Bir Hospital in Kathmandu was established in 18891 with eight staff, one doctor, one administrator, two cooks, two attendants, two sweepers,2 and 15 beds after then-Prime Minister Bir Shumsher Rana realized the need for a hospital in Nepal.
That event marked the foundation for the start of allopathic medicine, also called Western medicine or “modern medicine,” in Nepal. Bir Hospital is the oldest hospital in the country, with 133 years of history and a Department of Surgery that is more than a half century old.
Medical education in Nepal, in its primitive form, was established in 1934 when the Civil Medical School started training “dressers,” a mid-level healthcare workforce, in wound dressing. This occurred during an era when most doctors available in the country were on the staff of foreign embassies.
A formal Department of Surgery was established at Bir Hospital by Dr. Anjani Kumar Shrama in 1961,2 72 years after the establishment of the hospital. He was joined by Dr. Dinesh Nath Gongol in 1962.2
The original operating room was 20 feet by 20 feet with a marble floor and walls and a high dome-shaped ceiling with large windows along the northern wall for steady, shadowless light.2 The other source of light was a single lamp hanging from the center of the dome. Many times, operations were performed using torchlights as there wasn’t always an adequate electricity supply from the nearest hydropower station in Pharping. The first electrocautery was used in 1964.3 There also was a “Down brothers” hydraulic operating table in the operating room.
Eight years later, on May 10, 1969, the new operating theatre in Bir Hospital was inaugurated by Dr. Bhawani Bhakta Singh Pradhan, the first anesthetist in Nepal, who originally joined Bir Hospital staff in 1933.2 The name of the surgeon in the inauguration ceremony was not listed.
In the 1970s, during the early years after the operating theatre was established, surgical procedures were performed under open ether anesthesia, using an Epstein-Macintosh-Oxford ether inhaler. Chloroform also was used for anesthesia using Junker’s apparatus.
At that time, there was a “surgeon superintendent” who was appointed to both perform surgery and work with hospital administration.3 The surgeons were trained either in India or the UK and appointed by the government to work in Bir Hospital.
In that era, there was a lack of trained operating theatre support staff and nurses. Later, the US Agency for International Development helped bring in trained personnel.2 In 1986, there were six surgical consultants in the Department of Surgery; all were general surgeons who gradually started performing subspecialty surgery.2
Following the establishment of the operating theatre, surgical procedures of various subspecialties were performed. Laparoscopic surgery was not performed at Bir Hospital until the late 1980s, and regular laparoscopic services were possible only 2 decades later. During the initial years, a Sony-HR Trinitron monitor, an Olympus OTV-S3 light source, and an Olympus insufflator were used.
Postgraduate Surgical Education in Nepal
In 1987, Bir Hospital was the first institution in Nepal accredited by The Royal College of Surgeons of Edinburgh to train surgeons.1 This was approved by Prof. James Liester and Dr. Alasdair MacGregor of the Royal College3 and marked the beginning of the era of postgraduate surgical education in Nepal. At that time, the surgical training program at Bir Hospital and the qualifying examination at Tribhuvan University Teaching Hospital, both in Kathmandu, were completed.
The actual cost for the training program of £300 and £300 for the examination was reduced by The Royal College of Surgeons of Edinburgh to one-sixth of its actual cost, £50 for trainees at Bir Hospital.3
As a result, the Department of Surgery at Bir Hospital was the center of attraction for many aspiring surgeons from within the country as well as neighboring countries in South Asia. In 2002, Bir Hospital was developed into the National Academy of Medical Sciences (NAMS) of Nepal as a postgraduate training academy.
In 2005, NAMS held its first convocation ceremony with an address by director Dr. Gongol5 who had played a pioneering role in establishing surgery and its subspecialties at Bir Hospital. During the first convocation ceremony, NAMS fellowships (FNAMS) were awarded to surgeons in honor of their contributions to establishing surgery and its subspecialties and starting surgical education at Bir Hospital:5
Surgery
- Prof. Dr. Anjani Kumar Sharma (FRCS)
- Dr. Sudip Kumar Bhattacharya (FRCS, England)
- Prof. Dr. Govind Prasad Sharma (PhD, thoracic surgery, USSR)
Urological Surgery
- Dr. Vishwaraj Dali (Master of Surgery, India)
- Prof. Dr. Bhola Raj Joshi (Master of Surgery, India)
Cardiothoracic and Vascular Surgery
- Prof. Dr. Loke Bikram Thapa (FRCS)
General and Gastroenterology Surgery
- Prof. Dr. Mahesh Prasad Khakurel (FRCS, Edinburgh)
Neurosurgery
- Prof. Dr. Upendra Prasad Devkota (FRCS)
Today, surgical services are provided from a dedicated surgical building with modern operating rooms in Bir Hospital, and trauma services are offered in the adjacent trauma center.
Currently, there are 17 active ACS Fellows practicing surgery in Nepal and seven Associate Fellows who have applied to become Fellows at the 2023 Clinical Congress. The Nepali ACS Fellows are in the process of forming an International ACS Chapter. Nepali surgeons are working to be more active in the ACS, as demonstrated by my appointment to the History and Archives Committee in 2022.
