Sarah Rooney and Nayan Pokhrel (Fixer)

Dr. Rohendra is excited about his brand new orthopedic wing. “The orthopedic department will have its own dedicated operating theatre,” he says with relief. “Until now, we have been sharing the hospital’s main operating theatre and have had to schedule all our surgeries on a single day each week.”

The Patan Hospital, founded in the 1950s as a mission hospital, is today one of the largest and busiest in Nepal. Though it is now a secular institution partially funded by the government, doctors at the hospital still uphold the founding ethos of treating all patients “regardless of religious affiliation or ability to pay”. Over the past decades, the hospital has had to extend both its premises and staff in order to cater to a huge population increase in what is considered to be the fastest urbanizing country in South Asia. With almost all of this urbanization centred on the Kathmandu Valley where the three closely connected cities of Kathmandu, Patan and Bhaktapur are situated, institutions like Patan Hospital are finding ways to cope with an ever-increasing number of patients.

In addition to patients from within the valley, doctors like Rohendra must make time for others coming from across Nepal. Remote, mountainous regions beyond the valley often have only one doctor for each district and rural clinics are ill-equipped to deal with complex cases or chronic disease. This grim disparity between urban and rural healthcare is indicated in infant mortality rates, which are more than twice as high in the countryside than they are in urban areas. One method used by Patan Hospital to assist rural doctors and patients too ill to travel long distances is to offer remote consultations via telephone.

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Alleviating daily aches & pains

With hundreds of consultations to process and patients to administer to, Dr. Rohendra is always on the move. At the hospital’s new orthopedic wing, he begins each day with a morning round of the beds in his wards. After treating inpatients, he heads to the orthopedic clinic to receive outpatients. Five doctors, including Dr. Rohendra, share a large room in which they spend each morning examining a seemingly endless litany of joint stiffness, arthritis, old fractures, aching shoulders, and severe back pain.

“Many of these aches and pains are due to manual labour and heavy lifting,” says Dr. Rohendra. “People in Nepal, both men and women, are too often carrying heavy loads and it leads to pressure in the spine and, ultimately erosion of the bone.” Even in urban areas, heavy lifting is a necessary part of life; much of the Kathmandu Valley is without running water during the dry season and women have to carry large pots of water from communal wells to their homes. Likewise, the lack of small-scale lifting machinery means daily labourers take on the task of hoisting hefty loads at construction sites, markets and scrapyards.

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The thrill of putting people back together again

“Why I became a doctor is a somewhat emotional issue for me,” says Dr. Rohendra. “My father wanted to be a doctor but he was unable to fulfill his dream, so ever since I was a little boy I learnt to say, ‘I want to be a doctor’.” In high school, Rohendra took the medical preparation course and discovered that he did indeed have a natural aptitude and keen fascination for the topic, so much so that he ended up spending six and a half years in Bangladesh studying medicine. “Bangladesh was an opportunity for me to experience a different country and a different culture,” he says. “There are lots and lots of patients there and not enough doctors so I learned a lot!”

In Bangladesh, he met a professor of orthopedics who inspired him to specialize in putting people back together again. “Orthopedics is all about mechanics – it’s like being a carpenter,” explains Dr. Rohendra with great enthusiasm. “It’s all about knowing the physics of the human body. As a good orthopedic surgeon you can do incredible interventions once you fully understand these mechanics and that’s precisely what I am wanting to do!”

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It’s not just about being a hero and rushing into burning buildings

The Emergency Department at Patan Hospital is prepared, not only for daily medical emergencies, but for large-scale catastrophe. Nepal is one of the most seismically active places in the world and, a major earthquake is now believed to be overdue. In 2001, Patan Hospital became one of the country’s first hospitals to create a disaster management plan. The hospital buildings underwent a seismic assessment and staff began practicing annual emergency drills.

“The procedure is already in place,” says Dr. Rohendra. “We will divert all incoming patients through the Emergency Department and categorize them according to urgency.” The colour-coded sorting method is starkly efficient – red (critical cases), yellow (non-urgent cases), green (to be discharged), and black (deceased). The rest of the hospital has been mapped out along zones that coordinate with each of these colours so that the potentially massive influx of patients can be dealt with as quickly and efficiently as possible.

Dr. Rohendra is aware his orthopedic skills will be in great demand in the event of an earthquake but he is keen to emphasize that it’s not just hospitals that need to be prepared for such a disaster. Equally important, is the pre-hospital response, which happens in situ and which requires awareness within local communities and volunteers with first-aid training who can look after critically injured people until medical assistance arrives.“Emergency response is not just about being a hero and charging into a burning building to pull out survivors,” cautions Dr. Rohendra. “It’s going to be very important for people to provide adequate care at the site of the incident. In terms of saving lives, it’s all about buying time until the patient can receive full and proper medical attention at the hospital.”

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This article is part of our ongoing series Tales from the Himalaya: Urban Lives in Kathmandu

Photos by Nic Dunlop for Asia Dialogue

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Categories: Health, Migration, Resilience, Safety and Security