|
|||
|
|
|||
|
BPKIHS |
Boon Or Bane? The opening of B.P. Koirala Institute of Health Sciences (BPKIHS) has injected a new life to Dharan city which was withering away after the destructive earthquake of 1988 and the desertion of Ghopa Camp by the British Gurkhas. But this reason is not enough to justify the establishment of such a huge hospital which consumes more than 10 percent of annual health budget of the country. It is equipped with all modern facilities and buildings but the question remains do we need such a gargantuan institution? And more importantly can we sustain it? KESHAB POUDEL, in Dharan
For the almost deserted Dharan - an old trade and business center 500 km east of Kathmandu - establishment of BPKIHS was a boon to its existence but it could become a bane to the country as such in terms of investment concentration. BPKIHS - a teaching hospital with more than 600 beds - is the first of its kinds established outside the capital valley but the question is how long can Nepal sustain to bear the huge investment and the operating costs that would corner as much as ten percent of the country's total annual health budget running to almost 300 million rupees a year. The institute is sprawled over 699 acres of land which includes sports complex including 18 hole golf course, swimming pool and tennis court along with small bungalows. As one of the ambitious health projects, the aim of the institute is to provide a common platform for specialists from various countries of the world to interact with each other. The institute was conceptualized on the premises of University town much the same like Oxford or Cambridge. The concept is high sounding and imaginative for a country like Nepal where large number of people are yet to get basic health services. Compared to other health institutions in the country, running cost of BPKIHS is sky-high as it generates very nominal resources on its own. The salary at the institute is also higher compared to other hospitals in the country. Although it lies in the middle of the three crowded municipalities of the eastern development region, the number of visiting patients is not going to be adequate enough to generate resources for the Institute. "One of the important aspects of the BPKIHS is the diversification of the resources out of Kathmandu," said Dr. Prakash Raj Regmi. "Whatever the cost may be, we have got an institution that is capable to provide service." Despite the claim by the management of the institute, it could take many years to lure more patients to the hospital. Even after the increase in the occupancy rate, it will require more maintenance cost. At a time when it needs support, one of the most challenging tasks for the BPKIHS is to enhance its credibility the a reliable hospital. As even a large number of affluent people of the country has tendency to go abroad for the health check up, BPKIHS can lure them by establishing itself as their first choice. "If the government fulfills its commitments and sanctions the budget it had agreed to, the hospital will definitely prove its excellence," said Shekhar Koirala, Vice Chancellor of the Institute. (see box) To make such a big hospital self reliant is not easy. Situated in the heart of the capital, Tribhuwan University Teaching Hospital (TUTH) is yet to become self reliant. TUTH which receives 110 million rupees a year from the government is gradually on its way to become self-sustaining. Established by an agreement between Nepal and India, the BPKIHS is the first of its kind whereupon the governments of India and Nepal have agreed to share the cost fifty-fifty. The inheriteel infrastructures of Ghopa camp, which served as a major army recruiting center for British army, seem to be gradually collapsing, how will the country bear maintenance cost for the new infrastructures erected under the Indian cooperation is a matter of concern. For sustainable management, a hospital of such a size requires a big market in and around it. But the population census shows that even by catering to all the residents of eastern region, the institute cannot become self-sufficient. As long as the hospital does not establish its reputation, it is impossible to lure Indian population of north-east and northern Bihar and Bengal. When large number of Nepalese people residing in border areas prefer to visit Indian hospitals nearby the region like in Calcutta and south, the target to offer services to affluent non-Nepalese citizens may just be a dream. The grim challenge seems to be generation of revenue from the poorer section of the people. Although the hospital has already launched what it claims to be the first health insurance programs in South Asia, the initiative is too small to recover the cost. The program under the social health insurance will cater to 500 hundred clients from 102 household of the Sundarpur village of Morang district. However, this may be a good beginning to generate resources for the hospital. Establishing the institution is in itself a positive step but the question is does Nepal need a hospital with 646 beds. One cannot rule out the possibility of such a hospital turning into another white elephant. As there are few possibilities to generate resources, critics argue that the hospital reflects heavy political overtones. During its nine months rule, CPN-UML had questioned the rationale of providing such a huge amount of money to maintain the hospital. Population-wise, there is no justification for the big hospital. According to government statistics based on 1991 census, the total population in the eastern region is 4.4 million. Labeling critics as people with no vision Shekhar Koirala said, "The decision to allow the construction of the hospital outside the valley is itself a great achievement." It is not that there is no significant population in the vicinity of the hospital. Dharan and Biratnagar are the cities with large number of affluent citizens as the population in Dharan town is dominated by former British and Indian Gurkhas whereas Biratnagar is a business hub. "There is a high scope to generate resources for the hospital," said a medical practitioner. "But the hospital has to prove its efficiency and reliable service to lure people." The concentration of huge resources in establishing the Institute could turn out to be the misuse of resources and influences. How long can the country suffering from resource crunch provide such a big amount of money to one hospital? Some people opposed the BPKIHS from the very beginning on the ground that it was over expensive. The hospital helps to diversify the medical facilities in the country. After the restoration of democracy, medical facilities started to expand in different parts of the country. Health institutions are expanding from east to west and health manpower are also being produced. For the eastern part of the country, this hospital could be a major boon. The discrimination in the salary between the Nepalese doctors and Indian doctors working at the Institute has also become controversial. Like other institutions, BPKIHS was also opened eyeing affluent Indians across the border. For the students, the institute provides opportunity to graduate in medicine inside the country. But due to discrimination, most of the Nepalese doctors do not prefer to work there. The hospital seems to be serving more political interests. As long as Girija Koirala remains Prime Minister, the hospital does not have to worry. If the service and education provided by the hospital is within the reach of common people it still may take considerable time to lure a large number of patients. The hospital projects some abstract dream to sell some of its so-called novel idea but it has not proved yet that majority of poor people will benefit from it. As the Bir Hospital is over-burdened with patients, the BPKIHS can lessen their burden if they can be lured to go to Dharan. If the hospital proves its credibility, it may pull the crowd. But the problem is even today large numbers of people don't know about the services offered by the Institute. The Institute needs to develop its credibility. As long as medicine and politics are linked together, the question of credibility will always be there. One must separate politics from medicine. In the name of late Congress leader B.P. Koirala, Nepal received big health institutions in Dharan and Chitawan which could be boon to the locals but could be bane to the nation. BPKIHS has all kinds of modern facilities including Cardiac Care Unit, CT Scan and Intensive Care Unit. There are all facilities but what is lacking is the man power. According to the agreement, India is supposed to provide expert manpower to the hospital. Instead of supplying senior doctors, most of the Indian doctors are too junior. Nepalese senior doctors who earlier went to Dharan have already returned to the capital. Some doctors even escaped from Dharan hospital denying to follow the agreement signed with the hospital. Their argument was that they were ignored by the hospital management. Since Dharan is a small city, there is no possibility for them to have big practice. Some doctors are joining BPKIHS unwillingly as the All India Medical Science admits only those students who completes a certain term in BPKIHS. A Nepali doctor is paid about 20,000 rupees a month which used to be one of the great attractions for new doctors but today no one thinks it is big enough. To make the institution survive, the hospital management should work to attract more patients from major Indian cities in north-eastern India. One of the positive aspects of the hospital is that it is the only well-equipped hospital outside of the Kathmandu valley which in a manner contributed to initiate more equitable distribution of resources in the country. Novel ideas like community health programs, insurance schemes and services in remote areas seem to be very innovative and interesting. It is very difficult, however, to materialize the dream. At a time when all major medical centers are concentrated in and around the capital city, it is a good beginning to have such hospitals outside the valley. With financial support from India, BPKIHS has got many big buildings. It is a highly ambitious program which may have to face severe financial constraints. The idea to send the doctors to rural areas is excellent. But is it practically possible or just a dream? BPKIHS has just started its program. It is too early to evaluate its performance in the medical sector. "BPKIHS is the only hospital which runs a community-based program," said Dr. Kumud Kafle. There are many hospitals in eastern region but BPKIHS is the only hospital which has teaching and learning facilities. BPKIHS has lavish infrastructures and has opened at a time when there are increasing number of medical colleges in the country. But the development of the Institute has been guided more by political reasons rather than professional attitudes. Being a big hospital does not necessarily mean it is a major achievement, what is important is how big a public service it can rendor. Before the completion of Dharan-Dhankuta highway, Dharan was known as a major trade point for 18 districts of the eastern region. Besides, it was one of the recruiting centers for British army until 1988. Even after the great earthquake of 1988, transfer of British Camp and direct road links to other areas, Dharan still retained its economic importance. Pensioners of British and Indian army kept the glory of the Dharan burning bright. Formerly used as recruiting camp for British army, Ghopa Camp -- the place where the BPKIHS is presently located -- was full of facilities even before it was handed over to the government in 1990. The hospital is yet to use many buildings which have facilities and instead of using them, the institute is erecting new buildings. First MBBS classes at BPKIHS started on October 19,1994. On July 16, 1993, HMG handed over 150 bed Eastern Regional Hospital to BPKIHS. It was established under the act of January 18, 1993, subsequently amended on October 18, 1993. It is an autonomous, Health Sciences University. Like other government hospitals in the country, BPKIHS also charges a nominal registration fee of Rs. 10 from new patients and Rs.5 from follow-up patients. Charges for bed, operation theater and investigations (pathology, radiology, Endoscopies etc) are highly subsidized. All charges are planned to be increased by 10% annually. A few paying beds are also available. Dharan residents had never imagined that their city would house such a huge institute after the 1988 earthquake crumbled the town severely. BPKIHS is the outcome of the initiative taken by former Indian Prime Minister Chandra Shekhar and Prime Minister Girija Prasad Koirala. Under the agreement, the government of India provided Indian rupees 640 million for the construction of a 350 bed hospital and 50 seat medical college complex. Part of the fund was used to renovate the old buildings to turn them into make-shift class rooms, laboratories and faculty rooms. BPKIHS was established at Ghopa as residential university envisaged as a self-governing, self-reliant international health sciences university that aims to attract students and teachers from all over the world. The concept of a 500 bed teaching hospital so far the biggest in the country was simply unimaginable eight years back. But good planning, hard work and better understanding on the both sides made it a reality. The institute is also visualized to lead a complete health development project through its teaching district which will create an environment friendly for human development initiative resulting in enhancement of quality of life of the people of Nepal and the people working in BPKIHS to ensure a high level of commitment to excellence and dedication to service," said Koirala. "Due to lack of budget, the campus is unable to add new modern facilities in the hospital area. If the government does not provide us adequate budget, we will be compelled to reduce the number of medical students," said Koirala. If the positive aspect is big institution like BPKIHS the negative side could be that it may turn out to be a white elephant BPKIHS At A Glance (Box) BPKIHS : A Center Of Educational Excellence BP Koirala Institute of Health Sciences (BPKIHS) established at Ghopa camp in the outskirts of Dharan, a small township of eastern Nepal, is in reality a residential university envisaged as a self-governing, self-reliant international health sciences university that hopes to attract students and teachers from all over the world to its constantly innovative educational programs.
When the Nepalese parliament established BPKIHS under the act of January 18, 1993, it was conceived as a center of national importance that would produce highly skilled manpower in health sector to meet the country's need and also to function as a center of excellence, particularly in the field of tropical and infectious disease, and to try to carry out research on national\international health problems. The hospital was formally started after the handover of eastern zonal hospital to the Institute in 1994. In the short period of five years, it has already produced 6 batches of MBBS, 4 batches of B. Sc Nursing, 1 batch of BDS (bachelor of dental surgery) and 1 batch of nursing certificate level. Altogether it runs classes for 346 students and has 646 bed. This progress would have been impossible had it not got commitment from the government, support of Indian government, project consultants and construction management teams and teachers, students and employees of the organization. The hospital is a part of late B P Koirala's dream of decentralization. Under the agreement, the government of India provided IC 640 million for the construction of a 350 bed hospital and 50 seats medical college complex. Part of the fund was used to renovate the old buildings to turn them into make shift class rooms, laboratories and faculty rooms. According to the agreement, Indian government has already spent 883.2 million rupees for the development of infrastructure in first and second phase, 190.2 million for the instruments and 250.6 million for manpower development. India has already invested more than 1.6 billion rupees in the project. Besides, under the agreement, 57 paramedical staffs have already received training from India and most of them are working in the hospital. Some are still in the Indian hospitals and more others are going there. There are now 50 Indian teachers working in the hospital who will be in Dharan till 2004. For the infrastructure development, Nepal government has agreed to invest 1.34 billion rupees but it just spent 730.5 million rupees, 120.6 million rupees was spent to procure modern equipment. On the government's part, the construction of approach road, land levelling, sewerage, electricity supply, drinking water supply has already been completed. The construction work of compound wall, internal road, residential buildings and hostel is yet to complete. This is a first of its kind project where two countries have agreed to share investment equally. It is very different in nature than other similar institutions. Its education, service and researches are target based. One of the aims of the institute is to provide medical care to the poor people of remote villages. Under the leadership of institute, district health offices, rural banks, UNICEF, Plan International, Family Planning Association of Nepal, BNMT are running different health related programs. The institute is trying to provide the health service in remote parts of the country. Due to this hospital, people in the region get opportunity for employment. Unlike other medical colleges, the institute starts the health program as a means of development. The policy of the institute is to develop all 16 districts of eastern region as educational districts. Its academic curriculum is based on rural orientation and students have to frequently visit the villages and involve in the research. After the completion of MBBS course, the student has to serve 6 months in the remote areas and 6 months in the hospital under the supervision of senior specialist. The policy of need-based community-oriented education system helps to upgrade the technical capability of the students. Due to these reasons, it is accepted as one of the colleges which has social accountability indicators. To offer the chances for the students of remote hill districts, 4 students of each 33 hill districts are allowed to study MBBS, 2 each in BDS and 17 in nursing certificate. Fifty percent of fees is waived to the students from the hills who are admitted to the nursing certificate level. These students are encouraged to go to their village after completion of education. There is also a system to provide loan to the students. The establishment of the hospital had reduced the pressure on the hospital of Kathmandu and people can get special medical cares outside the valley too. The hospital service is gradually made effective. Biopsy facility, multi-disciplinary faculty of general practice and auto analyzers are some special facilities the hospital provides. There is also a special facility to check bleeding disease, blood cancer and Hematology. Besides the HIV lab, special Kala-azar lab, eye-transplant facilities are also available. CT Scan facilities help the patients of eastern region to check up in their own region. The hospital also has intensive care Unit, Coronary Care Unit, National Intensive Care Unit for the children and Maternal Intensive Care Unit for the mothers and 52-bed private ward. Hemodialysis service, EEG, Pulmonary Function Test, Autonomic Function Test, Endoscopy service sleep lab, Tread Mill exercise are also available. For the poor people, the institute also offers free treatment. To reduce the burden on the institute, life insurance scheme was introduced to the family members of the staffs. The institute is making every effort to be self-reliant. This is the reason it is launching the programs for affluent people. (Excerpts of the statement delivered during the Institute's program by its Vice Chancellor Shekhar Koirala) ‘Dharan Is Gaining Reputation As Center For Educational Excellence’— Ganesh Kumar Shrestha
GANESH KUMAR SHRESTHA, Assistant Campus Chief of Mahendra Multi Purpose Campus, Dharan says the city is witnessing a gradual development following the establishment of BPKIHS. Excerpts of his interview: What changes have you seen in the last ten years after the establishment of BPKIHS? I have seen a lot of changes. Dharan recovered only after the establishment of the hospital. After the great earthquake of 1988 and the removal of Ghopa camp, it nearly looked as a dead city. The situation today is far better. Dharan is now developing as a new center. How do you see the facilities in the hospital? You can find excellent facilities in the hospital. It is equivalent to the top standard hospital. What are the economic benefits of the BPKIHS? Dharan gets enormous economic benefits from the hospital. Large number of people are coming from outside and economic activities are very high. There are direct and indirect benefits. After the establishment of BPKIHS, Dharan is now a leading city in the eastern region. Do people like it? Yes, the people in Dharan love BPKIHS very much. How is its business potential? Dharan is no more a business center of eastern region only. But it is gaining reputation as the center of education excellence. Besides BPKIHS, the food and technology and Mahendra campus are also offering different education for the students. Even people from Taplejung and Ilam are coming to Dharan. What are the problems of Dharan? One of the problems of Dharan is that it does not have industries. This is the reason there is a high number of unemployed people here. Dharan was known as a city of former Gurkha army. How do you look at it? It is still a city of former Gurkha army and pension is still a major source of the economy of Dharan. After Pokhara, Dharan is the next city which contributes to its development by pensions earned by former Gurkha officers. Large number of people are still going for employment in foreign army. It is the truth that Dharan's popularity is linked with the British army camp. What is the socio cultural position of Dharan? Dharan is the only city after Kathmandu valley which has multi-ethnic population. ‘BPKIHS Injected New Life To Dharan’
Manoj Kumar Myangbo is the mayor of Dharan Municipality. Myangbo sees BPKIHS as the back-bone of Dharan. He spoke on various issues related to the hospital. Excerpts: How do you see the present situation of Dharan? After the earthquake of 1988 and removal of British Camp, Dharan was declared as a dead city. Large number of people moved outside Dharan and price of land and houses fell sharply overnight. Then, how is it recovering? After the establishment of BPKIHS, the city started to recover again. In one word, it is BP Koirala hospital that injected new life to Dharan city. What is the city's state now? It is very lively. Many infrastructures were developed in Dharan like roads, drinking water and other facilities have already been improved. Some questioned the rationale of spending of such a huge amount of money just to maintain Dharan. How do you look at it? The hospital is not only for Dharan but it belongs to all the countrymen. It is just that it happens to be located at Dharan. Do you have any complaints about the hospital? I don't have major complaints as it is still in the stage of construction. The service is excellent and hospital management is cooperative. We are very pleased that the land used by British army has been used to serve the people. How about the response of the people? There are always two different types of people. I cannot rule out the possibility that all are not happy with the hospital management. In general, Dharan residents view the institution as something to be proud of. |
Coverstory | Editor's Note | Letters | Book Review | News Notes | Forum | Briefs | The Bottomline | Quote Unquote | Off The Record | Uml's Agitation | Nepal-Britain | Nepal Development forum | Interview | Economy | Police | Earth Day 2000 | | Tourism | Dakar meet | Cinema | Health | Main |
Send your feedback to the
editor: spotligh@mos.com.np |
