgeons so that they could serve a community which is massively deprived in certain parts of the country.

“As I was preparing to leave for Nepal, one of my mentors in Glasgow, Mr John Turner gave me valuable advice that to start the first neurosurgical unit I had to work with the general surgeons initially by taking off the burden of head injuries for them and then proceed to win their support for a separate unit. This was exactly what I did and within two years I had a thriving and happy neurosurgical unit, the credibility of which rapidly attracted neurosurgical patients from all over the country.

“This was the only unit in the country with a solo neurosurgeon; in a highly physically demanding situation like this, it was the moral and ethical standard that I had been indoctrinated with and the clinical competence I had acquired that kept me going. As the unit grew in strength in all aspects and almost all neurosurgical problems were tackled with heavily innovated local flavour, I thought time had come for us to share with friends in the region our experience and perhaps learn from theirs. It was in this context that neurosurgeons in the South Asia region got together and founded the South Asian Neurosurgical Society with the theme of regional collaboration. I was elected the Founder President and given the honour and responsibility of hosting the first South Asian Congress in 1999. The three-day congress was attended by 300 leading neurosurgeons from 12 countries. About 150 scientific presentations were made, of which my unit, the host, had 17. This congress put Nepalese neurosurgery on the world stage and established us as very strong partner in the region.”

In 2002, Professor Devkota was appointed as the Minister of Health, Science and Technology by His Majesty’s Government in Nepal. During his time in this senior cabinet post, he was able to achieve a number of important health reforms and gather the political support required to develop the National Neuroscience Institute.

“I imbibed everything around me, got thorough grounding in all aspects of neurosurgery and, above all, got the inspiration to dream for higher ideals”  

 “As fate would have it, I remember the Medical Director of the British Council and my sponsor for my British training from 1983 till 1989, Dr John Wood commenting that some of their successful scholars from developing countries eventually ended up being ministers in their countries; he suspected I could be one too and was absolutely right. Our success of establishing and running efficiently the most demanding of medical specialties, despite daunting adversity, credited me as one who could deliver in the most adverse situation and therefore I was requested by the then political establishment to run the relevant ministries of my expertise and, at the same time, negotiate a peace settlement with the Maoists who were then waging an insurgency against the regime.

“In the health sector, I worked with three basic strategies in mind. The first was providing universal health coverage to the populace through health insurance which was till then unheard of in this part of the world; secondly, to train the required human resource, particularly the specialists, within the country itself and finally, ensure various direct and indirect incentives for the healthcare providers to go to the periphery of the country and staff the peripheral health institutions. To address the second and the third strategies, I started the National Academy of Medical Sciences with a far reaching objective, very much similar to that of the Royal Colleges, of upgrading and recruiting all major hospitals in the country as training institutions under the academy to expand its specialist training base. Within a few days of assuming office, I also introduced compulsory seat belts and helmets for car and motorcycle riders and initiated the process of banning tobacco.”

It was while in post as Minister that Professor Devkota was inspired to design and build Nepal’s Neuroscience Institute, which opened in 2006 and where he is currently the senior neurosurgeon.

“As Minister for Health, I faced the depressing reality that the ministry did not have enough financial resources to set up super specialty institutions, which the country needed at the apex of its referral system. Therefore, I decided to set up the neurological institute on my own. This was achieved by heavily innovated technology, support with refurbished equipment donated by my friends from the UK and a personal bank loan. The Institute is now financially self-sufficient and an amalgam of the Glasgow Institute and the Atkinson Morley’s that I grew up with, with the addition of the Allied Sciences for multi-disciplinary approach to trauma care. As an acknowledgement of the strong British connection, soil from the Glasgow institute was laid in the foundation of the building and a magnolia tree planted at the entrance, a reminder of the Atkinson Morley’s. This institute has already shown leadership in the country by providing the highest level of patient care, human resource development in neurosciences and research in its field. This is exactly what a country expects from its apex institute, and hopefully this will continue long after I am gone.”

The RCSEd ad hominem Fellowship Award adds to previous accolades bestowed on him, including Honorary Membership of the Society of British Neurological Surgeons and Fellowship of the Hong Kong College in recognition of contributions to education. Commenting on receiving his recent ad hominem Fellowship from the Edinburgh College, he said: “The Royal College of Surgeons of Edinburgh has the enviable history of providing global leadership in surgical training and education for over 500 years. To be recognised by such a college is no doubt, one of the highest professional recognitions I could receive. I am extremely honoured and humbled by the gesture of the College. This makes me all the more committed to my professional goal.”

And what does he deem the highlights of such a remarkable career? “It has been tough and in a way I feel fortunate to have been born in primitive Nepal and grow up with its struggle for modernisation and contribute modestly in this historic process. Today, I feel proud to say that I went to school barefoot in a remote village in Gorkha, managed to win three successive government scholarships for college education, medical studies abroad, and, finally, neurosurgical training in the UK. I belong to a generation who transferred western technologies in developing countries, and I hope to be remembered as a source of inspiration to the millions of village boys and girls in this country that if they only dare to dream... it is achievable.”