A Nepalese plastic surgeon who is leading a program in his home country that has helped repair the faces and bodies of thousands of impoverished children will be given the 2004 Nathan R. Davis Award in International Medicine and Public Health on Saturday at the opening of the American Medical Association's House of Delegates meeting in Chicago.
Shankar Man Rai, M.D., 48, is director of the surgical outreach center in Nepal for Interplast, a Mountain View, Calif.-based humanitarian organization that provides free reconstructive surgery to people in developing countries around the world.
Rai, who has worked in association with Interplast since 1992, has helped gain treatment for more than 5,000 patients since then, many of them children with cleft lips or palates or burns.
Rai is the son of a career Nepalese army soldier and brother to four Gurkha Brigade soldiers who paid his way through school. Rai was the first in his family to receive an education, he said.
As a boy, Rai hiked two hours every day at 6,000-foot elevations from his remote village to the nearest school. Today, it still requires a three-day walk from his village to reach the nearest road, Rai said, and another 18-hour bus ride to make Katmandu.
But in the late 1970s, when Rai left home to go to college and then medical school in the Nepalese capital, he walked the entire way. It took 14 days, he said.
"We work in many developing countries on three continents, and the story is typically the physicians there are from wealthy families," said Bill Schneider, M.D., a plastic surgeon and chief medical officer of Interplast.
Schneider said he believes Rai's rural origins are the source of his dedication to the poor.
"He is a very modest man, but he has done incredible things in Nepal," Schneider said. "It's almost astonishing what he's done."
Due to political instability from a Maoist insurrection that has prompted a U.S. State Department advisory against travel to Nepal, Interplast has not sent U.S. surgical teams into the country for two years, according to Schneider.
"But that's the beauty of the program," Schneider said. "He's doing surgery every day on the poor so we don't need to be there."
Rai said he spends two or three days a week visiting rural hospitals, performing surgeries and rounding up patients at clinics outside of Katmandu in 52 of the 75 Nepalese districts that remain open to travel. As part of the outreach program, Interplast also helps pay for the parents of postoperative children to come and stay at the district centers for extended speech therapy.
Rai, who is employed by the government, said he cannot run a private practice due to his heavy travel requirements, and he has no thought of remaining in the U.S. to practice.
He said he would begin the 18-hour flight back to Nepal on Monday.
"My family is there. It's where I come from," he said during an interview in the glass-and-chrome atrium restaurant in the Hyatt Hotel in downtown Chicago on Friday.
"I don't belong here," he said, and smiled, as if in apology. "It's a foreign country. You'd have to understand people from Nepal. We try to stay in our own."
This is not Rai's first visit to the United States. In addition, he has traveled to Vietnam, Ecuador and Peru to meet with surgeons there to share his experiences with them in developing their own rural outreach programs.
Rai graduated from Nepal's Institute of Medicine in Katmandu in 1986 and took training in surgery in Bangladesh, where he worked until returning to Nepal in 1992. While working at the university hospital in Katmandu that year, Rai said he spotted a team of foreign surgeons and nurses in an operating room working on a child with a cleft palate and had an epiphany.
"Before I met these surgeons, I was not interested in plastic surgery," he said. "I watched one of these surgeons from beginning to end and in one hour I saw a radical change in the face of this child. I approached this surgeon and said I wanted to learn. He said no problem and let me assist."
Rai would go on from that first meeting with the visiting Interplast team of plastic surgeons to helping line up local patients in advance of their future visits, typically twice a year each for two weeks.
In 1994, Rai said, he met Dallas plastic and orthopedic surgeon Harry Orenstein, M.D., who was visiting Nepal and who helped arrange a year of training in plastic surgery at University of Texas Southwestern Medical Center in Dallas the following year. He returned to Nepal and came back to the U.S. for another 18 months of training at the Cleveland Clinic in 1997 and 1998.
Rai said he also pressed the visiting Interplast surgeons and nurses to teach other Nepalese physicians and surgeons. Today, there are five Nepalese surgeons, including Rai, who have received training this way. One is in Nepal working with Rai, he said. Two are currently in advanced training programs here in the U.S. and a third, Kiran Nakarmi, M.D., is taking specialty training in Australia.
On his return, Nakarmi will be the only Nepalese surgeon trained in hand surgery in the nation of 23 million, Rai said.
Rai also has introduced his colleagues to Internet learning through an Interplast site and WiredMD.com, run by Yale.
"Whenever I have a difficult case or a problem with a decision, or even a diagnosis, if I have a patient with a funny lesion, I post it and they give me advice," he said. "It's just like being in a room discussion where you pool your problems, but it's spread out."
The AMA will present Rai with a $20,000 grant for his work.
"We may be using that for speech therapy," he said.
