Dr. Bishal Gyawali (fourth from left) at a meeting in Nepal with colleagues from the Karnali Academy of Health Sciences.
Dr. Bishal Gyawali (fourth from left) at a meeting in Nepal with colleagues from the Karnali Academy of Health Sciences.

Changing Cancer Care in Nepal

Dr. Bishal Gyawali is making a big impact on cancer patients in Nepal. Most people would assume he lives in Kathmandu but surprisingly the man who is making systemic changes to oncology in his native country is doing a lot of the work from his office in a different city that starts with “K” – Kingston.

Helping Nepal is the main reason the oncology professor came to Queen’s in 2019. At the time, he had a full-time faculty position offer at Harvard University. He turned it down because he felt he could make a bigger impact while working at Queen’s.

It all started with a chance meeting at a conference with Queen’s Professor Chris Booth and Department of Oncology Head Scott Berry. 

They were eager to recruit the talented doctor and emphasized Queen’s Faculty of Health Sciences’ strong commitment to global health. Being allowed to spend several weeks a year working in Nepal made Kingston the better fit.

“Unlike other institutions that have multiple areas of focus, global oncology seems like the area of focus. By coming to Queen’s, I could make a difference,” says Dr. Gyawali, who is still doing collaborative work with Harvard and is grateful for the training he received there while on a fellowship.

In a country famous for Mount Everest, Dr. Gyawali has some major peaks to climb when it comes to improving cancer patient outcomes in Nepal.

Unlike Canada, there is no free health care. He and his colleagues conducted research and found shocking results on the financial barriers Nepali cancer patients face. 

They looked at a group of acute leukemia patients – who can be cured with chemotherapy drugs and weekly hospital visits – and found 100 per cent of the patients faced some form of financial stress. Three quarters faced extreme distress, which was defined as facing three factors: needing to sell property (land, home, or livestock), having to borrow money, and asking for charity. 

“This was eye opening. We expected people to have some financial toxicity, but did not expect this high degree of economic consequences,” says Dr. Gyawali, who is now pushing the Nepal government to provide low-interest loans to cancer patients so they don’t have to sell their homes.

Another systemic change Dr. Gyawali wants is to decentralize cancer treatment. All Nepali oncologists are located in the capital city, Kathmandu. So cancer patients from rural areas sometimes have to travel as long as 36 hours to get treatment. 

Dr. Gyawali, who was recently honoured with a research award from the Nepal government, is in the middle of setting up a program that teaches primary care doctors the basics of chemotherapy. Cancer treatment plans would still be done by oncologists, but it would enable patients to receive weekly chemotherapy closer to home, greatly improving the access to health care.

Queen’s has already signed a memorandum of understanding with the Karnali Academy of Health Sciences to help run the program, and the first trainees are expected by 2023.

Surprisingly, Dr. Gyawali feels he can do more to help Nepali cancer patients by working at Queen’s instead of working in Kathmandu. 

“I have time to spend on research projects, whereas in Nepal, I would be a full-time clinician, 24-7,” says Dr. Gyawali, who is also teaching Nepali researchers how to do clinical trials and publish research. “By being at Queen’s – and with the Queen’s global health and oncology teams – we can make a difference in Nepal.”