Nepali Times
A people’s hospital


Land is wealth for Shiva Phatyang, a 50-year-old farmer from Dhulikhel. Yet he happily donated one ropani of his farm to Dhulikhel Hospital, saying that he was just returning it to his motherland. Seven years ago, when Phatyang met Dr Ram Shrestha (see pic, bottom), he instantly trusted that the doctor would do far more for the people than any health minister ever had. "The moment I met him, I believed that he would fulfill his promise to build a great hospital for us," recalls Phatyang.

The farmer was among 23 Dhulikhel residents who donated 28 ropanies of land to build one of Nepal's first community hospitals. What began in 1996 with just two rooms, is now a sprawling facility run by a dedicated team of some 130 medical personnel. The modern hospital today treats more than 59,000 patients every year from several surrounding districts. And as a community hospital, it provides patients with high quality treatment at a subsidised price.

Children under five and pregnant women receive free treatment. The hospital also has five outreach primary health care centres. Local communities and health workers are involved in planning and operating the centres. The Bolde station, 45km from Dhulikhel, serves about 30,000 villagers who come here from as far as Ramechhap and Sindhuli.

For the modest doctor who started it all, this is obviously a labour of love. Ram Shrestha firmly believes Nepalis are just as capable as anyone else of running things efficiently. "We don't have a culture of giving the disadvantaged an equal opportunity to get ahead in life. We have to change that," he told us.

Shrestha himself got that opportunity and has made full use of it to help his community. He is from a farming family in Dhulikhel, and after graduating from Amrit Science Campus in Kathmandu, he applied to 40 universities around the world for a scholarship in medicine. The only positive response came from the University of Vienna, but that came with a condition: he would only receive a study grant if he learned to speak and write German fluently within 21 months.

Shrestha took private lessons in German and practiced in Vienna's parks, pubs and university premises: within three months he was speaking German fluently. He applied himself to his degree with the same determination, but his professor told him that it was impossible to complete the seven-year MD course in just five. Shrestha took the matter to court with help of the student union and won. The university granted him his medical degree in five years, and it took another 12 years to for him to earn the Facharzt.

"Now I even dream in German," jokes the 43-year-old doctor as he operates on a patient with a severe gastric obstruction (see pic, below). The Austrian connection has been helpful in getting Dhulikhel Hospital started with a grant from the Vorarlberg-based Nepal Med Austria and support from Dhulikhel municipality and Dhulikhel Health Services Association.

At the end of the five-hour operation, 50-year old Man Bahadur Nepali is out of danger. "Surgery is my hobby, it helps to relieve the pressure," Ram Shrestha says with a smile in his eyes above the mask. Everyone at the hospital wants to be operated on by 'Dr Ram', and he has a full roster of patients to treat, as well as lectururing medical students and attending administrative meetings.

At present he is occupied not only with saving lives, but also with how to raise the Rs 130 million needed to run the hospital from 2005. Finances are a recurring worry. While the hospital generates some income through patient fees, a major chunk is dependent on international donors. Medical equipment and infrastructure don't come cheap.

Once a year, Shrestha spends two weeks in Austria to raise funds through lectures and programs. He is a popular draw on the European medical speaking circuit and his life has even been the subject of documentary films in Austria, Germany, France, Switzerland, Holland and Luxembourg. A few young German students were so inspired by his story that they raised about 15,000 euros last year by cycling from Germany to Beijing and Kathmandu.

For those of us who are used to dirty, smelly and dark hospitals, Dhulikhel Hospital is literally a breath of fresh air. It is bright, airy, and spotlessly clean. Patients who cannot read are asked to follow coloured strips of black, yellow and red paths for their various treatments. At lunchtime Shrestha eats the same free meal which is served to patients, paid for by various corporations and business people in Kathmandu who have been impressed by his dedication.

Ram Shrestha has made sure the hospital doesn't just look clean, but uses a system of treating hospital wastes and effluents. When the Ministry of Health Supervision Team visited the hospital in January 1998, it was so impressed that it described the hospital as "exceeding the national standards" and granted it permanent status as a Centre of Excellence to provide comprehensive preventive and curative services. Dhulikhel is also the only medical centre in Nepal with a Kevlar airflow system which streams germ-free air into all operation theatres.

Under Shrestha's leadership, his medical and administrative team have brought the hospital up to international standards, even persuading the University of Vienna in Austria to grant recognition for the clinical experiences of their medical students interning at Dhulikhel Hospital. Several students from Austria, Germany, Switzerland, France and the USA have completed their medical electives here, and the hospital is such a showcase that the government brings around foreign dignitaries for visits. Austria's Minister of State, the World Bank's head of the health sector, the Health Minister of Sri Lanka and Kathmandu-based ambassadors have all come through.

Some in Kathmandu's cynical circles have accused Ram Shrestha of establishing a 'personality cult', and say he is too closely identified with his institution. Shrestha doesn't let those comments worry him, or the praise distract him from his work. He says: "This hospital now has a life of its own."

(11 JAN 2013 - 17 JAN 2013)