Shanta Bhawan: Palace of Peace

Some believe it was divine intervention, and perhaps it was, because Nepal only began opening its doors to the foreign world and to the world of scientific medicine in the middle of the last century. It was a time when King Tribhuvan took up the task of leading the nation trapped in medieval manners and ways toward a prosperous future. It was 1951, after the rule of the Rana regime had come to an end, and the King promised that his government would do away with the country’s outmoded systems and strive for a new Nepal. Though the actual opening of the Shanta Bhawan Hospital did not occur until 1956, its coming began earlier, with the political and philosophical changes for the better that were brewing in ‘Nepal’, as the Kathmandu valley was often called in those days. Strangely enough, it began with a request by a missionary working in India to study birds in Nepal.

That missionary was the American Robert Fleming, an avid ornithologist who taught science at Woodstock School in northern India. He had a PhD degree in education, but collecting birds consumed much of his and his family’s vacation time. Curious about the feathered species that existed in India’s closed and isolated neighbor, Nepal, ‘ Dr Bob’, as he was known, requested permission and was surprised when the Nepal government approved his proposed birding trip into the Nepal hills. At the end of October 1949, Fleming’s bird expedition team left on a three month trek to Tansen in central Nepal. The party returned with 720 bird specimens and also with an awareness of the vast medical needs of the country. Almost 18 months after the expedition, during the winter of
1951-52, a second trip was approved. This time, two medical doctors came along: Dr Bethel Fleming and Dr Carl Friedericks.

During the second tour a temporary clinic was set up at Tansen using medications and equipment that Dr Bethel and Dr Carl had personally bought with them. In the six weeks that it was open, they treated more than 2000 patients. The team was then approached by local leaders who requested them to open a permanent hospital. After their return to India, the Flemings and the Friedericks thought and prayed about this proposition and concluded that they were, indeed, being called to establish medical work in Nepal. In February 1952 Bob and Bethel Fleming, Carl Friedericks and Dr Moffatt wrote a letter to His Majesty’s Government (which had recently replaced the Rana regime) offering to open a hospital in Tansen. They also reported these events to their respective mission boards back in the USA.

Before starting anything, however, the Friedericks went on furlough to America and the Flemings returned to Nepal again to visit friends in Kathmandu. On this trip, Dr Bethel examined the meager health care facilities in the valley and approached the Health Ministry officials with an offer of help. As a response to the proposal to open a hospital in Tansen still had not materialized, Bob sent a letter restating the original offer, but with an added a proposal to establish maternity and child welfare clinics around the Kathmandu valley. With the assistance of a leading Nepali physician, Dr J. S. Malla, they convinced officials to accept the medical grant.

In a letter dated May 18, 1953, signed by K.A. Dikshit, Assistant Secretary of Foreign Affairs, the missionaries were at last granted permission to establish the Tansen hospital as well as five maternity and child health clinics in the Kathmandu valley. The first clinic was established in Bhatgaon (Bhaktapur) in 1954 and the next month saw another in an unused wing of the government Cholera Hospital in Teku. The Prime Minister, Matrika Prasad Koirala, officiated at the inauguration. Clinics in the nearby villages of Gokarna, Kirtipur, Banepa, Thimi, Sangu and Bungmati villages were set up next. Meanwhile, the Friedericks went to Tansen to begin planning for the hospital there. From the initial stage the Flemings and Friedericks shared a vision of establishing a united, interdenominational mission organization to coordinate the work in Nepal. This became a reality in March 1954, when eight missions joined together to form the United Mission to Nepal (UMN), which directed the work from then onward.

Though the Flemings were unexpectedly absent for almost two years on furlough, the clinics in Kathmandu functioned under a series of doctors and nurses who came to Nepal on loan from medical missions in India. The 15 bed Cholera Hospital soon evolved into a maternity hospital, but faced several difficulties. A report noted that sharing the small building with cholera patients made unhealthy companions for maternity work and that the hospital was being confronted by a host of non-maternity patients. In addition, the staff had trouble finding housing conveniently nearby and they described the work as a “wonderful chaos with complete dependence on God”. Dr Bethel had known of these difficulties prior to leaving on furlough and had asked the UMN’s Executive Secretary, Ernest Oliver, to keep an eye out for better accommodations.

In late 1955 Oliver learned of the availability of a medium sized Rana palace called Shanta Bhawan, ‘Palace of Peace’, south of the Bagmati River in Lalitpur District. The 60 room building offered space for wards, out-patient clinics, laboratory, operating rooms and staff housing. With the fledgling mission eager to expand its medical work, the UMN’s Business Manager, Fran Swenson, and Laboratory Technician, Daftan Sada, negotiated to lease the white stucco palace. The government indirectly sanctioned this new development by permitting Dr Edgar Miller, an Internist, and his wife Dr Elizabeth Miller, a Gynecologist, to assist in the work. The Millers were convinced by the Flemings to set aside their long established medical practices in America to join the new adventure in Nepal under the UMN banner. They found a church congregation in the state of Illinois to provide an annual grant of $2,500 to cover the rent on the palace-turned-hospital, then they set out on the two month sea voyage to India, then on to Nepal overland to join the new venture.

In January 1956 medical staff and equipment were moved out of the Cholera Hospital into Shanta Bhawan. The building was named for its owner, General Shanta Shamsher Jang Bahadur Rana. This new facility, the ‘Palace of Peace, was considered a fitting place for Christian work and medical care. In a report to the UMN Executive Committee, Ernest Oliver expressed his joy and hope for the new hospital site. “I wish you could all see Shanta Bhawan. I feel when God saw the Rana prince building the mansion; he knew that he would acquire it later for a hospital where his dear Son might be glorified.”

The décor of the new hospital was quite novel when the UMN first moved in. Large chandeliers, European parlor furniture, marble floors and life-size portraits of Rana family members were part of the package. More typical hospital furnishing gradually replaced these as services expanded into the many rooms of the palace. The orchestra balcony became the women’s surgical ward and later was converted to orthopedic storage. The room with hunting murals and trophies was replaced by the X-Ray Department. One room with a large tiled bathroom, quite exceptional for Nepal in those days, was converted for use by VIP and foreign patients. The heavy overhead chandeliers were removed because of apprehensive patients. The former card game cottage was converted into a quaint guesthouse. And the concubines’ residences were converted into staff quarters. This process was described in a report by Bob Fleming 15 months after Shanta Bhawan opened.

“Our effort in Kathmandu has been to set up a model hospital”, Fleming wrote. “A year ago we already had a delivery room, private maternity rooms, a laboratory and a ward for women. The Flemings and Millers arrived in April 1956 bringing a great deal of equipment. We soon opened a second women’s ward and a ward for men, set aside rooms for prayer, library, office, private rooms, out-patient clinic and drug rooms, all for their specific purposes. We remodeled an annex, now called Bethlehem as a residence for nurses while male staff live in a neighboring house. In March 1957, the  x-ray was installed and now the children’s ward is almost complete. All these things we have had to do to change a palace into a hospital.”

Revamping the Rana palace turned out to be an unending job over the years. As early as 1962 it gave rise to thoughts of building an entirely new hospital; but more important than the early remodeling efforts was the confidence and respect the hospital gained among the people of Nepal. Dr Bethel and Drs Edgar and Elizabeth Miller dedicated themselves to caring for patients suffering from tuberculosis, abdominal cysts, infections, malnutrition and other severe ailments. King Mahendra called upon Dr Edgar Miller as his personal doctor, and the Prime Minister and cabinet members, along with embassy officials, registered their approval of the hospital. Princess Princep Shah used to volunteer at the hospital, wheeling a trolley of books and other items around the patient wards. Within a few years Shanta Bhawan Hospital had, indeed, won approval from the needy people of Nepal. The local business community and the growing foreign community in the capital, the staff and families of the various embassies and aid agencies, looked to it for their medical care. Besides the needy, who were provided “charitable concessions” which frequently amounted to covering the entire bill, the new influx of Western tourists and trekkers also came to rely on the hospital. Sir Edmund Hillary and John D. Rockefeller III were among the early visitors to become friends of Shanta Bhawan, and they donated funds to build a new out-patient department in 1960.

At times the failure of the mission hospital to give more exclusive attention to the poor surfaced as a criticism. But, all the while, the establishment of a high quality and modern medical center in a country that had none was always on the mind of the mission. The UMN committee thus approved (and budgeted) a five year expansion plan in 1958 that aimed to increase the number of hospital beds, add specialty services, create nursing and lab training programs as well as continue the operation of the district clinics. About this time, a clinic (and later a hospital ) was also opened in Gorkha District, several days’ walk west of Kathmandu (before roads). And later, an associated community health program was opened in Okhaldunga District, east of Kathmandu.

During a severe cholera epidemic large volumes of intravenous solutions were required by Shanta Bhawan. Since bottles were in short supply, the hospital solicited bottles of different shapes and sizes from embassies and aid groups; thus, one could see patients apparently receiving intravenous infusions of whiskey, brandy and lemon squash, if you believed the labels.

By the end of 1964 Shanta Bhawan Hospital had made great progress towards its goals. Dr Robert Berry, a surgical specialist had arrived and performed the first closed heart surgery at the hospital. As a volunteer surgeon, Dr Edgar Miller Jr performed the first decortications of the lung for tuberculosis. The Departments of Medicine, Pediatrics and OB/GYN (Obstetrics/Gynecology) were also established and outpatients visits had increased considerably, as reported by Dr Eleanor Knox of the Pediatric Clinic. The School of Nursing had graduated a dozen nurses by then, and they were conditionally accredited by the Nepal Nursing Council. Nepali nursing graduates under the leadership of Nursing Superintendents Helen Berg and Mabel McLean were gradually replacing Western nurses in the wards. The hospital still lacked an anesthesiologist, orthopedic surgeon, pathologist and ophthalmologist and did not find a permanent dentist until Dr Neulon arrived from Germany in 1966. The UMN wanted an efficiently organized hospital of 250 beds, but the hospital had only expanded to 135 beds in 1964, which remained the official capacity until it shifted to a new building in 1982.

During the last half of the ’60s, Shanta Bhawan Hospital ran into various frustrations. When the Millers returned to the USA after nine years in Nepal, no specialist in internal diseases was immediately available to replace Dr Edgar. Four more doctors returned home in 1966, including Dr DeVol after developing eye problems. Tragedy struck the staff the next year when a number of the hospital workers were incapacitated by an unusual febrile disease, still undiagnosed. Among them were the Friedericks, who had to leave Nepal for a long period of convalescence. But hospital services continued unabated, even submitting to an influx of the world travelers, known as the “hippies”, who sought help and treatment for various illnesses. When 17 of them were diagnosed with hepatitis, the nurses called it “hippie-titis”. All the while, Shanta Bhawan Hospital continued to evolve into a well-equipped hospital.

The decade of the ’70s saw Shanta Bhawan Hospital continue the work as a base hospital supporting primary health care programs in Lalitpur District and keeping pace with important developments in community health. Nursing education and other training were also advanced by the hospital. Not only did the quantity of work increase spectacularly during this decade, but there was also an impressive upgrading in the quality and range of services offered to the patients. The hospital also became conscious of other medical work in the whole of Nepal and lent support where it could.

In 1973 the government offered UMN the option of transferring to a new hospital site in Patan, only two kilometers away but closer to the District’s urban center where patients would have better accessibility to the services. The proposal sparked mission staff enthusiasm and in April 1974, the UMN and the government signed an agreement concerning the new hospital. By then the old palace had become too crumbly and the clinical work had outgrown its walls. In November 1982, Shanta Bhawan Hospital moved into a new structure now popularly known as Patan Hospital. Though the old ‘Palace of Peace’ closed its gates as a hospital, the new Patan Hospital is a culmination of the dreams and hopes of many who gave themselves in service in Shanta Bhawan through the years.

The era of unselfish service had come to an end but the spirit, heart and soul of the ‘Palace of Peace’ is still alive even in this new millennium. Thus, the transition was not an ending but was a new beginning.

The author, whose parents were amongst the pioneers, were long-term employ-ees of the hospital, was born and raised at Shanta Bhawan. The old hospital complex is now occupied by Gyanodaya School. The UMN can be contacted at 422.8118 or 426.8900 and at umn@umn.org.np, and Patan Hospital’s phone numbers are 552.2266 or 552.2278, or email patanhospital@wlink.com.np.

Part of the Shanta Bhawan story is adapted from A Story of a Hospital by Douglas Cooley (1979) and Fifty Years in God’s Hand edited by the UMN (1954-2004).