Annual Report 2013 - sgnhc.org.np · dr. sitaram chaudhary dean national academy of medical sciences bir hospital mrs. anuradha koirala women representative mr. sanjeeb rajbhandari

GOVERNING BODY

chairmanMR. VIDYADHAR MALLIK

HON. MINISTER FOR HEALTH AND POPULATION

membersMR. NARAHARI ACHARYA

HON. MEMBER OF CONSTITUENT ASEMBLY

DR. PRAVEEN MISHRASECRETARY

MINISTRY OF HEALTH AND POPULATION

MR. ANANDA RAJ DHAKALJOINT SECRETARY

MINISTRY OF FINANCE

DR. SITARAM CHAUDHARYDEAN

NATIONAL ACADEMY OF MEDICAL SCIENCESBIR HOSPITAL

MRS. ANURADHA KOIRALAWOMEN REPRESENTATIVE

MR. SANJEEB RAJBHANDARISOCIAL WORKER

DR. ABANI BHUSAN UPADHYAYASR. CONSULTANT CARDIOLOGIST

DR. YADAV KUMAR DEO BHATTSR. CONSULTANT CARDIOLOGIST

DR. RAAMESH RAJ KOIRALACONSULTANT CARDIAC SURGEON

member secretary

DR. MAN BAHADUR K.C.EXECUTIVE DIRECTOR

EDITORIALShahid 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 BaidyaDr. Bijoy G RajbanshiDr. Dipanker PrajapatiDr. Amrit BogatiMs. Samjhana ShakyaMr. Mahendra LamsalMr. Santosh Dhakal

ANNUAL REPORT

2013

TABLE OF CONTENTqm=;+= lzif{s k]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 7-84 Department of Anesthesiology 9-115 Non-Invasive Cardiology and OPD Services 12-156 Pediatric Cardiology Service 16-197 Acute Coronary Syndrome 20-228 Medical Intensive Care Unit (MICU) 23-249 Interventional Cardiology Services 25-2710 Cardiac Electrophysiology and Device Implantation 28-2911 Emergency Services 30-3112 Medical Ward 32-3313 Department of Cardiac Rehabilitation & Health Promotiion 34-3614 Nursing Department 37-3915 Pathology Services 40-4116 Radiology Services 42-4417 Pharmaceutical Care 45-4618 Physiotherapy Services 47-4919 Annual Mortality : 2013 50-5220 My Days at SGNHC 53-5421 Ps lj/fdLsf] gh/df zxLb u+ufnfn /fli6«o x[bo s]Gb| 55-5822 A Roadmap for Positive Revolution in the Management 59-6123 s]Gb|df kl/:s[t x'“b}{ u/]sf] gl;{ª ;]jf 62-6324 l;=P;=P;=8L Ps dxTjk"0f{ ljefu 6425 God’s Clinic 6526 Avian Flu 66-6727 Zj]t j:qdf ltdL 6828 Waste Management System 69-7129 Photo Gallary 72-7930 Staff Lists 80-90

Annual Report 2013

Shahid Gangalal National Heart Centre, Bansbari, Kathmandu

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,

pkrf/ tyf /f]syfd ug]{ p2]Zon] :yflkt

o; zxLb u+ufnfn /fli6«o x[bo s]Gb|n] cfˆgf]

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

st{Ao ;Gtf]ifhgs ?kdf ;DkGg u/]sf] ;'gfpg

kfpFbf xfdL cToGt} uf}/jflGjt ePsf 5f}+ .

ut cfly{s jif{ @)^(.&) df s]Gb|åf/f ;+kflbt

k|d'v sfo{ljj/0f lgDgfg';f/ /x]sf] 5M

alx/+u ;]jf !,!!,@^) hgf

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 & RFA)

171

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

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tfklg d'6'/f]usf] /f]syfd / o;;DaGwL

hgr]tgf clej[l4 ug]{ sfo{df klg s]Gb|

lg/Gt/ nfluk/]sf] 5 . o; cfly{s jif{df

klg s]Gb|n] d]lrb]lv dxfsfnL;Ddsf

ljleGg efudf ljz]if1x?sf] 6f]nLn] ( j6f

k|ltsf/fTds sfo{qmdx? ;+rfng u/]sf] 5 .

h;sf] k|efj hg:t/df lgs} /fd|f] kfOPsf]

xfd|f] cg'ej 5 .

uDeL/ k|s[ltsf d'6'/f]usf] pkrf/df g]kfn

;/sf/n] cToGt} dxTj lb+b}cfPsf] s'/f

oxfFx?nfO{ ljlbt} 5 . ut cfly{s jif{df klg

g]kfn ;/sf/n] !% jif{d'lgsf afnaRrfx?

tyf &% jif{dflysf h]i7 gful/sx?nfO{

lgMz'Ns pkrf/sf] nflu ah]6sf] Joj:yf

u/]sf] 5 . To;}u/L d'6'sf] eNe ljlu|Psf

u/La tyf c;xfo la/fdLsf] nflu b'O{;o

j6f lgMz'Ns eNesf] Joj:yf u/]sf] 5 .

;fF3'l/Psf] eNe v'nfpg] PTMC k|ljlwsf]

nflu g]kfn ;/sf/åf/f ?=! s/f]8 &) nfv

ljlgof]hg ul/Psf] lyof] . o;sf] cltl/Qm

pNn]lvt ;/sf/L ;]jfleq gk/]sf jf To;n]

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/

b]lv Ps nfv;Dd cg'bfg lbg] Joj:yf ul/Psf]

5 . nf]kf]Gd'v hghfltsf nflu lgMz'Ns pkrf/

sf] Joj:yf ul/Psf] 5 . o; cltl/Qm hoGtL

d]df]l/on 6«i6, /fd lgjf; kjg s'df/

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

k|lti7fg nufotsf ljleGg ;xof]uL ;+3–;+:yf

tyf JojlQmx?n] klg u/La tyf c;xfo

lj/fdLsf] pkrf/df oyf;Sbf] cfly{s tyf

ef}lts ;xof]u ul//x]sf 5g\ .

s]Gb|nfO{ ;d;fdlos k|ljlw;Fu lg/Gt/

hf]l8/fVgsf] nflu sfl8{of]nf]hL, sfl8{ofs

;h{/L tyf gl;{Ë ljifodf pRr lzIff tyf

Super Specializati on sf] nflu ut cfly{s

jif{df klg :jb]z tyf ljb]zdf tfnLdsf]

Joj:yf ul/Psf] 5 . lrlsT;f lj1fg tyf

/fli6«o k|lti7fg (NAMS) ;Fu ;xsfo{ u/L

d'6'/f]usf] If]qdf pRr lzIffsf] cWofkg

lg/Gt/ hf/L 5 .

s]Gb|sf] ef}lts k"jf{wf/ tof/ ug]{ sfo{df klg

xfdL lg/Gt/ nflu /x]sf 5f}+ . s]Gb|sf] s"n

z}of ;+Vof @)) k'¥ofpg] sfo{ clGtd r/0fdf

k'u]sf] 5 . o;} cfly{s jif{df yk Ps yfg

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;DkGg e};s]sf] 5 .

cfly{s cg'zf;g / cfly{s sf/f]af/df

kf/blz{tf xfd|f] g}lts an xf] . xfdLn] ;Dk"0f{

v/Lb k|lqmof O{–6]08/dfkm{t k|efjsf/L¿kn]

ug{ ;kmn ePsf 5f}+ . ljut cfly{s jif{x?df

h:t} cf=j= @)^*.^( ;Dddf n]vf k/LIf0fdf

s]Gb|sf] a]?h' z'Go g} 5 .

cGtdf, s]Gb|sf] ljsf;, lj:tf/ / :yfoLTjsf]

nflu lg/Gt/ nflu/xg'ePsf s]Gb|df sfo{/t

;Dk"0f{ sd{rf/Lx?, ;+rfns ;ldltsf ;b:ox?,

g]kfn ;/sf/sf ;/f]sf/jfnf lgsfox?,

rGbfbftfx?, /Qmbftfx?, u}/;/sf/L ;+:yfsf

k|ltlgwLx?, kqsf/x?, lj/fdL tyf pgLx?sf

cfkmGtx? Pj+ ;Dk"0f{ z'e]R5's hgdfg;df

xflb{s wGoafb JoQm ug{ rfxG5' .

8f= dg axfb'/ s]=;L=

sfo{sf/L lgb]{zs

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 j^f sfo{s|d ;+rfng ug]{ nIo /flvPsf] / ;f] sfo{s|d ;+rfngsf nflu g]kfn ;/sf/sf] tkm{af^ kRrL; s/f]* kGrfgAa] nfv, :jf:Yo s/sf]ifsf] tkm{af^ b'O{ s/f]* PsxQ/ nfv ;f&L xhf/ / cfGtl/s >f]taf^ afpGg s/f]* %oQ/ nfv j]xf]g]{ u/L s'n /sd Psf;L s/f]* aofnL; nfv ;f&L xhf/ ah]^ Joj:yf ul/Psf]df o; cfly{s aif{df d'Vo 8 j^f sfo{s|d ;DkGg e} rf}xQ/ s/f]* PstL; nfv c&\;¶L xhf/ vr{ ;d]t e} pQm /sdaf^ pNn]lvt sfo{s|dx? ;+rfng ePsf %g\ .

1= d'^'/f]uLx?sf] k/LIf)f ;]jfM

o; cf=j=2069÷70 df hDdf s"n 100000 hgf lj/fdLx?nfO{ alx/+u ;]jfdfkm{t ;]jf k'¥ofpg] nIo /fv]sf]df o; cf=j=2069÷70 df hDdf 110840 hgf la/fdLx?sf] d'^'sf] k/LIf)f ul/Psf]% . o;/L aflif{s nIosf] cfwf/df 110% ef}lts k|ult b]lvPsf]% .

2= d'^'sf] zNols|of ;]jfM

cf=j=2069÷70 df hDdf 1200 hgf la/fdLsf] d'^'sf] zNols|of ug]{ sfo{s|d /flvPsf]df o; cf=j=2069÷70 df hDdf 1414 hgf la/fdLx?sf] laleGg vfn] d'^'sf] zNols|of ul/Psf]% . h;dWo] 1152 j^f cf]kg xf^{ ;h{/L, 133 j^f Snf]h xf^{ ;h{/L / 129 j^f cGo ;h{/Lx? ;DkGg ePsf %g\ . o;/L jflif{s nIosf] cfwf/df 118% k|ltzt ef}lts k|ult b]lvPsf]% .

3= PGhLof]u|fkmL÷Knfi^L k/LIf)f ;]jfM

cf=j=2069÷70 df hDdf 3500 hgf d'^'sf la/fdLx?sf] SofyNofa ;]jfdfkm{t PGhLof]u|fkmL÷Knfi^L nufotsf laleGg /f]ux?sf] k/LIf)f tyf lgbfg ug]{ nIo /fvLPsf]df jflif{s nIosf] cfwf/df o; cf=a=2069÷70 df hDdf 4282 hgf la/fdLx?sf] SofyNofa dfkm{t laleGg pkrf/ ul/Psf]% . pkrf/ u/fPsf] la/fdLx?dWo] 2268 hgf la/fdLsf] d'^'sf] PGhLof]u|fkmL, 766 hgf la/fdLsf] d'^'sf] PGhLof]Knfi^L, 435 hgf la/fdLsf] d'^'sf] lk=l^=Pd=;L, 219 hgf la/fdLsf] lklkcfO{, 196 hgf la/fdLsf] l^=lk=cfO{, 171 hgf la/fdLsf] OlkP; tyf cGo 227 hgf la/fdLsf] SofyNofa dfkm{t cGo ;]jfx? pknAw u/fOPsf] lyof] . o;/L jflif{s nIosf] cfwf/df 122% k|ltzt ef}lts k|ult b]lvPsf]% .

4= k|ltsf/fTds ;]jf M

cf=j= 2069÷70 df hDdf 7 j^f k|ltsf/fTds sfo{s|d ;]jf ;+rfng ug]{ nIo /flvPsf]df ;f] sfo{s|d cGtu{t o; s]Gb|n] d'Vo d'Vo &fp+df d'^'/f]u ;DaGwL lzla/ ;+rfng u/]sf] lyof] . h;dWo]==

• alb{of lhNnfdf 2 lbg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng u/L 1251 hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

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• k;f{ lhNnfsf] la/u+hdf 1 lbg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng u/L 457 hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• dsfjgk'/ lhNnfsf] x]^f}+*fdf 1 lbg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng u/L 238 hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

• l;Gw'kfNrf]s lhNnfdf 1 lbg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng u/L 320 hgf la/fdLsf] :jf:Yo k/LIf)f ul/Psf] .

• ;+v'jf;ef lhNnfdf 1 lbg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng u/L 530 hgf la/fdLsf] :jf:Yo k/LIf)f ul/Psf] .

• u'NdL lhNnfsf] /fgLjf;df 2 lbg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng u/L 560 hgf la/fdLsf] :jf:Yo k/LIf)f ul/Psf] .

• sf:sL lhNnfsf] kf]v/fdf 1 lbg] d'^'/f]u ;DaGwL lgMz'Ns :jf:Yo lzlj/ ;+rfng ul/ 251 hgf la/fdLsf] :jf:Yo kl/If)f ul/Psf] .

5= d'^'sf] eNe /fxt sfo{s|dM

cf=j= 2069÷70 df g]kfn ;/sf/$f/f z'Ns ltg{ g;Sg] d'^'sf ul/a la/fdLx?sf nfuL #f]lift /fxt sfo{s|d cg';f/ :jf:Yo dGqfno dfkm{t 200 j^f d'^'sf eNex? vl/b ug{ ?=80 nfv /sd lalgof]lht e} cfPsf]df pQm /sdaf^ 200 j^f d'^'sf eNex? vl/b sfo{ ;DkGg e} xfn pQm 200 j^f eNex? k|lsof k"/f u/L la/fdLx?nfO{ ljt/)f u/L ;lsPsf] / lt la/fdLx?nfO{ eNe nufOlbg] sfo{ lgoldt?kdf e} /x]sf]% . o;/L jflif{s nIosf] cfwf/df 100% k|ltzt ef}lts k|ult b]lvPsf]% .

6= 15 jif{d'gLsf ty 75 jif{ dflysf la/fdLx?sf] lgMz"Ns :jf:Yo ;]jf sfo{s|dM

cf=j= 2069÷70 df g]kfn ;/sf/$f/f z"Ns ltg{ g;Sg] 15 jif{d'gLsf d'^'sf ul/a la/fdLx? tyf 75 jif{ dflysf d"^"sf ul/a la/fdLx?sf nflu #f]lift /fxt sfo{s|d cg';f/ ?=10 s/f]* 8 nfv /sd lalgof]lht e} cfPsf]df pQm /sdjf^ 15 jif{d'gLsf d'^'sf

661 hgf ul/a la/fdLx?sf] laleGg lsl;dsf zNols|ofx? ;DkGg ul/Psf]% eg] 75 jif{ dflysf 137 hgf ul/a la/fdLx?sf] pkrf/ ul/Psf]% . o;/L jflif{s nIosf] cfwf/df 100% k|ltzt ef}lts k|ult b]lvPsf]% .

7= lk=^L=Pd=;L= ug]{ la/fdLx?sf] lgMz"Ns :jf:Yo ;]jf sfo{s|dM

cf=j=2069÷70 df g]kfn ;/sf/$f/f z'Ns ltg{ g;Sg] d'^'sf] eNe ;f+#'l/Psf] la/fdLx?sf] pkrf/sf nflu #f]lift /fxt sfo{s|d cg';f/ ?=1 s/f]* 70 nfv /sd lalgof]lht e} cfPsf]df pQm /sdaf^ 447 hgf ul/a la/fdLx?sf] lk=^L=Pd=;L=;DkGg ul/Psf]% . o;/L jflif{s nIosf] cfwf/df 100% k|ltzt ef}lts k|ult b]lvPsf]% .

8= k'jf{wf/ lgdf{)f tyf lasf; sfo{s|dM

cf=j= 2069÷70 df hDdf k'jf{wf/ lasf; tyf lgdf{)fsf nflu 1 j^f sfo{s|d cGtu{t ejg lgdf{)f tyf d]zLg/L cf}hf/ v/Lb sfo{s|d ;+rfng ug]{ nIo /flvPsf]df ;f] adf]lhd d'Vo d'Vo sfo{df SofyNoj d]zLg, xf^{n*= d]zLg, Osf] d]zLg, lx^/ s"n/, :^/gn z nufotsf cfjZos pks/)fx?sf] Aoj:yf ul/Psf], c:ktfnsf] nfuL kmlg{r/x?sf] Aoa:yf ul/Psf] ;fy} c:ktfndf lgoldt?kdf x'g] cGo dd{t ;'wf/sf sfo{x? k"/f ePsf]% .

lgisif{M

o; s]Gb|n] rfn' cf=j=2069÷70 sf] aflif{s sfo{s|d ;+rfngsf nflu d'Vou/L 8 j^f sfo{s|d to u/L ;f]xL adf]lhd ah]^sf] Joj:yf u/]sf]df jflif{s nIosf] cfwf/df tf]lsPsf] eGbf a(L cyf{t 100% eGbf klg a(L ef}lts k|utL xfl;n u/]sf] b]lvPsf]% eg] ljQLotkm{ jflif{s nIosf] cfwf/df 91=00% k|ltzt k|ult b]lvPsf]% .

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HOSPITAL INDICATORSIndicators 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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Annual Report 2013


DEPARTMENT OF CARDIOVASCULAR SURGERY

INTRODUCTIONWe all want progress. Daring to give exact defi nition to progress, which is varied and relative term in itself, is diffi cult. It can be the achievement relative to time, or for some, progress means getting nearer to the place where you want to be. Department of cardiovascular surgery has completed twelve years of service. For the department the year 2013 was a memorable one, especially regarding the optimization of our capacity to work with available resources and infrastructure. Thus, it can be claimed that the department has progressed with each successive year.

There are three surgical units in the department. Each surgical unit does heart surgeries twice a week and examines patients in the OPD four times a week. Number of OPD patients in 2013 year was 18191, 8.85 % increment from the previous year. Likewise, there was an increment

in the number of surgeries by 3.6% from previous year.

SURGERIESWith Available two operating theatres and 15 ICU beds, the total number of surgeries performed was 1389. The overall mortality was 5%. The group worst affected were those with complex congenital heart disease, severe pulmonary artery hypertension and low weight for age children. Surgeries for congenital heart diseases were 580 and those for heart valve diseases were 517. The number of CABGs done this year was 165. Complex operations that determine the quality of cardiac surgery service, such as surgery for The Transposition of Great Arteries, Fontan Procedure, Truncus Arteriosus, Ebstein’s Repair, Repair of Traumatic Aortic Transaction, surgery for Ascending and Thoraco-abdominal Aortic Aneurysm, Ventricular Reconstruction surgery, minimally invasive cardiac surgery

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etc are also done on regular basics.

ACADEMIC ACTIVITIESWinston Churchil quoted that “Sometimes doing your best is not good enough.

Sometimes you must do what is required”.

In November, a team from Mayo Clinic , Rochester , Minnesota, USA made their visit to Nepal .During the period there was one day seminar regarding ‘Causes Of Prolonged ICU Stay :Mayo clinic approach and approaches of cardiac surgical centers in Kathmandu’.

Prof. Prasanna Simha, an expert on Mitral Valve Repair from Sri Jayadeva Institute of Cardiovascular Sciences And Research, Banglore, India, visited to our centre. During his visit, the department organized an audio-video symposium with live demonstration of Mitral Valve Repair.

Prof. Mallakh Lall Shrestha, chief staff surgeon and director of Aortic Surgery, Department of cardiothoracic surgery, Hannover School of Medicine ,Germany visited the center in December, and shared with us his experience in complex aortic arch surgery. He has been appointed as

honorary visiting consultant surgeon by the centre.

We welcome back our colleague, Dr. Bijoy Gopal Rajbanshi, after completing of his fellowship in cardiac surgery from Mayo

Clinic, Rochester, Minnesota, USA and Yale University, New Haven, USA. His training from USA will defi nitely be benefi cial for the department.

THE FUTUREBeing responsible for society, our aim is to achieve maximum benefi t for maximum number of patients. We are planning for expansion of operation theatre and intensive care unit beds, development of minimal access cardiac surgery and train specialized surgeon in specifi c complex congenital cardiac surgery.

CONCLUSIONWe have progressed in the total number of patients being operated and also in the complexity of cases in 2013. While we feel proud to present the current result, we realize that harder task still lies ahead.

165

517580

6523 39

0

100

200

300

400

500

600

CAD Valve Congenital Aortic/Vascular CCP Others

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DEPARTMENT OF ANESTHESIOLOGYDr 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 Gangalal National Heart Centre is a multi-faceted division dedicated to perioperative cardiovascular care, education and research. The division encompasses:

Pre-operative assessment and preparation of all patients prior to surgery

Intra-operative anesthesia services including Trans-oesophageal echocardiography

Post-surgical intensive care management

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

variety of pacemaker and implantable cardioverter-defi brillator (ICD) and arrhythmia procedures, percutaneous procedures for diagnostic and therapeutic interventions in patients with congenital heart disease, balloon valvotomy of mitral, aortic and pulmonary valves in the cath lab. Multi-disciplinary intensive care for cardiac surgery patients is provided in the Cardiac Surgical Intensive Care Unit. Respiratory care support is also provided to the mechanically ventilated patients in the Coronary Care Unit.

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Total number of patients requiring anaesthesia services has considerably increased in the past year to 1790 from 1615 from the previous year. Among that 1686

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;

According to the type of cases in Operation Theater, maximum numbers of cases were congenital heart disease, followed by valvular heart disease. As usual coronary

however Kartik had least number of cases due to Dashain and Tihar, the major festivals of Nepalese people. This trend is seen almost every year.

Among all the anaesthetized cases in the operating room, adults accounted for 52%, paediatric 48%. Infants accounted for 6% of total cases.

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artery disease occupied the third position. The total number of re-explorations had increased in the past year from 1.30% to 2.84%.

Number of the patients requiring anaesthesia services in catheterization laboratory (cath lab) was 386. Among that right heart catheterization for cyanotic and acyanotic congenital heart diseases(CHD) were 187 (52%), device closure for ASD, VSD or PDA were 28 (8%), percutaneous coronary intervention (PCI) were 108 (30%), percutaneous trans-septal mitral commisurotomy (PTMC) were 17 (5%).

ACTIVITIES

Educational participation includes residency rotations for the National Academy of Medical Sciences, Department of Anesthesiology Residency Program and running CME programs of the hospital.

The goal of our department is to insure quality care for the patient in the hospital, critical care, cath lab and develop the subspecialty training in cardiac anaesthesia by fostering the research activities.

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NON–INVASIVE CARDIOLOGY AND OPD SERVICES

Dr. A. Bogati , Dr. S. Baniya, Dr. S.G. Baidya, Dr. D. Sharma

INTRODUCTIONShahid Gangalal National Heart Centre has been running Outpatient departments since the establishment of the institution. Nepalese people from all over the country including foreigners living in Nepal or for travel, have benefi tted from both general and paying OPD services. Along with the OPD consultations, patients undergo different investigative procedures which aid in the diagnosis of the diseases.

Non-invasive services form an integral part of this institution both in the form of services provided to the patients as well as a major source of income for the running of the hospital as a whole. Advanced non-invasive cardiology imaging technologies have dramatically improved early detection and treatment of cardiovascular diseases. They are typically safe and painless, and allow you to resume normal activities almost immediately.

Currently, the non-invasive unit in our institution is equipped with 5 functioning

Echo machines (2 high-end and 3 medium range), 3 treadmills, 20 functioning holter monitoring devices and 7 ABP devices. The services provided in our institution include Exercise Stress Testing/Treadmill Stress Test, Pharmacological (Dobutamine) Stress Tests, Exercise Stress Echocardiogram, Transthoracic Echocardiogram, Transesophageal Echocardiogram, Holter monitoring, Electrocardiogram (ECG), Ambulatory Blood Pressure monitoring, Chest X-ray, Fetal Echocardiography, Carotid Doppler, Enhanced External Counter Pulsation (EECP) and Benzathine Penicillin Injections.

SERVICES PROVIDEDDuring the Year 2013, there were total of 1,11,260 patients attending the outpatient department as compared to 1,05,941 patients last year. Each year there is signifi cant increase in the number of patients attending both general and paying OPDs, resulting the highest number of patients attending the outpatient department this year, since

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the establishment of this institution. This shows the increase in awareness of people towards their health.

Similarly, the number of almost all non-invasive procedures this year has exceeded the number from last year. Among them, the maximum number of people underwent Transthoracic Echocardiogram (total of 46,394).

Since the introduction of EECP (Enhanced External Counter-Pulsation) service at our centre for the fi rst time in this country in 2010, total of 25 patients have benefi tted from this service with refractory angina despite optimal medical management who are not candidates or not willing for revascularization.

Number of Pati ents Receiving Non-invasive Services in 2013

Investi gati ons Male Female TotalElectrocardiogram 20957 18185 39142Transthoracic Echocardiogram 24077 22317 46394Echo Screening 424 466 890Trans-oesophageal Echocardiogram 225 556 781Dobutamine Stress Echocardiogram 75 31 106Fetal echocardiogram 0 146 146Caroti d Artery Doppler 135 70 205Tread mill test 5836 3282 9118Holter monitoring 1379 1378 2757Ambulatory Blood Pressure Monitoring 704 472 1176Total OPD a endance 57379 53881 111260Benzathine Penicillin Injecti ons 2636 3704 6340X-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:

0

20000

40000

60000

80000

100000

120000

Num

ber

1999 2001 2003 2005 2007 2009 2011 2013

Year

Yearly OPD attendance

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10000Nu

mbe

r

1999 2001 2003 2005 2007 2009 2011 2013Year

Tread Mill Testing

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0200400600800

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0500

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013Year

Holter Monitoring

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PEDIATRIC CARDIOLOGY SERVICEDr. Urmila Shakya, Dr. Manish Shrestha, Dr. Shova Pandey Koirala

INTRODUCTIONIn Shahid Gangalal National Heart Centre, children suffering from heart diseases are mainly dealt in Pediatric Cardiology unit. Structural (congenital) heart disease and rheumatic heart disease are the major chunk of patients,

we came across here.

SERVICES PROVIDEDPediatric Cardiology unit provides OPD, Inpatient, Non-invasive and Invasive services. Pediatric Cardiology OPD was started on 2004A.D with very limited 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 patients in 2013 as compared to previous years. This is due to increase in OPD days i.e., from 3 days a week to 6 days a week. Fig 2 shows gender-wise distribution of patients visited to Pediatric OPD in 2013. In every month, the number of male patients exceeds female patients.

Fig. 2. Sex-wise distributi on of OPD pati ents

PEDIATRIC ECHOCARDIOGRAPHY Total number of Trans Thoracic Echocardiogram (TTE) performed in

pediatric patients in 2013 were 4806. Among them, 2855 (59.4 %) were male and 1951 (40.6 %) were female. Abnormal fi ndings in echocardiogram were found in 3657 (76.1 %) patients. Abnormal fi ndings were broadly categorised into Acyanotic,

Pediatric Cardiology unit is running dedicated inpatient service with allocated 6 bedded ward from the last 2 years. Total of 162 patients were admitted this year. Median age of children admitted was 10 years ranging from 11 days to 15 years; 84 were male and 78 were female.

Table 1: Distributi on of Inpati ent in Pediatric WardDiagnosis FrequencyHEART FAILURE 29INFECTIVE ENDOCARDITIS 27RHEUMATIC ACTIVITY 4ARRYTHMIA 6S/P RHC/LHC (Diagnostic cath study) 23S/P INTERVENTION (Therapeutic)Pericardial Effusion (including S/P pericardiocentesis)Complex CHD (including TOF)

3211

21MISCELLANEOUS 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.)

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Cyanotic, RHD, Status post-intervention, Status post-surgery and Miscellaneous (Fig 3). Acyanotic CHD outnumbered all and comprised 37.9% (i.e., 1822) of total (i.e., 4806).

Fig. 3: Echocardiography Findings. “Number” indicates percentage of specifi c category.

When compared to previous years, the total number of echocardiography performed this year has signifi cantly increased and so as in each category (Fig 4). This year not only the OPD service but also the echocardiography service has been extended from 3 days to 6 days a week. Apart from OPD, we get referral from different departments for echocardiography.

Fig. 4. Comparison of Echocardiography fi ndings in consecuti ve three years.

Regarding Invasive procedures, we perform diagnostic as well as therapeutic procedures (catheter based intervention). Since the advent of the Children Assistance Programme (CAP) by government, there is marked increase in the number of patients

undergoing diagnostic Cath study and therapeutic interventions like Balloon Pulmonary Valvuloplasty (BPV), Balloon Aortic Valvuloplasty (BAV), Percutaneous 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/LHC)

36

Balloon Pulmonary Valvuloplasty (BPV)

20

Balloon Aorti c Valvuloplasty (BAV)

4

Percutaneous Transluminal Mitral Commissurotomy (PTMC)

13

PDA Device Closure 10

ASD Device Closure 3

Coil Embolizati on (for Coronary fi stulas)

2

Fig. 5. Invasive Service comparison in consecuti ve years

While comparing our intervention services in the recent years, the number of diagnostic catheterization studies has been decreasing. This indicates that the quality of echocardiography has improved. The children are diagnosed early and many children are undergoing surgery without catheterization study. Our therapeutic

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interventions are increasing gradually. More and more children are being benefi tted from minimal invasive interventions.

HUMAN RESOURCESAt 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 cope with the load in future. We too have remarkable experts visit in our centre from different parts of world viz. Mayo Clinic, Minnesota; University of Texas Health Science, Texas; Escorts Heart Institute, New Delhi and so on. With their advice and guidance our goal of providing quality Pediatric Cardiology care is being more strengthened. We are also providing basic

training in Pediatric Cardiology including echocardiography to interested candidates from different institutes. This year two post graduate residents from different medical college were posted here for the period of one month for pediatric cardiology exposure.

CONCLUSIONDue to increased awareness of heart disease in Nepal, there has been steady increase in the number of patients attending Pediatric Cardiology OPD. With limited resources we are continually trying to give quality services and with more days to come we’ll leave no stone unturned for betterment of pediatric cardiology service.

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ACUTE CORONARY SYNDROME Dr. Dipanker Prajapati Dr. Prekshya Singh, Dr. Mukunda Sharma

INTRODUCTION

Coronary Heart Disease (CHD) is a worldwide health epidemic. Worldwide, 30% of all deaths can be attributed to cardiovascular disease, of which more than half are caused by CHD, and the forecasts for the future estimate a growing number as a consequence of lifestyle changes in developing countries. Globally, of those dying from cardiovascular diseases, 80% are in developing countries. Acute Coronary Syndromes (ACS) is a unifying term representing a common end result, acute myocardial ischemia. Acute ischemia is usually, but not always, caused by atherosclerotic plaque rupture, fi ssuring, erosion, or a combination with superimposed intracoronary thrombosis and is associated with an increased risk of cardiac death and myonecrosis. ACS encompasses acute MI (resulting in ST-segment elevation and non-ST-segment elevation) and unstable angina. ACS patients presenting with new evidence of ST-segment elevation on the presenting

ECG are labeled as having an ST-segment elevation MI (STEMI) and should be considered for immediate reperfusion therapy by thrombolytics or percutaneous coronary intervention (PCI); those without ST-segment elevation but with evidence of myonecrosis are deemed to have a non-ST-segment elevation MI (NSTEMI); and those without any evidence of myonecrosis are diagnosed with unstable angina.

SERVICE PROVIDED

Coronary care unit (CCU) in SGNHC has been especially designed to provide quality care for ACS patients. The 12 bedded CCU is well equipped with comprehensive central monitoring, central oxygen supply, 24 hour mobile X-ray, 24 hour mobile echocardiography, Defi brillator, Mechanical Ventilator and IABP support due to which patient care has become more effi cient and easier. On call cardiologists stay in house 24 hours on top of resident doctors who are on duty. Consultations with other specialists

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and subsequent interventions are rendered as necessary. The medical staffs are not only well trained and effi cient, but are also dedicated to excellence, compassion and integrity in patient care. The acute coronary cases are predominantly admitted through Emergency Department (ED) as they usually present with acute chest pain. Few are admitted directly through OPD. ECG is taken within 10 minutes on patient’s arrival. Patients with STEMI are managed with primary PCI or thrombolysed according to duration of chest pain and affordability of the patient. Rescue PCI is also rendered whenever necessary. Patients with STEMI, NSTEMI and high risk UA are almost all admitted in CCU. However patients with low to moderate risk UA are admitted in CCU if beds are available, otherwise in general ward. This article provides a brief outline of ACS admissions in the year 2013. There has been dramatic and consistent increment in the admissions of acute coronary syndromes from 63 patients in the year 2001 to 1188 patients this year as shown in fi gure.

DEMOGRAPHIC FEATURES

Among 1188 ACS cases admitted in SGNHC, 836 (70.37 %) were STEMI, 186 (15.66%) were NSTEMI and rest 166 (13.97%) were UA. Male preponderance was clearly seen as 857 (72.14%) were male and only 331 (27.86%) were female.

THROMBOLYSIS AND PRIMARY PCI

Among STEMI rate of Thrombolysis and Primary PCI this year were 128 (10.77%) and 101 (8.5%) respectively which was seen to be lower compared to last year (thrombolysis 13.02%, PCI 12.9% last year). There were 18 cases which received Tenecteplase in Thrombolysis group.

MORTALITY

The overall mortality of ACS was 57 (4.8%). Mortality in STEMI, NSTEMI and UA were 50 (6.0%), 2 (1.0%), 4 (2.4%) respectively.

Figure 1: Increasing trend of ACS

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The fi gures are comparable to the fi gures of west. The mortality in Extensive Anterior with Inferior Wall MI, Extensive Anterior Wall MI, Anterior wall MI were higher.

ACS admission pattern

DIAGNOSISTOT

CONCLUSION

Although we are one of the key centers to provide medical services to cardiac patients,

ST ELEVATION WALL MI

Total Admision STK TNK Primary PCI Mortality

M F Total % M F Total M F Total M F Total M F Total

Extensive Anterior Wall MI 83 24 107 (13%) 15 4 19 1 2 3 17 2 18 2 3 4

(3.73%)

Anterior Wall MI 179 73 252(30.14%) 23 7 29 7 0 7 28 4 32 12 8 20

(7.93%)

Antero Septal Wall MI 38 9 47(5.62%) 1 2 3 1 0 1 2 0 2 2 1 3

(6.38)

Inferior Wall MI 202 79 281(33.61%) 25 19 44 4 1 5 27 8 35 8 8 16

(5.7%)

Inferior Posterior Wall MI 60 28 88

(10.52%) 9 2 11 2 0 2 7 3 10 2 2 4(4.54%)

Inferior Posterior Lateral Wall MI 2 1 3

(0.35%) 0 0 0 0 0 0 0 0 0 0 0 0

Anterior And Inferior Wall MI 3 0 3

(0.35%) 0 0 0 0 0 0 0 0 0 0 0 0

Inferior and Lateral Wall MI 7 2 9

(10.76%) 1 0 1 0 0 0 0 1 1 0 0 0

Inferior with RV Infarc-tion 16 6 22

(2.63%) 2 1 3 0 0 0 0 0 0 0 1 1(4.54%)

Lateral Wall MI 12 3 15(1.79%) 0 0 0 0 0 0 1 1 2 1 0 1

(6.66%)

Extensive Anterior and Inferior Wall MI 2 1 3

0.35% 0 0 0 0 0 0 0 0 0 1 0 1(33.34%)

Posterior Wall MI 4 2 6(0.71%) 0 0 0 0 0 0 0 0 0 0 0 0

Total STEMI 608 228 836(70.37%) 76 35 110 15 3 18 82 19 100 28 23 50

(6%)

Unstable Angina 125 41 166(13.87%) 0 0 0 0 0 0 0 0 0 2 2 4

(2.4%)

NSTEMI 124 62 186(15.66%) 0 0 0 0 0 0 0 0 0 0 2 2

(1.0%)

TOTAL 857 (72.14%)

331(27.86%) 1188 76 35 110 15 3 18 82 19 101 30 27 57

(4.8%)

we still need to upgrade our services regularly. The facilities we are providing are still not enough though. Mortality from CAD can be further decreased by training more effi cient and dedicated personnel, extending this health facility to rural areas so that they won’t delay treatment until being referred to our centre, formulation of plans so that best treatment possible for CAD can be cost worthy and feasible to all socioeconomic class.

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MEDICAL INTENSIVE CARE UNIT (MICU) Dr. Sanjay Signh K.C, Dr. Anjal Bista, Dr. Binay Kumar Rauniyar

INTRODUCTION

Medical Intensive Care Unit (MICU) at SGNHC was established for critical patients requiring intensive monitoring and care primarily for heart failure patients. Though established at cardiac center mainly focusing for terminal heart failure, MICU has been providing services to patients with co-morbid illness mainly respiratory, nephrology and neurological problems effectively.

Since August 2002 MICU has been offering service to patients requiring intensive care due to different etiologies, mainly cases with refractory heart failure.

SERVICES PROVIDED LAST YEAR

In the year 2013, 1019 patients were admitted in MICU with females accounting 359 and 660 males. ACS was the leading cause of admission accounting 34.05 % of total admission followed by Dilated Cardiomyopathy and RHD in the second and third place respectively. Major cause of mortality was due to ACS with female preponderance. Two patients were admitted with diagnosis of HTN only, otherwise other patient of HTN had other co-morbid conditions as well.

Many patients were elderly with co morbid conditions. So, taking care of the patients was a big challenge. Table below summarizes last year-

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Disease Pa ern, Sex Distributi on and Mortality Figures

Diagnosis Admission Mortality

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, PTMC as well as infants and children with congenital heart disease undergoing Right heart catheterization and/or left heart catheterization including other cath procedures. Cases under Ischemic heart diseases mostly included old MIs with reduced EF. Different types of arrhythmias were admitted, including, patients with temporary pacemaker implanted for Complete Heart Block.

Cases under the title others include Pleural Effusion, Digoxin toxicity, Primary Pulmonary Hypertension, Pulmonary Embolism, Deep Vein Thrombosis, aortic dissection etc.

We can see an increase in the number of patients with Acute Coronary Syndrome this year. The main reason behind this was increasing number of coronary cases in our region. Second reason being unavailability of beds in CCU.

MICU received a signifi cant number of patients in terminal stage with refractory heart failure. This year many patients were

received (transferred in) from different wards in a state of gasping needing urgent CPR and ventilator support. Patients crashing in general wards were transferred in and were taken care of which signifi cantly increases the mortality in MICU.

Patients in cardiogenic shock and respiratory arrest were managed with mechanical ventilator. Patients were also managed with the expert opinions of visiting consultant of different faculties (nephrology, neurology, hepatology etc) as most of the patients had multi-organ disorder/failure involving renal, hepatic, neurology system.

MICU also supports fi nancially weak patients through CHARITY fund raised by the doctors and nurses for meals, transportation charges. We have a special MICU charity for those needy patients.

CONCLUSION

MICU provides the best management to heart failure patients irrespective of any cause and we as team members are proud to be a part of this center.

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INTERVENTIONAL CARDIOLOGY SERVICES

Dr. Nagma Shrestha, Dr. Deepak Limbu, Dr. Aamir Siddiqui

NTRODUCTIONCardiac catheterization is a branch of the medical speciality of cardiology used to diagnose and treat certain heart conditions. Today cardiac catheterization and angiography are preformed as a combined procedure for diagnostic and therapeutic purposes.

Cardiac catheterization and angiography remain the gold standard for the evaluation of anatomy and physiology of the heart and blood vessels. The history of cardiac catheterization dates back to Claude Bernard, who experimented on animal models, however, clinical application of cardiac catheterization begins with Werner

Frossmann who did his own right heart catheterization guided fl uoroscopically through left antecubital vein.

SERVICES PROVIDEDThe centre has two state of art catheterization laboratories and well trained interventional cardiologists and nursing assistants providing both diagnostic and therapeutic interventional procedures. Interventional cardiology got established at our centre in the year 2058 B.S. The number of procedures is increasing every year with decreasing rate of complications.

The procedures performed from Jan 1, 2013 to Dec 31, 2013 are shown below:

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SN Procedure Total1 Coronary Angiogram (CAG) 22942 Peripheral Angiogram (PAG) 533 Percutaneous Transluminal Coronary Angioplasty (PTCA) 7904 Renal Angioplasty (PTRA) 45 Coil Embolization 136 Electrophysiology Study/Radiofrequency Ablation (EPS/RFA) 1717 Permanent Pacemaker Implantation (PPI) 2388 Temporary Pacemaker Implantation (TPI) 1939 Percutaneous Transmitral Commissurotomy (PTMC) 403

10 Balloon Pulmonary Valvuloplasty/Balloon Aortic Valvuloplasty (BPV/BAV) 3011 Device Closure (ASD/PDA) 4412 Right Heart Catheterization (RHC) 7113 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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COMPLICATIONA) Death

Post PTCA: 3

Post PTMC: 1

Post PPI: 0

Post CAG: 0

B) CVA: 3

C) Groin Hematoma: 13

D) Contrast allergy: 4

E) Emergency MVR following PTMC: 1

F) Cardiac Tamponade following PTMC: 1

CONCLUSIONCardiac 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

gaining experience and expertise and the services provided by this centre are expanding and has established a reputation of respect. The quality of our care and of our outcomes is well-known and respected in the medical community nationwide.

Evidence based practice maintaining excellence and care of patients with quality services at affordable price is our goal. With time we are improvising and expanding our services and gaining experience to further enhance our performance.

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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 electrophysiological services for diagnosis and treatment of various conditions associated with rhythm disturbances. Our EP team holds the responsibility of catering services for those in need in an accepted

international standard. More than 650 clients were benefi tted from service of the Department of Electrophysiology in year 2013.

The different services and procedures received by clients are given below.

DISTRIBUTION OF EP PROCEDUREDIAGNOSIS MALE FEMALE TOTALTypical AVNRT 30 53 83Left lateral 18 9 27Left antero lateral 4 1 5Left Postero lateral 2 3 5Left posterior 3 0 3Left Postero septal 1 1 2Right Postero septal 1 2 3Right Posterior 3 0 3Right Postero lateral 2 0 2Antero lateral 1 1 2Antero septal or Para Hisian 2 3 5Atrial Tachycardia 1 5 6Fascicular VT 1 0 1Atypical AVNRT 3 3 6No Inducible tachycardia 5 4 9Others 2 3 5TOTAL 79 88 167

Note: AVNRT: Atrioventricular Nodal Re-entry Tachycardia, VT: Ventricular Tachycardia

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OUTCOME OF EP PROCEDURE

OUTCOME MALE FEMALE TOTALSuccessful ablation 73 82 155Relapse 0 1 1No inducible tachycardia 4 3 7Ablation not attempted 2 2 4TOTAL 79 88 167

COMLICATIONS DURING EP PROCEDURE

OUTCOME TOTALPneumothorax 1A-V Fistula 1Pericardial Tamponade 1Death 0TOTAL 3

DISTRIBUTION OF DEVICE IMPLANTATIONTYPES OF DEVICE TOTALTemporary Pacemaker Insertion 193Permanent Pacemaker Insertion 238Dual Chamber Implant 2AICD 1CRT 1CRT/D 0Generator Replacement/ Lead Readjustment

10

TOTAL 445

Note: AICD: Automated Internal Cardioverter Defi brillator, CRT: Cardiac Resynchronization Therapy, CRT/D: Cardiac Resynchronization Therapy with Defi brillator

INDICATION OF DEVICE IMPLANTATION*INDICATION MALE FEMALE TOTALComplete Heart Block 108 77 185Sick Sinus Syndrome 13 6 192:1 AV Block 8 3 112o AV Block 3 1 4High Degree AV Block 3 2 5Bifascicular Block 2 0 2Vasovagal Syncope 0 1 1CRT/CRT-D 0 1 13:1 AV Block 1 0 1Junctional Rhythm 0 2 2Others (End of bat-tery life, Redo, Lead change, DDD, AICD)

8 3 11

Total 146 96 242*Excluding Temporary Pacemaker Insertion

COMLICATIONS OF DEVICE IMPLANTATION

OUTCOME* TOTALA-V Fistula 1Pericardial Tamponade 1Death 0TOTAL 2

*Both complications were during Temporary Pacemaker Insertion

CONCLUSIONDespite scarcity of manpower for Electrophysiology services, SGNHC aims at achieving international standard of care. All dedicated team members at present are giving their best service. In future, the Department plans to establish more advanced facilities like electro anatomical mapping system and regular services in CRT/CRT-D and AICD etc.

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EMERGENCY SERVICESDr. Dharmanath Yadav, Dr. Bibek Baniya, Dr. Aamir Siddiqui, Dr. Dilip Kumar Sah

INTRODUCTIONEmergency department has transformed into an important service that signifi es the quality a health institution can provide. Since the establishment of SGNHC, our institution has strived hard to attend every possible cardiac emergencies hailing from every corner of Nepal with the involvement of competent and qualifi ed cardiologist, cardiac surgeons, resident doctors and supporting well trained staff 24 hrs a day.

SERVICE PROVIDEDObtaining EKG of all patients with chest discomfort with 5-10 minutes of arrival in the ER department as recommended by AHA/ACC guidelines.

Patients with acute MI are directly shifted to CCU from ER without delay. They receive thrombolysis within 30 minutes of arrival in ER (Door to needle time and primary angioplasty (Door to balloon time) within 90 minutes as recommended by AHA/ACC guidelines.

Those with unstable Angina and NSTEMI are promptly shifted to intensive care unit within 10-15 minutes. Patients with low to moderate likelihood of coronary artery disease are admitted for “Chest pain under evaluation” and are scheduled for tread mill test (TMT) and /or coronary angiogram.

All forms of life threatening arrhythmias are managed promptly. Patents who come to ER with complete heart block and other life threatening bradyarrhthmias get temporary pacemaker insertion without any delay. Emergency pericardiocentesis to relieve patients of tamponade are performed immediately.

Non cardiac emergencies are assessed and referred to concerned centers as required.

The present Emergency department has been expanded as per the demand of ever increasing number of patients. All together at present there are 18 beds (9 beds in the ER and 9 beds in ER observation).In an average 35-45 number of patients attend the ER daily.

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Relevant and essential emergency test including cardiac enzymes, Troponin I (qualitative and quantitative), Routine blood counts, biochemistry and electrolytes, ABG analysis, ECG, portable X rays, bed side echocardiogram screening are available 24 hrs . Emergency and ER observation wards are equipped with

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 1: Emergency Data in 2013

Male Female Admission Discharge Referred LAMA Mortality BD Total7097 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 CabinDeluxe CCU MICU SICU PICU NMW NSW ER

Observation TotalA 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%

monitors (ECG monitoring, SPO2, non invasive BP monitoring), central oxygen line, suction facilities, defi brillators. Crash carts with emergency drugs and intubation sets. This set up provides us the ability to provide advanced cardiac life support when required promptly.

Table 4: Provisional/Clinical Diagnosis

Hypertension 2420 18.9%Coronary Artery Disease 2804 21.85% Rheumatic/Valvular Heart Disease 1449 11.31%Arrhythmias 1156 9.0%Anxiety Disorder 593 4.6%Acute Peptic Ulcer Disease 886 6.9%COPD/RTI 655 5.1%Congenital Heart Disease 215 2.21%Pericardial Disease 185 1.44%

Cardiomyopathy 771 6.02%Vascular Disease 223 1.74%Others 1156 9.0%Total 12805 100%

CONCLUSIONThe data provided will give itself unearth the immense effort put on by the SGNHC ER team. “Cardiac emergency be dealt emergently”, with this motto we are working hard to meet the needs of cardiac patients from all over Nepal.

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MEDICAL WARDDr. Satish Kumar Singh, Dr. Krishna Prasad Adhikari, Dr. Saurav Sundar Shrestha,

Dr. Suman Thapaliya,

INTRODUCTIONSince the establishment in 1999 as a 9 bed-ded unit, General Medical Unit in our hos-pital has evolved into a 66 bedded (21 in General Ward A, 14 in New Medical Ward, 11 in Double Cabin, 18 in Single Cabin and 2 in Deluxe Cabin). With this capacity, it has provided its services to patients from all over the country and from abroad as well. The patients are fi nally pooled up through both direct admissions and the transfer of stabilised patients from the critical care units to medical ward. So, medical ward is the only unit which can truly refl ect the dis-ease pattern of this cardiac centre. In this article we provide a brief outline of the dis-ease pattern from 1st Jan. 2013 to 31st Dec. 2013.

DISEASE DISTRIBUTION A total of 4414 patients were admitted in medical ward last year. Most of the pa-tients admitted were coronary artery dis-ease (49.5%) followed by dilated cardio-myopathy (10.5%) and rheumatic heart disease(10.4%). Patients admitted as case of arrhythmia, valvular heart disease, hy-pertension, congenital heart disease, peri-cardial effusion, non specifi c chest pain, COPD, infective endocarditis and pulmo-nary embolism accounted for 8.9%, 5.4%, 4.6%, 2.6%,1% and 1% respectively. 5% of admissions are included in ‘Others’ cate-gory which includes Pulmonary embolism, Pulmonary edema, Chest infections, Aortic aneurysms, DVT, Aortic dissections, Myo-carditis, Pericarditis, Peripheral vascular disease and Takayasu arteritis.

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DISEASES WISE DISTRIBUTION OF CASES IN THE YEAR 2013S.

No.Name of Diseases No. of cases % of Total

Male Fe-male

Total

1 Coronary artery disease 1578 607 2185 49.502 Dilated cardiomyopathy 293 173 466 10.563 Rheumatic heart disease 166 294 460 10.424 Arrhythmia 235 159 394 8.935 Valvular heart disease 116 124 240 5.446 Hypertension 104 100 204 4.627 Others 110 83 193 4.378 Congenital heart disease 52 63 115 2.619 Pericardial effusion 27 27 54 1.2210 Non specifi c chest pain 29 16 45 1.0211 COPD 16 11 27 0.6112 Infective endocarditis 15 9 24 0.5413 Pulmonary embolism 7 0 7 0.16

Total 2748 1666 4414 100.00

CONCLUSIONWith 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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PREVENTION REHABILITATION RESEARCH

DEPARTMENT OF CARDIAC REHABILITATION AND HEALTH

PROMOTIONSamjhana Shakya, Pushpa Neupane

INTRODUCTION

Department of Cardiac Rehabilitation and Health Promotion is one of the key departments at Shahid Gangalal National Heart Center, playing important role in primary and secondary prevention of cardiovascular disorders.

Entire activities of this department are guided by three basic principles of health

promotion. The fi rst is Prevention. We conduct free cardiac camps, community awareness programs, school health programs; produce health education materials etc in order to raise health awareness among the people. Next principle is Rehabilitation. We provide counseling service to the patient. All of the patients with myocardial infarction and acute coronary syndrome go through exercise training. Moreover, we have been conducting structured education program for patients with coronary artery disease and its risk factors. Finally Research is another area we have been continuously working for.

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PROGRESS REPORTFREE CARDIAC CAMPS

SN Camp date Place Total participants Total Echo Total

ECG1 2013-Jan-4 Birgunj 457 166 1402 2013-Jan- 5 Hetauda 238 72 803 2013-Feb-1 Sindhupalchok 320 76 954 2013-Feb-10 Sankhuwasabha 530 210 1815 2013-Feb-22 /23 Gulmi 560 182 2096 2013-May- 25 Pokhara 251 56 577 2013-Oct-26 Nawalparasi 538 150 1958 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 them for making healthy food choice, carry out regular exercise according to their health condition, and motivate them for enhancing treatment compliance and more about disease and its related conditions. Moreover patients are referred for structured education program too in order to deliver

more intensive education for them.

STRUCTURED EDUCATION PROGRAM (SEP)

Structured Education Program is a weekly awareness program which runs every Tuesday and is designed for patients with coronary artery disease (CAD) and its risk factors. Its primary objective is to prevent

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.

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and manage CAD and its risk factors. It can also help patients who are recovering from a heart attack, as well as those who recently had heart surgery. Benefi ts of this cardiac rehabilitation program can include reduced cardiac symptoms, better long-term survival, weight loss, improved cholesterol and triglyceride levels, improved blood pressure, lower blood sugar levels in diabetics and reduced stress.One cycle of program consists of eight different classes. Up to now we have been running 13th cycle. In 2013 we conducted 43 Classes and almost one thousand (985) people have attended this program.

COMMUNITY AWARENESS PROGRAM

It is a community based awareness program. In 2013 we have conducted 4 programs in Bouddha, Panauti, New Baneswor and Shantinagar.

SCHOOL HEALTH PROGRAM

It is a school based awareness program targeted for school children and teachers.

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

point presentations. It provides free access of these materials for patients, health care providers and other institutions.

OBSERVATION OF SPECIAL DAYS

Every year we celebrate World Hypertension Day and World Heart Day. In World Hypertension Day, we conducted free blood pressure screening and counseling service in Civil Mall, City Center and Shahid Gangalal National Heart Center. About 1200 people (1165) participated in these programs. Likewise on World Heart Day, we conducted screening program for cardiovascular risk factors in Shahid Gangalal National Heart Center premises. About 400 people had participated on that program.

RADIO PROGRAM

There is regularly broadcasting of Public Service Announcement (PSA) about hypertension, heart attack, rheumatic heart disease and seven rules of healthy heart in Radio Sagarmatha.

HUMAN RESOURCEDr. Deewakar Sharma, Senior Consultant Cardiologist Head of the DepartmentDr Shaili Thapa PhysiotherapistSamjhana Shakya Public Health Offi cerPushpa Neupane Senior Staff NurseYashoda Luitel Assistant PhysiotherapistRajiv Yadav Assistant Physiotherapist

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NURSING DEPARTMENT

Nursing as a profession works for the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the nursing diagnosis, intervention and advocacy in the care of individual, families and communities. The nursing department of Shahid Gangalal National Heart Centre always dedicated toward the delivery of the quality nursing services. We believe that quality service always belongs with care providers head, heart and hands that is

knowledge, skill and attitude. Along with this we also believe on team spirit of health care professionals, without which, success is impossible.

Today with the move of 18 years of establishment, we have enrolling 160 beds which is almost all the time occupied. This centre has 19 units where 185 nurses are delivering their different levels of nursing care like preventive, curative and rehabilitative.

Modern Nursing Foundation

Head

HandHand

Heart

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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 ow1 CCU 12 16 13832 MICU 5 9 6873 A SICU 8 19 7434 PSICU 7 19 5905 NMW 14 10 11306 NSW 14 9 11917 GW-A 21 10 16768 GW-B 24 10 14299 Single Cabin 20 10 306

10 Double Cabin 11 9 29012 ER 8 11 1284113 ER observation 9 5 65114 Cath Observation 7 5 176415 Cath- Lab - 10 4321( Cath Procedures)16 OT - 14 1476 ( Surgeries)17 OPD - 11 39142/6340 (ECG/Penidura)18 Councelling - 1 579419 CSSD - 120 Study Leave - 4 MN-1/ BN-321 Matron / SNS - 2

ACHIEVEMENTS AND CHALLENGES With this evolving digitalized world, dealing with patient is the complex job so to prepare the nurses for a changing world of possibility and maintain the quality nursing service; the centre has been providing the opportunity to upgrade the academic qualifi cation for nurses. With this purpose, the centre has provision of paid and unpaid leave facilities for nursing professionals to enroll bachelor degree and master degree every year. This department has been enrolling classes for junior nursing professionals and senior nursing professionals separately every week. Moreover, to make nursing professionals aware toward existing scenario of nursing care; nursing research report presentation has been regularly carried out. Despite

all these, the regular round of senior nursing personnel, monitoring system of incharge, getting feedback from health care consumers and need base strategies development with nursing incharge is the routine work .The nurses of this centre are not only confi ned into hospital territory, they have been actively taking part on the outreach activities like participating in the cardiac camps and public awareness activities.

This year we have made some effort on nursing professional’s skill and knowledge development activities. For the fi rst time we have organized 3 days structured skill based Training of Critical Care Skill for senior and junior nursing personnel and one day Pediatric Critical Care Assessment and Management training for nurses in our centre. We also have conducted in-house

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nursing quiz contest in our hospital. Beside this, we have initiated structured nursing student’s supervision system for the benefi t of students learning in specialized centre and to trigger the knowledge and skill in academic fi eld among senior nursing professionals. We also have succeeded to develop fi rst draft of nursing procedure checklist for standardized nursing practice. This year we have succeeded to prepare three clinical skill trainers.

However the center has the some quota for the further study like bachelor and master’s degree in nursing ; the nursing manpower’s turnover rate for further study and attraction toward western countries making the greatest loss of skilled manpower in specialized centre like ours.

Nursing as the profession must possess head, heart and hand which means knowledge, skill and attitude. Today’s education of nursing become highly successful for the delivering the knowledge; obtaining distinction in the document but making

them update in skill and attitude in practical setup is becoming challenging as per their qualifi cation that makes very diffi cult to maintain the nursing standard as expected in clinical fi eld.

Every year number of cardiac cases is increasing because of various lifestyles of the people. The patient fl ow is also increasing but the number of nurses could not be increased as per the rate of patient fl ow in some areas.

FUTURE PLANFor coming days, we have planned to develop the nursing standard through the development of fi nal draft of nursing procedure manuals and procedure checklist. We also have planned to develop training site for this institution. We strongly believe that, however we do a small change to enhance nursing service, it can make a signifi cant impact in betterment of the service and consumer satisfaction.

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PATHOLOGY SERVICESDr. Bipesh Acharya

INTRODUCTIONLaboratories in Nepal today face increasing pressure to automate their system as they are challenged by the continuing increase in workload, need to reduce expenditure, and diffi culties in recruitment of experienced technical staff. Was the implementation of a laboratory automation system (LAS) in the Clinical Biochemistry Laboratory in Shahid Gangalal National Heart Hospital sucessfull? The answer rely on laboratory errors, staff satisfaction and the organization. However, no signifi cant difference was observed. Considerable effort is needed to overcome the initial diffi culties associated with adjusting to a new system, new software and new working procedure. Hence the quality service provided by the laboratory show the true image of the entire hospital.

PRESENT CONTEXTWith the increasing charm in automation, at present, department is equipped with following equipments:

1. Automated Five Parts and three parts Differential Cell Counter

2. Vitros 250 Dry chemistry Automation machine

3. Fully automated coagulation machine

4. Micro—Separate Blood bank

OVERVIEWThe Following details of the responsibilities of clinical laboratory:

• Hematology works with whole blood to do full blood counts and blood fi lms as well as many other specialised tests.

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• Coagulation requires citrated blood samples to analyze blood clotting times and coagulation factors.

• Clinical Biochemistry usually receives serum or plasma. They test the serum for chemicals present in blood. These include a wide array of substances, such as lipids, blood sugar, enzymes, and hormones.

• Microbiology receives clinical specimen including swabs, feces, urine, blood, sputum, cerebrospinal fl uid, synovial fl uid, as well as possible infected tissue. The work here is mainly concerned with cultures, to look for suspected pathogens which, if found, are further identifi ed based on biochemical tests. Also, sensitivity testing is carried out to determine whether the pathogen is sensitive or resistant to a suggested medicine. Results are reported with the identifi ed organisms and the type and amount of drugs that should be prescribed for the patient.

• Parasitology is a microbiology unit that investigates parasites. However, blood, urine, sputum, and other samples may also contain parasites.

• Virology is concerned with identifi cation of viruses in specimens such as blood, urine, and cerebrospinal fl uid.

• Immunology/Serology uses the concept of antigen-antibody interaction as a diagnostic tool.

• Blood bank determines blood groups, and performs compatibility testing on donor blood and recipients. It also prepares blood components, derivatives, and products for transfusion.

• Histopathology processes solid tissue removed from the body biopsies for evaluation at the microscopic level.

• Cytopathology examines smears of cells from all over the body such as from the cervix for evidence of infl ammation, cancer, and other conditions.

MORE ACHIEVEMENTS• Automation upgraded in biochemistry• Daily QC analysis in biochemistry• Regular QC analysis in Haematology• Regular QC analysis in CoagulationConducted blood donation programme with acquisition of local youth club which minimizes the problem for the patient to manage the blood components.Able to manage and minimize the rush of phlebotomy section by providing prompt reports and quality services.

FUTURE PLAN• To establish highly standard emergency

laboratory• Automation in the microbiology in

detection and isolation• Provision of blood bank services with

fully Automated Blood Component separation and cross match machine.

• Introducing Laboratory information system to the hospital information system along with electronic reporting system.

• To start Histopathology, Cytopatology and Bone marrow studies.

NUMBER OF TEST DONE IN 2013 418672

159867

194220432 29409

6365 34710

50000

100000

150000

200000

250000

300000

350000

400000

450000

Bioch

emist

ryHaem

atolo

gyM

icrobiolo

gyCoag

ulation

Sero

logy

Blood d

onatio

nSp

ecial t

est

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RADIOLOGY SERVICESIndesh Thakur

Radiology is a vital branch of medical science on which people trust enormously. At SGNHC, Radiology service is one of the most important services rendered. It is an integral part of health care delivery system without which no medical treatment & therapy can be successfully bestowed. As our hospital is specialized and dedicated health care centre for cardiac patients, so radiology service, here is specially predestined and intended for diagnosis & prognosis for relevant cardiac diseases and its periphery.

HISTORYAt SGNHC, radiology service commenced from 2055 B.S. along with OPD services. In the beginning, this service was provided with one mobile X- ray unit & manual

processing system both for OPD Patients and IPD Patients. The number of patients attending for x-ray examination was less in number at that time. One radiographer & one dark room operator were appointed for the radiology services & that too during day period only.

PRESENT SCENARIO Radiology services at SGNHC boost up 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) from both OPD Radiology unit & IPD Radiology unit. The CR services started at this centre from very start of the year (2066 B.S.). Now, our radiology department is allocated with the following sophisticated equipments:

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1. Three CR reader units (direct digitizers) with Computer Workstations (Konica Minolta, Japan)

2. Two Dry Laser Imagers (Konica Minolta, Japan)

3. One fi xed 800 mA X-ray Unit (Hitachi, Japan)

4. One mobile 400 mA X-ray Unit (Shimadzu, Japan)

5. One mobile 250 mA X-ray Unit (Hitachi, Japan)

6. One mobile 100 mA X-ray Unit (Siemens, Germany)

Very soon, we are going to add one more 500 mA fi xed X-ray machine & one 100 mA mobile X-ray machine to our department.

HUMAN RESOURCESWe have well trained and erudite technical manpower in this division which is as follows:

• One Sr. Radiography Technologist• Two Radiography Technologists• Nine Radiographers• One Sr. Dark Room Operator

Our staffs are posted in OPD Radiology & IPD Radiology units as well as in Cath Labs. We perform all kinds of general radiography with particular emphasis on chest radiography & bed side radiography in all wards such as ASICU, PSICU, ER, MICU, CCU, GW, etc. In SGNHC, we have three state of the art Cath Labs (Two Philips Integris & One Siemens Cath-Lab, Germany). These units are in full operation performing about 15 to 20 cases per day. Radiology manpower are concomitant to Cath Lab for a number of invasive procedures like CAG, RHC & LHC,

Peripheral Angiograms, Interventional procedures (PTCA, PTMC, BPV, BAV, Device Closures, PPI, TPI, EPS and Ablation etc ) assisting the cardiologists concerned.

FUTURE PLANIn future, we have plans to equip our Centre with Direct Digital Radiography (DR) System, PACS, Multi-Slice CT (MS CT), Nuclear Medicine Imaging Technology (NMIT), MRI modalities etc. to provide all kinds of confi rmatory diagnostic services to cardiac patients.

RADIATION AWARENESS AMONG MEDICAL STAFFSAs in many aspects of medicine, there are both benefi ts and risks associated with the use of x-ray imaging which utilizes ionizing radiation to generate images of the body. As SGNHC is especially dedicated to diagnose and treat diseases related to heart, therefore the use of medical x-ray is of mere compulsion. While the benefi t of clinically appropriate x-ray imaging examinations generally far outweights the risks, efforts should be made to minimize that risks by reducing unnecessary exposure to ionizing radiation to help reduce risks to the patients. All examination using ionizing x-ray radiation should be performed only when it is essential. However, ALARA (as low as reasonably achievable), TDS (Time Distance Shield) principle should always be followed when choosing equipment settings to minimize radiation exposure to the patient.

In doing so, we not only minimize the risks to the patient but also to ourselves as operators. In case of portable x-rays, there is always a chance of scattered radiation to arise. Portable X-rays in our institution

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is performed only in dire necessity and emergency conditions. By doing so, not only radiographers but also nursing staffs, doctors & others are benefi tted from required x-ray examinations.

Total patients: 48739

CONCLUSIONRadiology services at SGNHC are fully dedicated digital radiography services (Computed Radiography) & are in full operation. Many patients have benefi tted from our service and we hope to continue and provide better services in future.

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PHARMACEUTICAL CAREMadhu Giri

Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving defi nite outcomes that improve a patient's quality of life . These outcomes are

• Cure of a disease;

• Elimination or reduction of a patient's symptomatology;

• Arresting or slowing of a disease process; or

• Preventing a disease or symptomatology.

Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specifi c therapeutic outcomes for the patient.

This in turn involves three major functions:

• Identifying potential and actual drug-related problems;

• Resolving actual drug-related problems; and

• Preventing drug-related problems.

Pharmaceutical care is a necessary element of health care and should be integrated with other elements. Pharmaceutical care is, however, provided for the direct benefi t of the patient, and the pharmacist is responsible directly to the patient for the quality of that care.

The pharmaceutical care process was originally conceived to be undertaken in a community pharmacy, by community pharmacists. In 1996 the Pharmaceutical Society of Newzealand began a programme to implement the process throughout the country.

ASPECTS OF PHARMACEUTICAL CAREThe elements of pharmaceutical care for individual patients, taken together, comprehensive pharmaceutical care, the delivery of which requires an ongoing,

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covenantal relationship between the pharmacist and the patient. The pharmacist must use his clinical judgment to determine the level of pharmaceutical care that is needed for each patient. Examples of situations which call for comprehensive pharmaceutical care include:

- 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)

- Patients with medical conditions that require ongoing evaluation and manipulation of drug therapy to achieve optimal results (e.g. diabetes mellitus; asthma; hypertension; congestive heart failure).

- Patients who are taking multiple medication thereby placing them at higher risk for complex drug-drug or drug-disease interactions and for drug-food interactions.

- Patients requiring therapy with drugs that can be extremely toxic, especially if they are dosed, administered or used improperly (e.g. cancer chemotherapeutic agents, anticoagulants, parenteral narcotics).

- Patients whose acute illnesses can become life threatening if

the prescribed medications are ineffective or used improperly (e.g. certain infections, severe diarrhoea).

PHARMACY REPORTShahid Gangalal National Heart Centre has its own hospital pharmacy. All most every type of medicine and surgical according to the hospital formulary is found in the pharmacy. Hospital has indoor and outdoor pharmacy for the convenience of indoor and outdoor (OPD) where medicine is dispensed from the pharmacy by doing adequate counseling. Patients are dispensed medicine by registered pharmacy assistant and pharmacist. Transaction from hospital pharmacy is also increasing every year so both the patient and hospital are in benefi t from the SGNHC pharmacy.

As compared to previous fi scal years,

Identify patients with pharmaceutical care needs

Identify and review Pharmaceutical care issus

Implement and monitor pharmaceutical care plan

Formulate and document pharmaceutical care plan

Pharmaceutical Care

transaction has increased as shown in the diagram.

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PHYSIOTHERAPY SERVICES

Mrs. Yashoda Luitel Shrestha

INTRODUCTIONPhysiotherapy is a health care profession concerned with human function, movement and maximizing potential. It is a well establish branch of medical sciences being practiced at global level. Its treatment can be given to patient both in isolation and in conjunction with other types of medical and surgical management. Used in conjunction with certain medical or surgical techniques; physiotherapy can complement these techniques to help provide a speedy and complication-free return to normal activity.

Physiotherapy can help individuals by:

• Identifying the problem area and treating this directly.

• Identifying the causes and predisposing factors.

• Providing Rehabilitation following occupational or sporting injuries.

• Providing rehabilitation and exercise before and after surgery.

• Providing advice on exercise programs.

• Providing or advising on special equipment.

Physiotherapy unit of SGNHC is an integral part of Cardiac Rehabilitation and Health Promotion Department. It is well equipped and is located on the ground fl oor with a large waiting lounge for the patient and the visitors. It plays the vital role in prevention and management of cardiac disease.

HUMAN RESOURCESAt present our unit has one physiotherapist and two physiotherapy assistant.

Physiotherapist- Dr. Shaili Thapa Budhathoki (On Study Leave)

Physiotherapy Assistant- Mrs. Yashoda Luitel Shrestha

Physiotherapy Assistant- Dr. Rajeev Kumar Yadav

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SERVICE PROVIDEDPhysiotherapy unit at SGNHC have been giving its best service to the patients since 2057 B.S. It provides both in-patient and out-patient services regularly six days a week. We have also been effectively running cardiac rehabilitation program.

For inpatient patients, physiotherapy unit at SGNHC often deals with the function of the cardio-respiratory system. The Cardio-thoracic physiotherapy aims to optimize the function of the Cardio-thoracic system and patient comfort, resulting in increased exercise tolerance, a reduced chance of developing complications such as chest infections, reduced shortness of breath, and a reduced length of stay in hospital.

Classes about the importance and benefi ts of the exercises for the patients and their visitors under the Cardiac Rehabilitation program have been conducted since 2012 and are running successfully.

Some of the treatment techniques used by physiotherapy at SGNHC

• Breathing techniques either to reduce

shortness of breath or increase lung expansion

• Patient positioning • Oxygen therapy and nebulizer• Incentive spirometer • Sputum clearance with postural

drainage, percussion, vibrations, huffi ng,coughing, deep breathing, segmental breathing, ACBT, FET, suction.

• Mobilizing,sitting out of bed, or walking

• Medications • Exercise programsFor outpatient patients, we provide services to the entire patient with cardio-thoracic, musculoskeletal and neurological disorders who are seeking physiotherapy treatment and also provide treatment using all types of modalities .

STATISTICAL DATA OF THE YEAR 2013 (2069-2070 B.S.)

Total no. of patients treated in physiotherapy unit in 2013 In-patients – 4,879 Out-patients – 475 Grand total – 5,354

Months and yearNumber of In-pati ents

Number of 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• Providing safe and reliable physiotherapy

service to the hospital.• Aerobics classes and fi tness training.• Community exercises programs via

camps organized by SGNHC.• Measurement of exercise tolerance in

patients aft er myocardial infarction.

CONCLUSIONPhysiotherapy unit is an integral part of Cardiac Rehabilitation and Health Promotion Department at SGNHC. It gives the major contribution in prevention and management of cardiac disease. We would hope to provide and extend our services in coming days.

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ANNUAL MORTALITY: 2013Dr. Mahesh Bhattarai, Dr. Rabindra Pandey, Dr. Manoj Kumar Yadav, Dr. Bivek Baniya,

Dr. Dilip Shah, Dr .Aamir Siddiqui, Dr. Roshani Ghimire, Dr. Sebina Baniya

INTRODUCTIONShahid Gangalal National Heart Centre, established in 1995 AD, is a tertiary care referral hospital which has played a major role in minimizing the pain of Nepalese people in travel to foreign country to seek medical advice. Our hospital with 161 bed capacity has provided a quality care with the state of art medical facilities that includes eighteen beded emergency, twelve beded coronary care unit and fi ve beded medical intensive care unit. In this article the mortality in cardiology department from January 1st to December 31st in the year 2013 is outlined.

Distribution of mortality in terms of different level of careThis year total 12841 patient were managed in emergency department , seventy four patient were brought dead whereas thirty one patient succumbed to death while being managed in emergency department, the total mortality in emergency accounting to be o.81 percentage.

Among six hundred and eighty seven critical patient managed in MICU, one hundred and eight (15.72%) expired, whereas in CCU mortality this year was 6.22% out of 1383 admission.

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Table1:Distribution of mortality in different level of careLEVEL OF CARE Total admission Number of expired Mortality rate

MICU 687 108 15.72CCU 1383 86 6.22ER 12841 105 O.81GWA 1676 11 O.66NMW 1130 7 0.62S. CABIN 891 3 0.34D. CABIN 731 1 O.14

SEX DISTRIBUTIONAmong three hundred and twenty one mortality, one hundred and seventy four (54.2%) were male and female accounted to 45.8 % of deaths.

AGE DISTRIBUTIONThe 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 OF MORTALITYAmong three hundred and twenty one death, 156 (48.8%) were from outside the Kathmandu valley and Kathmandu being the leading district with 106 (33%) which is followed by Lalitpur33 (10.2%) and then Bhaktapur 26 (8%).

MORTALITY ACCORDING TO DISEASE IN CCU AND MICUDISEASE MORTALITY

Acute myocardial infarction- cardiogenic shock 36Acute myocardial infarction-VT/VF 22Heart failure 15Cardiac rupture 15Old IHD-heart failure 11Old IHD –VT/VF 3RHD heart failure 20RHD-IE 6RHD,post MVR stuck valve 1VHD heart failure 8DCM heart failure 21Septic shock 14Pneumonia 4COPD-respiratory failure 3Renal failure 4Pulmonary embolism 2Hypertensive acute left ventricular failure 2Bicuspid aortic valve 2ASD-heart failure 1PDA 1TOF 1HOCM heart failure 1Primary pulmonary hypertension 1

Among the one hundred and ninety four mortality in CCU and MICU, acute myocardial infarction with cardiogenic shock was the most frequent cause 36 (18.5%), followed by acute myocardial infarction with ventricular tachycardia. Twenty one patient died due to DCM with heart failure.RHD with heart failure leads to 20(10.3 %) of death while 6 patient (3%) of RHD succumbed to death due toinfective endocarditis.

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MY DAYS AT SGNHCMt Everest - Himalayas – is one of the most popular travel destinations in the world. It has always allured many a tourist from around the globe. My mission was to reach the foothills of the Himalayas for a different purpose – Healthcare. After completing my MPhil in interventional cardiology at the Imperial College, London, I was curious to know about the practise of cardiovascular medicine in Kathmandu, Nepal. The capital city, Kathmandu is bustling with over one million inhabitants and remains a fascinating showcase of Nepali culture, art and tradition.My cardiology fellowship began on the 15th of May, 2013, for a period of two and a half months under the supervision of Dr. Y.K.D. Bhatt and Dr. Man Bahadur K.C. I had to adjust to a 6 day working week, unlike in the UK. Saturday was a holiday and Sundays – it was cardiac catheterisation in full swing!!!! Daily admissions were presented at 9.00am every day by the juniors in cardiology to the cardio-thoracic directorate - cardiologists and cardio-thoracic surgeons. The next session were ward rounds in the 12 bedded CCU, 6 bedded ICU, single cabin, double cabin, deluxe cabin and in the general ward.

There were 2 catheterisation labs and a third one was being built.

The healthcare system at the SGNHC was completely different to the prevailing system in the UK. It was subsidised, means tested healthcare, in partnership with the government. I understood that there are exclusive private hospitals and public hospitals at Kathmandu. SGNHC adopted a delicate and a strategic blend of both systems which enabled the hospital to deliver the best quality of care to the patients. I had the chance to see the various methods of treatment for an acute myocardial infarction – conservative treatment, thrombolysis and primary PCI. The Director of the cath lab taught me a valuable lesson in life– “A good interventional cardiologist should know when to stop”.

I expressed my interest in conducting an audit concerning percutaneous mitral commissurotomy (PMC) at SGNHC. I am extremely grateful to the supervision offered by Dr. Bhatt and a database was created. The audit was presented by me; at the Friday lunchtime meeting and highlighted the key areas the department

Dr. Sujatha Kesavan, MBBS, MRCP, MPhilSpecialist Registrar in CardiologyJohn Radcliff e HospitalOxford, United Kingdom

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should focus in the future (eg public education, central database and mobile PMC units with the help of a 3D echo). My consultant at the John Radcliffe Hospital, Dr. Prendergast (Director) was pleased with the progress that I have made in my clinical and academic endeavours.

Maintaining a log book since the fi rst day enabled me to refl ect on my experiences. I have seen 327 cases at the outpatient clinics, 706 – (adult) transthoracic echocardiograms, 69 – diagnostic cardiac catheterisations, 165 – paediatric echo and Dr. A. Maskey supervised me during my fi rst transoesophageal echo – and I identifi ed a clot in the left atrium. Further procedures were seen – PDA closures, balloon pulmonary valvotomy, pericardiocentesis, left renal artery angioplasty, coil embolization, PPM

insertion, cardiac surgery for VSD, ASD, CABG and the list goes on and on….

Paediatric cardiology was an unknown fi eld to me. I found a great teacher in Dr. Urmila Shakya and am eternally grateful to her. Cardiac camps run by Dr. Deewakar Sharma interested me and I am keen to be a part of it. There is so much to do at SGNHC – Alas, Time is short – I have to leave for UK to complete my training. I would like to take this opportunity to thank all my teachers at SGNHC, patients, nurses in the wards, cath lab team and my colleagues. On my fl ight back to UK – via Delhi – I had the spectacular views of the Himalayan ranges at dawn, which is a scene to behold. With fond memories, I reached UK to tell my experiences at Kathmandu to my peers.

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Ps la/fdLsf] gh/dfzxLb uf+ufnfn /fli6«o x[bo s]Gb|

la=;+= @)^@ ;fn a}zfv @$ ut] dnfO{ klxnf]k6s d'6'df P]+7g h:tf] eof] . t/ d}n] To;nfO{ plQ uDeL/tfk"j{s lnO{g . olQs}df ToxL aif{ r}tdf a'jf 6Lsf/fd afF:tf]nfnfO{ x[bof3ft x'g uof] / xfdLn] pxfFsf] pkrf/ kf]v/fsf] dl0fkfn c:ktfndf ;kmntfk"j{s u/fof}+ . o; 36gfn] d]/f] 5ftLsf] P]+7g klg d'6's} sf/0f x'g'k5{ eGg] cfz+sfdf yk an ldNof] . To;sf] Ps dlxgfkl5 5ftL w]/} g} u?Ëf] eof] / @$ a}zfv @)^# ;fndf lzIf0f c:ktfn dxf/fhu~hsf] cfsl:ds sIf x'Fb} ;3g pkrf/ OsfOdf d a;]+ . To;kZrft\ kfFrj6f lgoldt cf}ifwLx? vfg yfn]+ . ha xfdLnfO{ s'g} /f]u nfU5, ta ;fdflhs, cfly{s / dfgl;s r"gf}tL ;d]t cfp+bf] /x]5 . dnfO{ cfk"m / cfˆgL hLjg;fyL lbk]Zj/f g]kfnaLrsf] km/flsnf] pd]/sf] km/sn] klg dgdf 3f]Rof] / ;f]r]+ st} d]/L hLjg;fyLnfO{ d}n] a}jflxs aGwgdf afFw]/ cGofo kf] u/]+ sL < lszf]/fj:yfdf k|j]z ub}{ u/]sf d]/f lk|o 5f]/f5f]/L cflzz / cl:dtfnfO{ ;Dem]/

d st{Aolad'v kf] x'G5' ls eGg] lrGtfn] k6sk6s unf ca?4 x'GYof] / cgfof;} cfFvf /;fp+Yof] . ljt]sf cf7 jif{ o;}u/L cf}ifwLsf] ;xf/fdf lat] . lgoldt sfo{qmdx? ;ef, ;df/f]x, uf]li7, lgl/If0f, k7gkf7g, u[x:y hLjg / :jwd{sf] kfngf ub}{ %& jif{ k'luof] . 3/, kl/jf/, Jojxf/, z'Ns, C0f cflbsf] rk]6fdf kb}{ hfFbf d]/f] :jf:Yo ;d:ofx? uf}0f x'Fb} uP .

o;}aLr la=;+= @)^& ;fn d+l;/df a'jfnfO{ k'gM /f]un] RofKof] / o;} s]Gb|df pkrf/ ul/of] . PlGhof]u|fkmLdf d'6'sf tLg}j6f /utaflxgL wdgLdf afSnf] n]k nfu]sf]n]] 8fO ;d]t k7fpg g;lsPsf] k|ltj]bg cfof] . PlGhof]Knfli6 jf v'Nnf d'6' zNolqmofsf] 9f]sf aGb eof] . cGTodf s]an !@ yl/sf cf}ifwLsf] e/df pkrf/df l;ldt x'g'eof] . la=;+= @)^( df3 * ut] $ ah] laxfg dnfO{ hf8f] eof] l;/s /fd|f];Fu cf]9fO{ lbg' eGg'ePsf] dflg; To;kl5 xfdL ;a}nfO{ a]va/ agfO{ laTg' eof] .

8f= lbg]z afF:tf]nf

;x–k|fWofks

lqe'jg ljZjljBfno

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a'jfsf] d[To'sf] * dlxgf gk'Ub} dnfO{ vf;u/L lx8\bf 5ftL ef/L x'g], !)–!@ kfOnf klg lx8\g g;Sg] ;d:ofn] ;tfof] . d o;} s]Gb|sf lrlsT;s 8f= ofbjb]j e§sf] z/0fdf k'u]+ . pxfFn] hlt;Sbf] rf8f] PlGhof]u|fd ug]{ / ;Dej eP ToxL df}sfdf PlGhof]Knfli6;d]t ug]{u/L tof/ /xg xfdLnfO{ ;Nnfx lbg'eof] . t/ ;f]+r]h:tf] kl/0ffd ePg . …d tfS5' d'9f] aGr/f] tfS5 3'F8f]Ú h:tf] eof] . PlGhof]Knfli6sf] klg ;Defjgf dnfO{ /x]g . hLjgdf Pp6f 7'nf] rf]6 nfUof] . d cfFkm}n] cfFkm}nfO{ lwSsf/]+ . æof] hLjgsf] cfo' u0fgf ug{ k'u]+ . lktf, dftf, xh'/af, xh'/cfdf / dfdf 3/sf ;a}sf] cfo' u0fgf u/]+ . cem} aL;b]lv kRrL; jif{ afFRg] pd]/ lgsfn]+ .Æ t/ d'6'sf] tLgj6} wdgLdf /f]u nfu]sf] 5 . ( 7fpFdf afSn} n]k nfu]sf] 5 . (( k|ltzt;Dd /utsf] axgdf cj/f]w 5 . ;DemFbf klg d cfFkm}nfO{ sxfnL nfU5 . >LdtLsf] 56\k6L / aNn lszf]/fj:yfdf /dfpg'kg]{ cfˆgf 5f]/f 5f]/Lsf] cg'xf/df tgfj b]Vbf g /ftdf lgGb|f nfU5 g ef]s g} . s;nfO{ s] eGg] < To; k/LIf0fkl5 8f= e§n] dnfO{ zNolrlsT;ssf] /fo lng eGg'eof] .

ca kl/jf/ / cfkmGthgdf 7'nf] v}nf a}nf eof] . cfkmGthgaf6 d]bfGt, a}+unf]/ / a}+ss;Ddsf :yfgdf pkrf/ u/fpg ;/–;Nnfx cfP . d lj/fdLsf nflu sf}8L g ;f}8L ahf/ ahf/ bf}8L g} x'g]eof] . zxLb u+ufnfn /fli6«o x[bo s]Gb|, afF;af/L, sf7df08f}df pkrf/ u/fpg t nfvf}+ nfU5 eg] ljb]zsf] nkm8fdf kg{ of] dg dfg]g . bzf}+ kf]sf /ut bfg lbg] cfkmGtsf] vf]hL, k};fsf] ;'/Iff, lj/fdLsf] x]/rfxnfO{ dflg;, ;DemFbf g} sxfnL nfUg] eof] dnfO{ . ;'/lIft tl/sfn] c:ktfn k'Ug],

;kmn zNolqmofsf nflu lrlsT;s /f]Hg] / ljb]zaf6 ;s'zn pkrf/kl5 g]kfn kms{g] w]/} 6f9fsf] ljifo h:tf] nfUof] . d]/f] kl/jf/ / d]/f nflu cfsfzsf] kmn cfFvft/L d/ eGg] h:tf] eof] . To;}n] a? cfˆg} b]zdf cfˆg} g]kfnL d'6' zNolrlsT;s ljz]if1;Fu zxLb u+ufnfn /fli6«o x[bo s]Gb|df g} pkrf/ u/fpg] lgwf] u/]+ . !% sflt{s @)&) df lrlsT;s /fd]z/fh sf]O/fnfsf] 6f]nLdf k;]+ . v'Nnf d'6' zNolqmof ;kmntfk'j{s ;DkGg eof] . hLjgdf bf];|f]k6s ;3g pkrf/ OsfOaf6 kmls{of] . kfFrf}+ lbgdf c:ktfnaf6 3/ cfOof] t/ %) ;]=dL=eGbf a9L z/L/sf] efusf ;fy} rf/ 7fpFdf sf6]/ dd{t u/]sf] d'6'sf] aflx/L kqdf k|ltlqmofhGo /Qm;|fj eof] . b]j|] kmf]S;f]df Go'df]lgof eof] / KNo'/fdf t/n hDdf eof] . lgtDasf] aLrdf v;|f] 5fnf e} hl6ntf y'k|} ljsf; eof] . hLjgdf 7f8f]sf] 7f8} eP/ $%) b]lv ()) sf sf]0fdf lgbfpg' / ;'Tg'kg]{ eof] . k|lth}ljs cf}ifwL -PlG6afof]l6s_sf] dfqf k"/f ul/;s]sf] lyPF . cGo cf}ifwLx? ;]jg ub}{ lyPF . PSsf;L ;f; lng / km]g{ ufx|f] eP/ Ps xKtfkl5 ldlt @)&).&.@^ bf];|f]k6s o;} s]Gb|df k'gM egf{ eOof] . hLjgb]lv of] hut a'em]h:tf] nfUof] . z/L/df krf; 7fpFdf l;of]n] 3f]r] xf]nfg\ . aL;k6s PS;/] ljls/0fdf xf]ldof] xf]nf . Ps 8fnf] cf}ifwL of] z/L/n] lnof] xf]nf . s]jn hLjgdf afFRg] /x/n] . bf];|f]k6s k'gM rf}w lbg c:ktfn a;L gofF hLjg lnP/ 3/ kmls{of] . afFsL hLjgdf k'g d'6'n] sfd ug]{ e/f];fdf cfh zNolqmof u/]sf] ;f7L lbgdf oL x/kmx? n]Vb}5' . b[li6 dlte|d w]/} b]lvof] . lrn, lu4 / afh cfsfzdf p8]sf] b]lvof] . c:ktfnsf kvf{n, e'O / 5tsf] :yfgdf ljleGg cfs[ltx? :ki6 b]lvof] . k"j{h ;fvf;Gtfgx? e]6\g cfPsf] klg k|z:t b]lvof] . zNolqmofkl5sf]

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lg/fzkgf slt s7f]/ x'Fbf]/x]5 Tof] klg cg'ej ul/of] . h] xf];\ o; s]Gb|sf ljlzi7 lrlsT;sx? /fd]z/fh sf]O/fnf, clgn cfrfo{, lgj]z /fhe08f/L, /ljGb|eQm ltldnf, dg axfb'/ s]=;L=, ofbj b]j e§, /lj dNn, rGb|d0fL clwsf/L / c?0f df:s] lj;{g g;lsg] JolQmTjdf k/] . To;}u/L ;Demgf zfSo, dx]Gb| nD;fn, ;'wf nD;fn nufot c:ktfnsf ;Dk"0f{ gl;{Ë / cGo ;/f]sf/ /fVg] sd{rf/Lx? wGoafbsf kfq ag] . d]/f] kl/jf/sf nflu b'O{ k':tf afa'– 5f]/fn] k'gM hLjg zxLb u+ufnfn /fli6«o x[bo s]Gb|, afF;af/L, sf7df08f}af6 kfof}+ . rfx] hLjgsf lbgx? lhpg] hlt lbg eP klg .

of] c:ktfn :yfkgf ePsf] klg cÝf/ jif{ ljt] . ;g]{/f]u dfqsf] ljuljuLeGbf klg cfh cfP/ g;g]{ /f]usf] ljuljuL emg\ 68\sf/f] ?kdf cfO/x]sf] 5 . oL /f]u;DaGwL hgr]tgfsf] :t/ hgdfg;df cToGt} Go'g 5 . k'j{ d]rL / klZrd dxfsfnLsf dflg;nfO{ sf7df08f}df pkrf/ ug{ cfpg] afWofTds cj:yfsf] g]kfn ;/sf/n] oyf;So rf8f] cGTo ug'{kb{5 . To;sf nflu g]kfnsf kfFr}j6f If]qLo ;b/d›sfdx¿df x[bo s]Gb|, d[uf}nf s]Gb|, cj'{b s]Gb| / :gfo' s]Gb| h:tf cGo ljwfsf] ;]jfnfO{ a9fP/ b]zel/sf hgtfnfO{ :jf:Yo ;]jf, lzIff / ;'ljwf lbg h?/t 5 . k|fljlws hgzlQm klg ;]tf] sf]6 nufP/ ;fj{hlgs :yndf 3fd tfKg], ;8ssf] Ps s'gfdf uO{ kfgLk'/L, rgfr6k6] vfg] / ;]tf] sf]6 nufP/ xf]6n /]i6'/]G6df uO{ vfgf vfg] dgl:yltaf6 aflx/ lg:sg h?/t 5 . To;}u/L g]kfnsf Joj:yfks Pj+ pRr ;Lk ePsf hgzlQmx?df c?n] sfd u?g\ d}n] sfd ug{ gk/f];\ eGg] k|j[lQ g]kfnsf sfof{nox?df k|z:t} kfOG5 . xflsdL k|j[lQ /

sfdrf]/sf] lznlznf b]vfb]lv o; s]Gb|df eg] Go'g b]lvG5 . cfhsf] lbgdf of] s]Gb| Ps 7'nf :jf:Yo ;]jf / lzIff lbg] ;+:yf e};s]sf] 5 . pRr l;k ePsf / lgM:jfYf{ ;]jfdf tlNng hgzlQmsf sf/0f o; s]Gb| d'6' /f]usf] pkrf/, /f]syfd / :j:y d'6' lzIffsf] nflu Ps e/kbf]{ / bLuf] ;+:yf xf] .

vr{sf lx;fan] afOkf; zNolqmofsf ;fy} cGo hl6ntfn] ubf{ b'O{b'O{ k6s c:ktfn egf{sf] hDdf ?=rf/nfv vr{ eof] . ;fob ljb]z / :jb]zs} lghL c:ktfndf egf{ e} pkrf/ u/]sf] eP olt /sd / olt ;lhnf] u/L sfd ;DkGg x'g] lyPg . d]/f] efUo, :Jff:YosdL{x?sf] kf}/v / b]zsf] uf}/j ag]sf] 5 zxLb u+ufnfn /fli6«o x[bo s]Gb|, afF;af/L, sf7df08f} . Pp6f lj/fdLnfO{ c:ktfnn] k'¥ofpg] pTs[i6 ;]jf / ;'ljwfafx]s cGo s'/fdf Tolt w]/} ToxfFsf] cfGtl/s Joj:yfkg, t5f8 / d5f8, k|lt:kwf{sf ;fy} :yfgLo /fhgLltaf6 lgs} 6f9f /xG5g\ . t;y{ of] s]Gb| Ps pRr gd'gfsf] ?kdf k|:t't eO{/x]sf] 5 . o; c:ktfnsf] :t/ cem a9\b} hfcf];\ .

nueu rf/;o sd{rf/Lsf] d]xgtdf ;kmf;'U3/ / pTs[i6 Joj:yfkgsf] gd'gfsf] ?kdf ljlzi6 ;]jf lbg] of] g} Pp6f dfq} g]kfn ;/sf/sf] :jfldTjdf /x]sf] c:ktfn xf] eGbf cTo'lQm gxf]nf . o:tf] c:ktfndf hgtfn] a9L cfzf ug'{ :jefljs} xf] . To;}u/L :jf:Yo k|fljlwsx?nfO{ :jf:Yo ;]jf / /f]syfdsf pkfox?sf ljifodf hgdfg;df r]tgf km}nfpg' csf]{ s7f]/ sfd xf] . pkrf/sf] qmddf dflg; cfpFbf ;j{k|yd ;]jfz'Ns a'emfpg] 7fpF, alx/+u ljefu / cfsl:ds ljefu g} cu|efudf kb{5g\ . ;]jf z'Ns

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lng] 7fpFsf] le8 x]bf{ / lj/fdLx?sf] :ofF:ofF / ˆofFˆofFsf] b[Zo b]Vbf o; s]Gb|df sfdsf] rfk cln al9 g} ePsf] xf] eGg] 7DofPsf] 5' . o;sf] plrt Joj:yfkg rfF8f]eGbf rfF8f] ug{ h?/L 5 .

csf]{ ;'wf/ ug{ ;lsg] kIf alx/+u laefudf b]v]sf] 5' . o; s]Gb|df ;]jf lng cfpg] dflg;n] alx/+u ljefudf lrlsT;s;Fu uf]Ko ;Nnfx lng] :yfg / jftfj/0f 5}g . alx/+u ljefudf bz–afx| hgf lj/fdL / pgsf ;xof]uLx?sf] hTyf g} x'G5g\ . uf]Kos'/f lrlsT;ssf cufl8 /fVg] df}sf;Dd lj/fdL / pgsf ;xof]uLn] kfpFb}gg\ . la/fdLn] cfˆgf cgluGtL ;d:ofx?sf] kf]sf] vf]Ng ldNg] jftfj/0fsf] ;[hgf oyf;So rfF8f] eO{lbP x'GYof] h:tf] nfu]sf] 5 .

zf:jt ;To eg]sf] hGd / d[To' xf] . hf] ;aeGbf lk8fbfos / ;+3if{do x'G5 . t}klg afFRg] t[i0ffn] g} hLjg 8f]¥ofPsf] x'G5 . t;y{ d]/f] hLjgdf tLgk6s ;3g pkrf/ OsfOaf6 kmls{ cem} afFRg] t[i0ffnfO{ gsfg{ ;s]sf] 5}g .

cfh cfP/ lbgx'F rf/j6f d'6';DaGwL cf}ifwL vfb}5' . hLjg lhpg] snfdf af];f]o'Qm vfgf jlh{t ul/Psf] 5 . b}lgs JofodnfO{ hLjgsf] c+u dflgPsf] 5 . yf]/} dfq g'gsf] k|of]u ug]{ ;Nnfx lbOPsf] 5 . dWokfg / w'd|kfg jlh{t ul/Psf] 5 . cGTodf, 5 dlxgf;Dd 5ftLdf rf]6k6s nfUgaf6 arfpg] ;Nnfx lbOPsf] 5 . cfzf 5, ;do;Fu} 5ftLsf] aflx/L rf]6 tyf lelq rf]6 b'a} sd x'Fb} hfg]5 .

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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 competitive business world”. In this context, managing the organization and keeping it in a sustainable way is becoming more complex and challenging. Still today, many organizations have been running with traditional approach of management. The main strategies of such management are establishing standards, rules, norms, and coercing the employees to follow the defi ned track without any kinds of difference in opinions. And, if certain things deviate from this usual track managers always precede her/his actions by discovering the weakness and then solving the problems. In such scenario, we as managers look like problem solver rather than creating, motivating and inspiring the people to do more creative things with minimum error. We expend huge amount of resources on

correcting problems that have relatively minor impact on our overall improvement of service or performance.

In the initial phase, this stereotypes of management may work but when we use it continually over a prolonged period of time, we as employees will become exhausted, and frustrate and our pace of doing things will defi nitely go downwards. This is a universal phenomenon which is proven by many studies. Many writers have claimed that after exercising for prolonged period of time, this approach can pave the way for negative culture. By saying this, I am not ignoring the problems, in fact I can’t because really we have numerous problems around us, but according to human psychology we just need to approach the problems from the other side. This is not just happy or cheap

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talk for winning the election of parliament but for “keeping the focus on the positivity” and giving the space for positivity. In this regard, famous positivist Ellen DeGeneres said that “It makes a big difference in your life when you stay positive”. Similarly, about the good effect of positivity within the organization James Allen’s statement is more memorable “Work joyfully and peacefully, know that right thoughts and right efforts will inevitably bring about right result”.

Most of us acknowledge that this competitive era is so dynamic it needs high pace and morale among our employees to do more and to win the race. Therefore we as managers need to cultivate high pace and spreading effect of creativity in our organization rather than keeping usual stereotypes of moment. This type of approach is nearly outdated because no one likes to do things either because of fear or just spend the time. But question is how to create such types of moment within the organization? Many of us are arguing whether it is possible or not. Of course! It is possible why not? Many researchers have proven that it is possible but we just need to keep our employees excited, motivated and energized. No matters what is previous history is, virtually any pattern of organizational action should be open to alteration and reconfi guration. Organizational behavior should not be automatically fi xed. Organization to be open to seek transformation in conventional practice by replacing usual image with new creative liberal image for our better future.

There are various approaches among them simply we can adopt appreciative inquiry (AI) approach both as a philosophy and as a process for our organizational betterment. As a philosophy AI emphasizes co creation and collaboration of all voices in the organization, people always support the things if they see ownership into it. In fact this approach allows changes as a journey rather than an event. Managers should not be afraid about the change or different opinion

or argument, rather they should invite the change, open their mind to listen to the voices of subordinates, and adopt the good ideas very quickly or in other words, they should handle the situation proactively. This is the main way how appreciative inquiry helps managers to make things better in sustainable manner. Actually, AI can be looked at as two separate words. Firstly, appreciate means valuing the other’s best things, new creation or discoveries within the organization and in people. Secondly, inquiry means act of examination, exploration or investigation and study. Exploring the best ideas, opinion and creativities within the people of institution and acknowledging them in order to motivate or energize the employees. These two aspects of managerial activities are like two parts of a coin which are very- very essential for creating inspiring organization for this competitive era.

AI actually is a vision driven way of management not problem driven. Whatever we have, we have to take them as an abundance of opportunities and organizational activities to be completed by collaborating with other people not by using others people only. Organizational responsibilities are to be carried out not as a transaction (for completing the job only) but as a relation and a full of meaning commitment. Such scenario motivates the employees to do assigned task not only of fear but also because of seeing the success in every step of their action in their life. Because people work not only for money, but also for meaning. For money or meanings in this regard, I always remember the saying of Charles Schwab, “The man who does not work for the love of work but only for money is not likely to neither make money nor fi nd fun in life” Therefore managers should try to build up such types of positive environment within the organization which can be able to create inspiring organization, and motivate the people to work effectively and effi ciently within the organization. Because the real abilities of managers lies not in their ability

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to overpower others, but to connect with them; to listen to them; to reach out to them and be reached out to.

In this regard, David Cooperrider has given clear direction to become appreciative leader. According to him, all leaders can become appreciative, just that they need appreciative eye to see truth, good, the better and the possible. It is the capacity

to see the most creative and improbable opportunities.

“Good management is the art of making problems so interesting and their solutions so constructive that everyone wants to get to work and deal with them”.

Paul Hawken

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s]Gb|df kl/:s[t x'“b} u/]sf] gl;{ª ;]jf

s[i0f s'df/L ;'a]bLlaBf sf]O/fnf

kl/ro M

kSs} klg, g;{ Pp6f To:tf] AolQm xf] h;sf] lbdfu a}1flgs ;/x x'G5, xftx? snfsf/sf h:tf x'G5g\ / d'6' cfdfsf] h:tf] x'G5 . oxL ;Totfn] ubf{ cfh gl;{Ë k]zf ljZje/ ;Ddflgt 5 . lasf;zLn d'n'sx?df eGbf ljsl;t d'n'sx?df o;sf] d'No, dfGotf / :t/ cem pRr 5 . laZjsf] gl;{Ë ;dfh;Fu xfd|f] b]zsf] t'ngf ug]{ xf] eg] jt{dfg ;dodf xfd|f] b]zdf klg gl;{Ë k]zfn] 7"nf] km8\sf] df/]sf] 5 . o; b]zdf pTkflbt gl;{Ë hgzlQmsf] lj:tf/ ljZjel/ g} 5 . ;do cg';f/ :jf:Yo If]qdf ePsf] ;a} lsl;dsf pknlAwx?nfO{ ;d]6\b} kl/dflh{t / kl/is[t

x'Fb} hfg' gl;{Ë k]zfsf] ;j{AofkL cfjZostf xf] . o; cy{df zxLb u+ufnfn /fli6«o x[bo s]Gb|sf g;{x? cu|k+lQmdf 5g\ eGbf cTo"lQm gxf]nf . ha o; s]Gb|sf] :yfkgf eof] To;a]nfb]lv g} o; s]Gbdf g;{x?sf] kb:yfkgf klg eof] . zxLb u+ufnfn /fli6«o Åbo s]Gb| ljsf; ;ldlt @)%@ cGtu{t :yflkt eO{ ;~rfngdf /x]sf] o; s]Gb|df la=;+= @)%^ sf] df3 dlxgfdf g;{x?sf] lgo'lQm ul/of] . df3sf] dlxgf lr;f] / 3dfOnf] lyof] . nueu @) hgfsf] ;+Vofdf g;{x?n] o; d'6' c:ktfndf /f]huf/Lsf] ;'cj;/ kfPsf lyof}+. To;a]nf c:ktfndf alx/Ë ;]jf dfq ;+rflnt lyof] . laut !* aif{nfO{ kms]{/ x]bf{ o; s]Gb|n]

æg;{ To:tf] JoQmL xf] h;sf] lbdfu j}1flgs ;/x æg;{ To:tf] JoQmL xf] h;sf] lbdfu j}1flgs ;/x x'G5, xftx? snfsf/sf h:tf x'G5gx'G5, xftx? snfsf/sf h:tf x'G5g\\ / d'6' cfdfsf] / d'6' cfdfsf] h:tf] x'G5 .Æh:tf] x'G5 .Æ

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7'nf] km8\sf] df/]sf] 5 . o; s]Gb|sf] lasf; ;Fu;Fu} gl;{Ë ;]jfdf klg 7'nf pknAwLx? ePsf 5g\ . of] ;+:yf, ;dfh b]z / cGo /fi6«x?sf] dfemdf kl/lrt x'Fb} uof] / xfdL klg cg'ejL / bIf x'Fb} uof}+ . la= ;+= @)%& df ( z}ofsf] cGt/Ë ;]jfaf6 d'6';DaGwL la/fdLx?nfO{ ;]jf lbg z'? u/]sf] o; ;+:yf;Fu xfn nueu !^) z}of / nueu !*@ hgfsf] xf/fxf/Ldf ljleGg txsf g;{x? sfo{/t 5f}F / cfjZostfg';f/ pQm ;+Vof la:tf/ ug]{ qmd hf/L g} 5 .

o; ;+:yfn] xfdLnfO{ ;Ifd / ;jn laleGg lsl;dsf k|lzIf0fx? ;+:yfleq} of aflx/ k7fP/ ePklg lg/Gt/ ?kdf ub}{ cfPsf] 5 . of] ;Ifdtf / ;jntfn] o; ;+:yfdf cfpg] ;a} ;]jfu|fxLnfO{ ;Gtf]ifk|b ;]jf lbg ;Sg] ePsf 5f} . cfh o; s]Gb|df sfo{/t g;{x? ;bf ;]jfu|fxLx?sf dfem k|z+zfsf kfq ag]sf 5g\ . xfd|f ;]jfx?nfO{ cem u'0f:t/, kl/is[t / ;do;fk]If agfpg xfdLn] o; ;+:yfleq} l;lgo/ tyf h'lgo/ g;]{;sf] 1fgnfO{ ;jn ;Ifd / k|efjsf/L agfP/ pTs[i6 ;]jf k|bfg ug{sf nflu k|zf;g tyf k|fljlws Aoj:yfksx?sf] ;xof]uaf6 g;]{; Ph's]zg sld6Ln] lgoldt clgjfo{ sIffx? ;+rfng u/]sf] 5 . h;n] ubf{ cfp+bf lbgx?df xfd|f 1fgx? c? a9L ;do ;fk]If x'g] 5g\ / xfdLn] o; ;+:yfdf cfzfsf ;fy cfpg] k|To]s ;]jfu|fxLsf] lxtdf ;jf]{Ts[i6, k|efjsf/L, / nfebfos ;]jf lbg ;Sg] 5f}+ eGg] laZjf; lnPsf 5f}+.

!* jif{ kf/ ub}{ ubf{ s]Gb|df gl;{ª sd{rf/L x?sf] z}lIfs :t/df b|'Qt/ ultdf ljsf; ePsf] Ps ;sf/fTds / ;jn kIf b]Vg kfpFbf uj{sf] cfefz eO/x]sf] 5 . xfn o; ;+:yfdf :gfsf]Q/ (M.N) u/]sf b'O{ hgf, :gfsf]Q/ (M.N) ub}{ ug]{ Ps hgf, :gfts

u/]sf sl/a %^Ü / k|df0ftxsf $#Ü gl;{ª sd{rf/L sfo{/t 5g\ . To;/Lg} gl;{ªdf al/i7tfsf] s|dsf] cfwf/df gl;{ª k|zf;g rnfpg] egL ;Dk"0f{ g;]{;x?af6 ul/Psf] ;fd'lxs k|ltj2tf / s]Gb|n] ToxL cg'?k :yfkgf u/]sf] glh/ csf]{ ;sf/fTds / ;jn kIf dfGg ;lsG5 .

o; ;+:yfdf sfo{/t gl;{Ë hgzlQmnfO{ yk ;Ifd / ;jn agfpg s]Gb|sf] tkm{af6 s]lx ;'wf/sf] ck]Iff ul/Psf] 5, h;df M

!= gl;{Ë ;]jfsf] nflu cfjZos kg]{ ;do ;fk]lIfs cfGtl/s tyf afXo tflndsf] Aoj:yfdf lg/Gt/tf .

@= ljut s]xL jif{ otf b]lv z'? ul/Psf] aflif{s ?kdf lglZrt l;6df gl;{Ë sd{rf/Lx?nfO{ s]Gb|sf] vr{df k9\g k7fpg] Aoa:yfdf lg/Gt/tf .

#= lglZrt cjlw k'/f ul/;s]sf sd{rf/L x?nfO{ a9'jf ug]{ kl/kf6LnfO{ kf/blz{ ?kdf ;do tflnsf agfO{ nfu" ubf{ sd{rf/Lx?df ;sf/fTds kl/jt{g cfO{ ;]jfdf u'0ffTds j[lb x'g] x'+bf To; tkm{ ;b}a Wofg lbg cfjZos b]lvG5 .

cGtdf s]Gb|sf] :t/f]Gglt tyf gl;{Ë ;]jfsf sd{rf/Lx?sf] dgf]jnnfO{ pRr /fVg xfdL gl;{Ë sd{rf/Lx?n] laleGg l/km/]G;sf cfwf/df d}g'jn tof/ kfg]{ k|of;df klg 5f}+ / s]Gb|sf ;j} lgsfosf] ;xof]u /x]df xfd|f] k|oTg cjZo ;kmn x'g]5 . xfdL ;Rrf nuglzn Psa4 eP/ ;+:yfk|lt OdfGbf/ /x]/ of] lty{:yndf cfpg] ;a} ofqLx?nfO{ cg'zfl;t /x]/ ;jf]{Ts[i6 ;]jf ug]{ 1fg, zlQm / ;Ifdtf cjZo k|fKt ug]{5f}+ .

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l;=P;=P;=8L= Ps dxTjk"0f{ ljefu

ljBf hf]zL sf]O/fnf

d]/f] lgo'lQm CSSD df geP;Dd dnfO{ o;

zfvfsf] dxTjsf] e|d lyof] . o; zfvfdf cfP/

1ft eof] ls of] t kbf{ k5fl8sf] ljz]if / clt

cfjZos zfvf /x]5 . h;n] clj>fd, l8df08

tyf ;KnfO{sf] l;4fGt / lgd{nLs/0fsf] p2]Zo

lnP/ sfo{ ug]{ /x]5 . of] zfvfdf yf]/} dfq km/s

k/]df / ckof{Kt Wofg ePdf ;+:yf cGtu{t ;'rf?

?kdf x'g] ;]jfu|fxLx?sf] ;]jfdf afwf / ;d:of

pTkGg x'g] /x]5 . cjZo klg s]xL zfvfx?df w]/}

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{

lgjf{x ubf{ hjfkmb]xL x'g} k5{ . ;+:yfsf ;a}

ljefu tyf zfvf s'g} g s'g} ?kdf ljz]if x'G5g\ . of]

zfvfdf ul/g] sfo{ / tof/Lsf ljwLx? hfGg, l;Sg,

l;sfpg / ug{ cfjZos 5 h:t} ;fdfgsf cfsf/

ldnfpg, sf6\g, tof/L ug{, Kofs ug{ / lgd{nLs/0f

u/]/ cfjZostfnfO{ cfk"lt{ ug{ . ljleGg

ljefun] ;+:yfdf cfpg] cyjf egf{ ePsf

;]jfu|fxLsf ;]jfdf k|of]u ug]{ pks/0fx?, ;]6x?,

8«dx?, 8«]kx?, 8]«g af]tnx?, 8«]l;Ë ;]6x? cflb

Jojl:yt tl/sfsf] k|of]uaf6 Kofs u/]/ ldlt

/fv]/ of] zfvfn] lgd{nLs/0f ub{5 .

To:t} u/]/ cGo dxTjk"0f{ pks/0fx? emf]n kbfy{

/ pRr tfkqmdaf6 lgd{nLs/0f ug{ gldNg]

cj:yfdf ljz]if k|sf/sf] Kofs]6df Kofs u/]/

l;n u/]/ ldlt /fv]/ ljz]if k|sf/sf] Uof;df

;fjwfgLk"j{s lgd{nLs/0f of] ljefun] u5{ .

d]l;gx?sf] ;~rfngdf afwf ePdf / ;d:of

oyflz3| ;dfwfg gePdf ;+:yf leq ;]jfu|fxLnfO{

lbOg] ;]jfdf afwf k'Ug] ;+efjgf x'G5 . To;sf/0f

;d:ofsf] t'?Gt lg/fs/0f cfjZos x'G5 .

of] zfvfn] cToGt} k|efjsf/L e"ldsf lgjf{x

ug]{ x'gfn] o; zfvfdf ;x[bo ;xeflu eP/

cfzfsf ;fy u'0ffTds kl/jt{gsf nflu kof{Kt,

k|lzlIft / bIf dfgjLo ;+;fwg cfjZos 5 .

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GOD’S CLINICPuja 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 FLUSantosh Acharya

Lab Technician

BIRD FLU/AVIAN FLU

Avian fl u is an infection that affects birds, thus also called as bird fl u. It is caused by a type of infl uenza virus. This is because this virus has the ability to infect humans and lead to a fatal infection. It is a type of zoo-notic infection. The virus tends to mutate and develop the ability to infect humans leading to not just a few isolated cases, but a worldwide epidemic of avian fl u in hu-mans.

WHAT IS AVIAN FLU?

Avian fl u is an infectious disease that is caused by infl uenza virus called the bird fl u virus. It generally infects domestic poultry birds like chickens, ducks, etc. When this virus undergoes mutation, it leads to avian fl u in humans. Avian fl u spreads through bird to bird contact. The nasal and respira-tory secretions of infected birds spreading to a healthy bird leads to an infection. Other ways of infection include birds coming in contact with feces, water, equipment con-taminated by an infected bird.

An infected bird shows the following signs and symptoms of fl u:

• Loss of appetite, Lack of energy, Dirty feathers, Purple, Diarrhea, Coughing, Sneezing, Sudden death

Causes of Avian Flu in Humans

Avian fl u in humans is caused by the H5N1 infl uenza A virus. This disease is transmit-ted to humans by contact with an infected bird. People who work closely with the birds like poultry farm workers, sellers of poultry products in open-air markets, as well as people who bring home poultry for food. The nasal and respiratory secretions from the infected bird or its feces help in the spread of the virus in the human body. Avian fl u does not spread by eating poultry products. It cannot pass from an infected person to a healthy person. In rare cases, very close contact with an infected person has led to person-to-person infection. Till the virus does not mutate into a human fl u virus, casual contact with an infected per-son will not lead to the spread of infection.

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Symptoms of Avian Flu

Avian fl u symptoms tend to vary person to person. The fi rst sign of avian fl u is general fl u-like symptoms. These symptoms may suddenly change into a more severe form that includes:

• High fever of about 100.4˚ F (38 ˚C) or more, Sore throat, Dry cough, Chills , Muscle pain, Chills, Sneez-ing, Diffi culty Sleeping, Lethargy, Diarrhea, Runny nose, Joint pain

The symptoms may appear in about 3 to 5 days after infection. These symptoms last for about a week. If left untreated, it could lead to severe pneumonia as well as multi-organ failure. In such a case, the disease proves to be fatal.

Diagnosis of Avian Flu

If one develops sudden high fever and se-vere fl u-like symptoms, they should seek medical attention. The doctor may carry out tests to confi rm avian fl u. These tests include chest X-ray, respiratory secretions culture, and certain blood tests for observ-ing white blood cells.

Treatment for Avian Flu

The treatment of avian fl u includes isolat-ing the patients till the symptoms of avian fl u subside. The patient is given plenty of rest, fl uids to drink along with a healthy diet. Medications such as aspirin are given for treating fever and general malaise. If a patient develops complications like pneu-

monia, they are kept on ventilator support and treated according to the complications arising. The prognosis for avian fl u is very poor. If the infection is very serious, it may lead to death due to complications. Preven-tion of avian fl u includes:

• Wash hands with an alcohol-based sanitizer as frequently as possible.

• Use clean knives, cutting boards, utensils, etc. when cooking poultry.

• Cook the chicken thoroughly and egg whites & yolks till fi rm.

• Avoiding bird-markets, farms and poultry areas during a fl u outbreak.

• Avoid consuming raw or half-cooked poultry products.

• Stay away from infected or sick birds, if possible.

• Avoid travelling to regions that have a fl u outbreak.

• Ask your doctor for a fl u shot to pre-vent infection from various types of infl uenza virus and build some im-munity against avian fl u.

If one develops fl u-like symptoms after coming in contact with birds or an infected person, they should seek immediate medi-cal attention. As this is a new virus, humans have still not developed immunity against the virus. Also, researchers still have to study the virus in detail. Thus, prevention is the only key to stay away from avian fl u.

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Zj]t j:qdf ltdLlg/f >]i7 dxh{g

:6fkm g;{zLtsf yf]kf;Fu} pbfpg] lzlz/sf] ;'gf}nf] ljxfgLs'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:gUwk/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 JoyfzAbdf cJoQm /x]5 uf}/jdo ltd|f] hLjgufyf;b\efjsf 3]/f sf]l/Psf d'xf/ slt sflGtdoc¿sf] hng d]6fpg] sfo{ ltd|f] d+undo

gegL /ftsf] zzL, clg lbgsf] k|sfzg t r}tsf] x'/L, g ebf}/] cfsfz

kLl8tsf] ;]jfdf /dfpg] ;xgzLnf ltdLkmnsf] cfzf gu/L sd{ ug]{ sd{of]lugL ltdL .

dfw'o{ / zfnLgtfn] k|efljt ltd|f] JolQmTjef}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]zkm}nfpFb} cfTdLotf ;adf lgsfnL /f]usf] ljif .

cfzf / ;+odtfn] el/k"0f{ ltd|f cFh'nLk/f]ksf/L lbO{ cfˆgf] OR5fsf] ltnf~hnL

e'nfpg lsg ;lSbgf} cfkm"nfO{ hutsf] :jfyL{ e'd/Ldfg t /+u\ofpg} ;S5f} cfkm"nfO{ ;dosf] xf]nLdf .

d]6fO/x" ltdL dflg;sf kL8f, nufO{ :g]xsf] dndsfod /xf];\ ;f}Do JolQmTj ljgf s'g} cxd\

/f]un] phf8]sf] hLjgnfO{ lbG5f} ;b\efjsf] /+u yl/yl/afFlr/x" o'uf}+o'u ltdL o;/L g} ;w}+e/L .

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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 amounts of diverse wastes that require disposal. Much of the waste is hazardous and much therefore need to be collected, transferred, and disposed properly to protect both the persons handling it and the environment. It affects not only the generators of waste but also the operators and the general public.

Wastes from health care institutions can be categorized as infectious or noninfectious. Infectious wastes include human, animal or biological wastes and any items that may be contaminated with pathogens. Noninfectious wastes include toxic chemicals, cytotoxic drugs, and radioactive, fl ammable and explosive wastes. A manifest impact of mismanagement of this waste is the alarming incidence of hospital-acquired infection.

Since the early recovery of the patient and health of clinical staff directly depends on infection prevention practices used in health care institutions. Waste management is one of the essential components of good infection prevention practices. It is essential that health care waste is collected, stored and disposed of in a proper and scientifi c

manner. General hygiene is a perquisite for good medical waste management in health care institutions. It is also vital that the whole health care institutions be kept clean and on a satisfactory state of hygiene.

With the steady increase in the number of health care institutions in Nepal, the amount of medical wastes generated is also increasing. But due to lack of proper waste management, guidelines, policies and legislations, most of the wastes from health care institutions are being disposed haphazardly, which is causing environmental and public health problem. Realizing the urgent need to manage health care institutions waste in Nepal. Nepal Health Research Council (NHRC) had prepared a Health care waste management guideline which needs to be updated.

Solid waste which is generated in the hospital is managed by the staff (Attendant, cleaner). There will be lot of infected & non-infectious wastes in the hospital which are collected from different points of hospital e.g. General ward, OPD, SICU, CCU, ICU, New medical ward & New surgical ward etc. infected or non-infected waste generated is around 75-100 kg per day. There is provision

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of segregation of the Health care waste by providing different colored buckets for different kinds of the waste: however, this 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.

OBJECTIVE• To support high quality patient care.• To contain the cost of Hospital

Waste Management.• To reduce the risk of nosocomical

infection.• To comply with regulations and or-

dinances.• To develop good community rela-

tions.• To support the preservation of envi-

ronmental quality.• To create awareness amongst the

staff , patient & community.• To manage the hospital waste prop-

erly and systematically.

LONG TERM PLANSGNHC has made long term plan for Health care waste management including.

1. Permanent Health care waste manage-ment treatment and storage house.

2. To buy autoclave machine to disinfect the Health care waste management.

3. To manage degradable waste by using biogas plant.

4. To use the available fund through Health care waste management committee.

ESTABLISHMENT OF MODEL WARD

For implementation of this project "Implementation of safe Healthcare waste management system in Shahid Gangalal National Heart Centre". General ward is a model ward of our hospital.

We have categorized 6 bucket in hospital which as

1. Green bucket for degradable waste

E.g. Pieces of fruits, waste foods, and wet paper.

2. Blue bucket for plastic items

E.g. Plastic bags, water bottles, plastic glass, plastic saline bottles etc.

3. Black buckets: ( for dry papers)

E.g. Dry newspapers, paper cartoon, medicine boxes etc.

4. Red bucket: (for sharp instrument)

E.g. - Needles, broken glass, blades etc.

5. Yellow buckets: (for infectious items)

E.g. Infectious gauze, pad, I/ V set, etc.

6. Gray/ White buckets:

E.g. UN broke glass bottles, vials, etc.

Figure 1: Waste Segregation System in the model ward

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Among those 6 buckets (3) a. Green bucket, Blue buckets & Black buckets will be kept in public area and Red bucket, Yellow bucket & Gray/ White buckets will be kept in closed area

TRAINING TO THE KEY PERSONS OF THE HOSPITALS

We have also conducted the training regarding health care waste management in our hospital for 30 staff of our hospital from 21 July 2013 to 26 July 2013. On the way, our staff also visited the waste management system in Bir hospital (Maha Bauddha) and civil hospital (Min Bhawan) Kathmandu. The training was fi nancially supported by W.H.O. We have also the system of waste which are following as;

A. COLLECTION OF WASTE

Figure 2: Theroy session during the training

The collection of the waste will be done in two different trolleys, one for the risk and other for the non-risk waste. These two trolleys will be used for the collection of the waste. The designing of the trolleys are in process.

The trolleys are designed out of the used trolleys in the hospital. The use of two different trolleys has helped to control the mixing of the risk waste with the non-risk wastes

B. STORAGE OF WASTEThe 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.

C. TREATMENT AND DISPOSAL

For the treatment of the waste, for the model ward, the infected waste will be autoclaved and then sent for fi nal disposal. In the other wards, the syringes are sent to incinerator, which will be slowly incorporated in the newly designed system. The wastes from the other areas requiring treatment prior to disposal are being chemically disinfected.

D. WASTE SALES DETAIL:

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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staff list

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SN NAME DESIGNATION1 Dr. Ramesh Raj Koirala Consultant Cardiac Surgeon2 Dr. Jyotindra Sharma Consultant Cardiac Surgeon & HOD3 Dr. Sidhartha Pradhan Consultant Cardiac Surgeon4 Dr. Bijoy Rajbansi Consultant Cardiac Surgeon5 Dr. Rabindra Bhakta Timala Consultant Cardiac Surgeon6 Dr. Nabin C Gautam Cardiac Surgeon8 Dr. Anil Acharya Cardiac Surgeon7 Dr. Yogeshwor Man Singh Registrar Surgery9 Dr. Bishow Pokhrel Registrar Surgery

10 Dr. Nivesh Rajbhandari Registrar Surgery11 Dr. Arun Upadhyaya Resident Doctor12 Dr. Bijay Sah Resident Doctor13 Dr. Raman Koirala Resident Doctor14 Dr. Saurav Sunar Resident Doctor15 Dr. Kiran Tiwari Resident Doctor16 Dr. Anjeela Kadel Resident Doctor17 Dr. Dikshya Joshi Resident Doctor18 Dr. Kripa Bhattarai Resident Doctor19 Dr. Sangam K.C. Resident Doctor20 Umesh Khan Sr. Perfusion Assistant21 Lalita Shakya Perfusion Assistant22 Ram Bharosh Yadav Perfusion Assistant

SN NAME DESIGNATION1 Dr. Man Bahadur K.C. Sr. Consultant Cardiologist & ED2 Dr. Arun Maskey Sr. Consultant Cardiologist3 Dr. Deewakar Sharma Sr. Consultant Cardiologist4 Dr. Rabi Malla Sr. Consultant Cardiologist5 Dr. Yadav Deo Bhatta Consultant Cardiologist & HOD6 Dr. Sujeeb Rajbhandari Consultant Cardiologist7 Dr. Rajeeb Rajbhandari Consultant Cardiologist8 Dr. Yubaraj Limbu Consultant Cardiologist9 Dr. Urmila Shakya Consultant Pediatric Cardiologist

10 Dr. Subodh Kansakar Consultant Cardiologist11 Dr. Roshan Raut Consultant Cardiologist12 Dr. Sajan G Baidya Consultant Cardologist13 Dr. Ranjit Sharma Consultant Cardiologist14 Dr. Himamshu Nepal Consultant Cardiologist15 Dr. Chandra Mani Adhikari Cardiologist16 Dr. Binay Kumar Rauniyar Cardiologist17 Dr. Murari Dhungana Registrar Cardiology

DEPARTMENT OF CARDIOVASCULAR SURGERY

DEPARTMENT OF CARDIOLOGY

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SN NAME DESIGNATION18 Dr. Dharma Nath Yadav Registrar Cardiology19 Dr. Dipanker Prajapati Registrar Cardiology20 Dr. Nagma Shrestha Registrar Cardiology21 Dr. Rabindra Pandey Registrar Cardiology22 Dr. Satish Kumar Singh Registrar Cardiology23 Dr. Manish Shrestha Registrar Pediatric Cardiology24 Dr. Anil Regmi Resident Doctor25 Dr. Saurav Sunder Shrestha Resident Doctor26 Dr. Suman Th apaliya Resident Doctor27 Dr. Aamir Siddiqui Resident Doctor28 Dr. Dilip Kumar Sah Resident Doctor29 Dr. Deepak Limbu Resident Doctor30 Dr. Bibek Baniya Resident Doctor31 Dr. Mukunda Sharma Resident Doctor32 Dr. Amrit Bogati Resident Doctor33 Dr. Prekshya Singh Resident Doctor34 Dr. Roshani Ghimire Resident Doctor35 Dr. Shova Pandey Resident Doctor36 Dr. Sanjay Singh K.C. Resident Doctor37 Dr. Rishikesh Rijal Resident Doctor38 Dr. Sebina Baniya Resident Doctor

SN NAME DESIGNATION1 Dr. Jejunath Pokharel Sr. Consultant Anesthesiologist2 Dr. Apurba Sharma Registrar Anesthesiology3 Dr. Ashis Amatya Registrar Anesthesiology4 Dr. Battu Kumar Shrestha Registrar Anesthesiology5 Dr. Surendra Bhusal Registrar Anesthesiology6 Dr. Bidhan Gyawali Resident Doctor

SN NAME DESIGNATION1 Dr. Deewakar Sharma Sr. Consultant Cardiologist & HOD2 Dr. Shaili Th apa Physiotherapist3 Samjhana Shakya Public Health Offi cer4 Pushpa Neupane Sr. Staff Nurse5 Yashoda Luitel Physiotherapy Assistant6 Rajeev Kumar Yadav Physiotherap Assistant

DEPARTMENT OF ANESTHESIOLOGY

DEPARTMENT OF CARDIAC REHABILATION & HEALTH PROMOTION

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Annual Report 2013


SN NAME DESIGNATION1 Nita Dangol Matron (Sr. Nursing Supervisor)2 Krishna Kumari Subedi Sr. Nursing Supervisor3 Sati Devi Manandhar Nursing Supervisor4 Anita Dewan Nursing Supervisor5 Prati Badan Dangol Sister6 Tulasa KC Sister7 Kopila Luitel Sister8 Vidhya Koirala Sister9 Roji Shakya Sister

10 Deoki Saru Sister11 Manju Timilsina Sister12 Kalpana Timilsina Sister13 Leela Rana KC Sr. Staff Nurse II14 Kunti Khanal Sr. Staff Nurse15 Dibyashori Khati Sr. Staff Nurse16 Bishnu Pandey Sr. Staff Nurse17 Anjana Koirala Sr. Staff Nurse18 Sunita Khadka Sr. Staff Nurse19 Lalita Maharjan Sr. Staff Nurse20 Rajyalaxmi Bhele Sr. Staff Nurse21 Lalita Poudel Sr. Staff Nurse22 Reshma Th apa Sr. Staff Nurse23 Shobhana Shrestha Staff Nurse24 Astha Baniya Staff Nurse25 Sapana Maharjan Staff Nurse26 Ganga Ter Staff Nurse27 Mamata Khadka Staff Nurse28 Sajana Maharjan Staff Nurse29 Krishna Shwari Gwachha Staff Nurse30 Rameswori Duwal Staff Nurse31 Suraksha Dhungana Staff Nurse32 Binita Tamrakar Staff Nurse33 Ushana Shrestha Staff Nurse34 Bina Paneru Staff Nurse35 Kamala Poudel Staff Nurse36 Anupama Sharma Staff Nurse

SN NAME DESIGNATION1 Dr. Ranjit Baral Consultant Cardiologist2 Dr. Dhandu Rani Shakya Consultant Anaesthesiologist3 Mr. Mahendra Bhatta Sr. Perfusionist

VISITING SPECIALISTS

DEPARTMENT OF NURSING

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Annual Report 2013


SN NAME DESIGNATION37 Puja Satyal Staff Nurse38 Basanta Sharma Staff Nurse39 Rashmi Karki Staff Nurse40 Srijana Th apa Magar Staff Nurse41 Ambika Shrestha Staff Nurse42 Man Kumari Shris Th apa Staff Nurse43 Sagun Sharma Staff Nurse44 Rukumani Khadka Staff Nurse45 Ratna Devekota Staff Nurse46 Pabitra Pandey Staff Nurse47 Shanta Singh Th akuri Staff Nurse48 Pratima Dhakal Staff Nurse49 Tulasa Banjara Staff Nurse50 Hira Adhikari Staff Nurse51 Yogina Maharjan Staff Nurse52 Supala Gautam Staff Nurse53 Januka khadka Staff Nurse54 Sharmila Th apa Staff Nurse55 Siba Laxmi Shrestha Staff Nurse56 Puspa Marasini Staff Nurse57 Ramita Maharjan Staff Nurse58 Bijaya Aryal Staff Nurse59 Jyoti Shrestha Staff Nurse60 Shova Shrestha Staff Nurse61 Mamta Bista Staff Nurse62 Srijana Bhele Staff Nurse63 Usha Paudel Staff Nurse64 Sangita Kafl e Staff Nurse65 Rupa Sharma Staff Nurse66 Ranjita Guragain Staff Nurse67 Chandika Gwachha Staff Nurse68 Raj Kumari Shrestha Staff Nurse69 Chahana Singh Staff Nurse70 Sabita Gyawali Staff Nurse71 Srijana Th apa Staff Nurse72 Shailee Karanjit Staff Nurse73 Puspa Kumari Gurung Staff Nurse74 Asmita Karki Staff Nurse75 Menuka Silwal Staff Nurse76 Jina KC Staff Nurse77 Madhuri Th apa Staff Nurse78 Kiran Sebedi Dahal Staff Nurse79 Manju Pyakurel Staff Nurse80 Mamata Ojha Staff Nurse

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Annual Report 2013


SN NAME DESIGNATION81 Chanchala Shrestha Staff Nurse82 Lhamu Sherpa Staff Nurse83 Punam Shrestha Staff Nurse84 Rekha Karki Staff Nurse85 Sushila Khanal Staff Nurse86 Renu Lama Staff Nurse87 Bal Kumari Chaudhary Staff Nurse88 Shreejana Gautam Staff Nurse89 Poonam Gurung Staff Nurse90 Kusum Th apa Staff Nurse91 Sisira Rajthala Staff Nurse92 Asha Kumari Jha Staff Nurse93 Chitra Pudasani (Adhikari) Staff Nurse94 Sajani Limbu Staff Nurse95 Rajani Shrestha Staff Nurse96 Manira Gautam Staff Nurse97 Arzoo Neupane Staff Nurse98 Tripti Singh Staff Nurse99 Renu Tamang Staff Nurse

100 Ishwori Gautam Staff Nurse101 Luniva Yakami Staff Nurse102 Shanti Gurung Staff Nurse103 Kabita Baniya Staff Nurse104 Shama Singh Kunwar Staff Nurse105 Shila Shrestha Staff Nurse106 Asmita Lamichhane Staff Nurse107 Chunam Khadka Staff Nurse108 Sumitra Poudel Staff Nurse109 Puja Kafl e Staff Nurse110 Bitika Adhikari Staff Nurse111 Sakuntala Karki Staff Nurse112 Prajita Shrestha Staff Nurse113 Manju Khadka Staff Nurse114 Roshni Shaha Mananadhar Staff Nurse115 Shakuntala Mahat Staff Nurse116 Sovita Sapkota Staff Nurse117 Bidhya Malla Staff Nurse118 Isha Lama Staff Nurse119 Prabha Paudel Staff Nurse120 Anjana Sharma Staff Nurse121 Sabina Baral Staff Nurse122 Nima Sherpa Staff Nurse123 Safala Subedi Staff Nurse124 Sujan G.C. Staff Nurse

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Annual Report 2013


SN NAME DESIGNATION125 Samjhana Karki Staff Nurse126 Apeksha Ghale Staff Nurse127 Sumitra Bhetuwal Staff Nurse128 Rekha Kumari Mandal Staff Nurse129 Namrata Ojha Staff Nurse130 Anita Bhandari Staff Nurse131 Aarati Gautam Staff Nurse132 Ravina Subedi Staff Nurse133 Shristi Maharjan Staff Nurse134 Sabina Th imi Staff Nurse135 Shushma Tamang Staff Nurse136 Ramita Pandey Aryal Staff Nurse137 Nilima Joshi Staff Nurse138 Srijana Tiwari Staff Nurse139 Lina Maharjan Staff Nurse140 Bandana Sankhi Staff Nurse141 Sangita Baskota Staff Nurse142 Ambika Th apa Staff Nurse143 Geeta Tiwari Staff Nurse144 Prabha Rawal Staff Nurse145 Sunita Awal Staff Nurse146 Sajina Sharma Ruwali Staff Nurse147 Alina Pandey Staff Nurse148 Janaki Ayer Staff Nurse149 Mukta Shrestha Staff Nurse150 Rubina Khadka Staff Nurse151 Shovna Shrestha Staff Nurse152 Nilima Pant Staff Nurse153 Ayushma Neupane Staff Nurse154 Pragya Kuikel Staff Nurse155 Nisha Th apa Staff Nurse156 Pramila Aryal Staff Nurse157 Sirjana Adhikari Staff Nurse158 Sajana Shrestha Staff Nurse159 Sushila Ghimire Staff Nurse160 Sarala Malla Staff Nurse161 Bhagawoti Chapagain Staff Nurse162 Bimala Acharya (Poudel) Staff Nurse163 Apurwa Sawad Staff Nurse164 Sanju Shah Staff Nurse165 Rashmi Basnet Staff Nurse166 Anisha Ghimire Staff Nurse167 Kripa Sankhi Staff Nurse168 Sabita Khanal Staff Nurse

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Annual Report 2013


SN NAME DESIGNATION169 Kamana Paudel Staff Nurse170 Nira Kumari Shahi Staff Nurse171 Ritu Karki Staff Nurse172 Kripa Poudel Staff Nurse173 Nira Shrestha Staff Nurse174 Neeta Guragain Staff Nurse175 Nirjala Khanal Staff Nurse176 Sanjita Dhakal Staff Nurse177 Namrata Maharjan Staff Nurse178 Aagya Pokharel Staff Nurse179 Bandana Bogati Staff Nurse180 Anuja Adhikari Staff Nurse181 Luna Maharjan Staff Nurse

SN NAME DESIGNATION1 Dr. Man Bahadur K C Executive Director2 Dipendra Khadka Dy. Chief of Administrative3 Dipendra Pokharel Sr. Administrative Offi cer4 Ram Prasad Acharya Administrative Offi cer5 Bimala Aryal Administrative Offi cer6 Bhupal Acharya Administrative Offi cer7 Bimala Sapkota Administrative Assistant8 Ram Babu Raut Medical Record Assistant9 Chunam Lama Administrative Assistant

10 Mahendra Lamsal Administrative Assistant11 Yuba Raj Timilsina Administrative Assistant12 Santosh Dhakal Administrative Sub- Assistant13 Bhagawati Gaire Administrative Sub- Assistant14 Dibyashor Pandit Administrative Sub- Assistant15 Pratima Malla Th akuri Administrative Sub- Assistant16 Bikash Khaniya Administrative Sub- Assistant17 Mandira Khadka Administrative Sub- Assistant18 Kabita Koirala Khatiwada Administrative Sub- Assistant19 Krishna Bahadur Budhathoki Driver II20 Sanu Lama Driver II21 Bharat Bahadur Khadka Driver22 Pitambar Bhujel Driver23 Bhej Bahadur Moktan Driver24 Bhai Narayan Maharjan Driver25 Rup Bdr Th apa Driver26 Gyan Kaji Maharjan Driver27 Sadhuram Pandit Driver

ADMINISTRATION

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Annual Report 2013


SN NAME DESIGNATION28 Yagya Bahadur Khulal Driver29 Sharada Khanal Offi ce Helper II30 Madhav Th apa Offi ce Helper II31 Bharat Bahadur Basnet Offi ce Helper II32 Shanti KC Offi ce Helper II33 Gauri Devi Sharma Offi ce Helper II34 Kalpana Bhattarai Offi ce Helper35 Kamala Gautam Offi ce Helper36 Sushila Bista Offi ce Helper37 Biju Kuwar Chhetri Offi ce Helper

SN NAME DESIGNATION1 Indesh Th akur Sr. Radiography Technologist2 Baidh Nath Yadav Radiography Technologist3 Shulav Paudel Radiography Technologist4 Shyam Th akur Sr. Radiographer5 Saroj Chhetry Radiographer6 Seema Gyawali Radiographer7 Shyam Kumar Adhikari Radiographer8 Bijaya Shrestha Radiographer9 Baburam Kharel Radiographer

10 Laxminarayan Singh Radiographer11 Sebika Baniya Pandit Radiographer12 Pramod Khatri Radiographer13 Ramesh Th apa Dark Room Assistant II

SN NAME DESIGNATION1 Bimal Kumar Upreti Chief Financial Administration2 Manoj Kumar Bista Sr. Finance Offi cer3 Naresh Chipalu Finance Offi cer4 Sabin Manandhar Account Assistant5 Niru Dahal Account Assistant6 Bibek Th apa Account Sub- Assistant7 Sanjay Maharjan Account Sub- Assistant8 Krishna Bahadur Kumal Account Sub- Assistant

RADIOLOGY

FINANCE

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Annual Report 2013


SN NAME DESIGNATION1 Madhu Giri Pharmacist2 Atmaram Timalsina Pharmacy Assistant3 Anu Acharya Pharmacy Assistant4 Prem Raj K.C. Pharmacy Assistant5 Kamal Bahadur Rana Pharmacy Assistant6 Nabina Th apa Pharmacy Assistant7 Upama Parajuli Pharmacy Assistant8 Jaykishor Shah Health Assistant9 Indrajit Yadav Health Assistant

10 Manoj Kumar Yadav Health Assistant11 Niru Ratyal Health Assistant12 Devendra Yadav Health Assistant

SN NAME DESIGNATION1 Dr. Bipesh Acharya Resident Doctor2 Binod Kumar Yadav Medical Lab Technologist3 Bindeshor Yadav Medical Lab Technologist4 Arya Tara Shilpakar Sr. Lab Technician5 Renu Shakya Sr. Lab Technician6 Narendra Shrestha Lab Technician7 Sarala Koirala Lab Technician8 Rajnarayan Mishra Lab Technician9 Sushila Shrestha Lab Technician

10 Prasanta Koirala Lab Technician11 Sunita Giri Lab Technician12 Bikash Bhusal Lab Technician13 Shanti Sharma Lab Technician14 Nawal Kishor Yadav Lab Technician15 Bijaya Kumar Th akur Lab Technician16 Santosh Acharya Lab Technician17 Suresh Kumar Gupta Lab Technician18 Pradeep Khanal Lab Technician19 Pranila Chitrakar Lab Technician20 Prem Hari Bhasima Lab Technician21 Birendra Chaudhary Lab Technician

PATHOLOGY

PHARMACY

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Annual Report 2013


SN NAME DESIGNATION1 Pradip Kumar Yadav Sr. Overseer2 Bhagawan Karki Overseer3 Nawaraj Roka Sub- Overseer4 Bhogendra Narayan Shah Sub- Overseer5 Shamsher Bahadur Basnet Plumber6 Kedar Raj Khadka Plumber7 Bishwa Ram Adhikari Plumber8 Dinesh Maharjan Plumber

MAINTENANCE

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Documents

Annual Report 2013 - sgnhc.org.np · dr. sitaram chaudhary dean national academy of medical sciences bir hospital mrs. anuradha koirala women representative mr. sanjeeb rajbhandari