UKH

http://www.abc.net.au/news/2018-02-01/australian-doctor-sarah-kemp-arrested...

https://kathmandutribune.com/aussie-doctor-arrested-nepal-illegal-practice-...

Volunteer doctors staff lots of medical aid posts throughout Nepal, and as far as I understand many of them don't obtain NMC registration, as that requires 12 months prior residency in Nepal. These arrests are a worrying change in how the permitting of foreign doctors works in Nepal, and may well affect the staffing of aid posts (and expeditions?) this season. It would be interesting to hear from anyone who has more direct experience of being a doctor in Nepal and what may happen in the next few weeks before the trekking and climbing season kicks off.

Cheers,

I know a couple of UK trained doctors who both have experience working in Nepal and plan(ned) on going there Mid Feb to staff the high altitude aid stations for trekkers / sherpas.

The NMC registration requirements are extremely difficult to fulfil for any foreign doctor and routinely ignored.

Despite these arrests happening in Kathmandu, rather than at altitude (I can't really imagine the authorities trekking for a couple of weeks to arrest someone) the charity that they work with is considering cancelling all the staffing of the aid posts they manage.

It's a bit too soon to know if that will actually happen; this is the initial reaction as charities see the grey space they have safely operated in radically reduced. It is worrying though.

Falling foul of regulations abroad can lead to serious repercussions locally and back in the UK with the General Medical Council. Even though the registration process abroad  is difficult to fulfill and the bureaucracy can be mind numbing and exasperating, regulations should not be disregarded. 

I have not worked in Nepal, but have worked in Africa, India, and Australasia

I don't disagree with what you're saying; but the registration requirements for Nepal include such things as 12 month residency in the country (prior to registration) a copy of the newspaper article where the job was advertised in Nepal and a personal reference from a current Nepalese consultant.

When you have rules like that in place it's no wonder that registration is avoided en masse.

Rules are there for a reason.

Who knows of the local situation in Nepal? Maybe someone else can shed light on this

My wife (Uk trained GP) and myself have just come back from a year in Mauritius where we tried unsuccessfully to work. She needed to have residency ( took 4 months) and then the Mauritian Medical Council dithered with registration application. She also needed a local reference. We gave up trying and instead had a really nice time on a sabbatical. There are many unemployed doctors in Mauritius and hence the goverment is trying to increase/improve their training rather than bring foreign ones in. 

Some people are campaigning the government about changing the rules of registration. And if you had a long term vision, then you would try that rather than just break the rules. I understand the above. The downside of this is that you lose out on 'foreign' experience

Any medical council will ask you if you had any issues abroad when working and certainly in the UK, you might face lots of problems. The Medical Council here states  as one of the duties of a doctor'Honesty and integrity are central to probity and define how any professional person should act: being upstanding and law-abiding, and respectful of the trust placed in you by others'

You should not think that just because you are going to 'help' in a foreign country that you will be welcome with open arms or not expected abide by what they require. 

Yup, fine. I don't disagree.

However, Nepal really struggles to recruit Doctors to go sit in a hut on a mountain for three months at a time; hence there being dozens of charities operating shelters and huts at altitude and they've been there for decades.

Whilst the Nepalese might rightly be closing down on abuse of the system, but they don't have the capacity to replace the services being provided. That's why charitable organisation routinely avoid the rules; because it's the only way they could get services into rural or mountainous areas. 

Realistically, the impact will be limited. Registration is only required if you're treating Nepalese locals; so if you're an exped doctor you're covered under your home registration. Those shelters are really problematic though. The charities that run them will have to decide whether they close them down this season, or risk flouting the rules again, knowing that this has happened.

A difficult issue. I wonder how we will know what this develops into....

The arrest doesn't sound worrying to me...the arrested doctor was running a private clinic in the countrys capital for three years while unlicensed?  Can you imagine if this happened in the UK?  I would imagine she has probably been reported to the local authorities by local docs.

Would be pretty short-sided of the NMC to go after volunteers in remote locations where the alternative is no care...but this doesn't seem to be what has happened. 

Does this therefore mean that an exped doctor cannot, by Nepalese law, treat a Nepali Sherpa or Porter ?

If so, does the Nepalese legal system expect exped doctors to stand by and watch them suffer and even die ?

Could the rules be got around if instead of calling themselves 'doctor' 'They instead operated in Nepal as a 'trained first aider' 

I would then call your probity into question. Doctors, in my opinion, are not governed by the same values as the rest of the public. 

Totally agree. You need some sort of mechanisms in place to protect patients. Otherwise what would stop a doctor who was struck off in their own country from relocating to Nepal and setting up clinic. From reading the articles I think she's left herself very vulnerable by working privately for three years without seeking permission. She's hardly a volunteer in a remote mountain post.

I agree there's a big difference between someone living in Nepal, getting paid and not registering when it would be perfectly possible (and necessary) to do so, and volunteers going out for 3-4 months. I don't have much sympathy for the aussie in the article, given the facts available. As someone mentioned above, if she tried that in the UK she'd be banged up.

The difficulty is that suddenly what has been ignored by the volunteer groups as an awkward grey area for years is suddenly now much more risky for these charities who can't get registered for the short periods for which they operate. In the short term it may well mean no volunteer doctors, as they'll not want to take the risk of breaking the rules. I can't see the Nepalese authorities changing their rules for registration in the next month or two.

I wasn't suggesting for them to pretend not to be doctors, although my wording of 'rules be got around' may have given that impression. 

I meant could they take on a lesser role, while they get themselves established? however I can see how this could cause problems if they carried out treatment beyond the remix of a first aider/medic.