A daring doc’s dedication
Until 2008, kidney failure was a curse for the majority of Nepalis as no transplant was possible inside the country. Deprived, and bereft of resources they could not afford to go abroad as that meant a whopping sum of Rs 1.5 million. Afflicted people were left with no option but to go for dialysis and wait for a slow death.
Time has changed for the poor, thanks to the idea of opening the kidney transplantation units that have taken full shape since 2008. This was perhaps the most awaited news for kidney patients and their relatives as the country’s oldest medical centre, Bir Hospital, geared up to carry out overall treatment process at a total cost of Rs 500,000.
As a result, the service got accessible to even a person like Nirmala KC, a resident of Rukum, and some who had organ donors, like her husband Bishwo KC, but who couldn’t afford to go India or elsewhere to have it transplanted.
Some three years ago, when the first kidney transplant service in the country was being carried out in Bir Hospital, the transplant team was worried that it would fail again like it had in 2004. But, their second attempt in December 2008 not only proved successful, it also surpassed international standards in some respects. The international average rate of post-transplant infection is five percent, but Bir’s dedicated team managed to slash it to a mere two percent. The Bir Hospital kidney transplantation unit has maintained zero per cent failure rate, till date.
Normally, government hospitals are not known for excellence in Nepal, but the kidney unit at Bir is breaking new ground. The success was due to the leadership of competent surgeon Dr Pukar Chandra Shrestha. This competent medic was working in government hospitals in the UK as a renal surgeon for six years, on a handsome salary but he preferred to quit that attendant security and chose to return home to apply his expertise to the service of his home country. He worked in three hospitals-Liverpool, New Castle and Burmingham-during his stay in the UK.
Bir Hospital attempt in November 2004 to transplant a kidney failed owing to the lack of expertise and adequate equipment. After four years, when the hospital decided to resume the work, Dr Shrestha quit his job in UK to lead the transplant unit. “When I came in 2008, the dust-ridden equipment was locked inside a room as the transplant unit was defunct,” he recalled his initial days at Bir Hospital. “The equipment was not adequate and I had to use my own operating instruments which haven’t changed even today.”
In December 2008, a team led by Shrestha including surgeons Dr Bijaya Kumar Sharma, Dr Damodhar Pokharel, Dr Bisworaj Joshi and Dr Paras Mani Shrestha including Dr Sandip Gulariya of All India Institute of Medical Sciences transplanted two kidneys at the hospital. Since then, Shrestha’s kidney team has been conducting transplants every Sunday. He is not satisfied with the frequency of transplants and wants to offer services every day. “I decided to return hoping that I would get to serve the public to the fullest of my ability, however the lack of facilities here has been a dampener,” Dr Shrestha lamented.
Even after three years of beginning transplant services, the unit does not have its own operating theatre and instead uses the theatre of Neurological Department. The unit also lacks dedicated nurses. “Managing the staff and facilities for transplants is like fighting a war,” Dr Shrestha said. His repeated pleas to the Health Ministry have fallen on deaf ears.
It is estimated that around 2.8 million people in Nepal have some sort of kidney problems while 3,000 people suffer from kidney failure every year and 90 percent of such people die without proper treatment. At present, just 100 transplants are conducted in Bir Hospital and Tribhuvan University Teaching Hospital every year. Dr Shrestha says he is willing to conduct more surgeries every day and if government provides adequate facilities more than 300 transplants can be done annually in Bir alone. In the absence of insufficient human resources and a dedicated operation theatre, the waiting period for kidney patients is over nine months.
The hospital management says that the transplant unit in Bir has proved excellent despite the inadequate facilities and expertise.
“Dr Shrestha has shown his competence in leading the unit and achieved excellent results despite many odds. I doubt that anybody other than he could have done it,” said Dr Buland Thapa, Director of Bir Hospital.
He added that Dr Shrestha and his team have made transplants in Bir the cheapest in the world, including diagnosis, operation and bed charge.
The record at the unit shows that of the 64 successful transplantation in Bir Hospital, just two percent of the patients had urology complaints like urine leakage and urniary impudence. This stands as a seven percent international record.
Kidney donation is regulated in Nepal by Human Organ Transplant Act-1998, which requires donors to provide a formal consent letter. With a view to control trade in kidney, the Act limits kidney donors to close relatives, namely father and mother, uncle and aunt, sister, brother, adopted son and daughter of the patient. As a result, many renal patients are unable to get a kidney for transplant due to constraints imposed by the law.
In order to maximise the list of potential donors, Dr Shrestha and his team have started registration of the persons willing to donate their organs, specially after brain-death. Over 60 people have signed up already.
Born in remote Baglung district of Western Nepal, Dr Shrestha has served in government hospitals both in Nepal and the UK for most of his life. Even as he seems frustrated with the pace of progress in Nepal, he isn’t giving up. He is now trying to work with New Castle Hospital in the UK to provide some exposure and training to improve the competence of Bir’s staff.
Posted on: 2011-09-19 08:41
Post Your Comment
Today's Paper
The Kantipur in Print
FROM THE PAST 7 DAYS
ENTER KEYWORD OR DATE
FROM THE PAST 7 DAYS
ENTER KEYWORD OR DATE
Abin
All of them discussed the issue. The result was the same...and we have committed to continue discussions on the issue till midnight.
ADVERTISEMENTS
OUR PUBLICATION :
