“Dead or alive, there is no option for me but to take my wife to Bir Hospital,” said Krishna Bahadur Balayar, pouring his heart out outside the emergency room of the hospital.
He said the doctor had asked him to arrange an ICU for his wife as the case was complicated.
“For people people like us, diseases are a curse,” he said.
Balayar from K.I. Singh Rural Municipality of Doti has been wandering in the emergency room (red zone) of the Bir Hospital for two days hoping to get an ICU bed for his wife.
Balayar took his wife, Chanda Devi, to the hospital on February 14 due to a high fever and lethargy. According to him, the doctor did not diagnose the disease until February 16. The doctor informed them that the test report would only be available after four days.
Balayar does not have the funds to take his wife to a private hospital, and Bir Hospital, a more affordable option, has no available beds. He said waited for days for an ICU bed to be available.
Every time he asked, he was told there were none. With every no, a chill went down his spine fearing his wife would die.
“I heard two patients died because they did not get an ICU bed,” he said, visibly distraught.
Two more patients were in the ICU in the emergency room of Bir Hospital. Meanwhile, outside the hospital’s emergency area, the ambulance that arrived with a patient had to turn back because there were no empty ICU beds. Health workers in the emergency room say that they are forced to feel helpless and witness the scene of patients dying quickly due to the lack of ICU beds.
Locked hope
Bir Hospital, the country’s oldest hospital, should have been the centre for public trust in health services. However, due to a lack of skilled workforce and an economic crisis, the hospital’s ICU and ward rooms are locked, and tests have also been stopped.
According to hospital data, although it can operate 960 beds, only 560 beds are currently in operation. The 60-bed ICU has now decreased to 27 beds, and the 33-bed High Dependency Unit (HDU) has reduced to eight.
Furthermore, the nine-bed Gastroenterology and Hepatology ICU room on the first floor of the surgical building has been locked for three months. Additionally, the 18-bed cabin on the second floor remains locked. Moreover, the 48-bed ortho-plastic ward and 14-bed HDU in the surgical building are also closed.
Similarly, the cardiology ward has decreased to 16 beds from 24, and the medical ward has reduced to 25 beds from 40. The Anaesthesia ICU on the fourth floor has been reduced to eight beds from 18, while the Neuro ICU has decreased to six beds from nine. Additionally, the nine-bed Cardio ICU has been reduced to four beds.
Furthermore, the senior citizen ward in the old building has been closed for months, and most department services have been scaled down. According to departmental heads, the closure of wards and departments is solely due to the removal of hospital nursing staff.
Despite the closures, the ICUs remain well-equipped with bedside monitors, central oxygen pipelines, ventilators, and other expensive equipment.
All of this is a snowballing effect of a decision taken by the Minister for Health and Population Mohan Bahadur Basnet. In October 2023, Basnet citing a lack of budget, decided not to extend the contract period of 276 employees of Bir Hospital. This included 185 nurses.
Santosh Paudel, director of Bir Hospital, acknowledged that services, from surgery to ICU, were affected when the staff were removed all at once.
“When ICU and HDU were operated with 90 beds, the cases of patients having to go to other hospitals were significantly fewer,” he said. “Things became difficult when we became short-staffed.”
Relatives of middle and low-income patients immediately search for available beds upon entering the emergency room. Unfortunately, in the yellow area, two to three patients are occupying a single bed. Additionally, the green area remains inaccessible.
Some patients endure pain while seated in wheelchairs, while others lie on the ground, connected to saline drips. Due to delays in admission to the ward and ICU, some patients have to endure waiting times of two to three days in the emergency room.
Health workers at the Bir Hospital themselves are frustrated watching people in pain in the emergency room waiting for death.
“When will the ministry see this? How many people have to die for them to take action,” said a health worker asking to remain anonymous.
Shortstaffed health services
The emergency room at Bir Hospital is overcrowded. Dr Suresh Nepal, head of the emergency room, states that up to 200 patients arrive at the emergency room every day. However, following the reduction of 12 medical officers and an equal number of nurses, the number of beds has decreased from 48 to 25.
“We have requested eight additional nurses from the administration on numerous occasions, but they have been unable to provide them,” he says.
Previously, regular surgery services from 13 operation theatres have been reduced by half. According to the hospital administration’s data, 40 moderate and complicated surgeries are performed daily. Previously, there were up to 80 surgeries per day.
Dr Ravin Bahadur Basnet, Head of the Department, stated that there were up to 125 operations in 6 days of the week.
The Urology and Neurology departments at Bir Hospital are among the busiest. To address long waiting times for operations, which had stretched to over 18 months, the hospital administration arranged for urology surgeries to be conducted six days a week, reducing the waiting period for patients to five months.
However, following the removal of eight nurses and one doctor from the Department of Urology, operations are now limited to three days a week. Currently, only 40 to 45 operations are being performed within this timeframe. Consequently, as the number of operations has decreased, the waiting time has surged to nine months. Moreover, the number of beds in the Urology ward has decreased from 50 to 22.
The hospital administration has been unable to provide even the basic equipment necessary for surgery, citing financial constraints. They admitted to performing operations with deteriorating tools for eight years, expressing concern that urology operations could halt at any moment.
Furthermore, the plan to conduct four kidney transplants two days a week has also fallen through.
The situation in Neurology is also similar. There were 125 operations per month, but now it has dropped below 90, while the 60-bed neurology service has shrunk to 40 beds. Most of the departments at Bir Hospital are facing a similar situation.
Closing for good?
Dr Bhupendra Basnet, Vice-Chancellor of the National Academy of Medical Sciences (NAMS), says he is unaware of the service shutdown.
“It would be appropriate to ask the director how the hospital services are being operated,” he said trying to shy away from the question.
He argued that everything appeared empty due to the shifting of services from the old building to the new one. This transition created the perception of vacant space, despite the ongoing operation of services in the new facility.
Recently, it has been discovered that the pathology service at Bir Hospital has also been severely affected. According to the laboratory staff, due to the lack of reagents, all blood tests such as thyroid, hormone, vitamin D, B12, cancer-related tests, CA 90.9, AFP, PSA, and other tests have been suspended, said Neelam Thakur.
Similarly, tests such as hepatitis B, hepatitis C viral load, human papillomavirus (HPV) PCR, back pain, and HLA-B 27 have been suspended.
Out of approximately 2,000 patients who visit daily, between 700 and 1,000 patients require lab tests. However, a laboratory employee said that even patients in the emergency room are unable to undergo necessary tests.
“If this situation persists, the lab itself may have to close,” said a staff at the laboratory.
Examination and treatment fees are very low at Bir Hospital. The government grant is the primary source of income for the hospital. However, last year, its budget was drastically cut.
Bir Hospital received a grant of Rs 260 million last year, but it has been drastically reduced to Rs 11.6 million in the current fiscal year. Apart from that Rs 1.43 billion was allocated for regular hospital operations last year, but it has decreased to Rs 73 million in the current fiscal year.
According to him, the hospital’s internal revenue is limited to salaries and allowances. The hospital had an internal revenue of Rs 55 million last year but salaries of 650 employees at the National Institute of Medical Sciences (NAMS) and Bir Hospital worth Rs 53 million were covered.
The hospital administration has repeatedly requested Rs 920 million from the Ministry of Health this year, citing the difficulty in maintaining services. However, they were only granted Rs 190 million.
Officials from the Ministry of Health state that the hospital cannot be allocated the requested amount. Ministry spokesperson Dr Prakash Budhathoki explains that since the Ministry of Health lacks a budget, the request needs to be submitted to the Ministry of Finance, with proper documents and evidence to obtain the necessary funds.
Dr Budhathoki suggests, putting a common voice together, “Simply voicing concerns in the media won’t resolve the issues!”
