NEPAL • MEDICAL

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MEDICAL FACILITY RELATIONSHIPS PROJECT  

The goal of our medical program is to compile contact information of local hospitals and clinics in different regions, with the objective of establishing working relationships between willing medical facilities.  We hope that once a platform is established both short and long-term, cooperative relationships will begin to develop. 

Capacity:700 beds

Number of patients seen daily: 450 outpatients with 70-80 patients admitted daily

Number of medical personnel at your facility:  120 physicians, 100 nurses, 200 related medical and non medical personnel

Most common illnesses treated: Due to the rural areas served, Manipal Teaching Hospital (MTH) sees an extremely diverse array of illnesses including, but certainly not limited to: trauma, general health issues, terminal illnesses, obstetric complications, general aging problems, and surgery. 

Area Served:  Although Pokhara is a fairly large city of Nepal, MTH is the tertiary hospital for many surrounding rural communities.  Some patients certainly reach the hospital via bus, ambulance and other motorized vehicles, however Dr. S. P. Kapoor explained that many patients still travel to the hospital by foot over a period of days, "This is a horrible way to reach here for the patient".  Due to the length of time between the inception of a patients illness and her/him reaching medical care, the condition of the patients has often deteriorated significantly, creating a more challenging treatment regimen. 

Overview of the facility:  The facility is less than 10 years old and well equipped to handle the multitude and magnitude of a diversity of cases.  Upon entering the main building, a large waiting area with a television is provided for patients and families while they wait to be called to the numerous counters with staff directing patients to the appropriate departments.  For US$ 1 one can receive access to six physician consultations extending over a duration of 10 days.  We were very impressed with both the affordability and concessions
made to ensure everything realistically possible is done to assist patients from rural areas not able to pay for treatment.  Dr. Kapoor described one such example as he often turns a blind eye to family members and relatives, not able to afford local accommodations, overnighting in patient rooms.  He explained that this may not seem like a big deal, however each Nepalese family has an average ratio of 8 relatives to 1 patients.  The main outpatient pharmacy is located on the 1st floor.  Most medicines can be purchased here over the counter with the exception of sedatives and habit forming narcotics which are regulated by the government. 

Note: Manipal Hospital is a teaching hospital.  For details about the medical school, please visit the Nepal Education Page.

Capacity: Only outpatient services

Number of patients seen daily: 15-20 patients

Number of medical personnel at your facility:  One paramedic (1-2 years of medical training) who has worked at the clinic for the last 20 years.

Most common illnesses treated: Ukla Clinic's most commonly treated maladies includes diarrhea, worm infestation, pneumonia, and vomiting.  Due to its close proximity to Kohalpur Teaching Hospital, more serious cases can be referred to this larger facility. 

Area Served: Ukla is a small, privately owned clinic which mainly serves low income, local residents. 

Overview of the facility:  There is no fee for medical services at this clinic.  Charges are associated with medications only.  This is the main reason why this clinic treats relatively low income local residents.  The paramedic explained that it cost about 200 Nepalese rupees (US$3) to see a doctor in a major hospital and many families simply cannot afford this fee.  Although paramedic staffed clinics provide these services, there is a concern amongst the medical community in Nepal regarding the conflict of interest which can arise when a medical personnel's wages are dependent upon the amount or type of medications they prescribe.  While visiting a government run clinic, we saw a public health poster warning patients about this issue, as a resistance to antibiotics is an concern in Nepal.  Ambulance service is available from the clinic to the two nearby major hospital facilities, Kohalpur Teaching Hospital and Nepalganj Hospital.  During our visit, the paramedic was busy treating two young children, both with upper respiratory infections.

Location:  Waling, Nepal

Capacity:  10 beds 

Number of patients seen daily: winter season: 60-70 patients, summer season: 100-120 patients

Number of medical personnel at your facility:  approximately 15-20 staff, including: 1 medical officer (doctor), 2 health assistants, 4 nurses (1 head nurse and 3 other nurses), 3 midwifes, 1 lab assistant, 5-7 volunteers responsible for registering patients, dressing wounds, etc.

Most common illnesses treated: typhoid fever, diarrhea, dysentery, skin diseases, malaria (patients coming from the southern plains)

Area Served: Waling city and surrounding villages  

Hours of Operation: 10:00am - 6:00 pm, with 24 hours delivery/emergency service, 1 health assistant  and 1 nursing staff always on duty during hours of operation, the medical officer is on call 24 hours. 

Overview of the facility:  The clinic has 30-40 deliveries per month and provides an ambulance service to Pokhara (major hospital).  The ambulance was a gift from the Indian Embassy.  The clinic also supplies an X-ray service and can cast uncomplicated fractures on the premise.  Throughout the clinic, public health posters are displayed on the walls, educating patients on such issues as proper nutrition, leprosy and pre and post natal care.

Click on image to see more pictures from this hospital

Location:  Kohalpur, Nepal

Most common illnesses treated: upper respiratory infections, hepatitis, worm infestation, diarrhea, tuberculosis, liver diseases (due to the high prevalence of alcoholism in the area), and COPD's

Area Served:  Although Kohalpur is a fairly large town in Nepal, KTH is the tertiary hospital for many surrounding rural communities.  Similar to MTH, patients reach the hospital via bus, ambulance and other motorized vehicles, however patients still travel to the hospital by foot over a period of days. 
Pediatric Ward
        Number of medical personnel: 10 nurses, 5 doctors
        Capacity:  36 beds
        Most common illnesses treated: meningitis, rheumatic fever, diarrhea, chest colds,        

Length of stay: varies from a few days to 1 month, with the average being 7-8 days.

Overview of the KTH facility: We met Dr. Shristha, a intern at KTH, in the Emergency Room and started with a tour of the hospital. Since our visit coincided with a Hindu holiday, there were no scheduled operations in the Operation Theatre, but we toured the facility regardless. Kohalpur Teaching Hospital has 500 beds, smaller than Manipal Teaching Hospital, but similar in general facilities and curriculum for medical students. KTH is a private facility where patients pay a nominal fee due to the fact that the majority of hospital finances are derived from student tuition.  Before leaving the facility, we had the opportunity to tour the dialysis department, where two patients were receiving treatment.  Overall, the wards we visited were fairly well-equipped.  In fact, KTH is in the process of creating an ICU ward, further enhancing their current services.  

Location:  8 kilometers west of Kohalpur, Nepal

Capacity:  outpatient services only 

Number of patients seen daily: 20 avg.

Number of medical personnel at your facility:  approximately 5-7 staff, including: 1 medical officer (Dr. Shristha), 1 health assistant, and 2-3 nurses

Area Served: Being a primary care clinic, the majority of the patients are local, rural residents

Overview of the facility: The clinic is extremely well-equipped, as it is one of the best primary care clinics in all of Nepal due to its proximity to the KTH.   Free medications are regularly sent from government reserves and patients pay a nominal fee for these medications.  Most health services, including family planning options, are provided free of charge.   In an attempt to lower the infant mortality rate in Nepal, pregnant women in this district are paid 500 N.R.S. (about US$7) to give birth in this or a nearby medical facility, as currently only 10% of births occur in a clinical setting.   Due to this low percentage of hospitalized deliveries, according to the medical officer, birth related complications are the number one cause of death in child-bearing aged females in Nepal.  

MEDICAL PERSPECTIVES PROJECT

• What access do you have to medical resources?
• What opportunities do you have for continuing education?
• What salary do you receive?
• Are you adequately supplied with necessary materials?
• What types of ailments do you see on a daily basis?

Name:   Dr. S.P. Kapoor

Position:  Medical Superintendent (Director) of Manipal Teaching Hospital- The Hospital of Manipal College of Medical Sciences

Location:  Pokhara, Nepal 

Field:  Hospital and Medical College Chief Director

Responsibilities: Manage and direct the administration and operations of both Manipal Hospital and Manipal College of Medical Sciences.

Overview:  After an afternoon with Dr. S.P. Kapoor, it seems as though he doesn't get much sleep. His responsibilities are seemingly endless, ranging from overseeing cafeteria staff to ensuring the orderly operations of medical personnel.  Even though he has this vast range of duties and tight time constraints, he was very willing to sit down with us and answer a variety of questions.  After discussing
various aspects of both the hospital operations and the medical college, he called several physicians
to meet with us and tour the facilities. 

Note: For specific details about the medical school at Manipal Hospital please visit the Nepal Education Page.

Name:   Dr. Sandish Shristha

Position:  Medical Officer (Intern) at Kohalpur Teaching Hospital and Head Physician at a rural  primary care clinic

Location:  Kohalpur, Nepal

Field: General Medicine

Overview: Dr. Shristha is one of the 10% of Nepalese students each year who earn a government sponsored seat for their entire length of medical studies.  In return for this free education, each student is required to provide 2 years of service in a rural area of Nepal, where few doctors choose to serve. Although this rule has been in effect for quite a long time, it has never been actively enforced until 2006 and many government sponsored students had never filled their commitments.   Dr. Shristha explained that the students do not work in these areas, since most medical students are from a city and do not enjoy living in rural areas where there are limited services and entertainment.   Also, the training and experience these doctors receive working in rural areas is much more limited than working in a larger
city.

Dr. Shristha, who is in his fifth year of medical studies at Kohalpur, is also working at a government run rural clinic about 10 kilometers from Kohalpur Teaching Hospital to fulfill his 2 year obligation to the government. We were able to visit this primary care clinic with Dr. Shristha.   He considers himself very fortunate in the sense that he is still able to have the high quality training afforded by working at a large teaching hospital, while concurrently gaining leadership experience serving as the head doctor at this small, rural health clinic.   Because the service agreement between the government and medical students was not enforced until this year, this clinic was without a doctor for the last two years. As a result, the local villagers are extremely happy to have Dr. Shristha's services.