As I walked past the corridors of Bir Hospital for this article, I was transported back in time. Twenty-four years ago to be precise. When I was a child back then, I would accompany my grandfather, a patient of bronchitis, to the hospital for his regular check-up. Bir Hospital has barely changed after all these years. The corridors that I walked as a child, the counters where patients and their relatives gather, and the hospital building itself look and feel the same. The only thing that seems to have changed over the years is the absence of natural lights that would pass from the windows to light up the corridors. The corridors need to be illuminated by electrical lights these days. Though Bir Hospital has constructed new wings and departments, its main building is falling into disrepair. The taps that were either broken or leaking, and windows that were without panes have not been fixed. Toilet doors that used to have bolts are gone now and the tap water is murky. The hospital bathrooms look and smell horrendous—hygiene and sanitation be damned.

Long queues, lack of sitting arrangements, wheelchairs

The hospital services are no better either. People holding medical reports while assisting their sick relatives to walk, elderly people sitting on the floor or wandering aimlessly wearing confused expressions on their faces, and long queues outside counters are common sights that you see here. The hospital lacks basic things like wheelchairs and sufficient seating space for patients and visitors. A hospital cleaning staff member tells me there is only one wheelchair in the emergency room. It is clear to see that the oldest hospital in the country is not functioning well. Established in 1889 by Bir Shumsher, Bir Hospital is where people who cannot afford private hospital fees come for treatment from around the country. The hospital receives around 2,000 patients in a day, but not every one of them gets the medical attention they need. The hospital boasts  multi-special care from more than 30 departments, not a single one of them is well-managed. There are long queues at the OPDs of every department, at the pharmacy, and at the laboratory. “There are queues everywhere. It is difficult getting anything done here,” laments Shreemaya Budhathoki, a 66-year-old patient who has traveled all the way from Lamjung district. Lack of nurses I have a distinct memory of following my mom around the hospital, looking for a nurse whenever my grandfather’s health deteriorated or his saline drip needed to be adjusted or replaced. The experience is the same for patients and their relatives who visit Bir Hospital these days. In a medical ward filled with more than 20 patients, I observed there were only two nurses to attend to their needs. My suspicion was confirmed by Dr Bhupendra Basnet, former acting executive director of the hospital, who told me that Bir Hospital requires over 500 nurses to provide smooth services to the patients. “If the hospital can recruit the required number of nurses, it could run the 500 beds in its new building,” says Basnet. “But there is a severe dearth of nursing staff.” A lack of nurses has also affected the hospital services. Out of 15 operation theaters, only nine are running. “There are only two trained nurses in our department. If we can recruit specialized nurses the service delivery can be increased,” says Dr Robin Bahadur Basnet, head of the Urology Department. Old equipment Outdated machines and equipment have also hindered services at Bir Hospital. Some of the equipment is so old that in case they are broken, services will be indefinitely halted. Dr Basnet says the hospital has not bought new equipment in a long time. “Every now and then we have to replace parts of the machines to make them work. We are still relying on old equipment to provide services,” he adds. But it is not enough that the hospital added new equipment, it also needs to train its staff to use them correctly. A UroDynamic machine, which was bought by the hospital five years ago, has still not been installed.  The machine detects whether the urine leakage in a patient is because of a neurological or prostate issue. The hospital staff are not trained and incentivized to carry out their duty effectively. “For the hospital to deliver quality services, the government must increase the budget,” says Dr Basnet, the former executive director of Bir Hospital. Wait list for surgery Despite its crumbling infrastructure, poor services and  lack of equipment and human resources, Bir Hospital continues to draw a large number of patients every day. This is where the people with poor economic backgrounds come to seek medical help. And large patient volume often means delayed services. Take the Urology Deparment for example, where patients in need of surgery have been put on a wait list for up to nine months. It’s the same for other departments as well. The Urology Department runs outpatient services for three days in a week, during which over 600 patients are offered medical help and consultation. Its surgery department is one of the busiest and performs 15-20 operations daily. Dr Basnet, the head of Urology Department, says patients are waitlisted based on three categories: emergency, semi emergency and elective. “We can lower the waitlist period if the hospital hires more nurses,” he says, once again pointing out the problem of insufficient nursing staff. Lack of information While Bir Hospital staff members blame the lack of human resources and equipment for poor service delivery, they seem to overlook the common problems faced by the patients that could be fixed just with better management skills. Issues such as long queues, scheduling appointments and setting up a proper information center call all be resolved without the need for a big budget or equipment. Patients like Budhathoki from Lamjung, visiting the hospital for the first time, do not know where to go, because the hospital doesn’t have a proper information desk. “After getting the ticket for OPD I didn’t know where to go for the service,” she says. “Some of us have traveled far away for treatment and when the services are delayed, it all adds up in our expenses.” Radhika Khadka, a resident of Betrawati, Nuwakot, says when she entered the hospital, she was overwhelmed by the crowd and chaos. She has come to Kathmandu to treat her son’s fractured arm. “I don’t know how the services can be taken here,” she says. Hari Bahadur Rai, another resident of Nuwakot, says for the past one week he has been running around the hospital waiting and collecting medical reports of his wife, who is suffering from fever and chest pain. “We are still in the process. The actual treatment has not even started,” he says. Doctors and other health professionals at Bir Hospital say part of the reason why the hospital is overcrowded is because many patients refuse to visit their local health facilities. If people were to take available health services and medical tests in their home districts, they claim the hospital would not be so crowded and unmanageable.