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GE Ratcliffe. the BMH Dharan Silver Jubilee Symposium

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GE Ratcliffe. the BMH Dharan Silver Jubilee Symposium --------------------------------------------------,. J R Army Med Corps: first published as 10.1136/jramc-133-02-12 on 1 June 1987. Downloaded from iN Army Med IMp!. lW!7; 133: 100-102 The BMH Dharan Silver Jubilee Symposium Lieutenant Colonel G E Ratcliffe, MBMRCPRAMC Senior Medical Officer and Co nsultant Physician BMH Dharan, Nepal BMII Dharan (Figures 1--4) was built in the lat e 1950's inaccessible parts of the couTltry. The hcalth posts are as all integral part uf Dharan Ca ntonment in Ei1st Nepal, run by health assistants and <I uxiliary health workers to provide medical aid for all British personnel and their under tht: control of community leadcrs. fami lies, Gurkha personnel and their families in The life expectancy in Nepal is 44.5 years, and Or • Dharan. for the locally employed civilians in the Pandey described the importance of educ<1t in g the Cantonment and for Gurkh::ts returning for or from v<1riuus e thnic groups throughout the country in basic leave. Its other mai n functiun has heen to provide hC<1lth techniques. This was of particular relevance in facilities each year for the medical examination of trying LO reduce the infant mortality ratc, for \vhich snfe potential Gurkha rc-emits. water and sanitation programmes arc in progress. Since the hospital opened, however, it has developed Because of various homeopathi(.: and faith·healing • Cl reputation for treating many other sick and needy teChniques in use throughout the country, there was Cl people in East Nepal, an area where medical facilities certain amo unt of scepticism by the local populatio n are not well developed. Succeeding members of staff about the introduction o f Western medical techniques. have over the past twenty·five yeflrs put in many hours Progress tended to be slow therefore, although proguest. Protected by copyright. · • of hard work to build a very e nviable reputation. To grammes arc in hand to cont rol tuberculosis, leprosy. celebrate its Silver Jubi Ice , a symposium was held to gastroenteritis. etc, using immunis<1t ion and basic which guests from various medical organisations were medi cal educatio n. Similarly a major family planning invited to speak in an attempt to keep in perspecti ve the programme is in progress. work of the hospital. Dharan Educational and Medical Training • The Golden Throat Schemc (DEMTS) After a few introductory remarks from the SMO This programme was set up under the auspices of thc \""elcoming members of staff and guests alike , the Overseas Development Agency to te(tch various sk ill s programme opened with a videotape, 'The Golden to ex·servicemen of the Brigade of Gurkhas. The • Throat' , kindly donated hy UNICEF in K<lthmandu. medica l training is organised oy O r U P Gurung who This demonstrated the in cidence uf endemic goitn.: in described the present system of up to two years' training, Tuli Besi, a small vill age in the Mustang area of Nepal, depending on previously ohtained educational quali· and the attempts made hy UNICEF in co.operation with fications. • the Nepalese Government Medical Authorities to This scheme is now accepted by the Inst itutt:! of http://militaryhealth.bmj.com/ reduce this incidence hy injecting iodised oil into a ll Medicine in th e Tribhuwan Ulliver~ity in Kathtnandu as members of thc local population. Nepal has a major lack a n alternative training for aux il iary health worke rs in of iodine in its soil , particularly in the mountainous.lt:!ss Nepal. The OEMTS training programme produces 20- accessible regions o f the country. SUl.:h injections 25% of the tntined auxiliary health workers in Nepal. In • hopefully will provide sufficient iodine for normal the fir st ye<1r instruction in basic anatomy and physio logy metabolism for 5 years, and their use, particularly in is given togelh~r with teaching uf health adm ini strat ion, young adults. should reduce the incidence of cretin ism sanitation and immunisation. Practical ex perience is to a much lower ratc. gain ed in community surveys. in wawr purifi cation. drug Incidentally, 'The Golden Throat' refers to the reply dispensing, laooratory techniques, and in maternal and given by one of the ladies in the a rea under investigation ch ild health . Some timc is spent in the Zonal Hospital in • who. when asked what she thought was in her goitre. Biratn<1g<1r as we ll as the BMI-I in Dharan. and sin ce replied "Gold", 1979 olle hundred and eleven students have successfull y on October 1, 2021 by comple ted their training. M~di(.'al Organi~ation in N~pa l Dr K R Pandey. the Civi l Surgt:!on fr0111 the Koshi Medit..'al Education in Tribhuwan Uni\'ersit)" Anchal Hospital , Biriltnagar. spoke about His Majesty's Medical School • Departme nt o f Health programme for Nepal. The Or J Diekin~on , Medical Superinte nde nt of Patan country is divided into Zoncs (Anchals) in the main Hospital, Kathlllandu discussed the founding of the centres of which are large Zonal H ospil<ll s of 150- 200 Medical Sl.:hool in Kathmandu. 'l"hi s was set up with the 1 beds each, with smaller district hospitals elsewhere in help of the ·World Health Organization in the late 1970s • lhe zone. reducing in size to the basic unit , the health and thc first thirty Nepalese trained doctors qualified in post , in the periphery and for the most part, in very 1984 fo llowed by a si milar number in 1985. 1 J R Army Med Corps: first published as 10.1136/jramc-133-02-12 on 1 June 1987. Downloaded from • • • • • • • • • • I BMH Dharan• British Gurkhas Nepal I guest. Protected by copyright. I I I I I Fi~. I. Hospital Sign Fig. 2. BMH J)hanHl - Casualty & Recepliun I I http://militaryhealth.bmj.com/ I I I I on October 1, 2021 by I - - - - . ~--... ,...... " .. - ------ Fig. J. 8:\IH Dharan - TB and I\'linimnl Care Wards Fig. 4. From I. to R Men's Medical Ward . TB W;lrd and Minimal Care Ward "" • J R Army Med Corps: first published as 10.1136/jramc-133-02-12 on 1 June 1987. Downloaded from 102 Th e HMI-I Dlwran Silver Jf/ bilee Symposium • He described the difficulties of trying to produce a It had been huped to compleme nt this talk by asking medical training scheme appropriate to the needs of the Dr Roy We lford , the Medical Directur of Save the country, where unquestionably the main requirements Children Fund (UK) in Dhankuta, to disl:uSS the work at this stage are for community health and primary of SCF in East Nepal. Unfortunately, because of staff health care , with much less emphasis being laid on such prohlems, he was unable to a ttend. things as expensive investigation techniques, renal • dialysis or bone marrow transplantation. Potential Japanese Encephalitis medical students we re chosen from para-medical Since the first great interest in this disease in South workers, laboratory technicians, etc. Following quali­ East Nepal by Major Alan Hendersun in 1982-83, a t-icalion, these doctors are committed to service in research project to quantify various aspects of the district hospitals for four years. Tu emphasise furthe r prohlem has been in progress o rganised hy the Royal • the paramount importance of community health, any Army Medica l Coll ege, the Lundon School of Ilygie ne para-medic who has worked in the remoter areas fo r 3 and Tropical Medicine and the U .S. A rmed Forces years is much more likely to be accepted for medical Medical Research In stitute in Bangkok. training, assuming the necessary educational require­ A slll all epi demi c of the di sease occurred in South ments have been met. East Nepal in 1984 , but in the mo nsoon period of 1985 He also spoke of hi s work setting up the Physiology the bi ggest epidemi c so far of over 300 cases occ urred. • Department of the ~:fedical School. He described the The initial re sults from these cases, attcmpts to isolate value of using everyday mechanical devices to demon­ the virus in fatal cases, the collection of blood samples strate various aspects of physiology; to illustrate this he from sentinal pigs (l:onsidered then to be the amplifying described a simple water supply from the cop to the host of the virus), and the various entomological aspectsguest. Protected by copyright. hottom of a hill with various intervening taps to control of th e di sease we re di scussed by Dr C Leake. Virologi st • flow as an example of a negative feedhack system. from the London School of Hygiene and Tropical Medicin e, by Mr K Chctwyn , Entomologist fr om the Royal Army Medical College and by Captain D The End of the Road Bell_my. RAMC . Medical Office r tu the project. Mr Frank Guthrie, the Fi eld Director of the British Dr Leake spo ke with great enthusiasm anout the large • Nepal Medical Trust (BNMT) discussed the his tory of numher of pOS iti ve results from CSr- specim ens fro m the Trust .md the work it had done in East Nepal in the suspected cases. 'fhis hopefull y would enable confir­ management of tuberculosis since its in ception in the mati on of Ihe effi ciency of the Biken vaccine against the late 1960s. Hi s talk was illustrated by a videotape, "The di sea~c. With guarded optimism for the future success • End Of The Road", produced by BNMT. whi ch on this suhject. th e symposium dosed aft e r i l very varied described the work of its clinic in Chainpur.
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