Dr. Anil Bhattarai MD, MS, FCS, PhD
A consultant cardiovascular surgeon, TU Manmohan Cardiothoracic vascular and transplant center (MCVTC), Kathmandu, Nepal.
Dr Anil Bhattarai holds MS degree in cardiovascular surgery with continued PhD degree in the same subject from University of Padova, Italy,as well is even the first Nepalese individual to be awarded and honored with The FrancisFontan Award in 2011 AD, in Lisbon, capital of Portugal. The Appreciation is annually proffered to a talent in recognition of being ‘Young and Emerging Scientist’ on behalf of European Association for Cardiothoracic Surgery. Dr Bhattarai, who is working with capacity of Assistant Professor at MCVTC of Teaching Hospital, Tribhuwan University, has had profound trainings and rich experience gained from Switzerland, Austria, Spain, Portugal, Russia, USA and England in course of studies and other trainings cum seminars. Dr Anil Bhattaraiworks in the team of DrBhagawanKoirala, this team have recently introduced for the first time in Nepal new technique in the field of Heart surgery which called Minimally Invasive Technique, the team performed some open heart surgeries successfully with this new technique in TU MCVTC, Kathmandu.
Recently few patients with atrial septal defects (ASD) (hole inside the heart) underwent operation with only 4-5 cm small incision and total peripheral cannulation. For the first time in Nepal internal jugular vein cannulation was performed to conduct these operations. This new technique used to perform some selected open heart procedure through small incision in lateral wall of the thorax instead of doing traditional long midline (median sternotomy) incision. All operations performed successfully and all patients discharged home without any major complications.
A routine median sternotomy (incision in the middle of the chest) has been the conventional approach for surgical correction of ASD for many years. However, it often yields to poor cosmetic results with displeasure and psychological distress, especially in young female patients.
Here is an edited version of a talk by Rudra Bahadur Karki with Dr. Bhattarai in regard to charisma, chances and challenges of health sector in Nepal.
1) How have you been observing the present health condition of Nepal?
In fact there has been a remarkable revolution in health sector of Nepal in the last decade. Before than it, the district hospitals of Nepal would almost remain devoid of doctors. Only two or three medical colleges were there in the nation. The figures has proliferated nearly two dozen now. These days doctors are accessible up to the grass root of the country. Government has surmounted in establishment of health posts in each of the villages. It can be inferred that there has been a vast reformation over health conditions in nation. Mother’s morality, child and infant mortality rate have substantially gone down. Talking in propos of heart related diseases, the number of heath hospital was nil before ten or fifteen years. Now there are two hospitals immersing with pious services in the area.
Similar type of noticeable improvements and galloping changes are tangible in other domains of human health as well. Nonetheless this remark should never be synopsized to argue that everything of now is ok and has been up to the demand; it is crystal clear that things to be done for upcoming days are in due, a lot. At the moment, the cardinal challenge of Nepal is poverty. The situation of struggling to tackle hand to mouth problem still has enveloped many people. As poverty and prosperity in health sectors are binary oppositions to each other, health happiness can never be fully imagined unless poverty is eradicated. Viewing from the location, still a lot of works are to be unleashed in this area albeit the changes in comparison of past are worthy of cheers. Despite constant increment in number of health institutions, the question of quality is consistently being critical and ever attention driving.
2) Sometimes the patients’ casualties are reported on ground of doctors’ and medical staff’s sheer negligence. Are doctors really so very carefree towards responsibility?
I have reconfirmed already that a lot of things are to be improved in this sector though the progress in comparison of prior time is noticeable enough. The chef challenge of this nation is poverty; so the treatment is beyond reach though the total properties of villages are sold for medication and other curing options. But Nepal has made a significantly forwarding move in domain of heart related diseases. Our speed and acceleration in technological adoption is also admirable. The promotion of quality together with proliferation in number of health institution is an inseparable issue of discussion. And I hereby take pleasure to assure and convince that health institutions are capable enough for quality as well.
I refuse to believe on the preposterous remarks that doctors do for death of patients. They should not be blamed for some usually accidental and unavoidable circumstances during treatment, medication or operation. We have a wrong trend of approaching to medical institutions only at the eleventh hours when mostly the condition of patient is irrecoverably deteriorated. Kith and Kins normally expect to have automatic recovery at the home only; and when the situation goes in haywire, they think of taking in hospital. In such, mere doctors’ best wishes and endeavors won’t always turn to be fortunate for them. The prime factor is late and delayed entrance at hospital.
3) The health services of Nepal is said to be out of access for commoners. What is your assumption about it?
I believe not on it. Government owned hospital and health posts are nowhere and never out of publics’ reach. The must and possible services are regularly being discharged from those stations. But the tragic tale of the side is that, the number of hospitals and medical offers and officers or doctors is not as per the manageable proportion of the number of population. The people from far remote i.e. Humla, Jumla and other parts of country should incur a heavy financial expense to come to capital city for the medical treatment. Hence these special services should be extended throughout the nation. Health healings for people in any geographical part and topographical variation will be effectual only in that condition. City based service centers and health posts resulting in serene absence of health facilities to people of remote is one issue whereas the next is that people do not have idea about health insurance. In abroad, each one has health insurance. The access on facilities and healing on hazards both will be a great deal manageable if provision of health insurance can be implemented among people.
4) It is often said that doctors prefer to be profit motive than service motive. Hence they rush towards many clinics but don’t remain serious and conscious as demanded. So, many of patients get compelled to lose life. How do you perceive this charge?
Though this claim sometimes holds very little truth; I gainsay it and confirm that the condition is never so in large amount of reporting. If talked about us, we keep working till late evening as well, though our official duty is only up to 5 pm. From early dawn to late dusk, we are in hectic schedule, sometimes. Time constraint is irrational and inapplicable in cardiovascular related operations. Those cases can’t be ceased in the middle. Hence, I strongly refuse this charge of being slipshod on the duty.
5) In recent time, the hospitals are also in deep political encroachment. Moreover, the Teaching Hospital faced many demonstrations and hunger strike of renowned and senior doctors against of this encroachment. How far rational and justifiable is it to make hospitals a politically coloured institution?
The large scale organization may have some negligible loopholes. Provided there are no people to pinpoint them, the application of corrective measures may be off the road. The first and foremost duty of doctors is to serve the health hazards of patients. How to cure and recover the patients should be only the area of devotion and dedication for us. We, every one of cardiovascular department, remain ever conscious on the very issue. Therein lays the real success of doctors if we can make the patient return home with happy face.
6) In Nepal we have seen doctors themselves in demonstration. Is that admissible deed?
Even to burrow your exact dictum, this hospital was neither totally closed in that time. The emergency service was in full swing operation in that time as well. Though residential doctors were in movement for couple of days, faculties never decoupled their duties and remained ever on station. If targeted to us, I should make you known that we were mostly busy in operation theater when there were demonstrations outside.
7) Recently doctors have been raising an issue of professional insecurity. How do you respond on the provision of institutional compensations by hospitals if patient loses the life in course of due treatment?
One of critical questions, this is. I would love to clear that doctor is not the god. Doctors can heal the patients and elongate the life but cannot endow immortality. They ease the patient to live a little ahead. Even though patients die in course of time, this is universal acceptance throughout the globe. But the major challenge here is un-education. If a heart patient dies in course of treatment, people question on how about. Cardiovascular hazards are of different types varying from too normal to extremely risky. Each patient is not assured for better recovery which poses the question of insecurity. In foreign land, even each doctor is insured so that they feel secured, that we have not commenced yet. Thus is it must to assimilate and convince correctly that sometimes patients may have misfortune while in treatment but the number and ratio is very less like below that 2 or 3 percent. Hence the prime concern is to aware people about this indispensible reality.
8) So then, finally, what measures should be adopted to make health facilities accessible to each commoner.
The increment in number of patients in Nepal is being regularly underpinned because of vast poverty as well. The one with problem of hand to mouth each day expects no illness to attack them, tries healing in home itself if faced problem and only takes to hospital when internalizes that the condition is beyond control. Such the eleventh hour patients cannot be always guaranteed with health recovery.
Besides awareness, government has to extend the services and amenities up to the bottom level of administrative unit of the nation. Health posts should be diversified and decentralized. As instance, the number of only two heart hospitals should be expanded in to various areas. Though not possible into each of the villages, the expansion up to at least five developmental regions will be worth praising for this time. That might assure fast and fair health facility for people. It even takes it into lesser amount of expenses. This time an individual from Karnali as well should report to Kathmandu for treatment. State has to assure and ascertain him/her for treatment in own and respective area, where the expense of travelling Kathmandu will suffice for treatment.
In nutshell, there has been vast changes and improvements in comparison of past nonetheless we need to do a lot rather than growing gratified on this much.