Denise (00:06):
Hi, welcome again to Myth Magic Medicine with me, Denise -Mejia, and my guest today is Manisha, who originally came here to the US as a physician from Nepal. Thank you so much for coming today. Please tell us how to say your name properly. Okay.
Manisha (00:24):
This is Manisha Ghimire, I am from Nepal. Originally I did my medical school there and then I practiced one and a half years before I decided to come to United States. My full name is Manisha Ghimire, just to make sure. So I did my internship here, residency here, and then I have been practicing hospital medicine since then. It's been almost seven years since I've been practicing in Internal Medicine here.
Denise (01:03):
So you did Internal Medicine, did you have to take the American exams - when you were taking them? I assume you also had to take CS, the second part of Step 2 and you had to come here?
(01:18):
I did
(01:18):
Did you come over here to be with family while you went through all the exams or did you have to keep going backwards and forwards?
Manisha (01:25):
No, so I got married before I came in, so it was kind of easier transition for me because my husband was already resident so I can live with him and take care of my CS
Denise (01:36):
And somebody to guide you through the process. Exactly,
Manisha (01:45):
Yeah. I did my Step 1 there and then I did my Step 2 CS here.
Denise (01:54):
Okay. How long did it take to find a residency program? Did you need to stay close to where your husband was or did you go to a different area to do the residency? It's not easy to...
Manisha (02:07):
So I went to different area. My husband was doing residency in Baltimore, Maryland and I had to go to New York, so we lived apart three years. So even when he got his hospitalist, he was working as a hospitalist. He could not find job in New York, so he has to take somewhere near, so the nearest place was Philadelphia, so he lived in Philadelphia. So we were apart for three years,
Denise (02:37):
But at least you can get there in less than a day. It's not too difficult hour and a half away. So where were you in? Are you talking about New York City?
Manisha (02:47):
Yeah, so Montefiore Medical Center, that's where I got my residency and then we moved to Maryland as a hospitalist and now I'm in Raleigh North Carolina.
Denise (02:59):
Oh yeah, okay. The golden Triangle. That's wonderful.
Manisha (03:03):
Yeah. Oh yeah. Keeps us moving. Hopefully this is the place, last place.
Denise (03:09):
It's a great area. So you wanted to be an internist or you applied for, okay, that was that. You aimed at that.
Speaker 2 (03:17):
Yeah, that was the goal. Even if I was in Nepal, I would have done internal medicine. So I mean that's why, but usually when the foreign graduate come from Nepal, usually I think the opportunity here is more like internal Medicine or Pediatrics. So usually people tend to apply on those specialty, like internal medicine, pediatrics, some do apply in psychiatry too or family medicine. So those medical field are more, I guess easily ...
(03:48):
Well, they're less lucrative and therefore they appeal to
Manisha (03:52):
Fewer
Denise (03:53):
People perhaps. But things are changing. A couple of
(03:56):
Years
(03:56):
Ago you couldn't find an ER spot to save your life
(04:00):
Literally.
(04:01):
And nowadays, people feel differently. So things have their seasons too, and some of it's just luck. You just
Denise (04:09):
The right place. When I was looking, this is a very long time ago before the match was, I mean it happened, but not everybody was in the match and you could still match outside. I did peds, but I always wanted to do peds, but it was shoe leather. I got to know a lot of people. I trained in Manhattan also. I was at St. Luke's.
Manisha (04:29):
Okay, nice.
Denise (04:35):
So what first struck you, because you've been practicing as a doctor in Nepal, what first struck you as strange and American when you got here? Aside from the everybody speaks English and the cars go too fast and everything's too big. But what, from a healthcare point of view, what struck you as odd?
Manisha (05:02):
I think from the basic even because in Nepal mostly it is infectious disease. We see lot of infectious disease cases, a lot. It's our day-to-day thing. Here, it's not just the infection, the medicine that we practice there is different than the medicine we practice here. That's, like I said, it's more infectious disease. Here, it's overall like COPD, heart disease. Overr there it'll be more typhiod and other viral things. So enteric fever basically. So those are the main difference here and there. Also there people pay for medicine. All the medical care,
Denise (05:47):
Cash, cash-based,
Manisha (05:48):
There it's cash based. Here is insurance based. So that's why if you don't have money, it's very hard to get into, get the treatment there in Nepal, because it's all cash-based. At least the emergency part is covered by government here So people, if there's an emergency, they can go to emergency
Denise (06:15):
Even if they don't have cash or insurance, if you go to the emergency room, they have to do something
Manisha (06:19):
Exactly. Yeah, exactly. But
Denise (06:22):
The long-term care is going to be different, but the actual emergency, if it's an emergency, you have
Manisha (06:27):
Exactly ,emergency. Yeah, so that's different. But good part about practicing Nepal is patient interaction. There is not, when I practice there right now I think that some of them have EMR medical record system. But still, when I was practicing there, there was no electronic medical system and it was all handwritten. So we didn't use to spend so much time writing or documenting.
Denise (07:03):
The whole point of going to a computerized system was we would make it faster. Most people
Denise (07:09):
Type faster than they can write out in long hand. And because then there would be a record that anybody in the system could access.
Manisha (07:17):
Exactly.
Denise (07:18):
Now in quite a lot of European countries, the patient is given their medical record and so they walk around with their medical record. Is that the case in Nepal or do you? Yes. Okay.
Manisha (07:31):
Yes. So we give all the paperworks to the patient and then they take them wherever they have to go. Some forget. So then we have to reinvent the wheel again. But most of that time, if they are conscious about their health, they usually take all the files, a big chunk of files and go around to see all the doctors. So yeah, that's the case.
Denise (07:54):
Where in Nepal did you practice? I don't knnow very much geography I've heard, I've heard of, okay,
Manisha (08:02):
In the capital of Nepal. So I practice like 20 miles away from the Kathmandu It's the capital of Nepal. So it was 20 miles, my medical school was 20 miles. So not far from the capital of Nepal.
Denise (08:18):
Okay. And is there much difference in what's available in healthcare in the city and in the countryside? Does everybody have to come into the big town?
Manisha (08:27):
Yes. I mean if you had to do heart surgery, you have to do cardiac path or complicated heart surgery, definitely. But most of the time usually surgeries are performed. Most of the non-complicated surgeries are performed there. If it's very complicated obviously, and all the infectious disease, because everyone knows how to treat them, that's kind of their pregnancy related, maternity and all that stuff is also very good where I practiced. But it depends because my hospital that I worked was not that far from the city, I guess. So it was a medical school, so it did have all the departments, but not all. It's very hard to find all the system, everything in place in rural part of the country. And that's a lot like half of country
Denise (09:27):
Well this is also true parts of the US.
Speaker 2 (09:30):
Yeah, yeah, that's right.
Denise (09:33):
Alright, so the amount of time that you had to spend dealing with paperwork was the biggest challenge to you.
Manisha (09:43):
And then just the new system I practice in, I moved to Bronx to do my internal medicine and then just the accent is so different even when we are practicing English. But then when you go to Bronx, the accent is so different, it's just to understand what they're saying. Yeah. And then
Denise (10:04):
There's a lot of, if I was talking to you like this,
Speaker 2 (10:08):
Yeah,
Speaker 1 (10:09):
It's difficult at first
Speaker 2 (10:11):
It was, yeah. So it's different.
Denise (10:13):
Did you find patients were patient with your learning colloquial English or did you feel that it was a disadvantage being from another country?
Manisha (10:28):
No, actually it was not. I was able to finally understand and
Denise (10:35):
Yeah, it takes a while. I've spoken English my entire life. American accents can be difficult, especially in some some states - I'm at a loss.
Manisha (10:46):
Yeah, that's right. Even in North Carolina, the accent is slightly different than other part. It was challenging, but it was doable basically. So you can interact with people. Bronx population, it can vary. It was different because people, it was kind of like Nepal almost because people didn't know what was going on. So many of them, they had so many medical problems and they're not up to date on everything. So Nepal also people, they go to all the doctors, but they don't really know what exactly is going on with them. It's very, very, and they're
Denise (11:29):
Very, very helpful to tell you? "I take that little white pill for 'something' ".
Manisha (11:33):
Yeah, yeah, exactly. So Bronx was kind of like literacy, medical literacy was kind of almost same as Nepal I would say. You have to explain.
Denise (11:48):
Were there times when you were actually practicing when you said, oh, I wish I could do such, such that you couldn't do that you would've been able to do in Nepal? Other than take time because I think the amount of time we're so time pressed here with our interactions with patients.
Manisha (12:05):
Actually the electronic medical record and insurance was the main thing that I thought people would have benefited so much. Because every time patient goes to the doctor or someone bring this chunk of paperwork and half of them, you can't understand what's written there. Right? People handwriting, doctor, they say doctor handwriting. So it is kind of difficult to understand. So you have to do all the tests again and trying to figure out everything. So here with the electronic medical record at least it's easier to know what's going on with the patient. So it's just
Denise (12:44):
Such a pain to put the information in the first place.
Denise (12:47):
To turn your back to the patient so much to fill out the forms,
Manisha (12:51):
Yes. But in the long run, I think patient would have benefited just they don't have to go through same process. And I wish at least the emergency medical care would have been at least provided for all the Nepalese people like here, at least when you are in emergency, you can go to emergency and get at least the emergent care. Have your
Denise (13:18):
Life saved. Yeah, have your life
Manisha (13:20):
Saved there. It's really hard to even get that done. So it is.
(13:29):
All half of the country is rural or it it's like it is. It's mountain and hills. I mean it's gorgeous, but in terms of healthcare, I think we can do much more.
Denise (13:57):
You said that most of the things that you saw were the bulk of people's illnesses were infectious and I'm assuming things like TB and those sorts of things.
Speaker 2 (14:09):
Yeah, TB, enteric fever.
Denise (14:12):
But here the bulk of the issues that we deal with, not all obviously, but they're complicated even if they're not caused by, they're complicated by lifestyle issues. How does Nepal's lifestyle impact the people's health, both positively and negatively? Walking up and down mountains several times a day might actually be beneficial
Manisha (14:38):
Yeah, I think the health-wise, they do exercise because they walk around so much, they eat healthy. Most of the people have their own garden. They eat their own vegetable and fruits and everything from their garden. So I think diet wise, and it's mostly, I mean people eat a non-veg, but mostly it's a week thing. Once a week you have this meat in your house like goat meat or chicken or something, but it's just once a month. So I think diet wise it's organic, it's home based I think it really helps patient because we are so much focusing on lifestyle and diet these days. I think Nepalese people have already that in place.
Denise (15:34):
How about practices such as mindfulness and meditation? Does that feature in usual Nepalese life?
Manisha (15:44):
So Nepalese people, so most of them are Hindu, so they do prayers every morning and every evening, every household do prayers. Not all of them, but the elders like mom and dad, the elders do pray twice a day every, so I don't know how you take that as a meditation.
Denise (16:11):
No, I was thinking more the parts of the Indian subcontinent that have been gentrified over here in the US. So everybody and their mother does yoga and the longer practice of those things, that doesn't feature heavily?
Manisha (16:30):
No, no. Just whoever is very into that, they will do it.
Denise (16:35):
But ?
Manisha (16:35):
Not every, it's
Denise (16:37):
Not common to do that.
Manisha (16:39):
Not common. And I think maybe bud this does more because there is a part of Bist community also in Nepal. So they might do more but not Hindu population, not much that I haven't seen much.
Denise (16:55):
I'm very seriously organic and vegan, so I would love Nepal. Yeah, mountain's not so much.
Manisha (17:05):
You love mountains.
Denise (17:07):
I like looking at them, but walking at and down is a different thing, but so most people would walk where they wouldn't get in the car to go to places? Mostly,
Manisha (17:15):
No, not every people have cars. So even the most common, when I was growing up, I used to ride bicycle to the school, to the college, to the store, to the mall, everywhere. So bicycle was really common. Now it's kind of replaced by motorbike and car. Nowadays people do have car, but it is expensive. So not everyone have cars, but whoever is who can afford, they will have car. But it's mostly city. I don't think in the village they
Denise (17:50):
what if they only live 50 miles from the city or a hundred miles from the city. How would they get to the hospital? Is there a bus service that would work or they find a friend who has a car.
Manisha (18:01):
So usually that's how works, they usually have the contact information of someone who has the car and then if they need, they'll just call them and okay, let's transfer. So most of the time that's the case. You'll just ask for help. And then there's always someone to help you.
Denise (18:21):
Are most specialists in the different various faculties within the medical school? Are they trained in Nepal or in India or do they train in the UK? Where do they get their specialty training?
Manisha (18:36):
Everywhere actually. So India, it's very common. Nepal, there are a lot of fellowship program too, so they do that. Not all, but most of them are there. And then India is another most common place that they go. Some go to China also. Some of them Bangladesh is common. So yeah, mostly I guess it's mostly southeast Asia. Some goes to Pakistan only. If it is advanced fellowship training, they have to do one or two months of advanced training. Then they usually come to us, like some of my husband friends and some of my friends has come for that, but most of the other training Nepal.
Denise (19:23):
So they come under observer status?
Manisha (19:25):
Yeah, they do. And they have all their arrangements met. They do that and they go back.
Denise (19:32):
Right. Thank you. So what else would you like to tell us other than everybody should go to Nepal and visit, what else would you like to tell? Do you get back there that much?
Manisha (19:44):
So I go every two years. I went last year during Covid, I could not go four years,
(19:51):
Definitely Nepal is very beautiful country. Everyone should visit it. It's a different experience than US. Just the lifestyle and beauty and everything. People are very nice, generous, and always ready to help. But make sure you are all treated with all the infectious disease, disease. Get all your vaccinations,
Denise (20:13):
Go to travel medicine people first. Yeah,
Manisha (20:17):
Get travel medicine things before you go there. So definitely because even if you go now there we can get diarrhea or get sick. So it's
Denise (20:25):
Very common. Just change in water or do that.
Manisha (20:28):
Yeah, I think so. Yeah, I think that's the most important thing. And then yeah, keep subscribing in your podcast and subscribe. Oh, I wanted to tell about my, so we just started our podcast a few weeks ago too.
Denise (20:47):
Oh, congratulations. Thank you. Wish you told me before. I'll go listen right away. So what's your podcast about?
Manisha (20:54):
About progress with Manisha and Ananta?
(20:58):
This your husband? Yeah, Manisha and Ananta available in both Apple and Spotify. You guys can go and subscribe. It's about progress.
Denise (21:10):
I'll definitely put that in the show notes and make sure it's captioned when this goes out. So it's progress. This is your personal progress or this is progress of medicine? What's the
Manisha (21:25):
Yeah, like
Denise (21:26):
My title, it's a bit of everything.
Manisha (21:27):
Yeah, it's about progress. Initially right now we are planning to talk about our progress and how we did that. And then eventually we are planning to get the guest who had come to certain parl in their life. They had been successful, but how do they feel there? How was their progress or what are the failures they had been through? We just wanted to inspire other people so that failure is common. When you do things, there is always going,
Denise (21:57):
That's not failure. That's just trying. That wasn't the right way. Try again. Yeah,
Manisha (22:01):
Exactly. So it's a learning curve. So we just wanted to encourage people to keep going. You have to just progress and you'll ultimately be where you're supposed to be.
Denise (22:16):
It's the part that's an awful lot of the, use the wrong term. They colloquially use gurus in the business world online. It's going to visualize this and it will happen. No, visualize this and then make the plan to get to that thing because it takes a lot of work.
Manisha (22:32):
Even podcasts, a lot of learning curve, lot of, we have been kind of trying to learn all these new things. So it is interesting. It has been interesting.
Denise (22:45):
Well congratulations. I'll go listen right away. I wish I'd known before we did this . I will include it. That's wonderful. That's the primary side gig that you and your husband have right now. Is he still a hospitalist?
Manisha (23:01):
No, so he's a rheumatologist. So he was practicing as a hospital based medicine, but now he has his own clinic, so he's running his clinic for last three, four months. So that's a new
Denise (23:16):
Congratulations on that too. When did you move to current North Carolina?
Manisha (23:21):
2019. October. Around end of 2019.
Denise (23:25):
So you've had a time to get used to the area? Yeah,
Manisha (23:29):
Yeah. He practiced here almost two years and then now he's transitioning to his own practice. So that's something exciting going on right now and podcast and me. And I'm also interested in real estate and trying to learn real estate things on the way, which is also a learning curve because I didn't know anything.
Denise (23:54):
And that's something you need to get. Don't just go buy a building if they do your homework before yous
(24:00):
A big Exactly.
(24:01):
A podcast, fine. You just post that much. But yeah, exactly.
Manisha (24:05):
Yeah, that's so true. Podcast, it's fine. You don't spend so much money. But yeah, so that's why it's kind of, yeah, you have to learn and do your thing before you put all your savings there.
Denise (24:20):
But that's something you can discuss on your podcast. This is good. Yeah. Alright, thank you so much. I'll let you get on. It's very kind of you to join me and do send me the proper address so I can get it in there. Okay. Thank you so
Manisha (24:35):
Much. Thank you so much. Very nice meeting you again.
Denise (24:43):
Thank you for joining us at Myth Magic Medicine. If you have found this episode useful, you can apply for free CME credit through the link provided in the transcript. If you're not a medical professional, please remember while we're physicians, we're not your physicians, so please consult with your own healthcare professional if you think something you have heard might apply to you or a loved one. Until next time, bye-Bye.
