On the first floor, a large group consisting of both patients and visitors is awaiting its turn. There are parents carrying babies, pregnant mothers, and elderly citizens. The seating area is packed and some of them are sitting on the floor.
The 112-bed hospital has been serving more than 1,000 people daily. And the number of patients is rising. "The hospital lacks infrastructure to cater to a growing number of patients and visitors," says Prof Dr Bidhan Nidhi Paudel, executive director of the hospital. “Insufficient infrastructure and human resources are hindering our efforts to deliver quality health services." Dr Paudel says the hospital plans to extend the hospital and its services. The plan includes a 10-storey building with 1,000 beds. Once the government approves the budget, the construction work will begin. The hospital is hopeful of an early approval. "If we could shift the OPD to a new building, managing this kind of crowd will be no problem,” says Dr Paudel. For now, patients and visitors at the hospital will have to contend with the crowd, and service delays that come with it. Minimum two months waiting list for surgery The waiting list of patients needing surgery is serpentine, literally. “Some patients have been waiting for eight months. It takes a minimum of two months for surgery, depending upon your case,” says Dr Paudel. Though compiled data is unavailable, a large number of patients have been waiting for treatment from ENT, orthopedic and other surgery departments. The reason for the delay of surgical cases is the ongoing repair of four operation theaters. This could take another one-and-a-half months. "Once the operation theaters become operational, the number of patients on the waiting list will go down by half," says Dr Paudel. Right now, the hospital is performing emergency surgeries. Limited services Lack of infrastructure has made the hospital unable to provide multi-specialty services as well. Many patients are referred to other hospitals, as services related to spine, kidney and neuro, among others, are not available. The hospital has been offering MRI services with the 0.35T MRI machine, which cannot perform brain imaging. “If we had enough space and resources, we could have met the public’s demands to deliver multi-care services,” says Dr Paudel. Online registration, limited But there is a lot the hospital needs to improve on. It's not just the infrastructure it lacks. The hospital has an online registration system for patients. It’s a welcome initiative meant to serve the public better, but the service is pretty much limited. “According to the rules of the hospital, patients can buy tickets from 12:00 pm to 11:59 pm. For today, the hospital has already distributed a limited number of online tickets,” reads the hospital’s pre-registration page when this reporter tried accessing it. This means one thing: The hospital has run out of tickets for today. Try your luck tomorrow between the designated hours. “Online booking are meant to save your money and time. But you can only book ten tickets in a day,” says Santosh Bastola, who has come all the way from Khotang to get his grandparents Renuka Devi Bastola (81) and Namo Narayan Bastola (83) checked. "How is this helpful?" Limited online booking service means people queuing up from early morning, crowding the hospital counter and the parking space outside. “I stood in the line for more than three hours to get the token,” laments Sunita Shah, a resident of Lokanthali. But her struggle is nothing compared to those people who have come to the hospital from outside Kathmandu Valley. Service seekers wish the hospital increased the number of online tokens, so they could make appointments easily. “There were different lines for the civil servants and the public earlier. But now they are in the same lines, making the lines longer,” says Bastola. Service seekers also want the hospital to give priority to the elderly and disabled while delivering services. Open drainages and a dog on the loose It would also do well for the hospital if it put some effort to keep its building and surrounding clean. Open drainages on the hospital premises pose a huge health risk. The hospital staff do not seem to care that they are breeding centers for germs, especially during the summer. The hospital corridors and other sections also need some serious cleaning job. Old beds, couches and discarded stuff litter the building. And don’t be surprised if you encounter a stray dog walking idly by in the corridors. Vacancies announced, protest began The hospital needs consultants and experts to deliver quality health services. Treatment services need to be expanded covering spine and kidney diseases. For this, the hospital has announced vacancies—to be filled internally and externally. Amid all this, a group of employees have launched a protest demanding resignation of the hospital’s executive director and scrapping of the vacancy announcement. “The employees and doctors are hindering the process for fulfilling vacancies because they know it is a cut-throat competition and they don't want to sit in the exams fearing that they will fail. The vacancy has been announced after a decade and it will be fulfilled through examination and interview. Deserving candidates should come forward to improve the services. ,” added Dr Paudel. Crunch of medics in Nepal: WHO The World Health Organization has said that there is a shortage of medical practitioners in Nepal. In a recently released WHO health workforce support and safeguards list 2023, the UN health body has identified 55 countries as vulnerable for availability of health workers required to achieve the UN Sustainable Development Goal target for universal health coverage (UHC) by 2030. The UN health body has enlisted Nepal in the list along with Bangladesh and Timor-Leste from the Southeast Asia region. No less than 55 countries are struggling with serious health worker shortages as they continue to seek better paid opportunities in wealthier nations that have stepped up efforts to recruit them amid the COVID-19 pandemic, it has said. “Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems do not have enough and many are losing their health workers to international migration,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. The countries included in the WHO health workforce support and safeguards list 2023 have a UHC service coverage index below 55 and health workforce density below the global median: 49 medical doctors, nursing and midwifery personnel per 10,000 people. These countries require priority support for health workforce development and health system strengthening, along with additional safeguards that limit active international recruitment. The WHO does not prohibit international recruitment, but recommends that government-to-government health worker migration agreements be informed by health labor market analysis and the adoption of measures to ensure adequate supply of health workers in the source countries; engage Ministries of Health in the negotiation and implementation of agreements; and specify the health system benefits of the arrangement to both source and destination countries. The health body noted that the negative health, economic and social impact of COVID-19, coupled with the increasing demand for health and care workers in high-income countries, might be increasing vulnerabilities within countries already suffering from low health workforce densities. According to Nepal Medical Council, there are 10,080 specialized doctors, 27,805 MBBS and 4,413 BDS registered doctors in the country. According to Nepal Nursing Council, there are 73,889 nurses registered in the country. The medical practitioners have been migrating to developed countries seeking better pay and facilities.
