KATHMANDU, August 3: On Tuesday, Chandra Kumar Rai, 55, of Solukhumbu, underwent gallbladder surgery at Bir Hospital. However, he had to wait seven months for the surgery. In early February, he was referred to Bir Hospital by the District Hospital Solukhumbu. He also had high blood pressure and hadn't undergone surgery at that time. The doctor advised him to come to the hospital in mid-May. He arrived at the hospital in mid-May but was unable to have surgery due to high blood pressure. Then, on August 3, he finally underwent gallbladder surgery.
Ranjita Das, 47, of Bafal, Kathmandu, had to wait for four months for gallbladder surgery. She was initially brought to Bir Hospital in mid-April for treatment. However, the hospital summoned her in mid-July. In mid-July, she underwent surgery. Two years ago, she got an X-ray at a health center near her home, and gallstones were identified. The doctor advised that the surgery be completed on time and without haste. However, she went to Bir Hospital in mid-April when her back began to ache a lot. The surgical operation was completed after four months of waiting. Her gallbladder stone enlarged to 19 mm in size. She claimed that even after surgery, the back pain worsened. "If surgery had been done sooner, the gallbladder stone would not have increased."
Sarita Khatiwada of Sarlahi also waited for four months to undergo stone surgery at Bir Hospital. She came to Bir Hospital last mid-April due to health problems. She said that after knowing that Bir Hospital is better and more reliable than private hospitals, she visited for a health check-up and waited for four months for surgery. Her surgery took place in mid-July.
The situations described above serve as examples. Bir Hospital's waiting lists for surgeries are reportedly long, according to both the admitted patients and the doctors. This suggests that health services are not yet efficient and convenient to use, especially at government hospitals.
An urgent plea to protect healthcare providers
Problematic waiting period for months
Even a decade and a half ago, one had to wait for months to get a turn for surgery in Bir Hospital. The situation is still the same even now. It has not been improved. According to the director of the hospital, Santosh Paudel, although in some departments, the time for surgery comes quickly, in others, one has to wait for months. It is difficult for patients to receive healthcare on time for kidney stone removal, kidney transplant, bone transplant, and urology surgery. Paras Mani Shrestha, urologist of Bir Hospital, says that patients have to wait for six months to get an appointment for urology surgery.
Piyush Dahal, former dean of the National Academy of Medical Sciences and burn plastic surgeon, says that in recent years, Bir Hospital has been working on a plan to eliminate the need to wait for a long time for surgery, but it has not been effective. “There have been no changes in the surgical service according to time," said Dahal.
Shortage of operation theaters and manpower
Bir Hospital is the oldest and most reliable referral hospital in the country. The treatments are also provided under the health insurance program. The hospital also provides various services and facilities for the patients. Due to this, the number of patients coming to Bir Hospital has been increasing. Director Paudel says that due to the lack of equipment, operating rooms, doctors, anesthetists, and medical treatment, patients have to wait for months for surgery. He says that due to the increase in the number of patients in Bir Hospital along with the health insurance program, there is a delay in carrying out surgery. Bhupendra Basnet, vice-Chancellor of the National Academy for Medical Sciences, also says that as there are no doctors according to the volume of patients, patients have to wait for their turn for surgery. "The main reason is because of the high number of patients,” he said.
Urosurgeon Shrestha says that despite the lack of management of operating theaters and specialist doctors, patients under the urology department have to wait for a long time for surgery. “After the construction of the new surgical building, we asked for more operation theaters but we did not get them,” he said. Shrestha says that due to the quality, cheap, and free services at Bir Hospital, the number of patients has increased, so they have to wait for their turn for surgery. But he said that patients who are at risk are being operated on immediately.
Patients believe that Bir Hospital has quality surgery at a low cost. That's why the patients want to undergo surgery at Bir Hospital, despite having to wait for a long time, instead of visiting a private hospital. “Treatment, which costs Rs 200,000 to Rs 400,000 in private hospitals, is being provided for Rs 20,000 to Rs 30,000 at Bir Hospital,” said Director Paudel. According to the former Dean Dahal, the surgery is being delayed even though the hospital is not making maximum use of the resources it has. He said that after the construction of the new surgical building, the number of surgery rooms and daily surgery quota that should have been added is inadequate. According to the hospital, when the building was old, the hospital had nine operating rooms. Six operating rooms have been added to the new building. There are 250 doctors in the hospital. Out of which 80 are surgeons and 19 are anesthetists.
Measures to reduce the wait
The director of the hospital, Paudel, says that preparations are being made to increase the number of surgeries by performing additional surgeries. According to him, Bir Hospital provides health services from 8 AM to 4 PM. Paudel says that they are planning to provide health services by giving incentives to doctors for working after the normal office hours. For this, the hospital is planning to conduct additional outpatient services even after 4 PM and provide surgery services by charging more than the current fees. Paudel said, “By providing this service, both the doctor and the patient will be relieved.” According to him, Bir Hospital is not in a position to add more surgery rooms in the current structure of the hospital building. He says that the main way to solve the problem is to further mobilize the existing structures and resources.
Paudel says that if the government makes a policy to encourage doctors to perform a large number of surgeries, the morale of doctors will increase, and more surgery services can be provided. According to him, the surgery service is both risky and complicated, but the service provided to the doctor remains the same; those who examine the patients in the hospital, those who perform only a small number of surgeries, and those who perform a large number of surgeries get the same incentives. He says that the doctors’ morale has gone down due to the attacks by the supporters of patients whose health complications are raised after the surgery. “Many doctors don't want to do complicated surgery once they get attacked by the public,” he said.
