Interview | INVEST

SOLID &
STEADFAST
IN THE FACE
OF CRISIS
TRIBHUVAN UNIVERSITY TEACHING HOSPITAL EMERGES FROM THE
DEVASTATION OF THE 2015 NEPAL EARTHQUAKE WITH A STRONG REPUTATION,
THANKS TO THE LEADERSHIP OF DR DEEPAK PRAKASH MAHARA.
WORDS JENNIFER SIJNJA � IMAGES SHIVA LAL SHRESTHA

D
r Deepak Prakash Mahara, a graduate of the conducting research projects that valuably contribute to
Postgraduate Institute of Medical Education biomedical and health sciences research in Nepal.
and Research, in Chandigarh, India, is no The hospital has grown immensely over the past 35 years,
stranger to crisis. When accepting the position from 301 beds to 750 beds with super specialty services.
of Executive Director of the Tribhuvan However, its growth has not always been accompanied by an
University Teaching Hospital (TUTH) in increase in human resources. As a public hospital, it cannot
2014, Deepak was thrown into the deep end: the hospital charge to cover increasing costs, and in 2014 it was evident
was in the middle of a financial crisis, and a natural disaster in that funds would not cover the development of better health
2015 added to its difficulties. When Deepak’s four-year tenure services, improvements in equipment quality, and increases in
finished in July 2018, it had shifted from a negative to positive staffing. The hospital was struggling to even cover its existing
balance, with a surplus budget worth US$5 million. staff ’s salaries. “When I became director,” Deepak tells The
Established in 1983 with the support of the Japanese CEO Magazine, “my first goal was to bring it out of financial
As featured in
government, TUTH forms part of Tribhuvan University’s crisis. I tried to discover the underlying cause, and found that
The CEO Magazine Institute of Medicine (IOM), in Maharajgunj, Kathmandu, the biggest contributing factor lay in human resources.”
For more info visit Nepal. The practical elements of IOM’s academic programs So, he knew he needed to formulate a plan, and quickly.
theceomagazine.com
take place in the hospital, but it also functions as a national Deepak faced a tough battle with the government to get
hospital, providing health services at a tertiary level, and the human resources needed. He acknowledges that “it is »

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 Interview | INVEST

built on stable foundations. “I wrote an

“COMMUNITY open letter of appreciation to the Japanese
government,” Deepak says, “mentioning that the
HOSPITALS ARE Teaching Hospital’s successes in this time of

CONTINUALLY need was not only because of competence, but

also because of the strength of our buildings.
IMPROVING ... The Teaching Hospital has a great appreciation
for the people and the Japanese government,
THE TEACHING who constructed such a vision 35 years ago.”

HOSPITAL In turn, the Japanese government responded

with an appreciation of what TUTH had
SHOULD LEARN managed to achieve during a time of great
crisis. They asked Deepak how he would like to
FROM THEM.” take the hospital forward, and this is where he
saw a chance to seek improvements in the
quality of the hospital’s equipment. They offered
hospitals in the region affected, ours
was the only one that could cope with
the injured. Other hospitals could not
because their buildings were not safe.”
In the immediate aftermath of
the earthquake, before the devastating
aftershocks, TUTH had four operating
rooms running, extending to eight by
the first night. Over the following
20 days, 1,723 earthquake victims reputation for crisis response capability in the wake of the
were treated at TUTH, with 478 events of April and May 2015. An orthopaedic surgeon
major surgeries carried out. by training, he leaves the role excited about the hospital’s
very difficult to get the kind of resources we needed to As well as the work taking place in the hospital itself, expansion and advancement of the newly set-up orthopedic
be approved by the Ministry of Finance”, and his ability to TUTH established a Disaster Outreach Management department. Recently, a 75-bedded orthopedic ward,
procure even a third of the additional resources required was Committee, staffed by senior doctors, to aid additional six-bedded high dependency ward and three modular
celebrated as a remarkable achievement for a university districts heavily affected by the quake. Outreach camps operation theatres have been added. There is a commitment
hospital. Having started to tackle the problem of human were established in the Gorkha, Rasuwa and Sindhupalchok to making healthcare solutions available to those who
resources, Deepak turned to improving the quality of the districts, where treatment was available for minor injuries, and otherwise would be unable to afford them, with a focus on
hospital’s equipment, facing further constraints in having to individuals with major injuries were given an initial diagnosis providing cochlear implants to patients with hearing
follow a public procurement system. It was common practice and referred to various hospitals. To prevent overcrowding, money, but he politely refused. “I requested they do the difficulties. In Nepal, the devices are expensive, costing
to engage in a slow process of acquiring new equipment, TUTH coordinated with the Nepal Youth Foundation (NYF) international tender in Japan, rather than going through between US$10,000–12,000 per unit. Deepak fought for
technically capable but at the cheaper end of the spectrum. to send displaced patients to one of NYF’s Nutritional the procurement department in Nepal, so we could get government subsidies to the tune of US$5,000 per unit,
Things would change, however, in the wake of the next crisis. Rehabilitation Homes in Sunakothi. the best-quality equipment in the hospital.” As a result, offered to four patients each year, and the hospital plans to
On 25 April 2015, an earthquake registering 7.8 on Deepak notes that these remarkable efforts could not US$7 million worth of equipment, including a new MRI provide 24 patients with the implant every year.
the moment magnitude scale hit Nepal, with its epicentre in have happened without the support of many organisations, scanner, was handed over to TUTH in April 2018. Another area in development is an additional organ
Barpak, Gorkha. Building collapses were rife in Kathmandu, like the NYF, the International Organization for Migration, The hospital’s response to the quake was acknowledged transplant service. The hospital has been performing kidney
with avalanches and landslides occurring in the surrounding and Child Workers in Nepal, as well as Nepal’s Ministry of by the international media. The president of the Association transplants for seven years, and it has started to make
areas. More than 22,000 casualties were recorded, with Health and Population. Equally important to the hospital’s of Medical Doctors in Asia, Dr Shigeru Suganami, paid the arrangements for liver transplants this year. The budget is
a death toll of almost 9,000. Buildings in most government ability to respond to the crisis was the vision of those hospital a visit, praising its management. A memorandum government-approved and a construction of Liver transplant
hospitals in the capital, as well as those forming part of the committed during the hospital’s inception to ensure it was of understanding was established in July 2017 between the ICU (LICU) designed with postoperative liver transplant
private hospitals, were damaged in the quake, and only Association of Medical Doctors of Asia (AMDA) International recipients in mind has been completed and inaugurated »
TUTH remained fully functional. “We were so lucky,” Japan and TUTH for five years, designed to promote
“TUTH, being the biggest teaching hospital of the nation, is the central referral
Deepak acknowledges. “The hospital is an earthquake- hospital which deals with all types of diseases. It has a large portfolio for almost a Hospital Preparedness for Emergency faculty exchange. “TUTH is a not-for-profit, central, referral hospital. It deals with all types of
resistant structure, built 35 years ago with the help of the all types of MCH programs. Thus, working with TUTH explores maximum
opportunities and helps in developing good PR.” – Sanzu Rajkarnikar, Director,
While serving as executive director, Deepak oversaw diseases, and maintains high standards of health. TUTH is a landmark of
professionalism and I wish their mission success.” – Yagya Bahadur Bhandari,
Japanese government and their technology. Out of all the Himalaya Medical Technologies Pvt. Ltd. several initiatives and projects that built on the hospital’s Managing Director, Sindhu Surgical Concern Pvt. Ltd.

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INVEST | Interview

contribution to society and I knew we had to do something.” citizens and reflects their contributions. You must run your
The hospital is now half-way through a two-year project to organisation with a mission, vision, and united goal in mind.”
reform its waste management system, and there are plans to The fixed charity fund has reached US$100,000
develop a Hospital Waste Management Training Center. thanks to the overwhelming donations for earthquakes
Deepak made a point of always seeking to learn from victims from within the country and overseas. The funds will
other hospitals in the area, guided by the principle that treat the poor, underprivileged and unidentified patients at
hospitals like TUTH are meant to ensure improvements in TUTH, while some is carefully saved for future emergencies.
the quality of life of the people they treat. He is effusive Deepak reminisces on his childhood in Doti, where
in his praise for community hospitals in the Kathmandu people often could not access health facilities and other
Valley region, which are providing quality medical services basic needs. He attributes his career to his late father, Ganga
to impoverished communities. “Community hospitals are Prasad Mahara, who inspired him to become a doctor and
continually improving,” he says, “and when they do good, compassionately serve communities like Doti.
the Teaching Hospital should learn from them.” Despite Deepak established the Sagarmatha Health Foundation
their smaller size, if they have good systems in place, the (SHF), a not-for-profit committed to the physical, mental
hospital would be serving its patients to learn from them. and social wellbeing of the Nepalese people. In partnership
This devotion to the public good characterised Deepak’s with Health Care Nepal, USA, founded by Jack Starmer,
relationship with the hospital’s partners, and he made sure to SHF has been running free health camps, providing free
communicate this spirit when negotiating with potential medical services to thousands of Nepalese in remote places

“THE TEACHING suppliers. “I would approach companies asking them to

reduce prices without compromising quality, sharing how
for the past 20 years. “It is people like my late father and
Jack who continue to inspires me.”
HOSPITAL HAS A GREAT those in need would benefit,” he says. “TUTH is a public
hospital, so it’s everyone’s hospital. Its betterment is not the
“An important aspect of the TUTH project was that it had to be executed while
the hospital was operational. This challenge was met with great success with

APPRECIATION FOR With the mechanisms in place to distribute the oxygen

sole responsibility of the government and staff, but also the
public’s. “If its standard of service improves, it benefits all
help from JICA, Dr Deepak Prakash Mahara, Penta Trade Co. Ltd., Japan,
Tokyo Sangyo Co. Ltd. and the Consultant KRC.” – Roshan Shrestha,

THE PEOPLE AND THE having fallen into disrepair, the safety of the patients was at
Managing Director, Shrestha Construction Company

JAPANESE GOVERNMENT, risk due to oxygen concentration levels remaining stubbornly

below optimum. Deepak submitted a proposal to the America
WHO CONSTRUCTED Nepal Medical Foundation for an oxygen concentration plant
to supply oxygen to the hospital’s operating theatre, ICU, and
SUCH A VISION postoperative ward. More than a year ago, supported by the

35 YEARS AGO.” Nepalese government, two oxygen plants 1,000 litre/min and
500 litre/min were set-up and are fully functional. And
thanks to the America Nepal Medical Foundation (ANMF),
another 500 litre/min oxygen plant is currently being
by the Minister of Health and Population in July 2018. installed, dedicated to operation theatres, ICUs and post
The hospital has hired two surgeons specialising in liver operative ward. A gift from ANMF, it’s an appreciation for the
transplants, while radiologists, anaesthesiologists and swift aid offered to earthquake victims.
paramedics, trained in Australia and India, will soon be While these initiatives, and others like them, are worthy 匀䠀刀䔀匀吀䠀䄀
arriving. The necessary technical support for such a large of celebration, Deepak leaves the job with the recognition 䌀伀一匀吀刀唀䌀吀䤀伀一
undertaking is likely to be provided by the SingHealth that not everything about the hospital is as good as it ought 䌀伀䴀倀䄀一夀
䘀䄀䌀䤀一䜀 䌀䠀䄀䰀䰀䔀一䜀䔀匀Ⰰ 䘀䤀一䐀䤀一䜀 匀伀䰀唀吀䤀伀一匀
group of Singaporean healthcare institutions, Austin Hospital to be. He was disheartened by one component of the 匀䤀一䌀䔀 ㄀㤀㜀㜀
in Melbourne, Australia, Apollo Hospital in Delhi, India, and hospital’s operations in particular: its waste disposal methods.
the Singapore General Hospital in particular. Professor Tay After a small study, he found that 92 per cent of the hospital’s 圀䠀䄀吀 ⴀ䄀䤀刀倀伀刀吀匀      ⴀ䈀刀䤀䐀䜀䔀匀       ⴀ䈀唀䤀䰀䐀䤀一䜀匀
Boon Keng, under whom Deepak trained in sports waste was hazardous, when the standard is 15 per cent. “This 圀䔀 ⴀ䠀夀䐀䔀䰀匀        ⴀ䠀伀唀匀䤀一䜀匀      ⴀ䠀䤀䜀䠀圀䄀夀匀

medicine in 1998, will be an important figure in helping blew my mind,” he says. “Municipal trucks were removing 䐀伀㼀 ⴀ䤀刀刀䤀䜀䄀吀䤀伀一匀     ⴀ圀䄀吀䔀刀 匀唀倀倀䰀䤀䔀匀

the hospital get ready to carry out liver transplants. waste from the hospital and disposing of it at a dumping site,
A victory that Deepak recorded during his term involved leaving it with public waste. We were making a very negative
the overhaul of the hospital’s oxygen supply system. “Every
hospital should have its own oxygen supply,” he says, but in “TUTH is one of the most prestigious medical colleges and tertiary care hospitals
2016, TUTH obtained oxygen from cylinders sourced by an in Asia. We are privileged to be a partner and contributor in their incredible
journey. We wish them every success in days to come.” – Roshani Kasaju 䈀栀愀琀戀栀愀琀攀渀椀ⴀ㔀Ⰰ 䬀愀琀栀洀愀渀搀甀Ⰰ 一攀瀀愀氀 ⬀㤀㜀㜀ⴀ㄀ⴀ㐀㐀㄀　㤀㘀㤀
external supplier, at great expense and with poor efficiency. Shrestha, CEO, Serolab Group 猀栀爀攀猀琀栀愀挀漀渀猀琀爀甀挀琀椀漀渀䀀最洀愀椀氀⸀挀漀洀 眀眀眀⸀猀栀爀攀猀琀栀愀挀漀渀猀琀爀甀挀琀椀漀渀⸀挀漀洀

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