When Doug Lindberg and Dan Schwarz first met, it wasn’t at a professional conference or a meeting. They met in the virtual private community for recipients of the Up-to-Date International Grant Subscription Progam on GHDonline.org, our platform of communities where global health implementers discuss a wide range of issues.

Doug is medical director of the TEAM hospital in Dadeldhura, Nepal. TEAM hospital is run by Human Development and Community Services (HDCS), a Nepali nonprofit organization working in health care, education, and community development. Dan is executive director at Nyaya Health, a nonprofit that operates a hospital and mobile medical care services in Achham, a large district nearby Dadeldhura.

Nepal is among the poorest and least developed countries in the world, with almost one-quarter of its population living below the poverty line. In Nepal, one out of every 100 children born will not survive until their fifth birthday, and less than one in five expecting women will give birth with the help of a skilled birth attendant. (CIA The World Factbook; WHO Global Health Observatory)

Nyaya’s Bayalpata Hospital serves as the major referral centre for Achham and its surrounding two districts, and operates as a private-public partnership with the Nepalese Ministry of Health. According to Dan, TEAM hospital is the closest surgical facility to Bayalpata hospital in the ‘Far West’ of Nepal. But it is still a drive of more than six hours through mountain roads that frequently wash out with floods and landslides. Prior to their online meeting, Dan remembers, “we would refer patients to TEAM but had no regular communication between our staff members.” Now, instead of sending their patients off into an abyss of no follow-up through the mountains, Dan’s and Doug’s teams of physicians are able to communicate transfer and follow-up notes in a matter of minutes. Indeed, Dan recalls several examples where Nyaya’s team was able to tell Doug’s team about a patient in critical need of surgery, notifying them almost six hours before the patient arrived which previously was not possible.

Since first making the connection on GHDonline.org, their team members have built a strong relationship, from visiting each others’ facilities to discussing clinical and administrative issues. This new open line of communications has already enabled Doug and Dan to come up with strategies for addressing issues such as staff recruitment and retention, which are continuing challenges in the region. More recently, they have shared experiences in planning for new surgical facilities at their respective hospitals. “In such a remote area, having the ability to collaborate on projects is quite useful,” comments Doug.

Dan started working in health programs abroad and here in the U.S. almost ten years ago. Currently on academic leave from his M.D. at Brown University, he recently completed an MPH in health management and policy at Harvard School of Public Health, during which he also attended the Global Health Effectiveness Program. “GHDonline has been a fantastic tool for online communication and learning for thousands of people all over the world. In a region without good phone networks, electricity, or running water, and only slow satellite-based internet, we were able to start this collaborative relationship between two hospitals that has already profoundly affected patient care, and, in the long-term, will contribute to the development of a vastly improved health system in our region,” Dan says.

Several examples of such learning can be found in GHDonline communities. When they decided to expand the Bayalpata hospital to include some surgical services, the team at Nyaya Health consulted the Global Surgery & Anesthesia community at length and, later on, came back to the forum to receive pointed feedback on their newly created Surgical Implementation Protocol, which they have published open access. In their BMJ Open paper, Duncan Smith-Rohrberg Maru, one of Nyaya’s co-founder, Dan, and colleagues, write that the expanded services to be made available will include caesarean section, appendectomy, and surgical management of wounds and burns and of acute closed and open fractures to cite only a few.

Dan with Lab Director Drona Awasthi

Via the TB Infection Control community, Nyaya’s lab assistants gained a better understanding of how to appropriately wear N95s masks for their protection from tuberculosis. And in 2010, Nyaya’s team improved its laboratory space by removing all TB sputa examinations, which was found to be insufficiently ventilated, and also opened a new, TB-specific lab room in an adjacent building that uses a combination of hallway spacing, door-removal, and uni-directional fans for proper ventilation thanks to the information posted by community members. “While perhaps this is not an extremely fancy lab, we hope that these changes will significantly decrease our hospital’s morbidity and mortality from nosocomial infections. These changes were made for approximately $50 USD.”

Prior to making these changes, Dan recalls that he and the Medical Director of Nyaya Health consulted with other Nepali hospitals regarding their own efforts to prevent nosocomial infections. They found that similar issues existed throughout the region. “We decided that we needed to do better than our standards at the time, and sought out further expertise from international experts and the global community,” Dan notes. They found that expertise to be right at their fingertips, on GHDonline.org.