Translational research: A new paradigm in Nepal

But, this apparently simple solution must be carefully planned as the spectrum of research contains myriad forms of studies 

Research is an integral part of human development, and a nation’s participation in the promotion of this institute reflects the political will to propel itself towards progress. The last decade has seen a boost in Nepal’s involvement in research.

This has prompted the Nepal Health Research Council, the apex body for research in the country, to recognise research as a means of human development.

Following this, a new wave of zeal was experienced, with indigenous researchers working both within and outside the country to strengthen the foundation.

Translational research has begun to emerge in Nepal as a novel venture. This emergence is, however, still in the distant horizon, owing to the limited understanding of this brand of research among professionals, including academic researchers. Robust training and knowledge dissemination would educate and prepare the researchers and hone their skills. However, this apparently simple solution must be carefully planned and executed efficiently as the spectrum of research contains myriad forms of studies.

Equally pertinent is evaluation of the success of translational research. It must be flexible enough to accommodate the needs of individual institutions and trainees with outcome promising the parameters of excellence.

The transfer of new scientific discoveries into healthcare interventions has always been a challenge.

Although this era has made communication accessible, relevant data needs channeling. A strong translational team is required to achieve this and to extend beyond the academic environment. To succinctly summarise, I want to quote the great scientist and Nobel Prize winner, Professor Bernard Lown, who said that “Once a new paradigm holds, its acceptance is extra-ordinarily rapid, and one finds few who claim to have adhered to a discarded method.”

We need to make translational research this new paradigm. This new integrated model in Nepal will help increase healthcare effectiveness.

One of the significant landmarks the country has achieved in the field of research arena is winning theT32 grant for “Translational research capacity building initiative to address cardiovascular disease in Nepal”, funded by the National Heart Lung and Blood Institute, USA.

This is an inspiring example of Nepali researchers utilising their training from abroad and capitalising on their country’s policy of research development. Although a few academicians, clinicians and traditional researchers may perceive this project as a mere foreign donor investment to westernise the research culture in Nepal, the prudent and passionate ones view this as an opportunity to upgrade our systems, which would expedite holistic development.

Another area worth exploring is the thought put in by the brilliant minds in writing theT32 grant, which addresses the leading cause of death globally and in Nepal, “the deadly cardio vascular diseases” (CVDs), which again will invest in finding out the root cause of human mortality in the local context.

A multi-faceted, multi-sectoral synergistic effort is the need of the hour for the sustainable uptake of evidence-based interventions in routine clinical and community-based settings and to develop feasible implementation strategies for contextually appropriate evidence-based interventions.

These strategies will ultimately prevent premature mortality and give leverage to the Ministry of Health and Population to address this deadly epidemic with robust evidence.

Challenges for human development will always exist in the fragile public health system of Nepal where corruption, nepotism are rampant along with a weak bureaucracy.

The challenges of implementing translational research project could be argued in two ways: Internal and external challenges.

Internally, although a handful of researchers working in this project are trained abroad and possess skills to judiciously invest such a considerable grant, quite a few of the co-investigators, fellows, research assistants and other administrative and financial staff are ill-equipped. The pertinent reason being the stark difference between the superior facilities of the westernised world versus the low resource settings of Nepal. We can further break the internal challenges into: a) difference in education and training b); weak culture of grooming and absence of a good mentor-mentee relationship; c) lack of expertise in the required field; d) inexperience with big grants; and f) inefficient time management. Also, competing priorities for survival and financial motivation in the weak health system of the country are always hidden agendas.

Externally, translational research should move beyond academic environment as crossing boundaries brings about new challenges along with ideas that evolve the process. However, the lack of familiarity of this concept within different health institutions and higher authorities, very few trained personnel trained at the authority level, poor research infrastructure and uncertain priorities are some of the evident challenges at the national level.

However, the challenges can be overcome.This adage sums up my conditions for tackling troubles: “Great things happen to those who don’t stop believing, trying, learning and being grateful.”

Dr Pyakurel is with the B P Koirala Institute of Health Sciences, Dharan

Robust training and knowledge dissemination would educate and prepare the researchers and hone their skills.