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Quick facts Born on 24 July 1960 in Palpa Graduated from Kharkiv Medical Institute, Ukraine  Post-grad from National Institute of Cardiovascular Diseases, Dhaka University, Bangladesh  First performed open-heart surgery in 1997 Husband of Sandra Koirala Father to Nirabh Koirala I started my career as a young doctor at the Tribhuvan University Teaching Hospital. I worked as a house officer and later as senior house officer at the departments of casualty and surgery. I later joined the Department of Surgery as a junior faculty.  I pursued medical studies because I was interested in this field from a young age. I credit my lecturers for encouraging me to earn a career in medicine, particularly in the area of cardiac surgery.  I led the open-heart surgery program at the Teaching Hospital in 1997. The first open-heart surgery by a Nepali team was a milestone in the Nepali medical fraternity. Within three years of that historic surgery, 132 open-heart surgery cases were performed in Nepal. I converted an old shoe factory into a fully functional, high volume and efficient heart hospital, which helped a lot of heart patients.  Until 1997, regular open-heart surgery was rarely performed in Nepal. Every now and then, foreign cardiac teams used to visit Nepal to perform the procedure, but only a handful of patients benefited from such visits. Most patients couldn’t even visit India for treatment because they couldn’t afford the cost. This compelled us to establish an open-heart surgery service in Nepal itself.  When we started the open-heart surgery program in Nepal, we experienced several difficulties in the beginning because our resources were limited. Surgeons, anesthetics and nurses from Teaching Hospital had received a short training abroad to form the first all-Nepali open-heart surgery team. We assembled donated old instruments and machines for open-heart surgery.  The team also mobilized local dealers with available disposables, oxygenators and the prosthetic valves in the country. With the limited budget and resources, the hospital was able to purchase only a few spare parts for old instruments and machines. We didn’t have the budget to buy modern machines for open-heart surgery.  For the first four months, the team had only performed simple congenital repairs. As the team gained more experience and confidence, we started performing more complicated surgeries, including valve replacement surgeries.  But without intraoperative and perioperative supportive mechanical devices, such as transesophageal echocardiography, transducer and cardiac output monitors and intra-aortic balloon pump, the team didn’t perform complex congenital heart disease and coronary artery bypass surgery. Still, a large number of patients benefited from regular open heart surgery service.  The cost of these surgeries in Nepal was almost two to three times cheaper than that in India.  After the establishment of regular open-heart surgery in Nepal, a large number of hospital staff and residents also got the required exposure and training on the field. Today, it is easier for the cardiac centers in Nepal to perform open-heart surgeries. I have performed or directly supervised over 13,000 heart surgeries to date.  During my short tenure at the Teaching Hospital as the executive director, I cleaned up many irregularities and rescued the hospital from the brink of financial collapse. I also started a ‘Poor Patients Relief’ program in 2003, with the support of the government at the time, to provide free cardiac care for children, elderly and the poor.  Nepal still has a long way to go in order to be a prosperous nation. To achieve the desired growth and development, we should focus on some key areas. Health is one of them. To build this country, we need a physically and mentally healthy population.  The state must ensure quality healthcare for all. Nobody should be compelled to leave the country for treatment. To make this possible, we must improve our healthcare infrastructure, human resources, and management. There must be at least one hospital in the country with the facilities and resources to treat every kind of disease. It is also important to improve the quality of healthcare services at government-run hospitals and health facilities. They should at least maintain a minimum standard of care, which must be monitored regularly. Every province should have a multi-specialty hospital with an adequate number of specialists. Community health service is the backbone of Nepal’s healthcare. Our female community health volunteers are filling the health accessibility gap in rural areas, where doctors and healthcare workers are few and far between. So, until we can expand our health infrastructure and the number of professional healthcare workers across the country, our immediate concern should be improving the skills and capacity of our female community health volunteers. About him Surya Koirala (Uncle)   I was his senior at school, so I was like his guardian. When we came to Kathmandu, we stayed together and there too, I was his guardian. I never saw him indulge in bad habits. He is a sincere, honest and hardworking person. I'm proud of his contributions to the Nepali medical field.  Aalok Mishra (Student) For a medical student like me, Dr Koirala is one of the great sources of inspiration as we look up to him in each aspect. He has achieved his higher level studies from abroad but has always provided service to his country where he belongs. His contribution, open-heart surgery is a great achievement in the surgery field. Not only is he well performing in professional life but also a social worker. Bindeswari Gurung (Colleague)  Without his leadership, it would have been difficult to start open-heart surgery service in Nepal. His vision and mission toward Nepali healthcare system made it possible. Dr Koirala is always available for patients no matter how busy he is. Even if he fails to attend patients at OPD, he calls them at his office, which boosts the psychology of patients.

A healthy, educated, and hospitable country

Three ways to realize the vision: 

1) Ensure quality health care for all
2) Provide education for all and encourage meritorious students
3) Develop eco-friendly infrastructure 

Nepal still has a long way to go in order to be a prosperous nation. To achieve the desired growth and development, we should focus on some key areas. Health is one of them. To build this country we need a physically and mentally healthy population. We must also learn to be more cordial and kind, which will not only foster cooperation and build a peaceful society but also help promote tourism. 

Again, there are many engines that drive a country, but health, education, and infrastructure are the major ones. We should work on these three fields simultaneously to elevate our society.

Quality and accessible healthcare

The state must ensure quality healthcare for all. Nobody should be compelled to leave the country for treatment. To make this possible, we must improve our healthcare infrastructure, human resources, and management.

There must be at least one hospital in the country with the facilities and resources to treat every kind of disease. It is also important to improve the quality of healthcare services, particularly at government-run hospitals and health facilities. They should at least maintain a minimum standard of care, which must be monitored regularly. Every province should have a multispecialty hospital with an adequate number of specialists.

Also read: Onsari Gharti Magar: Make Nepal a socialist country

The government should also create adequate positions for all levels of health care workers, to fill in the gaps of HR. The minimum wage and other incentives for healthcare workers should be revisited. We should increase the number (pool darbandi) of positions of doctors and mobilize them to the primary level health facilities. This diversification and decentralization of healthcare workers will improve public health access. 

The other area of improvement is the quality of leadership in healthcare. Incompetent leadership is a major problem besetting Nepal’s healthcare, which owes largely to the culture of political appointments. So we should let experts’ panels rather than political leaders choose the leaders of our health institutions. The head of any health institution should have the managerial knowhow and skills to ensure smooth daily operation. A prospective manager should have a course or training on basics of management and public procurement rules. 

If we have well-functioning and robust institutions, it won’t matter even if the country’s politics and the leadership are faring badly.

The Government should also fund the treatment of curable pediatric conditions and establish multidisciplinary pediatric institutions. Partnership with non-profit organizations is one way to do this. We should look at this as an investment for our future generations. 

Likewise, treatment of non-communicable diseases and surgical conditions must be included in the national health programs so as to achieve universal health coverage. All these areas need funding and the sustainable way to do so is through national health insurance, which should be mandatory for all. The efficiency and capacity of the Health Insurance Board should be improved.

Community health service is the backbone of Nepal’s healthcare. Our female community health volunteers are filling the health accessibility gap in rural areas where doctors and healthcare workers are few and far between. So until we can expand our health infrastructure and the number of professional healthcare workers across the country, our immediate concern should be improving the skills and capacity of our female community health volunteers (FCHV). One way is to recruit FCHVs with more formal health education and give them incentives.

Education to develop well-rounded individuals

Education is another area where Nepal needs to improve. This country needs well-rounded individuals and for this we must change our approach to education. From early on, children should be taught social science by their parents and teachers. This will teach them moral values and behaviors that will serve them well for the rest of their lives. 

First, we must focus on improving education-access by investing in schools and colleges across the country. Each province must have at least one academic institution that offers quality higher education and produces qualified graduates in many disciplines. Nepal must decentralize its education so that students don’t always have to travel to Kathmandu to pursue higher studies.

Second, basic education should be made free and compulsory for all. As for higher studies, there should be merit-based admissions and need-based scholarships. 

The government and educational institutions should also offer internship and placement programs for new graduates so that they can get a head start before they begin their professional careers.

Eco-friendly infrastructure  

While infrastructure development is the key to economic growth, it can also have a deleterious impact on the environment. So Nepal needs eco-friendly methods of building infrastructure. We should always be mindful of the environment while developing large infrastructure projects. 

At the same time, we should plan for new settlements for relocation of villages in extremely remote and high altitude regions, where infrastructure like roads and bridges are difficult to build. This approach will help the economy and protect the environment.     

Nepal should also invest in green energy infrastructure and take steps to reduce the use of fossil fuels. For example, we can start by banning fossil fuel vehicles and domestic wood burning in conservation and national park areas, where many international tourists visit. We should then gradually phase out fossil fuels. Our leadership should set a time-bound goal for this. We must be ahead of the curve in climate action. Doing so will not just reduce pollution but also send a positive message about Nepal’s commitment to climate and environment conservation. 

Quick Questions:

1. What would you be if you were not a doctor?

I can imagine being anyone else other than a physician. But, if at all, a health assistant. I could also have become a carpenter.  

2. What is the best part of being a doctor? 

The satisfaction you get when you treat your patients.

3. A quote you live by.

I have two actually: ‘Set your expectations right’ and ‘Keep your weight and wealth slim’.