Voice of mindfulness

Psychiatry professor took long path to Arkansas.

Dr. Puru Thapa is a fatherly figure and something of a legend at the University of Arkansas for Medical Sciences, having a reputation for masterful teaching, conscientious patient care and a mindful, deep compassion for the world.

Likely one of the first things you’ll notice about Thapa is his voice. It’s warm, calm, lightly accented and comfortable with its pace; what needs to be said will be said in its own time. You’re unlikely to hear rushed tension. It’s a voice he has deliberately filled, after much practice and discipline, with mindfulness, kindness and compassion, three core concepts in his life. It’s a voice that listens first.

Thapa, affectionately known among students and residents as “Papa Thapa,” is a professor of psychiatry at UAMS and director of the university’s Wellness Programs for students, residents, staff and faculty. He’s also the founder and director of the UAMS Mindfulness Program started three years ago.

Thapa and his wife, Sushma, a professor of anesthesiology at UAMS, first came to the university in the late 1990s. “We are naturalized Arkansans now,” Thapa says with a smile, “It’s such a privilege to be part of UAMS. We love the state and are honored to make Little Rock our home.”

Though it’s not somewhere they ever expected to be.

AN EDUCATION AWAY FROM HOME

Thapa’s story starts more than 8,100 miles away in a small village in Nepal. He’s the son of Bhakta and Hem Kumari Thapa, whom he describes as uneducated farmers who had enough success and vision to send all four of their children to get the best education available. From the time he was 6 years old, Puru lived in a Jesuit boarding school in Kathmandu, the closest major city to his village. He says he considers his education one of his greatest gifts from his parents.

After graduation, Thapa studied biology in college in Kathmandu, then moved to India to attend medical school at King George’s Medical College at Lucknow University. Then, in his final year of medical school, he met Sushma, a bright-eyed Indian medical student. The two fell in love, got married and returned to Nepal to practice medicine in the early 1980s.

Nepal is in the Himalayan Goiter Belt, a mountainous region where food available to its many isolated villages is chronically low in iodine. Goiters and thyroid-related birth defects are endemic there. After medical school, Thapa traveled through the countryside giving injections of iodine oil, a simple remedy that was hard to come by.

Seeking advanced medical education, Puru and Sushma moved to the

United States in 1984. Puru studied epidemiology and earned a master’s in public health from the University of Washington at Seattle. Seven years later, the couple took positions in Nashville, Tenn., at Vanderbilt University Medical Center. As an associate professor at Vanderbilt, he researched pharmacoepidemiology, in other words, different drugs’ effects on patient populations.

Then, in 1998, Sushma accepted an anesthesiology faculty position at UAMS. “We’d never thought we’d live in Little Rock,” Puru says, “but we had two young daughters, and we thought it would be a good time to move.”

Thapa had an itch to practice medicine again, but first needed to complete a clinical residency in the United States. So, 20 years after medical school, Thapa tested to get a residency match. To his surprise, the residency he matched with at UAMS was in psychiatry. It wasn’t a field he’d seriously considered.

“Psychiatry was something that was never on my radar, not something that I thought would appeal to me,” he says. “But when I got the residency and started here in 1998, I absolutely loved it. It was like I had found my vocation.”

John Spollen is now interim chair of the department of psychiatry at UAMS; he has credited Thapa as the single most influential person in psychiatric education in Arkansas over the last decade. But before he was faculty colleagues with Thapa, Spollen was his residency supervisor.

“Even though he was probably 40 then, and I was much younger, I was his supervisor,” Spollen says with a chuckle. “He’s kind of like a warm, fatherly figure, a very gregarious personality guy. I don’t know anybody who doesn’t like Puru.”

CARING FOR THE SICKEST OF THE SICK

The Arkansas State Hospital (ASH), the state-run, inpatient psychiatric facility where patients with acute mental illnesses are treated, was Thapa’s first post as its staff psychiatrist. Thapa says he “absolutely loved” (drawing out “loved” for emphasis) working with the severely mentally ill patients.

“I don’t know if I’ve ever met a better psychiatrist with patients,” associate professor of psychiatry Jessica Coker says of her mentor, whom she first encountered 10 years ago as a medical student herself. “They sing his praises and respect him as a provider. I think it’s his empathy and understanding. He does not judge people. He’s able to use his voice to calm people down, and get them to listen to him, but also for him to listen to them. I think people feel really validated and like someone cares and is helping them, that he’s there to support them, not boss them around in any way.”

For the next 14 years. Thapa treated ASH patients and trained, as he puts it, “a generation” of Arkansas medical students and psychiatric residents. It remains one of his favorite things he has done in his life.

Coker says students also revere him. In fact, she says after winning so many teaching awards voted on by students and residents (23 awards in the 14 years he taught at ASH), “he’s basically cut off from winning more awards for a while,” she laughs. “Just about any time he’s eligible, he wins it.”

WELL, WELL, WELL

In 2016, UAMS’ chair of psychiatry asked Thapa to direct the Student Wellness Center, providing no-cost clinical psychiatric services and counseling for up to 3,000 students. Thapa was reluctant to leave his ASH patients. “He was able to persuade me by saying there was a huge need there to serve our students, and this is something you can grow and build,” Thapa says.

He went from one extreme to the other. “For me, going from the State Hospital as an inpatient psychiatrist, treating the sickest of the sick, to doing wellness and treating these high-functioning, soon-to-be-professionals, was quite a drastic change,” he says. “It’s as big a jump in practice as one can expect for a psychiatrist.”

But the new work suited him; under his leadership, students’ office visits have tripled. When students are battling anxiety, depression, grief or any other mental health problem, they can access the Student Wellness Clinic. Thapa has prioritized student body outreach, which includes sharing stress management techniques, working to destigmatize mental illness among the future physicians and reminding them the program is an available resource.

“Medical school is hard for everyone,” he says. “We let them know it’s OK to seek our help, and that we are here for them.” In late 2018, Thapa became director of the Residency Wellness program,

then in 2019 added the Faculty Wellness component. “I’m doing mostly clinical work right now,” Thapa says. “There’s a lot of pandemic stress out there in health care, especially with our faculty providers.”

He admits missing teaching psychiatry, but he has found a way to teach something new.

ON HIS MIND: THE PRESENT

Thapa had studied mindfulness for his psychiatric patients, and knew more than 5,000 evidence-based studies had proved mindfulness practice can improve health outcomes, from patients with chronic pain or terminal illnesses to those with mental health problems.

“From the beginning 2,600 years ago, mindfulness was meant to alleviate suffering and cultivate compassion,” Thapa says. “It can still do that in our modern lives. And it’s secular. Mindfulness is not Buddhist, Christian or Muslim; it is human.”

As he was treating worried, anxious and overwhelmed medical students, the idea to introduce mindfulness skills to the UAMS campus became clear.

“To put it very simply,” he says. “Mindfulness is intentionally being truly present with whatever is happening to you right here, right now, without judgment, with kindness and compassion, whether it’s pleasant or unpleasant.” It’s harder than it sounds. Thapa says memory and imagination are two characteristics that separate humans from other creatures. “They can help us accomplish wonderful things. But these two also can cause a lot of suffering and distress,” he says. While it’s important to learn from the past and plan for the future, he says too often people get fixated on what has already happened or on what lies ahead.

“We don’t know what’s going to happen, we can’t change the past. What is left is the ability to be truly present with what is happening to us right here, right now, pleasant or unpleasant, knowing that things always change,” he says. “That’s the law of impermanence. Nothing remains the same. It always changes.”

He is quick to remind people that mindfulness is not a panacea for all life’s problems. “Too often, people think if they are mindful, that’s all they need; that they can eschew other therapies or medicine. Sometimes you may need other help as well,” he says.

ZOOMING INTO CALM

Thapa uses the Koru Mindfulness Program developed specifically for busy students at Duke University. A $25,000 Chancellor’s Circle of Excellence grant provided funds to establish the program at UAMS and get more faculty trained to teach it. Since the first introductory mindfulness courses in 2019, he says they have taught the course 50 times, to more than 500 students, residents, faculty and others on campus. The program now offers daily guided meditations and has courses available to the public as well. Like so many other classes, the mindfulness courses have pivoted to Zoom (some meditations are also on YouTube). While grateful for technology, he hopes to offer a hybrid online/in-person program in the future.

Denise Compton, Ph.D., an associate professor of geriatric neuropsychology, is one of the faculty he recruited for UAMS’ Mindfulness Program. “Dr. Thapa has done a lovely job of bringing together a group of people who are very interested in and committed to this work. He’s nurtured the program along with very minimal resources. It has just grown and bloomed and still has lots of potential,” she says. “He has been a very powerful force in a very gentle way.”

COOKING UP MEMORIES

Puru Thapa says what he and Sushma love best is getting their family together for meals and merriment. His eldest, Richa Thapa, is a psychiatrist in North Little Rock, married to Scott Morey. “We have two wonderful grandchildren,” Thapa says, “a 5-year-old granddaughter and 3 ½-year-old grandson.”

Their second daughter, Priyenka Thapa, just completed a fellowship in infectious diseases and is practicing at CHI St. Vincent Infirmary.

When they gather together, Papa Thapa rolls out his culinary skills.

Spollen says he has gotten to know the whole Thapa family well. He and another colleague even visited the Thapas’ kitchen “six, eight, 10 times” over the course of a year, so Puru could teach them how to prepare Indian dishes. Spollen says, “We did a lot of cooking together, usually over a bottle of wine or two.”

Puru says that his own mindfulness practice has been a blessing, especially lately. “My older daughter was diagnosed with breast cancer a year ago. She’s been handling it beautifully,” he says. “But this is where my cultivation of mindfulness has helped me. Instead of going down that path fixating on whether this might happen or that, I’m trying to just be present with what’s happening. We can’t know what will happen, we just hope for the best.”

He admits, “Six or seven years ago, had this happened, I would probably have been a basket case. This is my daughter, right? That is not to say it has not been very hard or stressful. But mindfulness has helped me have that groundedness, if you will.”

Thapa finishes with wisdom: “We can’t change anything in the past. We can’t control the future. But we are going to live our life right now, as it is, without judgment and with kindness. Just appreciating this moment.”