GOVERNING BODY
chairman MR. VIDYADHAR MALLIK HON. MINISTER FOR HEALTH AND POPULATION
members MR. NARAHARI ACHARYA HON. MEMBER OF CONSTITUENT ASEMBLY
DR. PRAVEEN MISHRA SECRETARY MINISTRY OF HEALTH AND POPULATION
MR. ANANDA RAJ DHAKAL JOINT SECRETARY MINISTRY OF FINANCE
DR. SITARAM CHAUDHARY DEAN NATIONAL ACADEMY OF MEDICAL SCIENCES BIR HOSPITAL
MRS. ANURADHA KOIRALA WOMEN REPRESENTATIVE
MR. SANJEEB RAJBHANDARI SOCIAL WORKER
DR. ABANI BHUSAN UPADHYAYA SR. CONSULTANT CARDIOLOGIST
DR. YADAV KUMAR DEO BHATT SR. CONSULTANT CARDIOLOGIST
DR. RAAMESH RAJ KOIRALA CONSULTANT CARDIAC SURGEON
member secretary DR. MAN BAHADUR K.C. EXECUTIVE DIRECTOR
EDITORIAL Shahid Gangalal National Heart Centre, since its establishment, has strived to provide quality cardiac care to the Nepalese public of diverse socio-economic strata which includes the poorest receiving free medical and surgical services and the affording class, making their contribution for the running of the institute. Beginning from a tiny out patients setup, we have now achieved an establishment providing advanced care in Cardiology, Preventive Cardiology, Pediatric Cardiology, Cardiac Surgery and Cardiac Anesthesia.
Every year, an Annual Data of all the works accomplished within the institute is compiled into a report, which refl ects the hard work of all within the hierarchy of the working group. The team work, selfl essness and devotion of the working group to the patients are what has been the major driving force for the productivity and the achievements seen within the institute.
We as editors have had the wonderful opportunity of compiling such a diverse data, technical works and original articles. We thank all the contributors and the authors for their effort as well as achievements. Finally we wish Shahid Gangalal National Heart Centre, to remain a true National Heart Centre and a centre of excellence in the fi eld of Cardiac Science. Dr. Sajan G Baidya Dr. Bijoy G Rajbanshi Dr. Dipanker Prajapati Dr. Amrit Bogati Ms. Samjhana Shakya Mr. Mahendra Lamsal Mr. Santosh Dhakal ANNUAL REPORT 2013
TABLE OF CONTENT qm=;+= lzif{sk]h g+= 1 sfo{sf/L lgb]{zssf] jflif{s k|ltj]bg 1-3 2 cf=j=)^(÷&) sf] jflif{s sfo{qmdsf] k|ult tyf cfoJoo ljj/0f 4-6 3 Cardiovascular Surgery 7-8 4 Department of Anesthesiology 9-11 5 Non-Invasive Cardiology and OPD Services 12-15 6 Pediatric Cardiology Service 16-19 7 Acute Coronary Syndrome 20-22 8 Medical Intensive Care Unit (MICU) 23-24 9 Interventional Cardiology Services 25-27 10 Cardiac Electrophysiology and Device Implantation 28-29 11 Emergency Services 30-31 12 Medical Ward 32-33 13 Department of Cardiac Rehabilitation & Health Promotiion 34-36 14 Nursing Department 37-39 15 Pathology Services 40-41 16 Radiology Services 42-44 17 Pharmaceutical Care 45-46 18 Physiotherapy Services 47-49 19 Annual Mortality : 2013 50-52 20 My Days at SGNHC 53-54 21 Ps lj/fdLsf] gh/df zxLb u+ufnfn /fli6«o x[bo s]Gb| 55-58 22 A Roadmap for Positive Revolution in the Management 59-61
23 s]Gb|df kl/:s[t x'“b}{ u/]sf] gl;{ª ;]jf 62-63 24 l;=P;=P;=8L Ps dxTjk"0f{ ljefu 64 25 God’s Clinic 65 26 Avian Flu 66-67 27 Zj]t j:qdf ltdL 68 28 Waste Management System 69-71 29 Photo Gallary 72-79 30 Staff Lists 80-90 Annual Report 2013
sfo{sf/L lgb]{zssf] k|ltj]bg 8f= dg axfb'/ s]=;L= sfo{sf/L lgb]{zs g]kfnleq} ;a} k|sf/sf d'6'/f]ux?sf] lgbfg, kfpFbf xfdL cToGt} uf}/jflGjt ePsf 5f}+ . pkrf/ tyf /f]syfd ug]{ p2]Zon] :yflkt ut cfly{s jif{ @)^(.&) df s]Gb|åf/f ;+kflbt o; zxLb u+ufnfn /fli6«o x[bo s]Gb|n] cfˆgf] k|d'v sfo{ljj/0f lgDgfg';f/ /x]sf] 5M cÝf/f}+ aflif{sf]T;j dgfpg uO/x]sf] 5 . ljut jif{x?df h:t} of] jif{klg s]Gb|n] cfˆgf] sfd alx/+u ;]jf !,!!,@^) hgf st{Ao ;Gtf]ifhgs ?kdf ;DkGg u/]sf] ;'gfpg cGt/+u ;]jf$$!$ hgf Non Invasive Cardiology tkm{ Electrocardiography (ECG) 63330 Transthoracic Echocardiography (TTE) 46394 Transesophageal Echocardiography (TEE) 781 Treadmill Test (TMT) 9118 Holter Monitoring 2757 Ambulatory Blood Pressure Monitoring 1176 Stress Echocardiography 106 Carotid Doppler 205 Fetal Echocardiography 146
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Invasive Cardiology tkm{
Coronary Angiogram (CAG) 2294 Peripheral Angiogram (PAG) 53 Coronary Angioplasty 790 Percutaneous Transluminal Mitral Commisurotomy (PTMC) 403 Electrophysiological Study and Radiofrequency Catheter Ablation (EPS 171 & RFA) Right and left Heart Cathererization 71 Pacemakers and Devices 238 Device Closure (ASD / PDA) 44
Cardiac Surgery tkm{
Coronary Artery Bypass Graft (CABG) 165
Valve Replacement 517
Correction of Congenital Heart Defect 580
Vascular Surgical Procedures 65
CCP 23
Others 39 d'6'/f]uLx?sf] pkrf/ s]Gb|sf] d'Vo sfo{ eP lgMz'Ns pkrf/sf] nflu ah]6sf] Joj:yf tfklg d'6'/f]usf] /f]syfd / o;;DaGwL u/]sf] 5 . To;}u/L d'6sf' ] eNe ljlu|Psf hgr]tgf clej[l4 ug]{ sfo{df klg s]Gb| u/La tyf c;xfo la/fdLsf] nflu b'O{;o lg/Gt/ nfluk/]sf] 5 . o; cfly{s jif{df j6f lgMz'Ns eNesf] Joj:yf u/]sf] 5 . klg s]Gb|n] d]lrb]lv dxfsfnL;Ddsf ;fF3'l/Psf] eNe v'nfpg] PTMC k|ljlwsf] ljleGg efudf ljz]if1x?sf] 6f]nLn] ( j6f nflu g]kfn ;/sf/åf/f ?=! s/f]8 &) nfv k|ltsf/fTds sfo{qmdx? ;+rfng u/]sf] 5 . ljlgof]hg ul/Psf] lyof] . o;sf] cltl/Qm h;sf] k|efj hg:t/df lgs} /fd|f] kfOPsf] pNn]lvt ;/sf/L ;]jfleq gk/]sf jf To;n] xfd|f] cg'ej 5 . ck"u ePsf uDeL/ k|s[ltsf] d'6'/f]u nfu]sf lj/fdLx?nfO{ :jf:Yo dGqfnodfkm{t ljkGg gful/s sfo{qmd cGtu{t ?= krf; xhf/ uDeL/ k|s[ltsf d'6'/f]usf] pkrf/df g]kfn b]lv Ps nfv;Dd cg'bfg lbg] Joj:yf ul/Psf] ;/sf/n] cToGt} dxTj lb+b}cfPsf] s'/f 5 . nf]kf]Gd'v hghfltsf nflu lgMz'Ns pkrf/ oxfFx?nfO{ ljlbt} 5 . ut cfly{s jif{df klg sf] Joj:yf ul/Psf] 5 . o; cltl/Qm hoGtL g]kfn ;/sf/n] !% jif{d'lgsf afnaRrfx? d]df]l/on 6«i6, /fd lgjf; kjg s'df/ tyf &% jif{dflysf h]i7 gful/sx?nfO{ cu|jfn sf]if, kfNkf tfg;]g lgjf;L eujtL
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b]jL ;}+h' cIfo sf]if, g]kfn x[bo/f]u lgjf/0f ;DkGg e};s]sf] 5 . k|lti7fg nufotsf ljleGg ;xof]uL ;+3–;+:yf cfly{s cg'zf;g / cfly{s sf/f]af/df tyf JojlQmx?n] klg u/La tyf c;xfo kf/blz{tf xfd|f] g}lts an xf] . xfdLn] ;Dk"0f{ lj/fdLsf] pkrf/df oyf;Sbf] cfly{s tyf v/Lb k|lqmof O{–6]08/dfkm{t k|efjsf/L¿kn] ef}lts ;xof]u ul//x]sf 5g\ . ug{ ;kmn ePsf 5f}+ . ljut cfly{s jif{x?df s]Gb|nfO{ ;d;fdlos k|ljlw;Fu lg/Gt/ h:t} cf=j= @)^*.^( ;Dddf n]vf k/LIf0fdf hf]l8/fVgsf] nflu sfl8{of]nf]hL, sfl8{ofs s]Gb|sf] a]?h' z'Go g} 5 . ;h{/L tyf gl;{Ë ljifodf pRr lzIff tyf cGtdf, s]Gb|sf] ljsf;, lj:tf/ / :yfoLTjsf] Super Specializati on sf] nflu ut cfly{s nflu lg/Gt/ nflu/xg'ePsf s]Gb|df sfo{/t jif{df klg :jb]z tyf ljb]zdf tfnLdsf] ;Dk0f" { sd{rf/Lx?, ;+rfns ;ldltsf ;b:ox?, Joj:yf ul/Psf] 5 . lrlsT;f lj1fg tyf g]kfn ;/sf/sf ;/f]sf/jfnf lgsfox?, /fli6«o k|lti7fg (NAMS) ;Fu ;xsfo{ u/L rGbfbftfx?, /Qmbftfx?, u}/;/sf/L ;+:yfsf d'6'/f]usf] If]qdf pRr lzIffsf] cWofkg k|ltlgwLx?, kqsf/x?, lj/fdL tyf pgLx?sf lg/Gt/ hf/L 5 . cfkmGtx? Pj+ ;Dk"0f{ z'e]R5's hgdfg;df s]Gb|sf] ef}lts k"jf{wf/ tof/ ug]{ sfo{df klg xflb{s wGoafb JoQm ug{ rfxG5' . xfdL lg/Gt/ nflu /x]sf 5f}+ . s]Gb|sf] s"n z}of ;+Vof @)) k'¥ofpg] sfo{ clGtd r/0fdf 8f= dg axfb'/ s]=;L= k'u]sf] 5 . o;} cfly{s jif{df yk Ps yfg sfo{sf/L lgb]{zs cTofw'lgs SofyNofa d]lzg h8fg ug]{ sfo{ ldltM@)&).!).!%
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cf=j=@)^(÷)&) sf] jflif{s sfo{s|dsf] k|utL tyf cfo Joo laa/0f ladn s'df/ pk|]tL dgf]h s'df/ lai^ o; s]Gb|n] cf=j=2069÷70 df d'Vo 8 3= PGhLof]u|fkmL÷Knfi^L k/LIf)f ;]jfM j^f sfo{s|d ;+rfng ug]{ nIo /flvPsf] / ;f] sfo{s|d ;+rfngsf nflu g]kfn cf=j=2069÷70 df hDdf 3500 ;/sf/sf] tkm{af^ kRrL; s/f]* kGrfgAa] hgf d'^'sf la/fdLx?sf] SofyNofa nfv, :jf:Yo s/sf]ifsf] tkm{af^ b'O{ s/f]* ;]jfdfkm{t PGhLof]u|fkmL÷Knfi^L PsxQ/ nfv ;f&L xhf/ / cfGtl/s nufotsf laleGg /f]ux?sf] >f]taf^ afpGg s/f]* %oQ/ nfv j]xf]g]{ k/LIf)f tyf lgbfg ug]{ nIo u/L s'n /sd Psf;L s/f]* aofnL; nfv /fvLPsf]df jflif{s nIosf] ;f&L xhf/ ah]^ Joj:yf ul/Psf]df o; cfwf/df o; cf=a=2069÷70 df cfly{s aif{df d'Vo 8 j^f sfo{s|d ;DkGg e} rf}xQ/ s/f]* PstL; nfv c&\;¶L hDdf 4282 hgf la/fdLx?sf] xhf/ vr{ ;d]t e} pQm /sdaf^ pNn]lvt SofyNofa dfkm{t laleGg pkrf/ sfo{s|dx? ;+rfng ePsf %g\ . ul/Psf]% . pkrf/ u/fPsf] la/fdLx?dWo] 2268 hgf la/ 1= d'^'/f]uLx?sf] k/LIf)f ;]jfM fdLsf] d'^'sf] PGhLof]u|fkmL, 766 hgf la/fdLsf] d'^'sf] PGhLof]Knfi^L, 435 o; cf=j=2069÷70 df hDdf hgf la/fdLsf] d'^'sf] lk=l^=Pd=;L, s"n 100000 hgf lj/fdLx?nfO{ 219 hgf la/fdLsf] lklkcfO{, 196 alx/+u ;]jfdfkm{t ;]jf k'¥ofpg] nIo hgf la/fdLsf] l^=lk=cfO{, 171 hgf /fv]sf]df o; cf=j=2069÷70 df la/fdLsf] OlkP; tyf cGo 227 hDdf 110840 hgf la/fdLx?sf] hgf la/fdLsf] SofyNofa dfkm{t d'^'sf] k/LIf)f ul/Psf]% . o;/L cGo ;]jfx? pknAw u/fOPsf] aflif{s nIosf] cfwf/df 110% lyof] . o;/L jflif{s nIosf] ef}lts k|ult b]lvPsf]% . cfwf/df 122% k|ltzt ef}lts 2= d'^'sf] zNols|of ;]jfM k|ult b]lvPsf]% .
cf=j=2069÷70 df hDdf 1200 4= k|ltsf/fTds ;]jf M hgf la/fdLsf] d'^'sf] zNols|of cf=j= 2069÷70 df hDdf 7 j^f ug]{ sfo{s|d /flvPsf]df o; k|ltsf/fTds sfo{s|d ;]jf ;+rfng cf=j=2069÷70 df hDdf 1414 ug]{ nIo /flvPsf]df ;f] sfo{s|d hgf la/fdLx?sf] laleGg vfn] d'^'sf] cGtu{t o; s]Gb|n] d'Vo d'Vo &fp+df zNols|of ul/Psf]% . h;dWo] 1152 d'^'/f]u ;DaGwL lzla/ ;+rfng u/] j^f cf]kg xf^{ ;h{/L, 133 j^f sf] lyof] . h;dWo]== Snf]h xf^{ ;h{/L / 129 j^f cGo • alb{of lhNnfdf 2 lbg] d'^'/f]u ;h{/Lx? ;DkGg ePsf %g\ . o;/L ;DaGwL lgMz'Ns :jf:Yo lzlj/ % jflif{s nIosf] cfwf/df 118 ;+rfng u/L 1251 hgf la/fdLsf] k|ltzt ef}lts k|ult b]lvPsf]% . :jf:Yo kl/If)f ul/Psf] . ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 4 Annual Report 2013
• k;f{ lhNnfsf] la/u+hdf 1 lbg] 661 hgf ul/a la/fdLx?sf] laleGg d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lsl;dsf zNols|ofx? ;DkGg lzlj/ ;+rfng u/L 457 hgf ul/Psf]% eg] 75 jif{ dflysf 137 la/fdLsf] :jf:Yo kl/If)f ul/Psf] . hgf ul/a la/fdLx?sf] pkrf/ • dsfjgk'/ lhNnfsf] x]^f}+*fdf 1 lbg] ul/Psf]% . o;/L jflif{s nIosf] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo cfwf/df 100% k|ltzt ef}lts k|ult lzlj/ ;+rfng u/L 238 hgf b]lvPsf]% . la/fdLsf] :jf:Yo kl/If)f ul/Psf] . • l;Gw'kfNrf]s lhNnfdf 1 lbg] 7= lk=^L=Pd=;L= ug]{ la/fdLx?sf] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lgMz"Ns :jf:Yo ;]jf sfo{s|dM lzlj/ ;+rfng u/L 320 hgf la/fdLsf] :jf:Yo k/LIf)f ul/Psf] . cf=j=2069÷70 df g]kfn • ;+v'jf;ef lhNnfdf 1 lbg] ;/sf/$f/f z'Ns ltg{ g;Sg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo d'^'sf] eNe ;f+#'l/Psf] la/fdLx?sf] lzlj/ ;+rfng u/L 530 hgf pkrf/sf nflu #f]lift /fxt la/fdLsf] :jf:Yo k/LIf)f ul/Psf] . sfo{s|d cg';f/ ?=1 s/f]* 70 • u'NdL lhNnfsf] /fgLjf;df 2 lbg] nfv /sd lalgof]lht e} cfPsf] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo df pQm /sdaf^ 447 hgf ul/a lzlj/ ;+rfng u/L 560 hgf la/fdLx?sf] lk=^L=Pd=;L=;DkGg la/fdLsf] :jf:Yo k/LIf)f ul/Psf] . ul/Psf]% . o;/L jflif{s nIosf] • sf:sL lhNnfsf] kf]v/fdf 1 lbg] % d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo cfwf/df 100 k|ltzt ef}lts k|ult lzlj/ ;+rfng ul/ 251 hgf b]lvPsf]% . la/fdLsf] :jf:Yo kl/If)f ul/Psf] . 8= k'jf{wf/ lgdf{)f tyf lasf; sfo{s|dM 5= d'^'sf] eNe /fxt sfo{s|dM cf=j= 2069÷70 df hDdf k'jf{wf/ cf=j= 2069÷70 df g]kfn lasf; tyf lgdf{)fsf nflu 1 j^f ;/sf/$f/f z'Ns ltg{ g;Sg] d'^'sf sfo{s|d cGtu{t ejg lgdf{)f tyf ul/a la/fdLx?sf nfuL #f]lift d]zLg/L cf}hf/ v/Lb sfo{s|d /fxt sfo{s|d cg';f/ :jf:Yo dGqfno ;+rfng ug]{ nIo /flvPsf]df ;f] dfkm{t 200 j^f d'^'sf eNex? vl/b adf]lhd d'Vo d'Vo sfo{df SofyNoj ug{ ?=80 nfv /sd lalgof]lht e} d]zLg, xf^{n*= d]zLg, Osf] d]zLg, cfPsf]df pQm /sdaf^ 200 j^f lx^/ s"n/, :^/gn z nufotsf d'^'sf eNex? vl/b sfo{ ;DkGg e} cfjZos pks/)fx?sf] Aoj:yf xfn pQm 200 j^f eNex? k|lsof ul/Psf], c:ktfnsf] nfuL k"/f u/L la/fdLx?nfO{ ljt/)f kmlg{r/x?sf] Aoa:yf ul/Psf] ;fy} u/L ;lsPsf] / lt la/fdLx?nfO{ eNe nufOlbg] sfo{ lgoldt?kdf e} c:ktfndf lgoldt?kdf x'g] cGo /x]sf]% . o;/L jflif{s nIosf] dd{t ;'wf/sf sfo{x? k"/f ePsf]% . cfwf/df 100% k|ltzt ef}lts k|ult b]lvPsf]% . lgisif{M
6= 15 jif{d'gLsf ty 75 jif{ dflysf o; s]Gb|n] rfn' cf=j=2069÷70 la/fdLx?sf] lgMz"Ns :jf:Yo ;]jf sfo{s|dM sf] aflif{s sfo{s|d ;+rfngsf nflu d'Vou/L 8 j^f sfo{s|d to u/L cf=j= 2069÷70 df g]kfn ;f]xL adf]lhd ah]^sf] Joj:yf ;/sf/$f/f z"Ns ltg{ g;Sg] 15 u/]sf]df jflif{s nIosf] cfwf/df jif{d'gLsf d'^'sf ul/a la/fdLx? tf]lsPsf] eGbf a(L cyf{t 100% tyf 75 jif{ dflysf d"^"sf ul/a la/fdLx?sf nflu #f]lift /fxt eGbf klg a(L ef}lts k|utL xfl;n sfo{s|d cg';f/ ?=10 s/f]* 8 u/]sf] b]lvPsf]% eg] ljQLotkm{ % nfv /sd lalgof]lht e} cfPsf]df jflif{s nIosf] cfwf/df 91=00 pQm /sdjf^ 15 jif{d'gLsf d'^'sf k|ltzt k|ult b]lvPsf]% .
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HOSPITAL INDICATORS Indicators 2067/68 2068/69 2069/70 Total No. of OPD patients 101479 108145 110840 % Emergency Visits among total hospital visits 8.80% 9.08% 11.26% Bed Occupancy Rate 78.1% 80.8% 79.07% ALOS 3.30% 3.56% 3.47% Proportion of Non-communicable disease among inpatients 100% 100% 100% Death rate among surgery (%) 5.68 6.60 4.46% Death rate among All in patients (%) 2.36 2.41 2.04% Total Surgery Cases 1425 1378 1414 Major surgery among total surgery cases (%) 91.36 89.25 90.87 Doctor: In-patient ratio 213.30 202.38 193.93 Doctor: out-patient ratio 3303.80 3004.02 3358.78 Nurse: in patient ratio 66.79 68.94 70.03
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DEPARTMENT OF CARDIOVASCULAR SURGERY
in the number of surgeries by 3.6% from INTRODUCTION previous year. We all want progress. Daring to give exact defi nition to progress, which is varied and SURGERIES relative term in itself, is diffi cult. It can be the achievement relative to time, or for With Available two operating theatres and some, progress means getting nearer to the 15 ICU beds, the total number of surgeries place where you want to be. Department performed was 1389. The overall mortality of cardiovascular surgery has completed was 5%. The group worst affected were twelve years of service. For the department those with complex congenital heart disease, the year 2013 was a memorable one, severe pulmonary artery hypertension and especially regarding the optimization of our low weight for age children. Surgeries for capacity to work with available resources congenital heart diseases were 580 and and infrastructure. Thus, it can be claimed those for heart valve diseases were 517. that the department has progressed with The number of CABGs done this year was each successive year. 165. Complex operations that determine the quality of cardiac surgery service, There are three surgical units in the such as surgery for The Transposition of department. Each surgical unit does heart Great Arteries, Fontan Procedure, Truncus surgeries twice a week and examines Arteriosus, Ebstein’s Repair, Repair of patients in the OPD four times a week. Traumatic Aortic Transaction, surgery for Number of OPD patients in 2013 year was Ascending and Thoraco-abdominal Aortic 18191, 8.85 % increment from the previous Aneurysm, Ventricular Reconstruction year. Likewise, there was an increment surgery, minimally invasive cardiac surgery
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 7 Annual Report 2013 etc are also done on regular basics. honorary visiting consultant surgeon by the centre. ACADEMIC ACTIVITIES We welcome back our colleague, Dr. Bijoy Winston Churchil quoted that “Sometimes Gopal Rajbanshi, after completing of his doing your best is not good enough. fellowship in cardiac surgery from Mayo
600 580 517 500
400
300
200 165
100 65 23 39 0 CAD Valve Congenital Aortic/Vascular CCP Others
Sometimes you must do what is required”. Clinic, Rochester, Minnesota, USA and Yale University, New Haven, USA. His training In November, a team from Mayo Clinic , from USA will defi nitely be benefi cial for Rochester , Minnesota, USA made their the department. visit to Nepal .During the period there was one day seminar regarding ‘Causes Of THE FUTURE Prolonged ICU Stay :Mayo clinic approach and approaches of cardiac surgical centers Being responsible for society, our aim is in Kathmandu’. to achieve maximum benefi t for maximum number of patients. We are planning for Prof. Prasanna Simha, an expert on Mitral expansion of operation theatre and intensive Valve Repair from Sri Jayadeva Institute care unit beds, development of minimal of Cardiovascular Sciences And Research, access cardiac surgery and train specialized Banglore, India, visited to our centre. surgeon in specifi c complex congenital During his visit, the department organized cardiac surgery. an audio-video symposium with live demonstration of Mitral Valve Repair. CONCLUSION Prof. Mallakh Lall Shrestha, chief staff surgeon and director of Aortic Surgery, We have progressed in the total number Department of cardiothoracic surgery, of patients being operated and also in the Hannover School of Medicine ,Germany complexity of cases in 2013. While we visited the center in December, and shared feel proud to present the current result, we with us his experience in complex aortic realize that harder task still lies ahead. arch surgery. He has been appointed as
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DEPARTMENT OF ANESTHESIOLOGY
Dr Jeju Nath Pokharel, Dr Apurb Sharma, Dr Ashish Govinda Amatya, Dr Surendra Bhusal, Dr Battu Kumar Shrestha, Dr Bidhan Gyawali, Dr Dhandu Rani Shakya
Cardiac Anesthesiology at the Shahid variety of pacemaker and implantable Gangalal National Heart Centre is a multi- cardioverter-defi brillator (ICD) faceted division dedicated to perioperative and arrhythmia procedures, percutaneous cardiovascular care, education and research. procedures for diagnostic and therapeutic The division encompasses: interventions in patients with congenital heart disease, balloon valvotomy of mitral, Pre-operative assessment and preparation aortic and pulmonary valves in the cath of all patients prior to surgery lab. Multi-disciplinary intensive care for cardiac surgery patients is provided in Intra-operative anesthesia services including Trans-oesophageal the Cardiac Surgical Intensive Care Unit. echocardiography Respiratory care support is also provided to the mechanically ventilated patients in the Post-surgical intensive care management Coronary Care Unit.
All other respiratory care Approximately 1,400 open-heart procedures per year require anesthesia. These procedures include coronary artery bypass, valve replacement surgery, surgery for repair of congenital heart lesions, vascular surgery, pericardial surgery, cardiac tumours and others. Clinical anesthesia is also provided for a growing number and
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Total number of patients requiring According to the type of cases in Operation anaesthesia services has considerably Theater, maximum numbers of cases were increased in the past year to 1790 from 1615 congenital heart disease, followed by from the previous year. Among that 1686 valvular heart disease. As usual coronary
received general anesthesia, remaining 104 patients received monitored anesthesia care. Sex wise distribution of the patients managed in operation room is shown in pie chart below. There was even distribution of cases in different months; Among all the anaesthetized cases in the however Kartik had least number of operating room, adults accounted for 52%, cases due to Dashain and Tihar, the major paediatric 48%. Infants accounted for 6% festivals of Nepalese people. This trend is of total cases. seen almost every year.
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artery disease occupied the third position. ACTIVITIES The total number of re-explorations had increased in the past year from 1.30% to Educational participation includes 2.84%. residency rotations for the National Academy of Medical Sciences, Department Number of the patients requiring of Anesthesiology Residency Program and anaesthesia services in catheterization running CME programs of the hospital. laboratory (cath lab) was 386. Among that right heart catheterization for cyanotic and The goal of our department is to insure acyanotic congenital heart diseases(CHD) quality care for the patient in the hospital, were 187 (52%), device closure for ASD, critical care, cath lab and develop the VSD or PDA were 28 (8%), percutaneous subspecialty training in cardiac anaesthesia coronary intervention (PCI) were 108 by fostering the research activities. (30%), percutaneous trans-septal mitral commisurotomy (PTMC) were 17 (5%).
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NON–INVASIVE CARDIOLOGY AND OPD SERVICES Dr. A. Bogati , Dr. S. Baniya, Dr. S.G. Baidya, Dr. D. Sharma INTRODUCTION Echo machines (2 high-end and 3 medium range), 3 treadmills, 20 functioning holter Shahid Gangalal National Heart Centre monitoring devices and 7 ABP devices. The has been running Outpatient departments services provided in our institution include since the establishment of the institution. Exercise Stress Testing/Treadmill Stress Nepalese people from all over the country Test, Pharmacological (Dobutamine) Stress including foreigners living in Nepal or for Tests, Exercise Stress Echocardiogram, travel, have benefi tted from both general Transthoracic Echocardiogram, and paying OPD services. Along with Transesophageal Echocardiogram, Holter the OPD consultations, patients undergo monitoring, Electrocardiogram (ECG), different investigative procedures which Ambulatory Blood Pressure monitoring, aid in the diagnosis of the diseases. Chest X-ray, Fetal Echocardiography, Carotid Doppler, Enhanced External Non-invasive services form an integral Counter Pulsation (EECP) and Benzathine part of this institution both in the form of Penicillin Injections. services provided to the patients as well as a major source of income for the running SERVICES PROVIDED of the hospital as a whole. Advanced non- invasive cardiology imaging technologies During the Year 2013, there were total of have dramatically improved early detection 1,11,260 patients attending the outpatient and treatment of cardiovascular diseases. department as compared to 1,05,941 patients They are typically safe and painless, and last year. Each year there is signifi cant allow you to resume normal activities increase in the number of patients attending almost immediately. both general and paying OPDs, resulting the highest number of patients attending Currently, the non-invasive unit in our the outpatient department this year, since institution is equipped with 5 functioning
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the establishment of this institution. This Since the introduction of EECP (Enhanced shows the increase in awareness of people External Counter-Pulsation) service at our towards their health. centre for the fi rst time in this country in 2010, total of 25 patients have benefi tted Similarly, the number of almost all non- from this service with refractory angina invasive procedures this year has exceeded despite optimal medical management the number from last year. Among them, who are not candidates or not willing for the maximum number of people underwent revascularization. Transthoracic Echocardiogram (total of 46,394).
Number of Pati ents Receiving Non-invasive Services in 2013
Investi gati ons Male Female Total Electrocardiogram 20957 18185 39142 Transthoracic Echocardiogram 24077 22317 46394 Echo Screening 424 466 890 Trans-oesophageal Echocardiogram 225 556 781 Dobutamine Stress Echocardiogram 75 31 106 Fetal echocardiogram 0 146 146 Caroti d Artery Doppler 135 70 205 Tread mill test 5836 3282 9118 Holter monitoring 1379 1378 2757 Ambulatory Blood Pressure Monitoring 704 472 1176 Total OPD a endance 57379 53881 111260 Benzathine Penicillin Injecti ons 2636 3704 6340 X-Ray 25379 22636 48015
Graphs below show a comparison in the number of patients receiving non-invasive services since the beginning of the service at the OPD:
Yearly OPD attendance
120000 100000 80000 60000 Number 40000 20000 0 1999 2001 2003 2005 2007 2009 2011 2013 Year
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Tread Mill Testing
10000 8000 6000
Number 4000 2000 0 1999 2001 2003 2005 2007 2009 2011 2013 Year
Transthoracic Echocardiogram
50000
40000
30000
20000 Number
10000
0 1999 2001 2003 2005 2007 2009 2011 2013 Year
Ambulatory Blood Pressure Monitoring 1200 1000 800 600
Number 400 200 0 1999 2001 2003 2005 2007 2009 2011 2013 Year
Transesophageal Echocardiogram
800
600
400 Number 200
0 2001 2003 2005 2007 2009 2011 2013 Year
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Holter Monitoring
3500 3000 2500 2000 1500 Number 1000 500 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year
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PEDIATRIC CARDIOLOGY SERVICE
Dr. Urmila Shakya, Dr. Manish Shrestha, Dr. Shova Pandey Koirala
INTRODUCTION we came across here. In Shahid Gangalal National Heart SERVICES PROVIDED Centre, children suffering from heart diseases are mainly dealt in Pediatric Pediatric Cardiology unit provides OPD, Cardiology unit. Structural (congenital) Inpatient, Non-invasive and Invasive services. Pediatric Cardiology OPD was heart disease and rheumatic heart started on 2004A.D with very limited disease are the major chunk of patients, resources. Till last year, Pediatric OPD was running thrice a week (Sunday/ Tuesday/ Thursday). From the month of March of this year, OPD has been running every weekday (i.e., Sunday to Friday). The total no. of OPD patients in 2013 were 5903. Among them, 3449 (58.4%) were male and 2454 (41.6%) were female. Fig. 1: No. of OPD pati ents as per year
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There is a sharp increment of number of Pediatric Cardiology unit is running patients in 2013 as compared to previous dedicated inpatient service with allocated years. This is due to increase in OPD days 6 bedded ward from the last 2 years. Total i.e., from 3 days a week to 6 days a week. of 162 patients were admitted this year. Fig 2 shows gender-wise distribution of Median age of children admitted was 10 patients visited to Pediatric OPD in 2013. years ranging from 11 days to 15 years; 84 In every month, the number of male patients were male and 78 were female. exceeds female patients.
Fig. 2. Sex-wise distributi on of OPD pati ents
Table 1: Distributi on of Inpati ent in Pediatric Ward Diagnosis Frequency HEART FAILURE 29 INFECTIVE ENDOCARDITIS 27 RHEUMATIC ACTIVITY 4 ARRYTHMIA 6 S/P RHC/LHC (Diagnostic cath study) 23 S/P INTERVENTION (Therapeutic) 32 Pericardial Effusion (including S/P 11 pericardiocentesis) Complex CHD (including TOF) 21 MISCELLANEOUS 9 Total 162 (NB: Someti mes due to unavailability of beds in Pediatric ward, children undergoing catheterizati on procedure had to be admi ed in other wards so disparity between numbers of catheterizati on related pati ents was seen.)
PEDIATRIC pediatric patients in 2013 were 4806. Among them, 2855 (59.4 %) were male ECHOCARDIOGRAPHY and 1951 (40.6 %) were female. Abnormal Total number of Trans Thoracic fi ndings in echocardiogram were found in Echocardiogram (TTE) performed in 3657 (76.1 %) patients. Abnormal fi ndings were broadly categorised into Acyanotic,
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Cyanotic, RHD, Status post-intervention, undergoing diagnostic Cath study and Status post-surgery and Miscellaneous (Fig therapeutic interventions like Balloon 3). Acyanotic CHD outnumbered all and Pulmonary Valvuloplasty (BPV), Balloon comprised 37.9% (i.e., 1822) of total (i.e., Aortic Valvuloplasty (BAV), Percutaneous 4806). Transluminal Mitral Commissurotomy (PTMC). Last but not the least, we are also performing device closure for ASD and PDA on selective basis. Number of pediatric patients who underwent invasive procedure this year is shown in table 3.
Table 3: Distributi on of pati ents undergoing interventi on Procedures Frequency Diagnosti c Cath Study (RHC/ 36 LHC) Fig. 3: Echocardiography Findings. “Number” Balloon Pulmonary indicates percentage of specifi c category. 20 Valvuloplasty (BPV) When compared to previous years, the total Balloon Aorti c Valvuloplasty 4 number of echocardiography performed this (BAV) year has signifi cantly increased and so as in Percutaneous Transluminal each category (Fig 4). This year not only the Mitral Commissurotomy 13 OPD service but also the echocardiography (PTMC) service has been extended from 3 days to PDA Device Closure 10 6 days a week. Apart from OPD, we get ASD Device Closure 3 referral from different departments for Coil Embolizati on (for Coronary 2 echocardiography. fi stulas)
Fig. 5. Invasive Service comparison in Fig. 4. Comparison of Echocardiography consecuti ve years fi ndings in consecuti ve three years. While comparing our intervention Regarding Invasive procedures, we services in the recent years, the number of perform diagnostic as well as therapeutic diagnostic catheterization studies has been procedures (catheter based intervention). decreasing. This indicates that the quality Since the advent of the Children Assistance of echocardiography has improved. The Programme (CAP) by government, there is children are diagnosed early and many marked increase in the number of patients children are undergoing surgery without catheterization study. Our therapeutic
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 18 Annual Report 2013 interventions are increasing gradually. training in Pediatric Cardiology including More and more children are being benefi tted echocardiography to interested candidates from minimal invasive interventions. from different institutes. This year two post graduate residents from different medical college were posted here for the period HUMAN RESOURCES of one month for pediatric cardiology exposure. At present, Pediatric Cardiology service is provided by one Consultant Paediatric Cardiologist, one Registrar and one Medical Offi cer. We hope to add further on it to CONCLUSION cope with the load in future. We too have remarkable experts visit in our centre from Due to increased awareness of heart disease different parts of world viz. Mayo Clinic, in Nepal, there has been steady increase in Minnesota; University of Texas Health the number of patients attending Pediatric Science, Texas; Escorts Heart Institute, Cardiology OPD. With limited resources New Delhi and so on. With their advice we are continually trying to give quality and guidance our goal of providing quality services and with more days to come we’ll Pediatric Cardiology care is being more leave no stone unturned for betterment of strengthened. We are also providing basic pediatric cardiology service.
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ACUTE CORONARY SYNDROME
Dr. Dipanker Prajapati Dr. Prekshya Singh, Dr. Mukunda Sharma
INTRODUCTION ECG are labeled as having an ST-segment elevation MI (STEMI) and should be Coronary Heart Disease (CHD) is a considered for immediate reperfusion worldwide health epidemic. Worldwide, therapy by thrombolytics or percutaneous 30% of all deaths can be attributed to coronary intervention (PCI); those without cardiovascular disease, of which more than ST-segment elevation but with evidence half are caused by CHD, and the forecasts of myonecrosis are deemed to have a non- for the future estimate a growing number ST-segment elevation MI (NSTEMI); and as a consequence of lifestyle changes in those without any evidence of myonecrosis developing countries. Globally, of those are diagnosed with unstable angina. dying from cardiovascular diseases, 80% are in developing countries. Acute SERVICE PROVIDED Coronary Syndromes (ACS) is a unifying term representing a common end result, Coronary care unit (CCU) in SGNHC has acute myocardial ischemia. Acute ischemia been especially designed to provide quality is usually, but not always, caused by care for ACS patients. The 12 bedded atherosclerotic plaque rupture, fi ssuring, CCU is well equipped with comprehensive erosion, or a combination with superimposed central monitoring, central oxygen supply, intracoronary thrombosis and is associated 24 hour mobile X-ray, 24 hour mobile with an increased risk of cardiac death and echocardiography, Defi brillator, Mechanical myonecrosis. ACS encompasses acute MI Ventilator and IABP support due to which (resulting in ST-segment elevation and non- patient care has become more effi cient and ST-segment elevation) and unstable angina. easier. On call cardiologists stay in house ACS patients presenting with new evidence 24 hours on top of resident doctors who are of ST-segment elevation on the presenting on duty. Consultations with other specialists
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 20 Annual Report 2013 and subsequent interventions are rendered DEMOGRAPHIC FEATURES as necessary. The medical staffs are not only well trained and effi cient, but are also Among 1188 ACS cases admitted in dedicated to excellence, compassion and SGNHC, 836 (70.37 %) were STEMI, integrity in patient care. The acute coronary 186 (15.66%) were NSTEMI and rest 166 cases are predominantly admitted through (13.97%) were UA. Male preponderance Emergency Department (ED) as they was clearly seen as 857 (72.14%) were usually present with acute chest pain. Few male and only 331 (27.86%) were female. are admitted directly through OPD. ECG is taken within 10 minutes on patient’s arrival. THROMBOLYSIS AND Patients with STEMI are managed with PRIMARY PCI primary PCI or thrombolysed according to duration of chest pain and affordability Among STEMI rate of Thrombolysis and of the patient. Rescue PCI is also rendered Primary PCI this year were 128 (10.77%) whenever necessary. Patients with STEMI, and 101 (8.5%) respectively which was NSTEMI and high risk UA are almost all seen to be lower compared to last year admitted in CCU. However patients with (thrombolysis 13.02%, PCI 12.9% last low to moderate risk UA are admitted year). There were 18 cases which received in CCU if beds are available, otherwise Tenecteplase in Thrombolysis group. in general ward. This article provides a MORTALITY brief outline of ACS admissions in the year 2013. There has been dramatic and The overall mortality of ACS was 57 consistent increment in the admissions of (4.8%). Mortality in STEMI, NSTEMI and acute coronary syndromes from 63 patients UA were 50 (6.0%), 2 (1.0%), 4 (2.4%) in the year 2001 to 1188 patients this year respectively. as shown in fi gure.
Figure 1: Increasing trend of ACS
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STK TNK Primary PCI Mortality ST ELEVATION WALL Total Admision MI M F Total % M F Total M F Total M F Total M F Total
Extensive Anterior 4 83 24 107 (13%) 15 4 19 1 2 3 17 2 18 2 3 Wall MI (3.73%) 252 20 Anterior Wall MI 179 73 23 7 29 7 0 7 28 4 32 12 8 (30.14%) (7.93%) 47 3 Antero Septal Wall MI 38 9 123101202 21 (5.62%) (6.38) 281 16 Inferior Wall MI 202 79 25 19 44 4 1 5 27 8 35 8 8 (33.61%) (5.7%) Inferior Posterior Wall 88 4 60 28 9 2 11 2 0 2 7 3 10 2 2 MI (10.52%) (4.54%) Inferior Posterior Lateral 3 21 000000000 00 0 Wall MI (0.35%) Anterior And Inferior 3 30 000000000 00 0 Wall MI (0.35%) Inferior and Lateral 9 72 101000011 00 0 Wall MI (10.76%) Inferior with RV Infarc- 22 1 16 6 213000000 01 tion (2.63%) (4.54%) 15 1 Lateral Wall MI 12 3 000000112 10 (1.79%) (6.66%) Extensive Anterior and 3 1 21 000000000 10 Inferior Wall MI 0.35% (33.34%) 6 Posterior Wall MI 42 000000000 00 0 (0.71%) 836 50 Total STEMI 608 228 76 35 110 15 3 18 82 19 100 28 23 (70.37%) (6%) 166 4 Unstable Angina 125 41 000000000 22 (13.87%) (2.4%) 186 2 NSTEMI 124 62 000000000 02 (15.66%) (1.0%) 857 331 57 TOTAL 1188 76 35 110 15 3 18 82 19 101 30 27 (72.14%) (27.86%) (4.8%)
The fi gures are comparable to the fi gures of we still need to upgrade our services west. The mortality in Extensive Anterior regularly. The facilities we are providing with Inferior Wall MI, Extensive Anterior are still not enough though. Mortality from Wall MI, Anterior wall MI were higher. CAD can be further decreased by training more effi cient and dedicated personnel, ACS admission pattern extending this health facility to rural areas so that they won’t delay treatment until DIAGNOSIS being referred to our centre, formulation TOT of plans so that best treatment possible for CONCLUSION CAD can be cost worthy and feasible to all socioeconomic class. Although we are one of the key centers to provide medical services to cardiac patients,
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MEDICAL INTENSIVE CARE UNIT (MICU)
Dr. Sanjay Signh K.C, Dr. Anjal Bista, Dr. Binay Kumar Rauniyar
INTRODUCTION SERVICES PROVIDED LAST YEAR Medical Intensive Care Unit (MICU) at SGNHC was established for critical In the year 2013, 1019 patients were patients requiring intensive monitoring and admitted in MICU with females accounting 359 and 660 males. ACS was the leading care primarily for heart failure patients. cause of admission accounting 34.05 % Though established at cardiac center mainly of total admission followed by Dilated focusing for terminal heart failure, MICU Cardiomyopathy and RHD in the second has been providing services to patients and third place respectively. Major cause with co-morbid illness mainly respiratory, of mortality was due to ACS with female nephrology and neurological problems preponderance. Two patients were admitted effectively. with diagnosis of HTN only, otherwise other patient of HTN had other co-morbid Since August 2002 MICU has been offering conditions as well. service to patients requiring intensive care Many patients were elderly with co due to different etiologies, mainly cases morbid conditions. So, taking care of the with refractory heart failure. patients was a big challenge. Table below summarizes last year-
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Disease Pa ern, Sex Distributi on and Mortality Figures
Admission Mortality Diagnosis Male Female Total % Male Female Total % Rheumati c Heart Disease 35 34 69 6.77 8 5 13 9.77 Dilated Cardiomyopathy 50 22 72 7.06 16 3 19 14.29 Valvular Heart Disease 34 33 67 6.57 9 12 21 15.79 Ischemic Heart Disease 19 13 32 3.14 5 3 8 6.02 Arrhythmia 16 16 32 3.14 0 3 3 2.26 Acute Coronary Syndrome 231 116 347 34.05 15 17 32 24.06 Hypertension 93 52 145 14.24 5 13 18 13.54 Congenital heart disease 3 9 12 1.18 1 2 3 2.25 Post-Cath/Post-OP 126 45 171 16.79 6 1 7 5.26 Others 53 19 72 7.06 7 2 9 6.76 Post Cath cases consisted of ACS, received (transferred in) from different PTMC as well as infants and children wards in a state of gasping needing urgent with congenital heart disease undergoing CPR and ventilator support. Patients Right heart catheterization and/or left crashing in general wards were transferred heart catheterization including other cath in and were taken care of which signifi cantly procedures. Cases under Ischemic heart increases the mortality in MICU. diseases mostly included old MIs with reduced EF. Different types of arrhythmias Patients in cardiogenic shock and respiratory were admitted, including, patients with arrest were managed with mechanical temporary pacemaker implanted for ventilator. Patients were also managed with Complete Heart Block. the expert opinions of visiting consultant of different faculties (nephrology, neurology, Cases under the title others include Pleural hepatology etc) as most of the patients Effusion, Digoxin toxicity, Primary had multi-organ disorder/failure involving Pulmonary Hypertension, Pulmonary renal, hepatic, neurology system. Embolism, Deep Vein Thrombosis, aortic dissection etc. MICU also supports fi nancially weak patients through CHARITY fund raised We can see an increase in the number of by the doctors and nurses for meals, patients with Acute Coronary Syndrome transportation charges. We have a special this year. The main reason behind this was MICU charity for those needy patients. increasing number of coronary cases in our region. Second reason being unavailability CONCLUSION of beds in CCU. MICU provides the best management to MICU received a signifi cant number of heart failure patients irrespective of any patients in terminal stage with refractory cause and we as team members are proud heart failure. This year many patients were to be a part of this center.
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INTERVENTIONAL CARDIOLOGY SERVICES Dr. Nagma Shrestha, Dr. Deepak Limbu, Dr. Aamir Siddiqui
NTRODUCTION Frossmann who did his own right heart catheterization guided fl uoroscopically Cardiac catheterization is a branch of the through left antecubital vein. medical speciality of cardiology used to diagnose and treat certain heart conditions. SERVICES PROVIDED Today cardiac catheterization and angiography are preformed as a combined The centre has two state of art catheterization procedure for diagnostic and therapeutic laboratories and well trained interventional purposes. cardiologists and nursing assistants providing both diagnostic and therapeutic Cardiac catheterization and angiography interventional procedures. Interventional remain the gold standard for the evaluation cardiology got established at our centre of anatomy and physiology of the heart in the year 2058 B.S. The number of and blood vessels. The history of cardiac procedures is increasing every year with catheterization dates back to Claude decreasing rate of complications. Bernard, who experimented on animal models, however, clinical application of The procedures performed from Jan 1, 2013 cardiac catheterization begins with Werner to Dec 31, 2013 are shown below:
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SN Procedure Total 1 Coronary Angiogram (CAG) 2294 2 Peripheral Angiogram (PAG) 53 3 Percutaneous Transluminal Coronary Angioplasty (PTCA) 790 4 Renal Angioplasty (PTRA) 4 5 Coil Embolization 13 6 Electrophysiology Study/Radiofrequency Ablation (EPS/RFA) 171 7 Permanent Pacemaker Implantation (PPI) 238 8 Temporary Pacemaker Implantation (TPI) 193 9 Percutaneous Transmitral Commissurotomy (PTMC) 403 10 Balloon Pulmonary Valvuloplasty/Balloon Aortic Valvuloplasty (BPV/BAV) 30 11 Device Closure (ASD/PDA) 44 12 Right Heart Catheterization (RHC) 71 13 Others 3 Total 4307
Fig: Number of procedures and cases performed in 2013
Fig. Comparison of no. of procedures and cases performed from 2008 to 2013
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COMPLICATION gaining experience and expertise and the services provided by this centre are A) Death expanding and has established a reputation of respect. The quality of our care and of Post PTCA: 3 our outcomes is well-known and respected Post PTMC: 1 in the medical community nationwide.
Post PPI: 0 Evidence based practice maintaining excellence and care of patients with quality Post CAG: 0 services at affordable price is our goal. With B) CVA: 3 time we are improvising and expanding our services and gaining experience to further C) Groin Hematoma: 13 enhance our performance. D) Contrast allergy: 4
E) Emergency MVR following PTMC: 1
F) Cardiac Tamponade following PTMC: 1 CONCLUSION Cardiac catheterization is considered as an integral part of any cardiac centre. SGNHC has established its reputation as the best centre for cardiac catheterization in Nepal. Both diagnostic and therapeutic interventional procedures are performed routinely in this centre. With time we are
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CARDIAC ELECTROPHYSIOLOGY AND DEVICE IMPLANTATION Dr. Sudhir Regmi, Dr. Rishikesh Rijal, Dr. Murari Dhungana, Dr. Sujeeb Rajbhandari, Dr. Man Bahadur K.C,
Since 2004 AD SGNHC is providing various international standard. More than 650 electrophysiological services for diagnosis clients were benefi tted from service of the and treatment of various conditions Department of Electrophysiology in year associated with rhythm disturbances. Our 2013. EP team holds the responsibility of catering The different services and procedures services for those in need in an accepted received by clients are given below. DISTRIBUTION OF EP PROCEDURE DIAGNOSIS MALE FEMALE TOTAL Typical AVNRT 30 53 83 Left lateral 18 9 27 Left antero lateral 4 1 5 Left Postero lateral 2 3 5 Left posterior 3 0 3 Left Postero septal 1 1 2 Right Postero septal 1 2 3 Right Posterior 3 0 3 Right Postero lateral 2 0 2 Antero lateral 1 1 2 Antero septal or Para Hisian 2 3 5 Atrial Tachycardia 1 5 6 Fascicular VT 1 0 1 Atypical AVNRT 3 3 6 No Inducible tachycardia 5 4 9 Others 2 3 5 TOTAL 79 88 167 Note: AVNRT: Atrioventricular Nodal Re-entry Tachycardia, VT: Ventricular Tachycardia
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OUTCOME OF EP PROCEDURE
OUTCOME MALE FEMALE TOTAL Successful ablation 73 82 155 Relapse 0 1 1 No inducible tachycardia 4 3 7 Ablation not attempted 2 2 4 TOTAL 79 88 167
DISTRIBUTION OF DEVICE IMPLANTATION COMLICATIONS DURING EP PROCEDURE TYPES OF DEVICE TOTAL Temporary Pacemaker Insertion 193 OUTCOME TOTAL Permanent Pacemaker Insertion 238 Pneumothorax 1 Dual Chamber Implant 2 A-V Fistula 1 AICD 1 Pericardial Tamponade 1 CRT 1 Death 0 CRT/D 0 TOTAL 3 Generator Replacement/ Lead 10 Readjustment TOTAL 445 COMLICATIONS OF DEVICE IMPLANTATION Note: AICD: Automated Internal Cardioverter Defi brillator, OUTCOME* TOTAL CRT: Cardiac Resynchronization Therapy, A-V Fistula 1 CRT/D: Cardiac Resynchronization Therapy with Defi brillator Pericardial Tamponade 1 INDICATION OF DEVICE IMPLANTATION* Death 0 INDICATION MALE FEMALE TOTAL TOTAL 2 Complete Heart Block 108 77 185 *Both complications were during Temporary Pacemaker Sick Sinus Syndrome 13 6 19 Insertion 2:1 AV Block 8 3 11 2o AV Block 3 1 4 High Degree AV Block 3 2 5 CONCLUSION Bifascicular Block 2 0 2 Vasovagal Syncope 0 1 1 Despite scarcity of manpower for Electrophysiology services, SGNHC aims CRT/CRT-D 0 1 1 at achieving international standard of care. 3:1 AV Block 1 0 1 All dedicated team members at present Junctional Rhythm 0 2 2 are giving their best service. In future, Others (End of bat- 8311 tery life, Redo, Lead the Department plans to establish more change, DDD, AICD) advanced facilities like electro anatomical Total 146 96 242 mapping system and regular services in *Excluding Temporary Pacemaker Insertion CRT/CRT-D and AICD etc.
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EMERGENCY SERVICES
Dr. Dharmanath Yadav, Dr. Bibek Baniya, Dr. Aamir Siddiqui, Dr. Dilip Kumar Sah
INTRODUCTION Those with unstable Angina and NSTEMI are promptly shifted to intensive care unit Emergency department has transformed within 10-15 minutes. Patients with low into an important service that signifi es the to moderate likelihood of coronary artery quality a health institution can provide. disease are admitted for “Chest pain under Since the establishment of SGNHC, our evaluation” and are scheduled for tread mill institution has strived hard to attend every test (TMT) and /or coronary angiogram. possible cardiac emergencies hailing from every corner of Nepal with the involvement All forms of life threatening arrhythmias of competent and qualifi ed cardiologist, are managed promptly. Patents who come cardiac surgeons, resident doctors and to ER with complete heart block and supporting well trained staff 24 hrs a day. other life threatening bradyarrhthmias get temporary pacemaker insertion without any delay. Emergency pericardiocentesis to SERVICE PROVIDED relieve patients of tamponade are performed immediately. Obtaining EKG of all patients with chest discomfort with 5-10 minutes of arrival Non cardiac emergencies are assessed and in the ER department as recommended by referred to concerned centers as required. AHA/ACC guidelines. The present Emergency department has Patients with acute MI are directly shifted to been expanded as per the demand of ever CCU from ER without delay. They receive increasing number of patients. All together thrombolysis within 30 minutes of arrival at present there are 18 beds (9 beds in the in ER (Door to needle time and primary ER and 9 beds in ER observation).In an angioplasty (Door to balloon time) within average 35-45 number of patients attend 90 minutes as recommended by AHA/ACC the ER daily. guidelines.
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Relevant and essential emergency test monitors (ECG monitoring, SPO2, non including cardiac enzymes, Troponin I invasive BP monitoring), central oxygen (qualitative and quantitative), Routine line, suction facilities, defi brillators. Crash blood counts, biochemistry and carts with emergency drugs and intubation electrolytes, ABG analysis, ECG, portable sets. This set up provides us the ability to X rays, bed side echocardiogram screening provide advanced cardiac life support when are available 24 hrs . Emergency and ER required promptly. observation wards are equipped with
Table 1: Emergency Data in 2013
Male Female Admission Discharge Referred LAMA Mortality BD Total 7097 5708 3774 9031 1278 179 32 67 12805
LAMA: Left against medical advice BD: Brought Dead
Table 2: Admissions through ER in Indoors:
General Ward Cabin ER Deluxe CCU MICU SICU PICU NMW NSW Total Observation A B Single Double
597 82 425 334 19 1025 339 11 3 431 6 440 3712
16.08% 2.20% 11.44% 8.99% 0.51% 27.61% 9.13% 0.29% 0.08% 11.61% 0.16% 11.85% 100%
Table 3: Presenting Complains
Chest Pain/Discomfort 4396 34.31% Shortness of Breath 3125 24.38% Palpitation 1125 8.78% Dizziness/Syncope 1264 9.8% Heartburn/Epigastric Pain 886 6.9% Headache 593 4.6% Swelling of body 323 2.5% Nausea/Vomiting 231 1.8% Epistaxis/Haemoptysis/Malena 107 0.8% Others 755 5.9% Total 12805 100%
Table 4: Provisional/Clinical Diagnosis
Hypertension 2420 18.9% CONCLUSION Coronary Artery Disease 2804 21.85% Rheumatic/Valvular Heart Disease 1449 11.31% The data provided will give Arrhythmias 1156 9.0% itself unearth the immense Anxiety Disorder 593 4.6% effort put on by the SGNHC Acute Peptic Ulcer Disease 886 6.9% ER team. “Cardiac emergency COPD/RTI 655 5.1% be dealt emergently”, with this Congenital Heart Disease 215 2.21% motto we are working hard Pericardial Disease 185 1.44% to meet the needs of cardiac Cardiomyopathy 771 6.02% patients from all over Nepal. Vascular Disease 223 1.74% Others 1156 9.0% Total 12805 100%
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MEDICAL WARD
Dr. Satish Kumar Singh, Dr. Krishna Prasad Adhikari, Dr. Saurav Sundar Shrestha, Dr. Suman Thapaliya,
DISEASE DISTRIBUTION INTRODUCTION A total of 4414 patients were admitted in Since the establishment in 1999 as a 9 bed- medical ward last year. Most of the pa- ded unit, General Medical Unit in our hos- tients admitted were coronary artery dis- pital has evolved into a 66 bedded (21 in ease (49.5%) followed by dilated cardio- General Ward A, 14 in New Medical Ward, myopathy (10.5%) and rheumatic heart 11 in Double Cabin, 18 in Single Cabin and disease(10.4%). Patients admitted as case 2 in Deluxe Cabin). With this capacity, it of arrhythmia, valvular heart disease, hy- has provided its services to patients from all pertension, congenital heart disease, peri- over the country and from abroad as well. cardial effusion, non specifi c chest pain, The patients are fi nally pooled up through COPD, infective endocarditis and pulmo- both direct admissions and the transfer of nary embolism accounted for 8.9%, 5.4%, stabilised patients from the critical care 4.6%, 2.6%,1% and 1% respectively. 5% of units to medical ward. So, medical ward is admissions are included in ‘Others’ cate- the only unit which can truly refl ect the dis- gory which includes Pulmonary embolism, ease pattern of this cardiac centre. In this Pulmonary edema, Chest infections, Aortic article we provide a brief outline of the dis- aneurysms, DVT, Aortic dissections, Myo- ease pattern from 1st Jan. 2013 to 31st Dec. carditis, Pericarditis, Peripheral vascular 2013. disease and Takayasu arteritis.
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DISEASES WISE DISTRIBUTION OF CASES IN THE YEAR 2013 S. Name of Diseases No. of cases % of Total No. Male Fe- Total male 1 Coronary artery disease 1578 607 2185 49.50 2 Dilated cardiomyopathy 293 173 466 10.56 3 Rheumatic heart disease 166 294 460 10.42 4 Arrhythmia 235 159 394 8.93 5 Valvular heart disease 116 124 240 5.44 6 Hypertension 104 100 204 4.62 7 Others 110 83 193 4.37 8 Congenital heart disease 52 63 115 2.61 9 Pericardial effusion 27 27 54 1.22 10 Non specifi c chest pain 29 16 45 1.02 11 COPD 16 11 27 0.61 12 Infective endocarditis 15 9 24 0.54 13 Pulmonary embolism 7 0 7 0.16 Total 2748 1666 4414 100.00
CONCLUSION With the ever increasing number of patients in the hospital, the medical ward works as an important unit to serve the most numbers of patients in the hospital and as transit be- tween critical care and discharge. With the plan to increase bed capacity, it will serve better in the days to come.
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DEPARTMENT OF CARDIAC REHABILITATION AND HEALTH PROMOTION
Samjhana Shakya, Pushpa Neupane
promotion. The fi rst is Prevention. We INTRODUCTION conduct free cardiac camps, community awareness programs, school health Department of Cardiac Rehabilitation programs; produce health education and Health Promotion is one of the key materials etc in order to raise health departments at Shahid Gangalal National awareness among the people. Next Heart Center, playing important role in principle is Rehabilitation. We provide primary and secondary prevention of counseling service to the patient. All of cardiovascular disorders. the patients with myocardial infarction and acute coronary syndrome go through PREVENTION REHABILITATION RESEARCH exercise training. Moreover, we have been conducting structured education program for patients with coronary artery disease and its risk factors. Finally Research is Entire activities of this department are another area we have been continuously guided by three basic principles of health working for.
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PROGRESS REPORT more intensive education for them. FREE CARDIAC CAMPS OUTDOOR COUNSELING
This department has extended outdoor counseling services from fi scal year 2068/69. It targets for educating patients and visitors who have attended outpatient department. Hypertension is the most common topic we counsel for, followed by Heart Attack and its risk factors, Valvular Heart Disease, Heart failure etc. In 2013, we counseled 5955 patients and their family members. Total Total SN Camp date Place Total Echo participants ECG 1 2013-Jan-4 Birgunj 457 166 140 2 2013-Jan- 5 Hetauda 238 72 80 3 2013-Feb-1 Sindhupalchok 320 76 95 4 2013-Feb-10 Sankhuwasabha 530 210 181 5 2013-Feb-22 /23 Gulmi 560 182 209 6 2013-May- 25 Pokhara 251 56 57 7 2013-Oct-26 Nawalparasi 538 150 195 8 2013-Decr-14 Sarlahi 437 94 150 Total 3331 1006 1107 There were total 8 cardiac camps conducted in 2013 in different areas of Nepal. Three thousand three hundred and thirty one participants directly benefi ted from the program. There were 1006Echocardiograms and 1107 electrocardiograms had done in community. INDOOR COUNSELING
This is our regular facility to provide counseling service for admitted patients. In 2013 we counseled 2359 patients and their visitors. During counseling, we educate STRUCTURED EDUCATION them for making healthy food choice, carry PROGRAM (SEP) out regular exercise according to their health condition, and motivate them for Structured Education Program is a weekly enhancing treatment compliance and more awareness program which runs every about disease and its related conditions. Tuesday and is designed for patients with Moreover patients are referred for structured coronary artery disease (CAD) and its risk education program too in order to deliver factors. Its primary objective is to prevent
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In 2013 we have conducted 3 programs in Budhanilkanth, Apex College and Thimi. HEALTH EDUCATION MATERIAL PRODUCTION
Our department has been serving as a resource center for health education materials. We have produced plenty of brochures, posters, pamphlets and power and manage CAD and its risk factors. It point presentations. It provides free access can also help patients who are recovering of these materials for patients, health care from a heart attack, as well as those who providers and other institutions. recently had heart surgery. Benefi ts of this cardiac rehabilitation program can include reduced cardiac symptoms, better long-term OBSERVATION OF SPECIAL survival, weight loss, improved cholesterol DAYS and triglyceride levels, improved blood Every year we celebrate World Hypertension pressure, lower blood sugar levels in Day and World Heart Day. In World diabetics and reduced stress. Hypertension Day, we conducted free One cycle of program consists of eight blood pressure screening and counseling different classes. Up to now we have been service in Civil Mall, City Center and running 13th cycle. In 2013 we conducted Shahid Gangalal National Heart Center. 43 Classes and almost one thousand (985) About 1200 people (1165) participated in people have attended this program. these programs. Likewise on World Heart Day, we conducted screening program COMMUNITY AWARENESS for cardiovascular risk factors in Shahid PROGRAM Gangalal National Heart Center premises. About 400 people had participated on that It is a community based awareness program. program. In 2013 we have conducted 4 programs in Bouddha, Panauti, New Baneswor and RADIO PROGRAM Shantinagar. There is regularly broadcasting of Public SCHOOL HEALTH PROGRAM Service Announcement (PSA) about hypertension, heart attack, rheumatic heart It is a school based awareness program disease and seven rules of healthy heart in targeted for school children and teachers. Radio Sagarmatha. HUMAN RESOURCE Dr. Deewakar Sharma, Senior Consultant Cardiologist Head of the Department Dr Shaili Thapa Physiotherapist Samjhana Shakya Public Health Offi cer Pushpa Neupane Senior Staff Nurse Yashoda Luitel Assistant Physiotherapist Rajiv Yadav Assistant Physiotherapist
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NURSING DEPARTMENT
Head
Heart
Hand Modern Nursing Foundation Hand
Nursing as a profession works for the knowledge, skill and attitude. Along with protection, promotion, and optimization of this we also believe on team spirit of health health and abilities, prevention of illness care professionals, without which, success and injury, alleviation of suffering through is impossible. the nursing diagnosis, intervention and advocacy in the care of individual, families Today with the move of 18 years of and communities. The nursing department establishment, we have enrolling 160 beds of Shahid Gangalal National Heart Centre which is almost all the time occupied. always dedicated toward the delivery of This centre has 19 units where 185 nurses the quality nursing services. We believe are delivering their different levels of that quality service always belongs with nursing care like preventive, curative and care providers head, heart and hands that is rehabilitative.
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Distribution of nursing professionals according to unit and patient fl ow at the related units in the year 2013
S.N Name of units No. of beds No of staffs Patient fl ow 1 CCU 12 16 1383 2 MICU 5 9 687 3 A SICU 8 19 743 4 PSICU 7 19 590 5 NMW 14 10 1130 6 NSW 14 9 1191 7 GW-A 21 10 1676 8 GW-B 24 10 1429 9 Single Cabin 20 10 306 10 Double Cabin 11 9 290 12 ER 8 11 12841 13 ER observation 9 5 651 14 Cath Observation 7 5 1764 15 Cath- Lab - 10 4321( Cath Procedures) 16 OT - 14 1476 ( Surgeries) 17 OPD - 11 39142/6340 (ECG/Penidura) 18 Councelling - 1 5794 19 CSSD - 1 20 Study Leave - 4 MN-1/ BN-3 21 Matron / SNS - 2
ACHIEVEMENTS AND all these, the regular round of senior CHALLENGES nursing personnel, monitoring system of incharge, getting feedback from health With this evolving digitalized world, care consumers and need base strategies dealing with patient is the complex job development with nursing incharge is the so to prepare the nurses for a changing routine work .The nurses of this centre are world of possibility and maintain the not only confi ned into hospital territory, quality nursing service; the centre has been they have been actively taking part on the providing the opportunity to upgrade the outreach activities like participating in academic qualifi cation for nurses. With the cardiac camps and public awareness this purpose, the centre has provision of activities. paid and unpaid leave facilities for nursing This year we have made some effort on professionals to enroll bachelor degree and nursing professional’s skill and knowledge master degree every year. This department development activities. For the fi rst time has been enrolling classes for junior we have organized 3 days structured skill nursing professionals and senior nursing based Training of Critical Care Skill for professionals separately every week. senior and junior nursing personnel and Moreover, to make nursing professionals one day Pediatric Critical Care Assessment aware toward existing scenario of nursing and Management training for nurses in our care; nursing research report presentation centre. We also have conducted in-house has been regularly carried out. Despite
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 38 Annual Report 2013 Review Article nursing quiz contest in our hospital. Beside them update in skill and attitude in practical this, we have initiated structured nursing setup is becoming challenging as per their student’s supervision system for the benefi t qualifi cation that makes very diffi cult to of students learning in specialized centre maintain the nursing standard as expected and to trigger the knowledge and skill in clinical fi eld. in academic fi eld among senior nursing professionals. We also have succeeded to Every year number of cardiac cases is develop fi rst draft of nursing procedure increasing because of various lifestyles checklist for standardized nursing practice. of the people. The patient fl ow is also This year we have succeeded to prepare increasing but the number of nurses could three clinical skill trainers. not be increased as per the rate of patient fl ow in some areas. However the center has the some quota for the further study like bachelor and master’s degree in nursing ; the nursing manpower’s FUTURE PLAN turnover rate for further study and attraction toward western countries making For coming days, we have planned to the greatest loss of skilled manpower in develop the nursing standard through specialized centre like ours. the development of fi nal draft of nursing procedure manuals and procedure checklist. Nursing as the profession must possess head, We also have planned to develop training heart and hand which means knowledge, site for this institution. We strongly believe skill and attitude. Today’s education of that, however we do a small change to nursing become highly successful for enhance nursing service, it can make a the delivering the knowledge; obtaining signifi cant impact in betterment of the distinction in the document but making service and consumer satisfaction.
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PATHOLOGY SERVICES
Dr. Bipesh Acharya
INTRODUCTION PRESENT CONTEXT
Laboratories in Nepal today face increasing With the increasing charm in automation, pressure to automate their system as they at present, department is equipped with are challenged by the continuing increase in following equipments: workload, need to reduce expenditure, and 1. Automated Five Parts and three diffi culties in recruitment of experienced parts Differential Cell Counter technical staff. Was the implementation of 2. Vitros 250 Dry chemistry a laboratory automation system (LAS) in Automation machine the Clinical Biochemistry Laboratory in 3. Fully automated coagulation Shahid Gangalal National Heart Hospital machine sucessfull? The answer rely on laboratory 4. Micro—Separate Blood bank errors, staff satisfaction and the organization. However, no signifi cant difference was observed. Considerable effort is needed to OVERVIEW overcome the initial diffi culties associated with adjusting to a new system, new The Following details of the responsibilities software and new working procedure. of clinical laboratory: Hence the quality service provided by the • Hematology works with whole laboratory show the true image of the entire blood to do full blood counts hospital. and blood fi lms as well as many other specialised tests.
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• Coagulation requires citrated blood • Cytopathology examines smears of samples to analyze blood clotting cells from all over the body such times and coagulation factors. as from the cervix for evidence of • Clinical Biochemistry usually infl ammation, cancer, and other receives serum or plasma. They test conditions. the serum for chemicals present in NUMBER OF TEST DONE IN 2013 blood. These include a wide array 450000 418672 of substances, such as lipids, blood 400000 sugar, enzymes, and hormones. 350000 • Microbiology receives clinical 300000 specimen including swabs, feces, 250000 urine, blood, sputum, cerebrospinal 200000 159867 fl uid, synovial fl uid, as well as 150000 possible infected tissue. The 100000 50000 20432 29409 work here is mainly concerned 1942 6365 3471 0 with cultures, to look for suspected pathogens which, if found, Serology Coagulation Special test are further identifi ed based on BiochemistryHaematologyMicrobiology lood donation B biochemical tests. Also, sensitivity testing is carried out to determine MORE ACHIEVEMENTS whether the pathogen is sensitive or resistant to a suggested medicine. • Automation upgraded in biochemistry Results are reported with the • Daily QC analysis in biochemistry identifi ed organisms and the type • Regular QC analysis in Haematology and amount of drugs that should be • Regular QC analysis in Coagulation prescribed for the patient. Conducted blood donation programme • Parasitology is a microbiology with acquisition of local youth club which unit that investigates parasites. minimizes the problem for the patient to However, blood, urine, sputum, manage the blood components. and other samples may also contain parasites. Able to manage and minimize the rush of • Virology is concerned with phlebotomy section by providing prompt identifi cation of viruses in reports and quality services. specimens such as blood, urine, FUTURE PLAN and cerebrospinal fl uid. • Immunology/Serology uses the • To establish highly standard emergency concept of antigen-antibody laboratory interaction as a diagnostic tool. • Automation in the microbiology in • Blood bank determines blood detection and isolation groups, and performs compatibility • Provision of blood bank services with testing on donor blood and fully Automated Blood Component recipients. It also prepares blood separation and cross match machine. components, derivatives, and • Introducing Laboratory information products for transfusion. system to the hospital information • Histopathology processes solid system along with electronic reporting tissue removed from the body system. biopsies for evaluation at the • To start Histopathology, Cytopatology microscopic level. and Bone marrow studies.
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RADIOLOGY SERVICES Indesh Thakur
Radiology is a vital branch of medical processing system both for OPD Patients science on which people trust enormously. and IPD Patients. The number of patients At SGNHC, Radiology service is one of the attending for x-ray examination was less in most important services rendered. It is an number at that time. One radiographer & integral part of health care delivery system one dark room operator were appointed for without which no medical treatment & the radiology services & that too during day therapy can be successfully bestowed. As period only. our hospital is specialized and dedicated health care centre for cardiac patients, so radiology service, here is specially PRESENT SCENARIO predestined and intended for diagnosis & prognosis for relevant cardiac diseases and Radiology services at SGNHC boost up its periphery. by leap and bound operating for 24 hours a day. Today, we serve on an average 140 patients each day. Here, we provide digital imaging services (Computed Radiography) HISTORY from both OPD Radiology unit & IPD Radiology unit. The CR services started at At SGNHC, radiology service commenced this centre from very start of the year (2066 from 2055 B.S. along with OPD services. B.S.). Now, our radiology department is In the beginning, this service was provided allocated with the following sophisticated with one mobile X- ray unit & manual equipments:
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1. Three CR reader units (direct digitizers) Peripheral Angiograms, Interventional with Computer Workstations (Konica procedures (PTCA, PTMC, BPV, BAV, Minolta, Japan) Device Closures, PPI, TPI, EPS and Ablation etc ) assisting the cardiologists 2. Two Dry Laser Imagers (Konica concerned. Minolta, Japan)
3. One fi xed 800 mA X-ray Unit (Hitachi, Japan) FUTURE PLAN In future, we have plans to equip our Centre 4. One mobile 400 mA X-ray Unit with Direct Digital Radiography (DR) (Shimadzu, Japan) System, PACS, Multi-Slice CT (MS CT), 5. One mobile 250 mA X-ray Unit Nuclear Medicine Imaging Technology (Hitachi, Japan) (NMIT), MRI modalities etc. to provide all kinds of confi rmatory diagnostic services to 6. One mobile 100 mA X-ray Unit cardiac patients. (Siemens, Germany) Very soon, we are going to add one more RADIATION 500 mA fi xed X-ray machine & one 100 mA mobile X-ray machine to our department. AWARENESS AMONG MEDICAL STAFFS As in many aspects of medicine, there are HUMAN RESOURCES both benefi ts and risks associated with the use of x-ray imaging which utilizes We have well trained and erudite technical ionizing radiation to generate images of the manpower in this division which is as body. As SGNHC is especially dedicated follows: to diagnose and treat diseases related to • One Sr. Radiography Technologist heart, therefore the use of medical x-ray • Two Radiography Technologists is of mere compulsion. While the benefi t • Nine Radiographers of clinically appropriate x-ray imaging • One Sr. Dark Room Operator examinations generally far outweights the risks, efforts should be made to minimize that risks by reducing unnecessary exposure Our staffs are posted in OPD Radiology to ionizing radiation to help reduce risks to & IPD Radiology units as well as in Cath the patients. All examination using ionizing Labs. We perform all kinds of general x-ray radiation should be performed only radiography with particular emphasis on when it is essential. However, ALARA (as chest radiography & bed side radiography low as reasonably achievable), TDS (Time in all wards such as ASICU, PSICU, ER, Distance Shield) principle should always MICU, CCU, GW, etc. In SGNHC, we be followed when choosing equipment have three state of the art Cath Labs (Two settings to minimize radiation exposure to Philips Integris & One Siemens Cath-Lab, the patient. Germany). These units are in full operation performing about 15 to 20 cases per day. In doing so, we not only minimize the Radiology manpower are concomitant risks to the patient but also to ourselves as to Cath Lab for a number of invasive operators. In case of portable x-rays, there procedures like CAG, RHC & LHC, is always a chance of scattered radiation to arise. Portable X-rays in our institution ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 43 Annual Report 2013 is performed only in dire necessity and CONCLUSION emergency conditions. By doing so, not only radiographers but also nursing staffs, Radiology services at SGNHC are fully doctors & others are benefi tted from dedicated digital radiography services required x-ray examinations. (Computed Radiography) & are in full operation. Many patients have benefi tted from our service and we hope to continue Total patients: 48739 and provide better services in future.
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PHARMACEUTICAL CARE
Madhu Giri Pharmaceutical care is the responsible • Preventing drug-related problems. provision of drug therapy for the purpose of achieving defi nite outcomes that improve a Pharmaceutical care is a necessary element patient's quality of life . These outcomes are of health care and should be integrated with other elements. Pharmaceutical • Cure of a disease; care is, however, provided for the direct benefi t of the patient, and the pharmacist • Elimination or reduction of a is responsible directly to the patient for the patient's symptomatology; quality of that care. • Arresting or slowing of a disease process; or The pharmaceutical care process was originally conceived to be undertaken in • Preventing a disease or symptomatology. a community pharmacy, by community pharmacists. In 1996 the Pharmaceutical Pharmaceutical care involves the process Society of Newzealand began a programme through which a pharmacist cooperates to implement the process throughout the with a patient and other professionals in designing, implementing, and monitoring a country. therapeutic plan that will produce specifi c therapeutic outcomes for the patient. This in turn involves three major functions: ASPECTS OF PHARMACEUTICAL CARE • Identifying potential and actual drug-related problems; The elements of pharmaceutical care • Resolving actual drug-related for individual patients, taken together, problems; and comprehensive pharmaceutical care, the delivery of which requires an ongoing,
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 45 Annual Report 2013 covenantal relationship between the Pharmaceutical Care pharmacist and the patient. The pharmacist must use his clinical judgment to determine Identify patients with the level of pharmaceutical care that is pharmaceutical care needs needed for each patient. Examples of situations which call for comprehensive pharmaceutical care include: Identify and review Pharmaceutical care issus - Patients who are particularly vulnerable to adverse effects because they are physiologically compromised (e.g. infants; the elderly; those with kidney, liver or respiratory failure) Implement and monitor Formulate and document pharmaceutical care plan pharmaceutical care plan
- Patients with medical conditions the prescribed medications are that require ongoing evaluation and ineffective or used improperly (e.g. manipulation of drug therapy to certain infections, severe diarrhoea). achieve optimal results (e.g. diabetes mellitus; asthma; hypertension; congestive heart failure). PHARMACY REPORT - Patients who are taking multiple medication thereby placing them at Shahid Gangalal National Heart Centre has higher risk for complex drug-drug its own hospital pharmacy. All most every or drug-disease interactions and for type of medicine and surgical according drug-food interactions. to the hospital formulary is found in the pharmacy. Hospital has indoor and outdoor pharmacy for the convenience of indoor - Patients requiring therapy with and outdoor (OPD) where medicine is drugs that can be extremely toxic, dispensed from the pharmacy by doing especially if they are dosed, adequate counseling. Patients are dispensed administered or used improperly medicine by registered pharmacy assistant (e.g. cancer chemotherapeutic and pharmacist. Transaction from hospital agents, anticoagulants, parenteral pharmacy is also increasing every year so narcotics). both the patient and hospital are in benefi t from the SGNHC pharmacy. - Patients whose acute illnesses can become life threatening if As compared to previous fi scal years, transaction has increased as shown in the diagram.
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PHYSIOTHERAPY SERVICES Mrs. Yashoda Luitel Shrestha
INTRODUCTION • Providing advice on exercise programs. Physiotherapy is a health care profession • Providing or advising on special concerned with human function, movement equipment. and maximizing potential. It is a well establish branch of medical sciences being Physiotherapy unit of SGNHC is an integral practiced at global level. Its treatment can part of Cardiac Rehabilitation and Health be given to patient both in isolation and in Promotion Department. It is well equipped conjunction with other types of medical and and is located on the ground fl oor with a surgical management. Used in conjunction large waiting lounge for the patient and the with certain medical or surgical techniques; visitors. It plays the vital role in prevention physiotherapy can complement these and management of cardiac disease. techniques to help provide a speedy and complication-free return to normal activity. Physiotherapy can help individuals by: HUMAN RESOURCES • Identifying the problem area and At present our unit has one physiotherapist treating this directly. and two physiotherapy assistant.
• Identifying the causes and Physiotherapist- Dr. Shaili Thapa Budhathoki predisposing factors. (On Study Leave)
• Providing Rehabilitation following Physiotherapy Assistant- Mrs. Yashoda Luitel occupational or sporting injuries. Shrestha • Providing rehabilitation and Physiotherapy Assistant- Dr. Rajeev Kumar exercise before and after surgery. Yadav ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 47 Annual Report 2013
SERVICE PROVIDED shortness of breath or increase lung expansion Physiotherapy unit at SGNHC have been • Patient positioning giving its best service to the patients since • Oxygen therapy and nebulizer 2057 B.S. It provides both in-patient and • Incentive spirometer out-patient services regularly six days • Sputum clearance with postural a week. We have also been effectively drainage, percussion, vibrations, running cardiac rehabilitation program. huffi ng,coughing, deep breathing, segmental breathing, ACBT, FET, For inpatient patients, physiotherapy unit at SGNHC often deals with the function of suction. the cardio-respiratory system. The Cardio- • Mobilizing,sitting out of bed, or thoracic physiotherapy aims to optimize walking the function of the Cardio-thoracic system • Medications and patient comfort, resulting in increased • Exercise programs exercise tolerance, a reduced chance of For outpatient patients, we provide services developing complications such as chest to the entire patient with cardio-thoracic, infections, reduced shortness of breath, and musculoskeletal and neurological disorders a reduced length of stay in hospital. who are seeking physiotherapy treatment and also provide treatment using all types Classes about the importance and benefi ts of modalities . of the exercises for the patients and their visitors under the Cardiac Rehabilitation STATISTICAL DATA OF THE YEAR 2013 (2069- program have been conducted since 2012 2070 B.S.) and are running successfully. Total no. of patients treated in Some of the treatment techniques used by physiotherapy unit in 2013 physiotherapy at SGNHC In-patients – 4,879 Out-patients – 475 • Breathing techniques either to reduce Grand total – 5,354
Number of Number of Months and year In-pati ents Out-Pati ents JANUARY – 2013 (Poush – Magh 2069) 248 23 FEBURARY -2013 (Magh – Falgun 2069) 292 45 MARCH – 2013 (Falgun – Chaitra 2069) 375 53 APRIL – 2013 (Chaitra – Baisakh 2070) 381 34 MAY – 2013 (Baisakh – Jestha 2070) 426 33 JUNE – 2013 (Jestha – Ashad 2070) 442 23 JULY – 2013 (Ashad – Shrawan 2070) 396 23 AUGUST – 2013 (Shrawan – Bhadra 2070) 439 43 SEPTEMBER – 2013 (Bhadra – Ashoj 2070) 440 47 OCTOBER – 2013 (Ashoj – Kartik 2070) 443 44 NOVEMBER – 2013(Kartik – Mangsir 2070) 446 50 DECEMBER – 2013 (Mangsir – Poush 2070) 551 57
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UP COMING PROGRAMS CONCLUSION • Providing safe and reliable physiotherapy Physiotherapy unit is an integral part service to the hospital. of Cardiac Rehabilitation and Health • Aerobics classes and fi tness training. Promotion Department at SGNHC. It gives • Community exercises programs via the major contribution in prevention and camps organized by SGNHC. management of cardiac disease. We would • Measurement of exercise tolerance in hope to provide and extend our services in patients aft er myocardial infarction. coming days.
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ANNUAL MORTALITY: 2013
Dr. Mahesh Bhattarai, Dr. Rabindra Pandey, Dr. Manoj Kumar Yadav, Dr. Bivek Baniya, Dr. Dilip Shah, Dr .Aamir Siddiqui, Dr. Roshani Ghimire, Dr. Sebina Baniya
INTRODUCTION Distribution of mortality Shahid Gangalal National Heart Centre, in terms of different level established in 1995 AD, is a tertiary care of care referral hospital which has played a major role in minimizing the pain of Nepalese This year total 12841 patient were managed people in travel to foreign country to seek in emergency department , seventy four medical advice. Our hospital with 161 patient were brought dead whereas thirty bed capacity has provided a quality care one patient succumbed to death while being with the state of art medical facilities that managed in emergency department, the includes eighteen beded emergency, twelve total mortality in emergency accounting to beded coronary care unit and fi ve beded be o.81 percentage. medical intensive care unit. In this article Among six hundred and eighty seven the mortality in cardiology department critical patient managed in MICU, one from January 1st to December 31st in the hundred and eight (15.72%) expired, year 2013 is outlined. whereas in CCU mortality this year was 6.22% out of 1383 admission. ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 50 Annual Report 2013
Table1:Distribution of mortality in different level of care LEVEL OF CARE Total admission Number of expired Mortality rate MICU 687 108 15.72 CCU 1383 86 6.22 ER 12841 105 O.81 GWA 1676 11 O.66 NMW 1130 7 0.62 S. CABIN 891 3 0.34 D. CABIN 731 1 O.14
SEX DISTRIBUTION Among three hundred and twenty one mortality, one hundred and seventy four (54.2%) were male and female accounted to 45.8 % of deaths.
AGE DISTRIBUTION The most common age group was 60-80 years, 139(43.3%) followed by40-60 year 98(30.52%) whereas 39(12.1%) were octagenerian.
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PLACE DISTRIBUTION Among the one hundred and ninety four mortality in CCU and MICU, acute OF MORTALITY myocardial infarction with cardiogenic shock was the most frequent cause 36 Among three hundred and twenty one (18.5%), followed by acute myocardial death, 156 (48.8%) were from outside the infarction with ventricular tachycardia. Kathmandu valley and Kathmandu being Twenty one patient died due to DCM with the leading district with 106 (33%) which heart failure.RHD with heart failure leads is followed by Lalitpur33 (10.2%) and then to 20(10.3 %) of death while 6 patient (3%) Bhaktapur 26 (8%). of RHD succumbed to death due toinfective endocarditis. MORTALITY ACCORDING TO DISEASE IN CCU AND MICU
DISEASE MORTALITY Acute myocardial infarction- cardiogenic shock 36 Acute myocardial infarction-VT/VF 22 Heart failure 15 Cardiac rupture 15 Old IHD-heart failure 11 Old IHD –VT/VF 3 RHD heart failure 20 RHD-IE 6 RHD,post MVR stuck valve 1 VHD heart failure 8 DCM heart failure 21 Septic shock 14 Pneumonia 4 COPD-respiratory failure 3 Renal failure 4 Pulmonary embolism 2 Hypertensive acute left ventricular failure 2 Bicuspid aortic valve 2 ASD-heart failure 1 PDA 1 TOF 1 HOCM heart failure 1 Primary pulmonary hypertension 1
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Dr. Sujatha Kesavan, MBBS, MRCP, MPhil Specialist Registrar in Cardiology John Radcliff e Hospital Oxford, United Kingdom MY DAYS AT SGNHC Mt Everest - Himalayas – is one of the most There were 2 catheterisation labs and a third popular travel destinations in the world. one was being built. It has always allured many a tourist from around the globe. My mission was to reach The healthcare system at the SGNHC was completely different to the prevailing the foothills of the Himalayas for a different system in the UK. It was subsidised, means purpose – Healthcare. After completing my tested healthcare, in partnership with the MPhil in interventional cardiology at the government. I understood that there are Imperial College, London, I was curious to exclusive private hospitals and public know about the practise of cardiovascular hospitals at Kathmandu. SGNHC adopted a medicine in Kathmandu, Nepal. The delicate and a strategic blend of both systems capital city, Kathmandu is bustling with which enabled the hospital to deliver the over one million inhabitants and remains a best quality of care to the patients. I had fascinating showcase of Nepali culture, art the chance to see the various methods of and tradition. treatment for an acute myocardial infarction My cardiology fellowship began on the 15th – conservative treatment, thrombolysis and of May, 2013, for a period of two and a half primary PCI. The Director of the cath lab months under the supervision of Dr. Y.K.D. taught me a valuable lesson in life– “A Bhatt and Dr. Man Bahadur K.C. I had to good interventional cardiologist should adjust to a 6 day working week, unlike in the know when to stop”. UK. Saturday was a holiday and Sundays – it was cardiac catheterisation in full swing!!!! I expressed my interest in conducting Daily admissions were presented at 9.00am an audit concerning percutaneous mitral every day by the juniors in cardiology to the commissurotomy (PMC) at SGNHC. I cardio-thoracic directorate - cardiologists am extremely grateful to the supervision and cardio-thoracic surgeons. The next offered by Dr. Bhatt and a database was session were ward rounds in the 12 bedded created. The audit was presented by me; CCU, 6 bedded ICU, single cabin, double at the Friday lunchtime meeting and cabin, deluxe cabin and in the general ward. highlighted the key areas the department
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 53 Annual Report 2013 should focus in the future (eg public insertion, cardiac surgery for VSD, ASD, education, central database and mobile CABG and the list goes on and on…. PMC units with the help of a 3D echo). My consultant at the John Radcliffe Hospital, Paediatric cardiology was an unknown Dr. Prendergast (Director) was pleased with fi eld to me. I found a great teacher in Dr. the progress that I have made in my clinical Urmila Shakya and am eternally grateful to and academic endeavours. her. Cardiac camps run by Dr. Deewakar Sharma interested me and I am keen to be a Maintaining a log book since the fi rst day part of it. There is so much to do at SGNHC enabled me to refl ect on my experiences. – Alas, Time is short – I have to leave for I have seen 327 cases at the outpatient UK to complete my training. I would like clinics, 706 – (adult) transthoracic to take this opportunity to thank all my echocardiograms, 69 – diagnostic cardiac teachers at SGNHC, patients, nurses in the catheterisations, 165 – paediatric echo and wards, cath lab team and my colleagues. Dr. A. Maskey supervised me during my fi rst On my fl ight back to UK – via Delhi – I transoesophageal echo – and I identifi ed a clot had the spectacular views of the Himalayan in the left atrium. Further procedures were ranges at dawn, which is a scene to behold. seen – PDA closures, balloon pulmonary With fond memories, I reached UK to tell valvotomy, pericardiocentesis, left renal my experiences at Kathmandu to my peers. artery angioplasty, coil embolization, PPM
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 54 Annual Report 2013
Ps la/fdLsf] gh/df zxLb uf+ufnfn /fli6«o x[bo s]Gb| 8f= lbg]z afF:tf]nf ;x–k|fWofks lqe'jg ljZjljBfno la=;+= @)^@ ;fn a}zfv @$ ut] dnfO{ d st{Aolad'v kf] x'G5' ls eGg] lrGtfn] klxnf]k6s d'6'df P]+7g h:tf] eof] . t/ d}n] k6sk6s unf ca?4 x'GYof] / cgfof;} To;nfO{ plQ uDeL/tfk"j{s lnO{g . olQs}df cfFvf /;fp+Yof] . ljt]sf cf7 jif{ o;}u/L ToxL aif{ r}tdf a'jf 6Lsf/fd afF:tf]nfnfO{ cf}ifwLsf] ;xf/fdf lat] . lgoldt sfo{qmdx? x[bof3ft x'g uof] / xfdLn] pxfFsf] pkrf/ ;ef, ;df/f]x, uf]li7, lgl/If0f, k7gkf7g, kf]v/fsf] dl0fkfn c:ktfndf ;kmntfk"j{s u[x:y hLjg / :jwd{sf] kfngf ub}{ %& u/fof}+ . o; 36gfn] d]/f] 5ftLsf] P]+7g klg jif{ k'luof] . 3/, kl/jf/, Jojxf/, z'Ns, d'6's} sf/0f x'g'k5{ eGg] cfz+sfdf yk an C0f cflbsf] rk]6fdf kb}{ hfFbf d]/f] :jf:Yo ldNof] . To;sf] Ps dlxgfkl5 5ftL w]/} g} ;d:ofx? uf}0f x'Fb} uP . u?Ëf] eof] / @$ a}zfv @)^# ;fndf lzIf0f c:ktfn dxf/fhu~hsf] cfsl:ds sIf x'Fb} o;}aLr la=;+= @)^& ;fn d+l;/df a'jfnfO{ ;3g pkrf/ OsfOdf d a;]+ . To;kZrft\ k'gM /f]un] RofKof] / o;} s]Gb|df pkrf/ kfFrj6f lgoldt cf}ifwLx? vfg yfn]+ . ha ul/of] . PlGhof]ufkmLdf| d'6'sf tLg}j6f xfdLnfO{ s'g} /f]u nfU5, ta ;fdflhs, /utaflxgL wdgLdf afSnf] n]k cfly{s / dfgl;s r"gf}tL ;d]t cfp+bf] nfu]sf]n] 8fO ;d]t k7fpg g;lsPsf] k|ltj]bg /x]5 . dnfO{ cfk"m / cfˆgL hLjg;fyL cfof] . PlGhof]Knfli6 jf v'Nnf d'6' lbk]Zj/f g]kfnaLrsf] km/flsnf] zNolqmofsf] 9f]sf aGb eof] . cGTodf s] pd]/sf ] km/sn] klg dgdf 3f]Rof] / an !@ yl/sf cf}ifwLsf] e/df pkrf/df ;f]r]+ st} d]/L hLjg;fyLnfO{ d}n] a}jflxs l;ldt x'g'eof] . la=;+= @)^( df3 * ut] $ aGwgdf afFw]/ cGofo kf] u/]+ sL < ah] laxfg dnfO{ hf8f] eof] l;/s /fd|f];Fu lszf]/fj:yfdf k|j]z ub}{ u/]sf d]/f lk|o cf]9fO{ lbg' eGg'ePsf] dflg; To;kl5 xfdL 5f]/f5f]/L cflzz / cl:dtfnfO{ ;Dem]/ ;a}nfO{ a]va/ agfO{ laTg' eof] .
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 55 Annual Report 2013 a'jfsf] d[To'sf] * dlxgf gk'Ub} dnfO{ ;kmn zNolqmofsf nflu lrlsT;s vf;u/L lx8\bf 5ftL ef/L x'g], /f]Hg] / ljb]zaf6 ;s'zn pkrf/kl5 g]kfn !)–!@ kfOnf klg lx8\g g;Sg] ;d:ofn] kms{g] w]/} 6f9fsf] ljifo h:tf] nfUof] . d]/f] ;tfof] . d o;} s]Gb|sf lrlsT;s 8f= kl/jf/ / d]/f nflu cfsfzsf] kmn cfFvft/L ofbjb]j e§sf] z/0fdf k'u]+ . pxfFn] hlt;Sbf] d/ eGg] h:tf] eof] . 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( 7fpFdf afSn} n]k nfu]sf] hDdf eof] . lgtDasf] aLrdf v;|f] 5fnf 5 . (( k|ltzt;Dd /utsf] axgdf e} hl6ntf y'k|} ljsf; eof] . hLjgdf 7f8f] cj/f]w 5 . ;DemFbf klg d cfFkm}nfO{ sxfnL sf] 7f8} eP/ $%) b]lv ()) sf sf]0fdf nfU5 . >LdtLsf] 56\k6L / aNn lgbfpg' / ;'Tg'kg]{ eof] . k|lth}ljs lszf]/fj:yfdf /dfpg'kg]{ cfˆgf 5f]/f cf}ifwL -PlG6afof]l6s_sf] dfqf k"/f ul/;s]sf] 5f]/Lsf] cg'xf/df tgfj b]Vbf g /ftdf lgGb|f lyPF . cGo cf}ifwLx? ;]jg ub}{ lyPF . PSsf;L nfU5 g ef]s g} . s;nfO{ s] eGg] < To; ;f; lng / km]g{ ufx|f] eP/ Ps xKtfkl5 k/LIf0fkl5 8f= e§n] dnfO{ zNolrlsT;ssf] ldlt @)&).&.@^ bf];|f]k6s o;} s]Gb|df k'gM /fo lng eGg'eof] . egf{ eOof] . hLjgb]lv of] hut a'em]h:tf] nfUof] . z/L/df krf; 7fpFdf l;of]n] ca kl/jf/ / cfkmGthgdf 7'nf] v}nf 3f]r] xf]nfg\ . aL;k6s PS;/] ljls/0fdf a}nf eof] . cfkmGthgaf6 d]bfGt, xf]ldof] xf]nf . Ps 8fnf] cf}ifwL of] z/L/n] a}+unf]/ / a}+ss;Ddsf :yfgdf pkrf/ lnof] xf]nf . s]jn hLjgdf afFRg] /x/n] . u/fpg ;/–;Nnfx cfP . d lj/fdLsf nflu bf];|f]k6s k'gM rf}w lbg c:ktfn a;L gofF sf}8L g ;f}8L ahf/ ahf/ bf}8L g} x'g]eof] . hLjg lnP/ 3/ kmls{of] . afFsL hLjgdf zxLb u+ufnfn /fli6«o x[bo s]Gb|, afF;af/L, k'g d'6'n] sfd ug]{ e/f];fdf cfh zNolqmof sf7df08f}df pkrf/ u/fpg t nfvf}+ u/]sf] ;f7L lbgdf oL x/kmx? n]Vb}5' . nfU5 eg] ljb]zsf] nkm8fdf kg{ of] dg b[li6 dlte|d w]/ } b]lvof] . lrn, lu4 / afh dfg]g . bzf}+ kfsf] /ut bfg lbg] cfsfzdf p8]sf] b]lvof] . c:ktfnsf kvf{n, cfkmGtsf] vf]hL, k};fsf] ;'/Iff, lj/fdLsf] e'O / 5tsf] :yfgdf ljleGg cfs[ltx? x]/rfxnfO{ dflg;, ;DemFbf g} sxfnL nfUg] eof] :ki6 b]lvof] . k"j{h ;fvf;Gtfgx? e]6\g dnfO{ . ;'/lIft tl/sfn] c:ktfn k'Ug], cfPsf] klg k|z:t b]lvof] . zNolqmofkl5sf] ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 56 Annual Report 2013 lg/fzkgf slt s7f]/ x'Fbf]/x]5 Tof] klg sfdrf]/sf] lznlznf b]vfb]lv o; s]Gb|df cg'ej ul/of] . h] xf];\ o; s]Gb|sf eg] Go'g b]lvG5 . cfhsf] lbgdf of] s]Gb| Ps ljlzi7 lrlsT;sx? /fd]z/fh sf]O/fnf, 7'nf :jf:Yo ;]jf / lzIff lbg] ;+:yf e};s]sf] clgn cfrfo{, lgj]z /fhe08f/L, /ljGb|eQm 5 . pRr l;k ePsf / lgM:jfYf{ ;]jfdf ltldnf, dg axfb'/ s]=;L=, ofbj b]j e§, tlNng hgzlQmsf sf/0f o; s]Gb| d'6' /lj dNn, rGb|d0fL clwsf/L / c?0f df:s] /f]usf] pkrf/, /f]syfd / :j:y d'6' lzIffsf] lj;{g g;lsg] JolQmTjdf k/] . To;}u/L nflu Ps e/kbf]{ / bLuf] ;+:yf xf] . ;Demgf zfSo, dx]Gb| nD;fn, ;'wf nD;fn nufot c:ktfnsf ;Dk"0f{ gl;{Ë / cGo vr{sf lx;fan] afOkf; zNolqmofsf ;fy} ;/f]sf/ /fVg] sd{rf/Lx? wGoafbsf kfq cGo hl6ntfn] ubf{ b'O{b'O{ k6s c:ktfn ag] . d]/f] kl/jf/sf nflu b'O{ k':tf afa'– egf{sf] hDdf ?=rf/nfv vr{ eof] . ;fob 5f]/fn] k'gM hLjg zxLb u+ufnfn /fli6«o ljb]z / :jb]zs} lghL c:ktfndf egf{ e} x[bo s]Gb|, afF;af/L, sf7df08f}af6 kfof}+ . pkrf/ u/]sf] eP olt /sd / olt ;lhnf] rfx] hLjgsf lbgx? lhpg] hlt lbg eP u/L sfd ;DkGg x'g] lyPg . d]/f] efUo, klg . :Jff:YosdL{x?sf] kf}/v / b]zsf] uf}/j ag]sf] 5 zxLb u+ufnfn /fli6«o x[bo of] c:ktfn :yfkgf ePsf] klg cÝf/ jif{ s]Gb|, afF;af/L, sf7df08f} . 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ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 57 Annual Report 2013 lng] 7fpFsf] le8 x]bf{ / lj/fdLx?sf] :ofF:ofF zf:jt ;To eg]sf] hGd / d[To' xf] . hf] / ˆofFˆofFsf] b[Zo b]Vbf o; s]Gb|df sfdsf] ;aeGbf lk8fbfos / ;+3if{do x'G5 . rfk cln al9 g} ePsf] xf] eGg] 7DofPsf] t}klg afFRg] t[i0ffn] g} hLjg 8f]¥ofPsf] 5' . o;sf] plrt Joj:yfkg rfF8f]eGbf x'G5 . t;y{ d]/f] hLjgdf tLgk6s ;3g rfF8f] ug{ h?/L 5 . pkrf/ OsfOaf6 kmls{ cem} afFRg] t[i0ffnfO{ gsfg{ ;s]sf] 5}g . csf]{ ;'wf/ ug{ ;lsg] kIf alx/+u laefudf b]v]sf] 5' . o; s]Gb|df ;]jf lng cfpg] cfh cfP/ lbgx'F rf/j6f d'6';DaGwL dflg;n] alx/+u ljefudf lrlsT;s;Fu cf}ifwL vfb}5' . hLjg lhpg] snfdf uf]Ko ;Nnfx lng] :yfg / jftfj/0f af];f]o'Qm vfgf jlh{t ul/Psf] 5 . b}lgs 5}g . alx/+u ljefudf bz–afx| hgf JofodnfO{ hLjgsf] c+u dflgPsf] 5 . lj/fdL / pgsf ;xof]uLx?sf] hTyf g} yf]/} dfq g'gsf] k|of]u ug]{ ;Nnfx lbOPsf] x'G5g\ . uf]Kos'/f lrlsT;ssf cufl8 5 . dWokfg / w'd|kfg jlh{t ul/Psf] /fVg] df}sf;Dd lj/fdL / pgsf 5 . cGTodf, 5 dlxgf;Dd 5ftLdf rf]6k6s ;xof]uLn] kfpFb}gg\ . la/fdLn] cfˆgf nfUgaf6 arfpg] ;Nnfx lbOPsf] 5 . cfzf cgluGtL ;d:ofx?sf] kf]sf] vf]Ng ldNg] 5, ;do;Fu} 5ftLsf] aflx/L rf]6 tyf lelq jftfj/0fsf] ;[hgf oyf;So rfF8f] eO{lbP rf]6 b'a} sd x'Fb} hfg]5 . x'GYof] h:tf] nfu]sf] 5 .
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 58 Annual Report 2013
A ROAD MAP FOR POSITIVE REVOLUTION IN THE MANAGEMENT
Krishna K. Subedi
Nothings is impossible in this world even word impossible itself says “I m possible” Anonymous
We all agree that “Today’s world is a correcting problems that have relatively competitive business world”. In this minor impact on our overall improvement context, managing the organization and of service or performance. keeping it in a sustainable way is becoming more complex and challenging. Still today, In the initial phase, this stereotypes of many organizations have been running management may work but when we use it with traditional approach of management. continually over a prolonged period of time, The main strategies of such management we as employees will become exhausted, are establishing standards, rules, norms, and frustrate and our pace of doing things and coercing the employees to follow the will defi nitely go downwards. This is a defi ned track without any kinds of difference universal phenomenon which is proven by in opinions. And, if certain things deviate many studies. Many writers have claimed from this usual track managers always that after exercising for prolonged period precede her/his actions by discovering the of time, this approach can pave the way for weakness and then solving the problems. negative culture. By saying this, I am not In such scenario, we as managers look ignoring the problems, in fact I can’t because like problem solver rather than creating, really we have numerous problems around motivating and inspiring the people to do us, but according to human psychology we more creative things with minimum error. just need to approach the problems from the We expend huge amount of resources on other side. This is not just happy or cheap
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 59 Annual Report 2013 talk for winning the election of parliament or argument, rather they should invite the but for “keeping the focus on the positivity” change, open their mind to listen to the and giving the space for positivity. In this voices of subordinates, and adopt the good regard, famous positivist Ellen DeGeneres ideas very quickly or in other words, they said that “It makes a big difference in your should handle the situation proactively. This life when you stay positive”. Similarly, is the main way how appreciative inquiry about the good effect of positivity within helps managers to make things better in the organization James Allen’s statement sustainable manner. Actually, AI can be is more memorable “Work joyfully and looked at as two separate words. Firstly, peacefully, know that right thoughts and appreciate means valuing the other’s best right efforts will inevitably bring about things, new creation or discoveries within right result”. the organization and in people. Secondly, inquiry means act of examination, Most of us acknowledge that this exploration or investigation and study. competitive era is so dynamic it needs high Exploring the best ideas, opinion and pace and morale among our employees to creativities within the people of institution do more and to win the race. Therefore and acknowledging them in order to we as managers need to cultivate high motivate or energize the employees. These pace and spreading effect of creativity two aspects of managerial activities are like in our organization rather than keeping two parts of a coin which are very- very usual stereotypes of moment. This type essential for creating inspiring organization of approach is nearly outdated because no for this competitive era. one likes to do things either because of fear or just spend the time. But question is AI actually is a vision driven way how to create such types of moment within of management not problem driven. the organization? Many of us are arguing Whatever we have, we have to take them whether it is possible or not. Of course! as an abundance of opportunities and It is possible why not? Many researchers organizational activities to be completed have proven that it is possible but we by collaborating with other people not by just need to keep our employees excited, using others people only. Organizational motivated and energized. No matters responsibilities are to be carried out not what is previous history is, virtually any as a transaction (for completing the job pattern of organizational action should only) but as a relation and a full of meaning be open to alteration and reconfi guration. commitment. Such scenario motivates Organizational behavior should not be the employees to do assigned task not automatically fi xed. Organization to be only of fear but also because of seeing open to seek transformation in conventional the success in every step of their action practice by replacing usual image with new in their life. Because people work not creative liberal image for our better future. only for money, but also for meaning. For money or meanings in this regard, I always There are various approaches among them remember the saying of Charles Schwab, simply we can adopt appreciative inquiry “The man who does not work for the love (AI) approach both as a philosophy and as of work but only for money is not likely to a process for our organizational betterment. neither make money nor fi nd fun in life” As a philosophy AI emphasizes co creation Therefore managers should try to build up and collaboration of all voices in the such types of positive environment within organization, people always support the the organization which can be able to create things if they see ownership into it. In fact inspiring organization, and motivate the this approach allows changes as a journey people to work effectively and effi ciently rather than an event. Managers should not be within the organization. Because the real afraid about the change or different opinion abilities of managers lies not in their ability
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 60 Annual Report 2013 to overpower others, but to connect with to see the most creative and improbable them; to listen to them; to reach out to them opportunities. and be reached out to. “Good management is the art of making In this regard, David Cooperrider has given problems so interesting and their clear direction to become appreciative solutions so constructive that everyone leader. According to him, all leaders can wants to get to work and deal with them”. become appreciative, just that they need appreciative eye to see truth, good, the Paul Hawken better and the possible. It is the capacity
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 61 Annual Report 2013
s]Gb|df kl/:s[t x'“b} u/]sf] gl;{ª ;]jf s[i0f s'df/L ;'a]bL laBf sf]O/fnf
æg;æg;{ TTo:tfo:tf] ] JJoQmLoQmL xfxf] ] h;sfh;sf] ] lbdfulbdfu j}1flgs}1flgs ;/x;/x x'G'G5,5, xftx?xftx? ssnfsf/sfnfsf/sf hh:tf:tf x'G'G5g5g\ / d'6' ccfdfsffdfsf] ] h:tfh:tf] x'G5'G5 .Æ.Æ kl/ro M x'Fb} hfg' gl;{Ë k]zfsf] ;j{AofkL cfjZostf kSs} klg, g;{ Pp6f To:tf] AolQm xf] h;sf] xf] . o; cy{df zxLb u+ufnfn /fli6«o x[bo lbdfu a}1flgs ;/x x'G5, xftx? snfsf/ s]Gb|sf g;{x? cu|k+lQmdf 5g\ eGbf cTo"lQm sf h:tf x'G5g\ / d'6' cfdfsf] h:tf] x'G5 . gxf]nf . ha o; s]Gb|sf] :yfkgf eof] To;a] oxL ;Totfn] ubf{ cfh gl;{Ë k]zf ljZje/ nfb]lv g} o; s]Gbdf g;{x?sf] kb:yfkgf ;Ddflgt 5 . lasf;zLn d'n'sx?df eGbf klg eof] . zxLb u+ufnfn /fli6«o Åbo ljsl;t d'n'sx?df o;sf] d'No, dfGotf / s]Gb| ljsf; ;ldlt @)%@ cGtu{t :yflkt :t/ cem pRr 5 . laZjsf] gl;{Ë ;dfh;Fu eO{ ;~rfngdf /x]sf] o; s]Gb|df la=;+= xfd|f] b]zsf] t'ngf ug]{ xf] eg] jt{dfg @)%^ sf] df3 dlxgfdf g;{x?sf] lgo'lQm ;dodf xfd|f] b]zdf klg gl;{Ë k]zfn] 7"nf] ul/of] . df3sf] dlxgf lr;f] / 3dfOnf] km8\sf] df/]sf] 5 . o; b]zdf pTkflbt gl;{Ë lyof] . nueu @) hgfsf] ;+Vofdf g;{x?n] hgzlQmsf] lj:tf/ ljZjel/ g} 5 . ;do o; d'6' c:ktfndf /f]huf/Lsf] ;'cj;/ cg';f/ :jf:Yo If]qdf ePsf] ;a} lsl;dsf kfPsf lyof}+. To;a]nf c:ktfndf alx/Ë pknlAwx?nfO{ ;d]6\b} kl/dflh{t / kl/is[t ;]jf dfq ;+rflnt lyof] . laut !* aif{nfO{ kms]{/ x]bf{ o; s]Gb|n] ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 62 Annual Report 2013
7'nf] km8\sf] df/]sf] 5 . o; s]Gb|sf] lasf; u/]sf sl/a %^Ü / k|df0ftxsf $#Ü gl;{ª ;Fu;Fu} gl;{Ë ;]jfdf klg 7'nf pknAwLx? sd{rf/L sfo{/t 5g\ . To;/Lg} gl;{ªdf ePsf 5g\ . of] ;+:yf, ;dfh b]z / cGo al/i7tfsf] s|dsf] cfwf/df gl;{ª k|zf;g /fi6«x?sf] dfemdf kl/lrt x'Fb} uof] / xfdL rnfpg] egL ;Dk"0f{ g;]{;x?af6 ul/Psf] klg cg'ejL / bIf x'Fb} uof}+ . la= ;+= @)%& ;fd'lxs k|ltj2tf / s]Gb|n] ToxL cg'?k df ( z}ofsf] cGt/Ë ;]jfaf6 d'6';DaGwL :yfkgf u/]sf] glh/ csf]{ ;sf/fTds / la/fdLx?nfO{ ;]jf lbg z'? u/]sf] o; ;jn kIf dfGg ;lsG5 . ;+:yf;Fu xfn nueu !^) z}of / nueu !*@ hgfsf] xf/fxf/Ldf ljleGg txsf o; ;+:yfdf sfo{/t gl;{Ë hgzlQmnfO{ yk g;{x? sfo{/t 5f}F / cfjZostfg';f/ pQm ;Ifd / ;jn agfpg s]Gb|sf] tkm{af6 s]lx ;+Vof la:tf/ ug]{ qmd hf/L g} 5 . ;'wf/sf] ck]Iff ul/Psf] 5, h;df M o; ;+:yfn] xfdLnfO{ ;Ifd / ;jn laleGg != gl;{Ë ;]jfsf] nflu cfjZos kg]{ ;do lsl;dsf k|lzIf0fx? ;+:yfleq} of aflx/ ;fk]lIfs cfGtl/s tyf afXo tflndsf] k7fP/ ePklg lg/Gt/ ?kdf ub}{ cfPsf] 5 . Aoj:yfdf lg/Gt/tf . of] ;Ifdtf / ;jntfn] o; ;+:yfdf cfpg] @= ljut s]xL jif{ otf b]lv z'? ul/Psf] ;a} ;]jfu|fxLnfO{ ;Gtf]ifk|b ;]jf lbg ;Sg] aflif{s ?kdf lglZrt l;6df gl;{Ë ePsf 5f} . cfh o; s]Gb|df sfo{/t g;{x? sd{rf/Lx?nfO{ s]Gb|sf] vr{df k9\g ;bf ;]jfu|fxLx?sf dfem k|z+zfsf kfq ag] k7fpg] Aoa:yfdf lg/Gt/tf . sf 5g\ . xfd|f ;]jfx?nfO{ cem u'0f:t/, kl/is[t / ;do;fk]If agfpg xfdLn] o; #= lglZrt cjlw k'/f ul/;s]sf sd{rf/L ;+:yfleq} l;lgo/ tyf h'lgo/ g;]{;sf] x?nfO{ a9'jf ug]{ kl/kf6LnfO{ kf/blz{ 1fgnfO{ ;jn ;Ifd / k|efjsf/L agfP/ ?kdf ;do tflnsf agfO{ nfu" ubf{ pTs[i6 ;]jf k|bfg ug{sf nflu k|zf;g tyf sd{rf/Lx?df ;sf/fTds kl/jt{g cfO{ k|fljlws Aoj:yfksx?sf] ;xof]uaf6 g;]{; ;]jfdf u'0ffTds j[lb x'g] x'+bf To; tkm{ Ph's]zg sld6Ln] lgoldt clgjfo{ sIffx? ;b}a Wofg lbg cfjZos b]lvG5 . ;+rfng u/]sf] 5 . h;n] ubf{ cfp+bf cGtdf s]Gb|sf] :t/f]Gglt tyf gl;{Ë lbgx?df xfd|f 1fgx? c? a9L ;do ;fk]If ;]jfsf sd{rf/Lx?sf] dgf]jnnfO{ pRr x'g] 5g\ / xfdLn] o; ;+:yfdf cfzfsf ;fy /fVg xfdL gl;{Ë sd{rf/Lx?n] laleGg cfpg] k|To]s ;]jfu|fxLsf] lxtdf ;jf]{Ts[i6, l/km/]G;sf cfwf/df d}g'jn tof/ k|efjsf/L, / nfebfos ;]jf lbg ;Sg] 5f}+ kfg]{ k|of;df klg 5f}+ / s]Gb|sf ;j} eGg] laZjf; lnPsf 5f}+. lgsfosf] ;xof]u /x]df xfd|f] k|oTg cjZo !* jif{ kf/ ub}{ ubf{ s]Gb|df gl;{ª sd{rf/L ;kmn x'g]5 . xfdL ;Rrf nuglzn Psa4 x?sf] z}lIfs :t/df b|'Qt/ ultdf ljsf; eP/ ;+:yfk|lt OdfGbf/ /x]/ of] lty{:yndf ePsf] Ps ;sf/fTds / ;jn kIf b]Vg cfpg] ;a} ofqLx?nfO{ cg'zfl;t /x]/ ;jf] kfpFbf uj{sf] cfefz eO/x]sf] 5 . xfn o; {Ts[i6 ;]jf ug]{ 1fg, zlQm / ;Ifdtf cjZo ;+:yfdf :gfsf]Q/ (M.N) u/]sf b'O{ hgf, k|fKt ug]{5f}+ . :gfsf]Q/ (M.N) ub}{ ug]{ Ps hgf, :gfts
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 63 Annual Report 2013
l;=P;=P;=8L= Ps dxTjk"0f{ ljefu ljBf hf]zL sf]O/fnf d]/f] lgo'lQm CSSD df geP;Dd dnfO{ o; ;]jfu|fxLsf ;]jfdf k|of]u ug]{ pks/0fx?, ;]6x?, zfvfsf] dxTjsf] e|d lyof] . o; zfvfdf cfP/ 8«dx?, 8«]kx?, 8]«g af]tnx?, 8«]l;Ë ;]6x? cflb 1ft eof] ls of] t kbf{ k5fl8sf] ljz]if / clt Jojl:yt tl/sfsf] k|of]uaf6 Kofs u/]/ ldlt cfjZos zfvf /x]5 . h;n] clj>fd, l8df08 /fv]/ of] zfvfn] lgd{nLs/0f ub{5 . tyf ;KnfO{sf] l;4fGt / lgd{nLs/0fsf] p2]Zo To:t} u/]/ cGo dxTjk"0f{ pks/0fx? emf]n kbfy{ lnP/ sfo{ ug]{ /x]5 . of] zfvfdf yf]/} dfq km/s / pRr tfkqmdaf6 lgd{nLs/0f ug{ gldNg] k/]df / ckof{Kt Wofg ePdf ;+:yf cGtu{t ;'rf? cj:yfdf ljz]if k|sf/sf] Kofs]6df Kofs u/]/ ?kdf x'g] ;]jfu|fxLx?sf] ;]jfdf afwf / ;d:of l;n u/]/ ldlt /fv]/ ljz]if k|sf/sf] Uof;df pTkGg x'g] /x]5 . cjZo klg s]xL zfvfx?df w]/} ;fjwfgLk"j{s lgd{nLs/0f of] ljefun] u5{ . lhDd]jf/L x'G5 / s'g}df clnslt sd x'g] ub{5 . t/ klg lhDd]jf/L t lhDd]jf/L g} xf] h;nfO{ d]l;gx?sf] ;~rfngdf afwf ePdf / ;d:of lgjf{x ubf{ hjfkmb]xL x'g} k5{ . ;+:yfsf ;a} oyflz3| ;dfwfg gePdf ;+:yf leq ;]jfu|fxLnfO{ ljefu tyf zfvf s'g} g s'g} ?kdf ljz]if x'G5g\ . of] lbOg] ;]jfdf afwf k'Ug] ;+efjgf x'G5 . To;sf/0f zfvfdf ul/g] sfo{ / tof/Lsf ljwLx? hfGg, l;Sg, ;d:ofsf] t'?Gt lg/fs/0f cfjZos x'G5 . l;sfpg / ug{ cfjZos 5 h:t} ;fdfgsf cfsf/ of] zfvfn] cToGt} k|efjsf/L e"ldsf lgjf{x ldnfpg, sf6\g, tof/L ug{, Kofs ug{ / lgd{nLs/0f ug]{ x'gfn] o; zfvfdf ;x[bo ;xeflu eP/ u/]/ cfjZostfnfO{ cfk"lt{ ug{ . ljleGg cfzfsf ;fy u'0ffTds kl/jt{gsf nflu kof{Kt, ljefun] ;+:yfdf cfpg] cyjf egf{ ePsf k|lzlIft / bIf dfgjLo ;+;fwg cfjZos 5 .
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GOD’S CLINIC Puja Kafl e Staff Nurse
I went to God’s clinic to have my routine checkup and I confi rmed I was ill.
When God took my blood pressure, he saw I was low in tenderness.
When He read my temperature, the thermometer registered 400 of anxiety.
He ran an electrogram and found that I needed several love “bypasses” since my arteries were blocked with loneliness and could not provide for an empty heart.
I went to orthopedics, because I could not walk by my brother’s side and I could not hug my friends since I had fractured myself when tripping with envy.
God also found I was shortsighted since I could not see beyond the short coming of my brother and sisters.
When I complained about deafness, the diagnosis was that I had stopped listening to God’s voice talking to me on a daily basis.
For all that God gave me a free consultation. Thanks to his mercifulness so my pledge is that once I leave this clinic, only take the natural remedies he prescribed through his words of truth.
“Every morning, take a full glass of gratitude. When getting to work, take one spoon of peace. Every hour, take one pill of patience, one cup of brotherhood and one glass of humility. When getting home, take one dose of love. When going to bed, take two tablets of clear conscience.”
God wants to show you things that only you can understand by living what you are living, and by being in the place you are now.
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AVIAN FLU Santosh Acharya Lab Technician
BIRD FLU/AVIAN FLU An infected bird shows the following signs and symptoms of fl u: Avian fl u is an infection that affects birds, thus also called as bird fl u. It is caused by a • Loss of appetite, Lack of energy, type of infl uenza virus. This is because this Dirty feathers, Purple, Diarrhea, virus has the ability to infect humans and Coughing, Sneezing, Sudden death lead to a fatal infection. It is a type of zoo- notic infection. The virus tends to mutate Causes of Avian Flu in Humans and develop the ability to infect humans leading to not just a few isolated cases, but Avian fl u in humans is caused by the H5N1 a worldwide epidemic of avian fl u in hu- infl uenza A virus. This disease is transmit- mans. ted to humans by contact with an infected bird. People who work closely with the WHAT IS AVIAN FLU? birds like poultry farm workers, sellers of poultry products in open-air markets, as Avian fl u is an infectious disease that is well as people who bring home poultry for caused by infl uenza virus called the bird fl u food. The nasal and respiratory secretions virus. It generally infects domestic poultry from the infected bird or its feces help in birds like chickens, ducks, etc. When this the spread of the virus in the human body. virus undergoes mutation, it leads to avian Avian fl u does not spread by eating poultry fl u in humans. Avian fl u spreads through products. It cannot pass from an infected bird to bird contact. The nasal and respira- person to a healthy person. In rare cases, tory secretions of infected birds spreading very close contact with an infected person to a healthy bird leads to an infection. Other has led to person-to-person infection. Till ways of infection include birds coming in the virus does not mutate into a human fl u contact with feces, water, equipment con- virus, casual contact with an infected per- taminated by an infected bird. son will not lead to the spread of infection.
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Symptoms of Avian Flu monia, they are kept on ventilator support and treated according to the complications Avian fl u symptoms tend to vary person to arising. The prognosis for avian fl u is very person. The fi rst sign of avian fl u is general poor. If the infection is very serious, it may fl u-like symptoms. These symptoms may lead to death due to complications. Preven- suddenly change into a more severe form tion of avian fl u includes: that includes: • Wash hands with an alcohol-based • High fever of about 100.4˚ F (38 sanitizer as frequently as possible. ˚C) or more, Sore throat, Dry cough, • Use clean knives, cutting boards, Chills , Muscle pain, Chills, Sneez- utensils, etc. when cooking poultry. ing, Diffi culty Sleeping, Lethargy, Diarrhea, Runny nose, Joint pain • Cook the chicken thoroughly and egg whites & yolks till fi rm. The symptoms may appear in about 3 to 5 days after infection. These symptoms last • Avoiding bird-markets, farms and for about a week. If left untreated, it could poultry areas during a fl u outbreak. lead to severe pneumonia as well as multi- organ failure. In such a case, the disease • Avoid consuming raw or half- proves to be fatal. cooked poultry products.
• Stay away from infected or sick Diagnosis of Avian Flu birds, if possible. If one develops sudden high fever and se- • Avoid travelling to regions that vere fl u-like symptoms, they should seek have a fl u outbreak. medical attention. The doctor may carry out tests to confi rm avian fl u. These tests • Ask your doctor for a fl u shot to pre- include chest X-ray, respiratory secretions vent infection from various types of culture, and certain blood tests for observ- infl uenza virus and build some im- ing white blood cells. munity against avian fl u. Treatment for Avian Flu If one develops fl u-like symptoms after coming in contact with birds or an infected The treatment of avian fl u includes isolat- person, they should seek immediate medi- ing the patients till the symptoms of avian cal attention. As this is a new virus, humans fl u subside. The patient is given plenty of have still not developed immunity against rest, fl uids to drink along with a healthy the virus. Also, researchers still have to diet. Medications such as aspirin are given study the virus in detail. Thus, prevention for treating fever and general malaise. If a is the only key to stay away from avian fl u. patient develops complications like pneu-
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Zj]t j:qdf ltdL lg/f >]i7 dxh{g :6fkm g;{ zLtsf yf]kf;Fu} pbfpg] lzlz/sf] ;'gf}nf] ljxfgL s'dfn]sf] rqmem}+ /x]5 dflg;sf] hLjg sxfgL /f]u clg kL8fdf 8'a]sfsf] ltdL b'Mv lgjfl/sf Zj]t a:qdf ;lhPsL ltdL kl/rfl/sf . bofdfofn] cf]tk|f]t ltd|f tL gog l:gUw k/f]ksf/df bQlrQ ltdL agfO{ j}/LnfO{ lg d'Uw lj/fdLsf] ;]jfdf ;dlk{t ltd|f efjgf slt s~rg ;lxi0f'tf / kljqtfn] /x]5 hLjg l;~rg . xg{ vf]H5f} c¿sf cfF;' n'sfO{ cfˆgf Joyf zAbdf cJoQm /x]5 uf}/jdo ltd|f] hLjgufyf ;b\efjsf 3]/f sf]l/Psf d'xf/ slt sflGtdo c¿sf] hng d]6fpg] sfo{ ltd|f] d+undo gegL /ftsf] zzL, clg lbgsf] k|sfz g t r}tsf] x'/L, g ebf}/] cfsfz kLl8tsf] ;]jfdf /dfpg] ;xgzLnf ltdL kmnsf] cfzf gu/L sd{ ug]{ sd{of]lugL ltdL . dfw'o{ / zfnLgtfn] kefljt| ltd|f] JolQmTj ef}ltstf eGbf lgs} pRr 5 ltd|f] cl:tTj p2]Zod"ns clg ;fy{stfn] k|fb"ef{j Tof] hLjg ;Dem'F Ps kn ltdLnfO{ ls xif{ ljef]/ x'G5 dg . ;xof]u clg :g]x¿kL /f]zgLsf] lnO{ pHofnf] x6fpg tD;]sL ltdL dflg;sf] hLjgsf] t'Fjfnf] ;defjn] sd{ u5f}{+ glnO{ dgdf s'g} Sn]z km}nfpFb} cfTdLotf ;adf lgsfnL /f]usf] ljif . cfzf / ;+odtfn] el/k"0f{ ltd|f cFh'nL k/f]ksf/L lbO{ cfˆgf] OR5fsf] ltnf~hnL e'nfpg lsg ;lSbgf} cfkm"nfO{ hutsf] :jfyL{ e'd/Ldf g t /+u\ofpg} ;S5f} cfkm"nfO{ ;dosf] xf]nLdf . d]6fO/x" ltdL dflg;sf kL8f, nufO{ :g]xsf] dnd sfod /xf];\ ;f}Do JolQmTj ljgf s'g} cxd\ /f]un] phf8]sf] hLjgnfO{ lbG5f} ;befjsf\ ] /+u yl/yl/ afFlr/x" o'uf}+o'u ltdL o;/L g} ;w}+e/L .
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 68 Annual Report 2013
WASTE MANAGEMENT SYSTEM
Mr. Dipendra Pokharel , Ms. Nita Dangol, Ms. Krishna Kumari Subedi, Ms. Sati Devi Manandhar, Ms. Anita Dewan
Health care institutions generate large manner. General hygiene is a perquisite for amounts of diverse wastes that require good medical waste management in health disposal. Much of the waste is hazardous care institutions. It is also vital that the and much therefore need to be collected, whole health care institutions be kept clean transferred, and disposed properly to and on a satisfactory state of hygiene. protect both the persons handling it and the environment. It affects not only the With the steady increase in the number generators of waste but also the operators of health care institutions in Nepal, the and the general public. amount of medical wastes generated is also increasing. But due to lack of proper Wastes from health care institutions can be waste management, guidelines, policies categorized as infectious or noninfectious. and legislations, most of the wastes Infectious wastes include human, animal from health care institutions are being or biological wastes and any items that disposed haphazardly, which is causing may be contaminated with pathogens. environmental and public health problem. Noninfectious wastes include toxic Realizing the urgent need to manage health chemicals, cytotoxic drugs, and radioactive, care institutions waste in Nepal. Nepal fl ammable and explosive wastes. A manifest Health Research Council (NHRC) had impact of mismanagement of this waste is prepared a Health care waste management the alarming incidence of hospital-acquired guideline which needs to be updated. infection. Solid waste which is generated in the Since the early recovery of the patient and hospital is managed by the staff (Attendant, health of clinical staff directly depends cleaner). There will be lot of infected & non- on infection prevention practices used in infectious wastes in the hospital which are health care institutions. Waste management collected from different points of hospital is one of the essential components of good e.g. General ward, OPD, SICU, CCU, ICU, infection prevention practices. It is essential New medical ward & New surgical ward etc. that health care waste is collected, stored infected or non-infected waste generated is and disposed of in a proper and scientifi c around 75-100 kg per day. There is provision
ShahidShahid Gangalal National Heart Centre, Bansbari, Kathmandu Page 69 Annual Report 2013 of segregation of the Health care waste by ESTABLISHMENT OF providing different colored buckets for different kinds of the waste: however, this MODEL WARD concept might not be in place properly because of poor knowledge of the users and lack of monitoring. The infectious waste is normally collected separately and burnt in the incinerator but, the operator might not have the proper skill and knowledge to operate the incinerator and hence may operate at very low temperature. Hence, this proposal intends to get help from WHO for proper management of the health care waste generated in SGNHC. Figure 1: Waste Segregation System in the model ward
For implementation of this project OBJECTIVE "Implementation of safe Healthcare waste • To support high quality patient care. management system in Shahid Gangalal • To contain the cost of Hospital National Heart Centre". General ward is a Waste Management. model ward of our hospital. • To reduce the risk of nosocomical infection. We have categorized 6 bucket in hospital • To comply with regulations and or- which as dinances. 1. Green bucket for degradable waste • To develop good community rela- tions. E.g. Pieces of fruits, waste foods, and wet • To support the preservation of envi- paper. ronmental quality. • To create awareness amongst the 2. Blue bucket for plastic items staff , patient & community. E.g. Plastic bags, water bottles, plastic • To manage the hospital waste prop- glass, plastic saline bottles etc. erly and systematically. 3. Black buckets: ( for dry papers) LONG TERM PLAN E.g. Dry newspapers, paper cartoon, medicine boxes etc. SGNHC has made long term plan for Health care waste management including. 4. Red bucket: (for sharp instrument)
1. Permanent Health care waste manage- E.g. - Needles, broken glass, blades etc. ment treatment and storage house. 2. To buy autoclave machine to disinfect 5. Yellow buckets: (for infectious items) the Health care waste management. E.g. Infectious gauze, pad, I/ V set, etc. 3. To manage degradable waste by using biogas plant. 6. Gray/ White buckets: 4. To use the available fund through H e a l t h c a r e w a s t e m a n a g e m e n t E.g. UN broke glass bottles, vials, etc. committee.
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Among those 6 buckets (3) a. Green The collection of the waste will be done in bucket, Blue buckets & Black buckets two different trolleys, one for the risk and will be kept in public area and Red bucket, other for the non-risk waste. These two Yellow bucket & Gray/ White buckets trolleys will be used for the collection of will be kept in closed area the waste. The designing of the trolleys are in process.
TRAINING TO THE The trolleys are designed out of the used KEY PERSONS OF THE trolleys in the hospital. The use of two different trolleys has helped to control the HOSPITALS mixing of the risk waste with the non-risk wastes
B. STORAGE OF WASTE The present storage area will be cleared up and used as the new waste storage area. The area has already been cleared up and the required installments are being made in the area, such as the drainage of the water, different blocks for different categories of the waste etc. Figure 2: Theroy session during the training C. TREATMENT AND DISPOSAL We have also conducted the training regarding health care waste management in For the treatment of the waste, for the model our hospital for 30 staff of our hospital from ward, the infected waste will be autoclaved 21 July 2013 to 26 July 2013. On the way, and then sent for fi nal disposal. In the other our staff also visited the waste management wards, the syringes are sent to incinerator, system in Bir hospital (Maha Bauddha) and which will be slowly incorporated in the civil hospital (Min Bhawan) Kathmandu. newly designed system. The wastes from The training was fi nancially supported by the other areas requiring treatment prior to W.H.O. We have also the system of waste disposal are being chemically disinfected. which are following as; D. WASTE SALES DETAIL:
A. COLLECTION OF WASTE After training with support from WHO, hospital is also earning the money by selling Non Hazardous waste. The hospital has initiated recycling of the waste. This has helped the hospital to recover some percentage of the cost used in the health care waste management.
Figure 3: Non-Risk waste transportation trolley
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Photo Gallary
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staff list
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DEPARTMENT OF CARDIOVASCULAR SURGERY SN NAME DESIGNATION 1 Dr. Ramesh Raj Koirala Consultant Cardiac Surgeon 2 Dr. Jyotindra Sharma Consultant Cardiac Surgeon & HOD 3 Dr. Sidhartha Pradhan Consultant Cardiac Surgeon 4 Dr. Bijoy Rajbansi Consultant Cardiac Surgeon 5 Dr. Rabindra Bhakta Timala Consultant Cardiac Surgeon 6 Dr. Nabin C Gautam Cardiac Surgeon 8 Dr. Anil Acharya Cardiac Surgeon 7 Dr. Yogeshwor Man Singh Registrar Surgery 9 Dr. Bishow Pokhrel Registrar Surgery 10 Dr. Nivesh Rajbhandari Registrar Surgery 11 Dr. Arun Upadhyaya Resident Doctor 12 Dr. Bijay Sah Resident Doctor 13 Dr. Raman Koirala Resident Doctor 14 Dr. Saurav Sunar Resident Doctor 15 Dr. Kiran Tiwari Resident Doctor 16 Dr. Anjeela Kadel Resident Doctor 17 Dr. Dikshya Joshi Resident Doctor 18 Dr. Kripa Bhattarai Resident Doctor 19 Dr. Sangam K.C. Resident Doctor 20 Umesh Khan Sr. Perfusion Assistant 21 Lalita Shakya Perfusion Assistant 22 Ram Bharosh Yadav Perfusion Assistant
DEPARTMENT OF CARDIOLOGY SN NAME DESIGNATION 1 Dr. Man Bahadur K.C. Sr. Consultant Cardiologist & ED 2 Dr. Arun Maskey Sr. Consultant Cardiologist 3 Dr. Deewakar Sharma Sr. Consultant Cardiologist 4 Dr. Rabi Malla Sr. Consultant Cardiologist 5 Dr. Yadav Deo Bhatta Consultant Cardiologist & HOD 6 Dr. Sujeeb Rajbhandari Consultant Cardiologist 7 Dr. Rajeeb Rajbhandari Consultant Cardiologist 8 Dr. Yubaraj Limbu Consultant Cardiologist 9 Dr. Urmila Shakya Consultant Pediatric Cardiologist 10 Dr. Subodh Kansakar Consultant Cardiologist 11 Dr. Roshan Raut Consultant Cardiologist 12 Dr. Sajan G Baidya Consultant Cardologist 13 Dr. Ranjit Sharma Consultant Cardiologist 14 Dr. Himamshu Nepal Consultant Cardiologist 15 Dr. Chandra Mani Adhikari Cardiologist 16 Dr. Binay Kumar Rauniyar Cardiologist 17 Dr. Murari Dhungana Registrar Cardiology
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SN NAME DESIGNATION 18 Dr. Dharma Nath Yadav Registrar Cardiology 19 Dr. Dipanker Prajapati Registrar Cardiology 20 Dr. Nagma Shrestha Registrar Cardiology 21 Dr. Rabindra Pandey Registrar Cardiology 22 Dr. Satish Kumar Singh Registrar Cardiology 23 Dr. Manish Shrestha Registrar Pediatric Cardiology 24 Dr. Anil Regmi Resident Doctor 25 Dr. Saurav Sunder Shrestha Resident Doctor 26 Dr. Suman Th apaliya Resident Doctor 27 Dr. Aamir Siddiqui Resident Doctor 28 Dr. Dilip Kumar Sah Resident Doctor 29 Dr. Deepak Limbu Resident Doctor 30 Dr. Bibek Baniya Resident Doctor 31 Dr. Mukunda Sharma Resident Doctor 32 Dr. Amrit Bogati Resident Doctor 33 Dr. Prekshya Singh Resident Doctor 34 Dr. Roshani Ghimire Resident Doctor 35 Dr. Shova Pandey Resident Doctor 36 Dr. Sanjay Singh K.C. Resident Doctor 37 Dr. Rishikesh Rijal Resident Doctor 38 Dr. Sebina Baniya Resident Doctor
DEPARTMENT OF ANESTHESIOLOGY SN NAME DESIGNATION 1 Dr. Jejunath Pokharel Sr. Consultant Anesthesiologist 2 Dr. Apurba Sharma Registrar Anesthesiology 3 Dr. Ashis Amatya Registrar Anesthesiology 4 Dr. Battu Kumar Shrestha Registrar Anesthesiology 5 Dr. Surendra Bhusal Registrar Anesthesiology 6 Dr. Bidhan Gyawali Resident Doctor
DEPARTMENT OF CARDIAC REHABILATION & HEALTH PROMOTION
SN NAME DESIGNATION 1 Dr. Deewakar Sharma Sr. Consultant Cardiologist & HOD 2 Dr. Shaili Th apa Physiotherapist 3 Samjhana Shakya Public Health Offi cer 4 Pushpa Neupane Sr. Staff Nurse 5 Yashoda Luitel Physiotherapy Assistant 6 Rajeev Kumar Yadav Physiotherap Assistant
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VISITING SPECIALISTS
SN NAME DESIGNATION 1 Dr. Ranjit Baral Consultant Cardiologist 2 Dr. Dhandu Rani Shakya Consultant Anaesthesiologist 3 Mr. Mahendra Bhatta Sr. Perfusionist
DEPARTMENT OF NURSING SN NAME DESIGNATION 1 Nita Dangol Matron (Sr. Nursing Supervisor) 2 Krishna Kumari Subedi Sr. Nursing Supervisor 3 Sati Devi Manandhar Nursing Supervisor 4 Anita Dewan Nursing Supervisor 5 Prati Badan Dangol Sister 6 Tulasa KC Sister 7 Kopila Luitel Sister 8 Vidhya Koirala Sister 9 Roji Shakya Sister 10 Deoki Saru Sister 11 Manju Timilsina Sister 12 Kalpana Timilsina Sister 13 Leela Rana KC Sr. Staff Nurse II 14 Kunti Khanal Sr. Staff Nurse 15 Dibyashori Khati Sr. Staff Nurse 16 Bishnu Pandey Sr. Staff Nurse 17 Anjana Koirala Sr. Staff Nurse 18 Sunita Khadka Sr. Staff Nurse 19 Lalita Maharjan Sr. Staff Nurse 20 Rajyalaxmi Bhele Sr. Staff Nurse 21 Lalita Poudel Sr. Staff Nurse 22 Reshma Th apa Sr. Staff Nurse 23 Shobhana Shrestha Staff Nurse 24 Astha Baniya Staff Nurse 25 Sapana Maharjan Staff Nurse 26 Ganga Ter Staff Nurse 27 Mamata Khadka Staff Nurse 28 Sajana Maharjan Staff Nurse 29 Krishna Shwari Gwachha Staff Nurse 30 Rameswori Duwal Staff Nurse 31 Suraksha Dhungana Staff Nurse 32 Binita Tamrakar Staff Nurse 33 Ushana Shrestha Staff Nurse 34 Bina Paneru Staff Nurse 35 Kamala Poudel Staff Nurse 36 Anupama Sharma Staff Nurse
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SN NAME DESIGNATION 37 Puja Satyal Staff Nurse 38 Basanta Sharma Staff Nurse 39 Rashmi Karki Staff Nurse 40 Srijana Th apa Magar Staff Nurse 41 Ambika Shrestha Staff Nurse 42 Man Kumari Shris Th apa Staff Nurse 43 Sagun Sharma Staff Nurse 44 Rukumani Khadka Staff Nurse 45 Ratna Devekota Staff Nurse 46 Pabitra Pandey Staff Nurse 47 Shanta Singh Th akuri Staff Nurse 48 Pratima Dhakal Staff Nurse 49 Tulasa Banjara Staff Nurse 50 Hira Adhikari Staff Nurse 51 Yogina Maharjan Staff Nurse 52 Supala Gautam Staff Nurse 53 Januka khadka Staff Nurse 54 Sharmila Th apa Staff Nurse 55 Siba Laxmi Shrestha Staff Nurse 56 Puspa Marasini Staff Nurse 57 Ramita Maharjan Staff Nurse 58 Bijaya Aryal Staff Nurse 59 Jyoti Shrestha Staff Nurse 60 Shova Shrestha Staff Nurse 61 Mamta Bista Staff Nurse 62 Srijana Bhele Staff Nurse 63 Usha Paudel Staff Nurse 64 Sangita Kafl eStaff Nurse 65 Rupa Sharma Staff Nurse 66 Ranjita Guragain Staff Nurse 67 Chandika Gwachha Staff Nurse 68 Raj Kumari Shrestha Staff Nurse 69 Chahana Singh Staff Nurse 70 Sabita Gyawali Staff Nurse 71 Srijana Th apa Staff Nurse 72 Shailee Karanjit Staff Nurse 73 Puspa Kumari Gurung Staff Nurse 74 Asmita Karki Staff Nurse 75 Menuka Silwal Staff Nurse 76 Jina KC Staff Nurse 77 Madhuri Th apa Staff Nurse 78 Kiran Sebedi Dahal Staff Nurse 79 Manju Pyakurel Staff Nurse 80 Mamata Ojha Staff Nurse
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SN NAME DESIGNATION 81 Chanchala Shrestha Staff Nurse 82 Lhamu Sherpa Staff Nurse 83 Punam Shrestha Staff Nurse 84 Rekha Karki Staff Nurse 85 Sushila Khanal Staff Nurse 86 Renu Lama Staff Nurse 87 Bal Kumari Chaudhary Staff Nurse 88 Shreejana Gautam Staff Nurse 89 Poonam Gurung Staff Nurse 90 Kusum Th apa Staff Nurse 91 Sisira Rajthala Staff Nurse 92 Asha Kumari Jha Staff Nurse 93 Chitra Pudasani (Adhikari) Staff Nurse 94 Sajani Limbu Staff Nurse 95 Rajani Shrestha Staff Nurse 96 Manira Gautam Staff Nurse 97 Arzoo Neupane Staff Nurse 98 Tripti Singh Staff Nurse 99 Renu Tamang Staff Nurse 100 Ishwori Gautam Staff Nurse 101 Luniva Yakami Staff Nurse 102 Shanti Gurung Staff Nurse 103 Kabita Baniya Staff Nurse 104 Shama Singh Kunwar Staff Nurse 105 Shila Shrestha Staff Nurse 106 Asmita Lamichhane Staff Nurse 107 Chunam Khadka Staff Nurse 108 Sumitra Poudel Staff Nurse 109 Puja Kafl eStaff Nurse 110 Bitika Adhikari Staff Nurse 111 Sakuntala Karki Staff Nurse 112 Prajita Shrestha Staff Nurse 113 Manju Khadka Staff Nurse 114 Roshni Shaha Mananadhar Staff Nurse 115 Shakuntala Mahat Staff Nurse 116 Sovita Sapkota Staff Nurse 117 Bidhya Malla Staff Nurse 118 Isha Lama Staff Nurse 119 Prabha Paudel Staff Nurse 120 Anjana Sharma Staff Nurse 121 Sabina Baral Staff Nurse 122 Nima Sherpa Staff Nurse 123 Safala Subedi Staff Nurse 124 Sujan G.C. Staff Nurse
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SN NAME DESIGNATION 125 Samjhana Karki Staff Nurse 126 Apeksha Ghale Staff Nurse 127 Sumitra Bhetuwal Staff Nurse 128 Rekha Kumari Mandal Staff Nurse 129 Namrata Ojha Staff Nurse 130 Anita Bhandari Staff Nurse 131 Aarati Gautam Staff Nurse 132 Ravina Subedi Staff Nurse 133 Shristi Maharjan Staff Nurse 134 Sabina Th imi Staff Nurse 135 Shushma Tamang Staff Nurse 136 Ramita Pandey Aryal Staff Nurse 137 Nilima Joshi Staff Nurse 138 Srijana Tiwari Staff Nurse 139 Lina Maharjan Staff Nurse 140 Bandana Sankhi Staff Nurse 141 Sangita Baskota Staff Nurse 142 Ambika Th apa Staff Nurse 143 Geeta Tiwari Staff Nurse 144 Prabha Rawal Staff Nurse 145 Sunita Awal Staff Nurse 146 Sajina Sharma Ruwali Staff Nurse 147 Alina Pandey Staff Nurse 148 Janaki Ayer Staff Nurse 149 Mukta Shrestha Staff Nurse 150 Rubina Khadka Staff Nurse 151 Shovna Shrestha Staff Nurse 152 Nilima Pant Staff Nurse 153 Ayushma Neupane Staff Nurse 154 Pragya Kuikel Staff Nurse 155 Nisha Th apa Staff Nurse 156 Pramila Aryal Staff Nurse 157 Sirjana Adhikari Staff Nurse 158 Sajana Shrestha Staff Nurse 159 Sushila Ghimire Staff Nurse 160 Sarala Malla Staff Nurse 161 Bhagawoti Chapagain Staff Nurse 162 Bimala Acharya (Poudel) Staff Nurse 163 Apurwa Sawad Staff Nurse 164 Sanju Shah Staff Nurse 165 Rashmi Basnet Staff Nurse 166 Anisha Ghimire Staff Nurse 167 Kripa Sankhi Staff Nurse 168 Sabita Khanal Staff Nurse
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SN NAME DESIGNATION 169 Kamana Paudel Staff Nurse 170 Nira Kumari Shahi Staff Nurse 171 Ritu Karki Staff Nurse 172 Kripa Poudel Staff Nurse 173 Nira Shrestha Staff Nurse 174 Neeta Guragain Staff Nurse 175 Nirjala Khanal Staff Nurse 176 Sanjita Dhakal Staff Nurse 177 Namrata Maharjan Staff Nurse 178 Aagya Pokharel Staff Nurse 179 Bandana Bogati Staff Nurse 180 Anuja Adhikari Staff Nurse 181 Luna Maharjan Staff Nurse
ADMINISTRATION SN NAME DESIGNATION 1 Dr. Man Bahadur K C Executive Director 2 Dipendra Khadka Dy. Chief of Administrative 3 Dipendra Pokharel Sr. Administrative Offi cer 4 Ram Prasad Acharya Administrative Offi cer 5 Bimala Aryal Administrative Offi cer 6 Bhupal Acharya Administrative Offi cer 7 Bimala Sapkota Administrative Assistant 8 Ram Babu Raut Medical Record Assistant 9 Chunam Lama Administrative Assistant 10 Mahendra Lamsal Administrative Assistant 11 Yuba Raj Timilsina Administrative Assistant 12 Santosh Dhakal Administrative Sub- Assistant 13 Bhagawati Gaire Administrative Sub- Assistant 14 Dibyashor Pandit Administrative Sub- Assistant 15 Pratima Malla Th akuri Administrative Sub- Assistant 16 Bikash Khaniya Administrative Sub- Assistant 17 Mandira Khadka Administrative Sub- Assistant 18 Kabita Koirala Khatiwada Administrative Sub- Assistant 19 Krishna Bahadur Budhathoki Driver II 20 Sanu Lama Driver II 21 Bharat Bahadur Khadka Driver 22 Pitambar Bhujel Driver 23 Bhej Bahadur Moktan Driver 24 Bhai Narayan Maharjan Driver 25 Rup Bdr Th apa Driver 26 Gyan Kaji Maharjan Driver 27 Sadhuram Pandit Driver
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SN NAME DESIGNATION 28 Yagya Bahadur Khulal Driver 29 Sharada Khanal Offi ce Helper II 30 Madhav Th apa Offi ce Helper II 31 Bharat Bahadur Basnet Offi ce Helper II 32 Shanti KC Offi ce Helper II 33 Gauri Devi Sharma Offi ce Helper II 34 Kalpana Bhattarai Offi ce Helper 35 Kamala Gautam Offi ce Helper 36 Sushila Bista Offi ce Helper 37 Biju Kuwar Chhetri Offi ce Helper
RADIOLOGY
SN NAME DESIGNATION 1 Indesh Th akur Sr. Radiography Technologist 2 Baidh Nath Yadav Radiography Technologist 3 Shulav Paudel Radiography Technologist 4Shyam Th akur Sr. Radiographer 5 Saroj Chhetry Radiographer 6 Seema Gyawali Radiographer 7 Shyam Kumar Adhikari Radiographer 8 Bijaya Shrestha Radiographer 9 Baburam Kharel Radiographer 10 Laxminarayan Singh Radiographer 11 Sebika Baniya Pandit Radiographer 12 Pramod Khatri Radiographer 13 Ramesh Th apa Dark Room Assistant II
FINANCE
SN NAME DESIGNATION 1 Bimal Kumar Upreti Chief Financial Administration 2 Manoj Kumar Bista Sr. Finance Offi cer 3 Naresh Chipalu Finance Offi cer 4 Sabin Manandhar Account Assistant 5 Niru Dahal Account Assistant 6 Bibek Th apa Account Sub- Assistant 7 Sanjay Maharjan Account Sub- Assistant 8 Krishna Bahadur Kumal Account Sub- Assistant
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PATHOLOGY
SN NAME DESIGNATION 1 Dr. Bipesh Acharya Resident Doctor 2 Binod Kumar Yadav Medical Lab Technologist 3 Bindeshor Yadav Medical Lab Technologist 4 Arya Tara Shilpakar Sr. Lab Technician 5 Renu Shakya Sr. Lab Technician 6 Narendra Shrestha Lab Technician 7 Sarala Koirala Lab Technician 8 Rajnarayan Mishra Lab Technician 9 Sushila Shrestha Lab Technician 10 Prasanta Koirala Lab Technician 11 Sunita Giri Lab Technician 12 Bikash Bhusal Lab Technician 13 Shanti Sharma Lab Technician 14 Nawal Kishor Yadav Lab Technician 15 Bijaya Kumar Th akur Lab Technician 16 Santosh Acharya Lab Technician 17 Suresh Kumar Gupta Lab Technician 18 Pradeep Khanal Lab Technician 19 Pranila Chitrakar Lab Technician 20 Prem Hari Bhasima Lab Technician 21 Birendra Chaudhary Lab Technician
PHARMACY
SN NAME DESIGNATION 1 Madhu Giri Pharmacist 2 Atmaram Timalsina Pharmacy Assistant 3 Anu Acharya Pharmacy Assistant 4 Prem Raj K.C. Pharmacy Assistant 5 Kamal Bahadur Rana Pharmacy Assistant 6 Nabina Th apa Pharmacy Assistant 7 Upama Parajuli Pharmacy Assistant 8 Jaykishor Shah Health Assistant 9 Indrajit Yadav Health Assistant 10 Manoj Kumar Yadav Health Assistant 11 Niru Ratyal Health Assistant 12 Devendra Yadav Health Assistant
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MAINTENANCE
SN NAME DESIGNATION 1 Pradip Kumar Yadav Sr. Overseer 2 Bhagawan Karki Overseer 3 Nawaraj Roka Sub- Overseer 4 Bhogendra Narayan Shah Sub- Overseer 5 Shamsher Bahadur Basnet Plumber 6 Kedar Raj Khadka Plumber 7 Bishwa Ram Adhikari Plumber 8 Dinesh Maharjan Plumber
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