Ramu Kharel is an Assistant Professor of Emergency Medicine at the Warren Alpert Medical School of Brown University and a faculty member within the Brown Global Emergency Medicine Division. Recently, in 2023, he worked as the Principal Investigator for the establishment of the Nepal Poison Information Center (PIC) initiative. The initiative was launched through Tribhuvan University Teaching Hospital (TUTH) and supported by a grant from the Brown University Department of Emergency Medicine. For the development of this Poison Information Center, he’s been awarded a BMJ South Asia Award, which is among the most prestigious recognitions in the region focusing on excellence in healthcare. Specifically, Kharel and his team were awarded the Primary Care Award for the PIC, the first of its kind in the country. The PIC is a 24/7 hotline providing guidance to healthcare providers across Nepal, significantly improving the efficacy of poison care especially in resource-limited areas.  

Kharel's relationship to global health and the region he’s been working in is deeply personal. He was born and raised in rural Nepal until he was thirteen years old and so witnessed firsthand the challenges of accessing emergency care, especially in rural areas where there is less infrastructure. This not only developed his passion for global health but also gave him insight into what investments and improvements needed to be made. Particularly, he saw a lack of centralized poison control systems and toxicology expertise that led to fragmented care and delay in the use of life-saving antidotes. As a result, preventable deaths from causes like snake bites and pesticide ingestion were far too common. Meanwhile, a lack of robust data collection measures meant that these problems were largely invisible on the policymaking front due to a lack of evidence, awareness, and urgency. 

Before working on the PIC initiative, Kharel worked on the 2015 earthquake response, he worked to improve community emergency care programs across Nepal, and started a non-profit called HAPSA in 2013. During the COVID-19 pandemic, Kharel worked with another non-profit, ASK Foundation, to develop a COVID response hotline which served as the foundation for the Poison information Center. This was a critical development that identified partners and relationships in Nepal and with the Nepalese government to centralize and make accessible expert driven guidance across the country.

Planning for the Poison Information Center began in 2022 and by early 2023 partnerships had been developed and a grant secured to move forward. In mid 2023, the hotline infrastructure at TUTH was set up, with service beginning in October and by the end of the year the center was officially launched. At the end of 2024, the Center was stable enough to maintain itself while being under local leadership, with Kharel remaining as an advisor. This independence both demonstrates the success of the program as well as the local community’s investment and passion for this initiative. Now, along with other research and collaboration projects, they are helping to develop another PIC at Dhulikhel Hospital. Through this process they had to overcome the challenges of making a sustainable model from the ground up in a setting where many of the needed resources were scarce, while administratively working through consensus between partners and coordination across many institutions. However, in many ways those difficulties illustrate the success of this program. Through this cooperation, they’ve seen healthcare providers gain the confidence and knowledge to quickly execute potentially life saving treatment daily. 

This whole project was only made possible, not only with the help of TUTH and the Brown Department of Emergency Medicine, but all the toxicology experts who offered their mentorship and consultation, Emory University’s toxicology section that provided training to the specialist Nepal, and all the other local partners. It is a testament to the benefits of collaboration across countries with a shared purpose that Kharel hopes will inspire more collaborative global health efforts.