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  1. Anil Pandit1,
  2. Amit Arjyal1,
  3. Jeremy Farrar2,
  4. Buddha Basnyat1,3
  1. 1Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
  2. 2Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
  3. 3Medical Director, Nepal International Clinic, Lal Durbar, Kathmandu, Nepal
  1. Correspondence to:
 Dr A Pandit, GPO 252, Kathmandu, Patan Hospital, Lalitpur, Nepal;

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Nepal is a tiny Himalayan kingdom situated between China and India with a population of 21 million people of diverse ethnicities and religions. The country has snow clad mountains on the northern side bordering China and plains on the southern side bordering India. It is one of the poorest countries in the world, with a gross national product of only $200 per person. Almost 90% of the population live in rural areas, and 40% live below the poverty line. About 50% of children are undernourished. Infant mortality and maternal mortality are the worst in the region. The doctor:population ratio is 1:5000 people.

Nepal was once a peaceful country but has been turned into a conflict zone after the Communist Party of Nepal-Maoist declared civil war against the state in 1996. So far more than 11000 Nepalese have lost their lives as a direct result of the conflict, which has affected both rural and urban healthcare facilities. However, the rural population has suffered more. People staffing rural health posts have deserted because of fear of being targeted. On 2 April 2005, the Maoist called for an 11 day total strike to block the transportation route to the capital Kathmandu. This blockade lead to a number of major healthcare problems, with referrals from outside Kathmandu not being able to get access to the city’s hospitals, including women in obstructed labour. There have also been attacks on health posts and ambushes on ambulances carrying patients. However, no teaching hospitals and institutions, medical personnel, or paramedical staff have been threatened or abducted by the warring parties.

Medical education started in Nepal in 1978 when the Institute of Medicine was established with the vision of producing community oriented doctors. The first batch of doctors graduated in 1984. Until 1996, there were only two medical schools; …

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