KATHMANDU
Prof Dr Bhagawan Koirala - a name that needs no introduction for us - this renowned heart surgeon of Nepal has operated on more than 14,000 hearts and served hundreds of thousands of people over the years. He is also known for pioneering open-heart surgery in Nepal while also heading the country's Shahid Gangalal National Heart Centre. He also proved his managerial skills while leading the Tribhuvan University Teaching Hospital and being a part of the Manmohan Cardiothoracic Vascular and Transplant Centre.
Recognising his invaluable contribution to Nepal's healthcare system, the Royal College of Surgeons of Edinburgh (RCSEd) recently honoured him with the Fellowship of the Royal College of Surgeons (FRCS).
He is at present deeply occupied in his passion project of delivering an integrated multispecialty high-quality child healthcare in the country.
FRCS honour
The RCSEd is the oldest surgical institute in the world, established in 1505. Its website mentions, "By joining The Royal College of Surgeons of Edinburgh (RCSEd) as an Affiliate, Member or Fellow, you will become part of a prestigious network of 32,000 professionals in over 100 countries across the world. From our founding in 1505, the College has been committed to the advancement of surgery and driving patient safety standards worldwide... Membership of the College provides professional accreditation from one of the oldest, most prestigious, and respected surgical bodies, and indicates that you have gone through a rigorous process to ensure the highest levels of professional competence."
One can get the degree from the College clearing exams; but if they award someone (without having to sit for any exam), it is regarded more honourable. This honour is given to highly accomplished and established people like Prof Dr Koirala.
Receiving such a prestigious award "is a good thing" the doctor told The Himalayan Times, yet he professed his humility as he pointed out, "I am not the sole person to get this from Nepal. There are a few others who have received FRCS without exam... FRCS is a regular thing and dozens of Nepalis have got FRCS. All our teachers were FRCS.
Degrees like FRCS and MRCP used to be common with our seniors."
He pointed out that the Royal College's presence in Nepal used to be huge prior to 2001. "It played an important role in post-graduate surgical trainings in Nepal."
There was a gap since but now they want to revive this connection. Prof Dr Koirala's achievement is definite step in adding value to Nepal's medical education.
"The challenge of medical education in Nepal is that there are very limited seats in post-graduate degrees. Per year they teach around 1,900-2,000 MBBS students in Nepal, but there are only between 800-1,000 post-graduate seats."
He added, "It means almost an equal number or more number of doctors do not get into post-graduate programmes. So, they start looking for options; many go out (of the country), and do not come back."
Therefore, he says there is a need for quality and standardised post-graduate degree programmes in Nepal - be it Nepali or international not just in surgery but also in medicine and medical specialities.
"So, if programmes like that of the Royal College are brought into Nepal, I think that will add value to our post-graduate surgery training programmes," Prof Dr Koirala opined, while adding that aspects like conducting examinations in Nepal for FRCS are under consideration.
"It is important to bring courses the Royal College conducts - related to patient safety, quality improvement, communication skills, rural surgery, rural medicine, and emergency medicine/surgery. If such things could be brought to Nepal, they would make our doctors better," he said.
He added that as a professor of surgery and now networking for the children's hospital, there are many things that they could do together.
Passion of child healthcare
The Kathmandu Institute of Child Health (KIOCH), a not-for-profit organisation which was borne with the motive of making significant contribution to the country's child healthcare - is his "project of passion".
Prof Dr Koirala, who is the Chairperson of the board of directors of KIOCH (all pro-bono) informed, "There has been very little focussed initiative to improve the health care of the country's children. Although a lot has been done in disease prevention through vaccinations, in maternal child health, more can be done in terms of taking care of sick babies and children."
He put forth three rationales behind starting KIOCH: "There are too many deaths due to something that we could prevent - many children who are born either with congenital defects or apparently healthy, die because of some very trivial conditions. There are not many systematic initiatives that look at child healthcare as a different expertise - children need to be taken care of by people who know how to handle children. And third, there is not much decentralisation - we have some facility in Kathmandu, but we have really not focussed on anything taking outside Kathmandu for child health in terms of treatment. There are branches of medical colleges, but they are not centrally planned; it's not focussed. These seem to be just fulfilling the requirements of medical colleges."
With this clear vision, KIOCH was registered in 2017. But they have been able to work systematically only in the last 2.5 years - the time before that was used in finding a suitable piece of land, and then COVID-19 happened.
The idea is to build one central hospital in Kathmandu and satellite hospitals in all seven provinces of the country. They have already built one of the satellite hospitals in Damak (Koshi Province). In operation for past one-and-a-half years now, around 95,000 children have been treated in the OPD, and 13,000 emergency cases of children have been treated by now, as informed by the doctor.
He is happy with this successful project of theirs "particularly in the model that we are talking about".
He elaborated, "The most important thing is that we were able to partner with the Koshi Province government - the government pays for the cost of the treatment of select children - either they are referred to because they are complex, or they are admitted from the emergency rooms, or they are admitted to intensive care. The cost of treatment for these categories of children under 10 years of age are paid by the Koshi Province government."
"That's the model we want to practice - we will build it, we will develop it, we will treat people, we will hire people, we will place people, but the cost of the poor innocent children should be borne by the state," he emphasised.
He looks forward to complete all satellite projects by 2031, while in Kathmandu they are in the phase of construction of the hospital.
"It will take about a year to complete the building," he said sharing that they plan to operate 50 to 100 beds in the hospital in the first phase (expected to operate in around 18 months). The capacity is for 200 beds. "It is a bigger project in Kathmandu because we want to support the provincial satellites. Kathmandu is supposed to support technically, training wise, may be funding wise, and having international collaboration, partnerships, advocacy at the central level with the government. So, the central office would have a lot of role," he said while adding they will work as a central referral centre for all provinces for complex cases.
Now, in partnership with the Ministry of Health and Population (MoHP) with the involvement of various departments of health services, KIOCH is also implementing the PEN-Plus project in Nepal.
The Package of Essential NCD Intervention-Plus (PEN-Plus) is an integrated care delivery model focussed on alleviating the burden of non-communicable diseases (NCDs) such as type 1 diabetes (T1D), rheumatic heart disease (RHD), congenital heart disease (CHD), and sickle cell disease by increasing the accessibility and quality of severe and chronic NCD care at first-level hospitals, as per koich.org.np. And that includes "working with the district hospitals in the public health domain to train the district hospital staff in early detection, and treatment of major non-communicable disease among children and adolescence," as per the doctor who revealed that communicable diseases are now the most important cause of death in Nepal.
So, how far does he feel his passion project has come? "We have achieved something, but we need more support from within the government, within the community, society, and obviously from the international community to be able to help children."
In a project that is entirely based on donations, the good thing that he finds is that "almost a billion rupees (kind, cash or pledges), either committed or raised, 85 per cent is from within Nepal".
"That is good and people have trust in something. There is a lot of responsibility on our part to make sure it doesn't go to waste."
