Rukum Hospital

As Patan Hospital has become more self-sufficient in recent years, FOPH has found new avenues for fulfilling our charter to advance healthcare among the poor and underserved in Nepal. Through a series of personal connections with current and former medical missionaries to Nepal, we were able to facilitate the transfer of $20,000 from a donor-advised fund in the U.S. to a small rural hospital in the mid-western region of Nepal called Chaurjahari Hospital Rukum.

This small hospital was founded in the 1990's by TEAM, an American Christian missionary organization, but was forced to close down during the ten-year civil war. Rukum Hospital was eventually reopened by a national Nepali Christian NGO called HDCS (Human Development and Community Service) and is still the only hospital in the region. It sees up to 300 patients per day, handles up to 50 inpatients at a time, and performs about 3,000 surgeries per year. Hospital staff also perform community outreach and health education, with a special emphasis on reaching the poor, remote, and marginalized. You can read more about HDCS and the hospital at www.hdcsnepal.org.

Late-breaking news:
On November 3, 2023, the region around Rukum Hospital was hit with a 6.4 magnitude earthquake, killing around 200 people and injuring hundreds more. The hospital has been at the epicenter of disaster relief and care of the injured and was immediately distributing tarps, blankets, food, and hygiene kits to the hundreds of households affected. They are also preparing for the long-term care and rehabilitation of the newly disabled. FOPH is prepared to send immediate financial support for these efforts.

Mercy Clinic

COVID Pandemic at Patan Hospital

The COVID-19 pandemic has drastically altered our world, including life at Patan, since our last update in 2019.  Here is the story of how the pandemic played out at Patan Hospital:

After their highly successful mass-casualty response to the 2015 earthquakes, leadership at Patan Hospital presciently outlined a disaster plan for a potential infectious disease emergency.  In March 2020, just before the world went into lockdown, the Executive Council at PAHS activated the Hospital Incident Command System and declared a disaster state, which immediately expedited preparations and administrative decisions.  The HICS committee met with the executives of PAHS twice a week throughout the crisis. 

To overcome initial fear and panic, Patan conducted several classes to educate staff, and the psychiatry department conducted stress-management sessions.  Since PPE became almost impossible to procure, they turned one of the medical school faculty offices into a visor factory and put hospital tailors to work sewing head-to-foot gear from water impermeable cloth they had obtained.  They conducted donning-and-doffing training sessions for the new PPE suits.  A section of the maternity ward was converted to a laundry where housekeeping staff, in full protective gear, washed and dried the reusable suits.  Finally, the hospital arranged hostel accommodation nearby for staff who opted not to return home to their families in order to protect their loved ones from the virus.

Due to the terrible backlogs in COVID testing at the national laboratory, Patan rapidly developed its own PCR lab, buying a new machine, training technicians, and getting the new lab accredited in only three weeks.  On-site PCR testing allowed them to free up valuable isolation beds for suspected COVID patients much more quickly.  Patan was also the first hospital in Nepal to develop a protocol for providing surgical services for COVID-positive patients, quickly becoming the national referral center for these patients.   

In the early phase (March to July 2020), non-COVID patients stayed home and cases were few.  This provided a window for preparations but caused severe budget shortfalls as hospital revenue dropped almost 50%.  The national lockdown, which was only briefly lifted in July 2020 before having to be reinstated, also caused widespread economic hardship.  By the time COVID cases really began to spike in August 2020, staff morale began to flag as they realized how long the pandemic was likely to continue and how much worse things were going to get.

The hospital struggled to provide all its usual services as staff began testing positive and having to be quarantined.  Even kitchen staff were stretched to the limit providing meals for an over-full hospital with a skeleton staff. Those who remained often worked for weeks without a day off.  Fortunately, none of the staff fell seriously ill, and most are now vaccinated.  The first real surge of COVID patients hit in September 2020, with the inpatient COVID census peaking at 140 patients.  The hospital ordered a new oxygen plant, as the old plant had broken down some time earlier and been replaced by portable cylinders connected to the hospital pipe grid.  The portable cylinders worked well for the first surge but nearly failed catastrophically at the time of the second surge in May 2021.

At the peak of the second wave in May 2021, oxygen became critically scarce throughout the Kathmandu valley due to a the high volume of COVID patients compounded by the panicked hoarding of oxygen cylinders by organizations and individuals.  A team of 35 staff and daily laborers at Patan worked round the clock in all weather loading and unloading 100-pound cylinders that could barely be refilled fast enough.  Thanks to their heroic efforts, no patients were lost due to interruptions in oxygen flow.  

Dr. Mark Zimmerman, a FOPH board member currently working on the wards at Patan Hospital, had this to say of the COVID response at Patan:  “Of all the examples of leadership I’ve witnessed over my career, Patan Hospital’s response to this pandemic is exceptional. In a 700-bed hospital receiving only modest government funding and previously caring for 350,000 patients a year, management has created a central block dedicated to COVID care. This meant erecting barriers in each of the four floors to cordon off sections which could be entered only in PPE. Supply lines of medicine, equipment, food, drinking water, and oxygen course into this isolation bubble, with a single freight elevator linking the floors. Although many hospital staff have tested positive, not one has become seriously ill and all are now fully vaccinated.”

At the time of this writing (November 2021), the ICU at Patan is still full of very sick COVID patients, but the "cataclysmic days of June" – to use Dr. Zimmerman’s words - seem to be over.  Hoarding of oxygen by private citizens has ended.  The new oxygen plant is up and running.  Overall cases at Patan are down to about one-third what they were, and cases in Nepal are down by about 90%.  Patan Hospital remains a national leader in COVID care, accepting transfers of COVID-positive patients needing all manner of medical care, especially those who have depleted their funds at private hospitals.  With only about 25% of the population vaccinated, Dr. Zimmerman says, "I don’t see how we avoid a third surge, but we can hope."

Due to the severe financial stressors and general economic devastation brought on by the pandemic, Friends of Patan Hospital felt it was especially appropriate to increase our monetary support for the great work being done at Patan Hospital, and especially for the care being provided to those unable to pay.  Thanks to recent growth in our endowment fund and the generosity of our donors, we were able to send much more support in 2020 and 2021 than we have in recent years.  In total, we gave $100,000 to the Charity Fund and $100,000 to the Patan Hospital General Fund. 

Professor Dr. Rajesh Gongal named Vice-Chancellor of PAHS

Patan Expands Its Services in 2019

A new 24-bed single-room ICU opened at Patan in 2019.  Thanks to a generous gift from the Nick Simons Institute, the new ICU is already fully equipped with several new mechanical ventilators.  Expanded ICU services will benefit the sickest patients at Patan as well as enhance the education of Nepal’s future doctors at the Patan Academy of Health Sciences.

In addition to plain X-ray and ultrasound, Patan Hospital has in recent years acquired both a CT scanner and an MRI machine, greatly improving their diagnostic capability and eliminating the need for costly transfers to other facilities in order to obtain these life-saving images. As always, these services are  priced at a level that the general public can afford, as Patan continues to survive on a pay-as-you-go system in order to cover their day-to-day operating expenses.

New Equipment Purchased for Patan in 2019

Thanks to a generous $100,000 gift from long-time donors Russell and Marian Bernd, Friends of  Patan Hospital was able to purchase some important medical equipment for Patan Hospital this year. To ensure that every operating room at Patan is fully functional, we purchased a new high quality surgical table and operating light with HD camera that should serve the hospital well for years to come and aid in the training of future surgeons.

We also purchased four much-needed hemodialysis machines. Dialysis chairs are highly coveted in Nepal, with all available units in use almost 24 hours per day. If a renal failure patient is ever suddenly in need of emergency dialysis, they sometimes have to wait for a routine dialysis patient to voluntarily give up their scheduled dialysis session in order to accommodate the emergency. More dialysis machines means that this  difficult situation may become a thing of the past.

Bharat Yadav Appointed Vice Chancellor of Patan Academy of Health Sciences in 2017

Dr. Yadav first came to Patan Hospital in 1989 as its most junior doctor. Before that, he had been a health assistant in the remove Sankuwasaaba District. Several years later he entered Patan's new MDGP training program and graduated as Patan Hospital's first Nepali MDGP. Around 2004, he became Chief of the hospital's ER and outpatient department, a post he's held since that time, leading the department through doubling its doctor number and establishing PAHS's first postgraduate doctor program, a fellowship in ER Medicine. He was just six months shy of retirement when his recent appointment as Vice Chancellor of PAHS extended his time at the institution until 2021.

Among the hundreds who work at Patan Hospital, it would be hard to find a more committed soul. At 10 pm on the night after his VC appointment was announced, he was found where he often is at that time: checking up on junior doctors in the emergency room. He knows the institution inside and out and cares about sustaining its ethos. He is known as a loyal, courageous, and forthright individual who is willing to speak up for what is right and work to change what is not. He is held in high esteem by the senior doctors under whom he's worked, and he always treats juniors with respect and care. We at FOPH are very happy to see PAHS in such capable hands.

Patan’s Response to 2015 Earthquakes

The devastating earthquakes on April 25 and May 12, 2015, and frequent aftershocks caused close to 9,000 fatalities, innumerable injuries, and serious damage to many of the buildings in Nepal.  During the height of the crisis, Patan Hospital provided 24-hour emergency medical services as well as food and water to many families affected the earthquakes, handling over fifty casualties in the first 24 hours alone.  Fortunately, the buildings at Patan Hospital were not seriously damaged by the earthquakes and are for the most part intact.  However, in the weeks following the earthquakes all medical services had to be provided on the ground floor of the hospital or outdoors in tents.  Patan Hospital also operated a field hospital in Kathmandu which served over 200 patients each day at the height of the crisis. 

Medical students at Patan Academy of Health Sciences (PAHS) contributed greatly to the emergency response, with first, second and third year students filling support roles at Patan Hospital and fourth and fifth year students assisting in the rural areas. In Naukot, which lost its hospital in the April 25th earthquake, students treated patients and distributed food and shelter.

Jill Allison PhD, the Global Health Coordinator at Memorial University of Newfoundland and a friend of PAHS, visited Nepal twice after the earthquake and had the following to say:  “Patan Hospital has done a fantastic job of managing the earthquakes and their aftermath of health and social consequences. Staff of every kind, faculty, and students pitched in and “pitched up” in the classrooms, doing rotating shifts and sleeping, eating and trying to stay focused within the confines and walls of the hospital.  The fantastic disaster management plan developed last year and test run only a few months before the quake proved to be invaluable and worked like clockwork.  Very few glitches.  Tents went up, triage was established, and patients were seen immediately. Patan has been praised by government and NGOs for the great work they did and have been presented as a model for others to follow.  They are all very humble about this but also are very willing to share their personal experiences of the earthquakes. Compelling and brave and harrowing.  The staff at Patan proved that well-supported and confident practitioners, even in low income settings, can handle anything.  They did not need anyone to show up offering to help.  They needed moral support, financial contributions, and our willingness to continue partnerships and be available to do what was needed if requested.  In fact, it is a point of pride for all the staff at Patan that they knew what to do and just got on with it.”

Because of the excellent preparedness and emergency response by the staff at Patan, there was a remarkably low incidence of amputations for orthopedic injuries due to the timely and appropriate surgical care. Moreover, the effective operation of the field hospital that was established by Patan Hospital set a standard of care that was emulated by the Nepali Army as it responded to the medical needs in other parts of the country. The work done by the staff and students of PAHS was greatly appreciated by the government of Nepal, and PAHS – even more than before - is seen as a role model for the future of health education in Nepal.

Vice Chancellor of Patan Academy of Health Sciences Visits U.S. and Canada in 2014

Dr. Jay Shah, then Vice Chancellor of Patan Academy of Health Science (PAHS), travelled to the U.S in the summer of 2014 to attend the Harvard Macy Institute Program for Leading Innovations in Health Care and Education in Boston.  He was also able to visit several other major academic medical centers where certain faculty members have connections to Patan Hospital and to Nepal, including McMaster University in Toronto, the University of Colorado at Denver, the University of Alberta in Edmonton, and the Mayo Clinic in Rochester, Minnesota. Dr. Shah met with fellow medical educators and shared details of the groundbreaking work that is being done at PAHS.  Friendships were established that will lead to increased cooperation between Patan Hospital and these medical centers, including possible research partnerships with Mayo Clinic and Harvard, training opportunities for Nepali physicians at the Mayo Clinic as well as for Mayo residents at Patan Hospital, and collaboration with the University of Colorado on motivating doctors to work in rural areas. FOPH sponsored Dr. Shah’s Mayo and Denver visits and hosted a fundraising dinner in Denver at which several FOPH supporters and board members were able to meet Dr. Shah and hear more about his work at PAHS.  Many thanks to Jim and Amy Hecht for spearheading the Denver visit, and to Aaron Mansfield at Mayo, Karl Stobbe at McMaster, and Kim Solez in Edmonton for coordinating those visits.

Oxygen Plant Installed in 2012

FOPH provided $130,000 of the total $330,000 cost to install an oxygen plant and piping at Patan Hospital in 2012.  This simplified and improved the safety and provision of oxygen to patients and eliminated the cost and delivery problems associated with having to use oxygen cylinders furnished by outside suppliers.

Cytogenics Laboratory Opened in 2011

In December 2011, Mayo Clinic physician and FOPH vice president Dr. Aaron Mansfield traveled to Patan Hospital to help establish the new cytogenetics laboratory that will help in the administration of the cancer medication Gleevec.  Patan Hospital is the Gleevec International Patient Assistance Program Center for Nepal, and over 200 patients from all over Nepal have been given Gleevec free of charge through this program which is supported by the Max Foundation and Novartis Pharmaceuticals.  Dr. Mansfield assisted Patan Hospital by arranging for the donation of two fluorescent microscopes from the Mayo Clinic for use in the new cytogenetics laboratory. During his time at Patan Hospital he also lectured on chronic myeloid leukemia and cytogenetics to the pathologists and lab technicians.  FOPH provided support to help defray the travel expenses for this project.

PICU & NICU Units Opened in 2009

After three years of preparation, fully functional Pediatric and Neonatal Intensive Care Units with 6 beds each opened in July 2009 for patient care.  Comprehensive training over a 3 month period was provided by a team of 20 volunteers including six physicians, eleven nurses and three pharmacists, led by Dr. Sanjita Basnet, a Nepali physician who works in Illinois, and the late Michele Avila, a critical care nurse at Stanford who was Vice President of FOPH.  Dr. Theresa Grover, an Associate Professor at the University of Colorado Medical School who was in charge of the 60-bed NICU at Children's Hospital in Denver, also provided leadership in this training in Nepal.  A total of 25 physicians and 60 nurses at Patan received training  focused on assessment skills, 24-hour monitoring, and critical thinking. Emphasis was placed on teamwork, infection control practices and organization.  Nurses and physicians learned about assembly, use, care, and storage of equipment, medication calculations and errors, procedures, and general nursing care in these units. Further follow-up training for nurses and physicians was provided later in the year by FOPH volunteers including Dr. Saraswati Kache, who teaches at Stanford University School of Medicine.