Nepali Times Asian Paints
Health for those without wealth


Banepa and Dhulikhel are towns that most people drive past on their way to Jiri or Kodari. But in recent years, the twin towns 25 km east of Kathmandu are developing as a centre for model health care.

At a time when most medical facilities are based in the capital and are private profit-oriented ventures, Dhulikhel and Banepa have shown the way to provide affordable yet world class health care to Nepalis.

The four hospitals in Banepa and Dhulikhel run on one philosophy: quality health care need not be expensive. These self-run institutions can be a model for Nepal's private and state-run health care system.

Children first

Nine-year-old Sudina Dongol smiles as she tries her crutches for the first time at Banepa's HRDC.
Eight-year old Yasodha aims her strike on the carom board. Her striker hits the queen and it slides into the hole.

It's easy not to notice the metal braces on her right leg. The other children have white bandages on their hands and legs. Yasodha Iyer suffers from cleft foot deformity and is receiving treatment at Hospital and Rehabilitation for Disabled Children (HRDC) in Banepa.

"Because we deal with children, we have to use a different approach," explains Binod Bijukachhe, as he takes visitors inside the 'soft room' where patients play. This is a specialised hospital for children with physical disabilities, the only of its kind in Nepal. It focuses on reconstructive surgery, rehabilitation of the children and their integration into the society.

HRDC was established in 1985 with support from Terre des homes and Friends of the Disabled. It now has 72 beds, which are usually all occupied and a staff of 142. Every year, the hospital treats over 9,000 children. HRDC has had patients from not just Nepal but also from India, Pakistan, Tibet and even Mongolia.

For those who don't make it to the hospital, HRDC conducts medical camps every month, reaching out to 40 districts all over Nepal. The camps screen children and bring ones who need specialist attention to the hospital, a charity fund covers the costs of needy patients.

More than often, rehabilitation takes a long time and is expensive. To use the time well, the hospital has classrooms for children and vocational training.

Physiotherapist Sudip Ranjit says: "Although it is a challenge working with children, they heal much faster."

Backbone of health care

While medical treatment is understood as a necessity, the significance of rehabilitation is often ignored in Nepal. "Rehabilitation is crucial in spinal injuries which can completely change the life of the patient," says Esha Thapa of Spinal Injury Rehabilitation Centre (SIRC), the newest medical facility to open in Banepa.

SIRC is the first rehabilitation centre in Nepal for spinal injury. The lifestyle of the rural people in Nepal make them very prone to accidents that can result in spinal injury which can paralyse patients. Survival becomes difficult and most patients lose hope.

"It is possible to restore normalcy in their life through proper care, therapy and training," says Thapa. SIRC strives to help individuals with spinal injury through physiotherapy and occupational therapy, counseling and nursing. Its takes an average of 3 months for most patients to recover. SIRC also gives vocational training so that the individuals have means to sustain themselves later on.

The centre has helped over 550 patients to lead normal lives again. SIRC is moving this month from Jorpati to its purpose-built facility in Banepa. This building is wheel-chair friendly and is much better equipped for the treatment needs of patients.

Says Thapa: "Even if they can't walk again, patients who have lost hope of leading normal lives get back their hope."

We treat, God cures

Dhan Kumari Manandhar came to Scheer Memorial Hospital in Banepa after she broke her leg after falling down the stairs. Her doctor Rupesh Vaidya says she will recover.
"No matter what, a sick at the doors of the hospital should not go unattended," says Milan Gurung of Scheer Memorial Hospital in Banepa. In a country where patients are often turned away from hospitals because they are poor, this is a motto that can make a difference between life and death.

Scheer Memorial is a missionary hospital started by Seventh-day Adventist medical missionaries in 1958. What started out as a one-room facility is now a 150 bed general hospital with a staff of 190 and two ambulances.

Services are heavily subsidised with a charge of only Rs 50 per bed for a night. Many of the staff are volunteers from abroad and the hospital also has four outreach centres all over Nepal. Scheer Memorial also runs a Bsc in Nursing program. A primary school caters to children of staff.

A hospital with a heart

Cancer patient Man Bahadur Tamang (right) with his doctor, Ram Shrestha, at Dhulikhel Hospital. Tamang wouldn't have been able to afford his operation elsewhere.
Man Bahadur Tamang, a 61-year-old patient at Dhulikhel Hospital is worried. He has cancer but no money for treatment.

"Don't worry about anything, Buwa, we will operate on you on Monday," Ram Shrestha assures his patient. Shrestha set up Dhulikhel hospital precisely to provide affordable health care. But he tells us later he doesn't know where he will find the money for Tamang's operation.

He adds simply: "I can't deprive him of a chance to live just because he can't afford it. Something always comes up."

Shrestha started the hospital in 1995 with support from the Dhulikhel Municipality in land contributed by the locals.

The hospital has grown from a two-room facility to a full-fledged 317-bed model community health centre that treats 400,000 patients from all over the country every year.

The heavily subsidised services are as efficient and professional as any in an expensive city hospital. It includes specialised departments with 70 doctors, 120 nurses and 70 support staff with three ambulances.

The policy here is 'treatment first, bills later' which is a surprise to many who have heard horror stories of private hospitals demanding accident victims buy their own bandages and medicines before treating them.

"If someone is unable to pay, the hospital has a charity fund that covers expenses," explains Dipak Dahal, the hospital's administration officer. About 17 per cent of patients come from extremely poor families.

Dhulikhel runs eight outreach health centres in remote areas that basic, 24-hour services and are equipped for minor operations. Once a week, a specialist supervising team visits each centre. Regular mobile health camps are also organised.

While international grants were used for the buildings and equipment, treatment is subsidized by bachelor-level courses in medicine that Dhulikhel Hospital has started in collaboration with Kathmandu University.

Says Shrestha: "This hospital is proof that nothing is impossible. What is required is honest implementation."

(11 JAN 2013 - 17 JAN 2013)