समाचार

The pioneer nurse of Intensive Care Units in Nepal

Starting the ICU/CCU units in Nepal in 1973 wasn't an easy task. It started at the Bir Hospital, and for the next 20 years it was the only hospital which had ICU/CCU set up in Nepal. It was started even when other basic services were in a bad state. And, even talking of starting such service at the Bir Hospital would be taken as a joke. There is a fascinating story behind the historical establishment of ICU/CCU set up.

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It was in the year 1970 AD, late King Mahendra Bir Bikram Shah suffered from a heart attack in the jungles of Kailali, Kanchanpur in his hunting voyage. Once the news was out, a team comprising of Mr. Kritinidhi Bista (Prime Minister), Dr. Dwarika Manandhar (Pathologist), Ms. Mita Singh Thakur (Additional Matron of Bir Hospital) and Ms. Rameswari Shrestha (Staff Nurse) left for Kanchanpur. 

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Shrestha continues the narration, 'it was the first time I had heard the name of Mahendranagar itself.' Nurses were brought in from Lukhnow, India to care for his highness. This very incident highlighted the need of ICU/CCU set up in the country. She recalls, 'I thereby was sent to Australia to learn as many things possible to come back and start the unit here in Nepal. The time they gave me the news that I should leave for Australia, I just had a baby back then. So they gave me 40 days time to prepare and then I would have to go for the 1 year training.' 

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Training at Australia

Shrestha had a very supportive family, let us just think, a new mother having got to leave her child behind for a year long training program. Her family supported her decision and she left for Australia. She describes the moment, 'Once I was there, I was completely in awe to see how well they had set up the ICU/CCU. They had the protocols developed and everything was done by the book.'

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The training offered a very good platform for her to learn. She said she wondered like a small child astonished seeing all those new equipment for the very first time in her life. She had to learn not just to operate the machines, but also to troubleshoot errors. She was so busy back then and hardly had time for anything and one year seemed to pass by very soon. 

Establishing ICU/CCU at Bir Hospital

Having witnessed it all and learnt so many things, it was now her turn to get things done here in Nepal. It was a hassle trying to set it up for the very first time. During the set up, Dr Bhim Bahadur Pradhan was the superintendent at Bir Hospital and ICU/CCU had Dr. Mrigendra Raj Pandey as Medicine HOD, Dr. Narendra Rana as Anesthesia HOD and Rameswari Shrestha herself as Nursing Incharge. 

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Shrestha recalls, 'I would ask for various equipment and manpower for the unit and people would look at me as if I was asking different things for my personal use. No matter how difficult it was, the first unit set up eventually completed at the Bir Hospital.' She then invited her supervisors from Australia and they were indeed very happy that the young lady whom they had taught got the job done. 

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ICU/CCU was like a unit set up where you would bring in the people in their last minute, well even the 11th hour was too early for them. The image of ICU/CCU was such that people used to compare ICU/CCU with Pashupati Aryaghat, it being located within the hospital. People would be reluctant to shift their patients to ICU/CCU unit. It took a pretty long time and continuous hard work at end to change the concept. 

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She had the support of various people, in her endeavor. But sometimes it would be just her fighting for a cause that seemed to be just hers or that seemed to bug her only. But she toiled hard and did not lose hope and continued to struggle with or without support from others. If the patient needed a pacemaker replacement, the hospital would send for her. No matter what came up, she had to be present at the hospital.

Spread of ICU/CCU service

Well you may think that it was Bir Hospital, the government hospital, so all the trouble in the set up. She said,'but then I did not find setting up the ICU/CCU easy in any other hospitals either be it private or governmental.' After getting the ICU/CCU running at Bir she was sent to different places by the Government to whichever hospital intended developing one. Her expertise was used for setting up or upgrading the ICU/CCU at Biratnagar Hospital, IoM- Teaching Hospital, Shahid Gangalal Hospital, Shree Birendra Army Hospital, Norvic Hospital and KMCTH. Getting the manpower for ICU was very difficult in almost all hospitals.

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Not many people outside the medical profession know her says Rameswari Shrestha, the first ICU/CCU Nurse of Nepal in her very soft spoken tone. She says 'well these days even the new medical fraternity are unaware of how difficult things were back then and who all contributed to bring healthcare to the current state'. 

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Healthcare system in Nepal still has many flaws like other systems in Nepal. Even now, it is often said, do we even have a system. Just imagine what would have been the scenario back then. We would have to prepare our own Plaster of Paris bandages. The disposable syringes came in a lot later, earlier we had those glass syringes which had to be sterilized. Just imagine now you having to sterilize syringes, how hard would that be?

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Initially, Japan funded us for providing trainings to new nurses to work in ICU/CCU and four such training was organized each comprising of 10-12 participants. We train the new nurses time and often but retaining them in the same position has always been a problem. Well everyone seeks greener pastures, they were no different. Required to do all the difficult job out there and still not have the recognition or financial stability, made them to look for better opportunities. 

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The ICU/CCU Nursing protocol says you ought to have a 1:1 ratio of patient and nurse. We do not see that happening even now, even though we are producing so many nurses. This should change and the protocols should be followed if we are to provide good healthcare services. Are we ready for the change, now that we are having competition among hospitals in providing best patient care? Time will only show. 

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