Interview: Heart of Gold

An outspoken individual, Dr. Bhagwan Koirala – MD, is the Executive Director and Chief of Cardiac Surgery of Shahid Gangalal National Heart Center, Bansbari. He is also the Associate professor of Surgery – Tribhuvan University Teaching Hospital. Born in the year 1960 in Darunga, Palpa, he completed his intermediate education in Nepal and his graduation from Ukraine. For his post-graduation he traveled to the National Institute of Cardiovascular Diseases of Dhaka University, Bangladesh and then to the US for his Medical Licensing exam. Sometimes known as a “one man show” for his sincerity, honesty and commitment towards his job, Dr. Koirala gives credit to his entire team on all the commendable surgeries and charity work the hospital is involved with. He has done more than two thousand heart operations in the past four years and is adored by the public for his charity towards child heart patients and quotes, “No child of this country shall die of heart disease because of poverty.”

Why heart?
I guess it came from the encouragement given by my teachers and probably due to my home background, though I am the only doctor in my family. Somehow they inducted me into this field. In fact, I had the idea from the certificate level after school. I could never express that because I never thought I could achieve it. I was always thinking that maybe I should try, and always kept that in my mind, but never expressed it and worked hard. That is how it came about.

Is heart (cardiovascular) disease a growing problem in Nepal?
Interestingly, Nepal and countries like Nepal have a double burden of this disease. We have communicable diseases still very prevalent and on top of that, non-communicable diseases of which cardiovascular disease is one, is coming up very fast. It is the leading cause of death in the third world at present, except Africa and the fact is documented in the WHO report of 2002. It is a massive problem not only here but everywhere. What amount of resources we are going to allocate to deal with this problem is a different story at this stage, but we have to realize that it is a major problem for us.

Do we have all the services/treatment for heart patients? Or do we still need to go abroad for treatment?
Let me answer this in a different way. Do we really need a robotic surgery in heart? People are doing it elsewhere. Well! Americans are not practicing that. It always becomes complicated when you ask ‘Do you really have to go out for anything? Our standard routine services includes diagnostics, non surgical and surgical treatment, which means operating on children and adults, balloon valvotomy (opening valves without operating) etc. To be more specific, we correct birth defects of all types, repair and replace valves when necessary, bypasses and other forms of operation. To be honest, there are certain areas that are very complicated, which have very limited public health impact for which in my opinion, we still need help from outside. But that does not constitute any significant amount of our practice. The general answer is, you do not have to. No one has to go abroad by compulsion. If you have a lot of money, want a better, fancy place, well you have a choice, but it does not come by any compulsion.

What other heart projects are you engaged / affiliated with?
First of all I run this hospital. Fortunately, I have become an administrator at this stage and am doing as much as I can and I’m a fulltime practicing surgeon. So I have two full time jobs and am trying to balance them properly. So far, I have no regrets of what I’m doing and have done. A lot of resources need to be mobilized in order to perform my professional duties; which unfortunately are scarce in the hospital. Mind you, this is a public institution, an autonomous institution and not run by the government, where we do not have a lot of resources coming from the government and it is not possible to offer free services to all needy patients. So in order to run the hospital, and yet provide reasonable services at a low cost, we have to come up with a model of a third party support.

Somebody has to be involved in a different way. Thus, I’m involved with different projects, drives and campaigns to be able to raise funds and charity for needy patients. It helps my patients and team directly and I enjoy being a part of it. I’m also engaged with my professional society, the Cardiac Society of Nepal, of which I am the general secretary and other professional international and national organizations and I do take my chair of responsibility in those organizations seriously. I’m also involved with an organization that is totally dedicated to child health care called “Bal Dhadkan.” We are looking into the possibility of declaring that “No child of this country shall die of heart disease because of poverty.” It sounds challenging but is feasible. I was looking into possibilities that we could receive a sustainable amount of funding and that is not asking too much. We are working with different international organizations on the matter and have some light into that possibility. There are good signs that we will be able to fulfill that. In general, these are the areas apart from my professional job that I do.

“Now, heart patients will not die just because they do not have enough money for treatment.” Could you please elaborate on how you go about it?
First of all, I have a special interest in child heart surgery on top of adult heart surgery and I’ve had additional training on the subject. It is an exciting and challenging field and the issue is delicate and sensitive. Each year, I perform around 300 to 400 child heart surgeries out of a total of 800. It is disappointing at times to see a child handicapped and expecting treatment from the rest of the world when he has as good a potential as I have for a better future. And it is a touchy subject when the problem is no mistake of his own and that the parents are poor. Though some parents can pay for the operation, the majority cannot, and mind you, these are children who have a prospect of a normal life and lifestyle, with all the potential and abilities of a normal human being.  It is not like doing a bypass. Bypasses don’t have a brighter picture as a perfectly repaired child’s heart. So this is something that can be fixed for life, and is the most exciting part of the story. That is why I am involved with child heart care, and when I see them after a few years, it gives me immense pleasure to see them grown-up, progressed and changed.

Secondly, it is going to be difficult to sort out who can or cannot pay for the services. Out of three to four hundred child patients, only half of one third can pay for the service. That leaves about 140 to 200 children who actually need real help. Looking at our facility and (I don’t see any other major facility in the country) in the next few years, we can actually cater in a big way to child heart surgery. We are not talking about a single surgery but about busy, complex heart surgeries and high volume surgeries. If that is the case, we have figures, and again I repeat that we are not going to take care of all the children in the country. That’s not the statement. The statement is “We’re not going to deny treatment just because they do not have money.” We are going to do as much as we can from the hospitals side, but the government too has obligations. So it comes down to a concrete figure of 150 to 200 sponsored children. That’s the project we are working on and it has to be sustained for a period of time. Right now we are working with the Nepali community and business groups, about whatever they can do to assist. Some NGOs and friends in the US have taken interest. There are signs that we might have solid resources coming.

Do we have a particular sponsor as such?
No, we do not. Let me tell you how we stand financially. The major source is our own revenue and not that of the government. The hospital’s operational cost is largely met by our own revenue. Some operational cost comes from the National Health Tax Fund but again, as I said, the major share is ours. The government bears only nine to ten percent of operational cost, but offers grant for infrastructure development; which to some extent is significant. Jayanti Trust and The Hearts Club are closely involved with us and we are also associated with an American organization called “Direct Relief International” which is linked with hospitals in forty-two different countries. We have to meet their special criteria to receive their support. The Rotary Club, International friends, NGOs, INGOs donate a lot of disposables for the cause, but there is no exclusive donor.

Could you enlighten us on the volunteers working with you?
I consider this organization that I mentioned also involved because they basically came up with the idea to help us, but we have some other small groups or volunteers who are directly involved with the hospital. A trust nearby named “Chalise Trust” gives us volunteers to guide our patients here. We also have the Lincoln School Community Service Project involved. They have developed a childrens’ play room and they are basically replacing toys that children take away after they are discharged. Small gestures are important.

Advice for a healthy heart
A healthy heart is a healthy lifestyle. A structured guideline would be to have regular exercise, control stress, control diabetes and blood pressure and in case of high cholesterol, that needs to be controlled; need to check body weight. The foremost thing to remember is, no smoking. If unsure, you need to get diagnosed before the problem sets in.