On November 3, 2012, Dr Bishesh Poudyal with his medical team performed the first ever bone marrow transplant in Nepal at Nobel Hospital Pvt Ltd. The procedure is aimed at replacing damaged or destroyed bone marrow with healthy bone marrow stem cells to cure diseases in the blood-building system.
Dr Poudyal, clinical hematologist and bone marrow transplant physician, has already carried out bone marrow transplant in three patients since they started. He says that there’re other two to three patients lined up for transplant. [break]
The Week’s Asmita Manandhar caught up with Dr Poudyal to talk about his medical journey including his efforts to make bone marrow transplant surgery possible in Nepal.
Bhaswor Ojha
What made you realize the need of bone marrow transplant surgery in Nepal?
When I first started clinical hematology at Bir Hospital in 2007, we used to diagnose many benign to malignant blood related diseases. We used to work hard to help the patients recover from these diseases with the best available resources at the hospital. But when it came to blood cancer patients, though chemotherapy was available, many cases could not be resolved by it. When there were cases which required bone marrow transplant surgery, we had no option but to refer the patients to India.
I used to feel really helpless at that time. The feeling used to be even worse when we had to send patients who suffered from relapse after chemotherapy. At that point, I realized there was a huge void in the treatment of blood cancer in Nepal due to lack of bone marrow transplant service and that we should take appropriate measures to make the service available.
How did your plan materialize?
I tried to convince government authorities to invest in bone marrow transplant surgery equipments and trainings, but I couldn’t convince them enough. When Dr Lochan Karki, director at Nobel Hospital, contacted me regarding bone marrow transplant prospects in Nepal, I was more than happy to oblige.
At that time, I was working at Christian Medical College and Hospital at Vellore, India. Following a phone conversation, he visited my workplace with a few of his board members. Then, we began researching ways to make the surgery possible in Nepal. It required much patience and hard work and apart from that, we also needed a highly skilled team. So, we contacted experts who were performing the procedure at different hospitals in India. After about four years of research, we were able to successfully carry out bone marrow transplant surgery in Nepal.
Now that you’ve succeeded with the surgery, is there any hope of help from the government? And why is it important to have the government interested in it?
Yes, after we succeeded in the procedure through personal approaches, the government has also changed its stance and seems positive regarding investment on infrastructures and human resources. And I think that the concerned authorities have also realized that it’s high time to have bone marrow surgery in Nepal.
It’s important to have government’s interest and support because the surgery is highly expensive and government hospitals have budget allocations and subsidiaries because of which the surgeries can be carried out at a much cheaper rate. Investment from the government’s side can benefit many people who require the procedure but have limited resources to fund it.
Before the initiation of bone marrow transplant in Nepal, what kind of ordeal did patients have to face?
Though the charge at the hospital I worked at in Vellore is cheap, it’s still an arduous task for the patients and their families to travel to India for treatment. They’ll also need a lot of time to figure out the system in a different country. Many a times, the patients are unaware of the procedures being carried out by the medical team and there’s no explanation from the doctor’s part. Then, apart from the hospital and surgery costs, they’ll also need to take care of other expenses like food and accommodation.
What’s the total cost of such surgeries in Nepal and are there any other benefits for carrying out the procedure here?
Though the expenses in Nepal might vary according to the case and its complications, the whole procedure can be completed within six hundred thousand to 1.5 million. There’re two methods for a bone marrow transplant. Autologous transplants involve the infusion of the patient’s own stem cells to the damaged parts and this kind of transplant is relatively cheaper while Allogeneic transplant requires a donor’s stem cells and hence is more expensive.
Apart from low expenses, we also make sure that we provide a detailed description of the procedure to our patients and their families, so that they don’t get anxious or worried during the procedure. Another good thing is that, we’re being able to provide services and treatments of international standards to patients.
From your experience, what do you think about the trend of patients with blood related problems in Nepal?
Back in 2007, when I had just started practicing as a clinical hematologist, we had very few cases. Now after seven years in this field, I can say that the number of patients was less then because people weren’t aware of blood related problems. Also, there were very few hematologists and other doctors were in a fix regarding referral of those cases.
Currently the number of patients has escalated drastically. Though there’s an increase in various blood related problems, the number of people suffering from blood cancer is also increasing significantly. There’re around 30 new cases of blood related disorders every day.
Is there any sort of pattern that causes blood cancer in Nepal?
Though it’s hard to point out the exact causes of blood cancer, excess exposure to radiation, certain viral infections, use of chemotherapy for cancer patients and excessive use of benzene chemicals, that are found in paints, rubber and leather industries are some of the triggering factors.
One important fact about the pattern of blood related diseases is that, it’s increasingly seen in people who have been a migrant worker in Arab countries in the past. Excessive contact with paint and petroleum might have been the culprit in those cases. These issues need to be addressed separately.
Also, age is another interesting factor in Nepal. The patients with blood related problems are either above 50 years or below 15 years of age. Earlier, we used to treat children as well but now we refer them to Kanti Children’s hospital, where these cases are handled by highly specialized doctors.
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