A DISPENSARY IN HIS VILLAGE
Once upon a time, there was a young Nepalese called HARI KRISHNA DHAKAL, who at the age of 12, cherished the dream to become a doctor and care for his fellow villagers.
Once upon a time and at the same providential moment, there was a group of trekkers distributing 3 tons of clothes and shoes to children, in six remote villages on the Himalayan paths.
Those so different destinies, by luck or whatever, met and that unpredictable encounter gave birth to our association “A dispensary in his village”.
Today, this already well advanced adventure goes on to its final step, to build and operate a dispensary then, to become as soon as possible a large hospital.
We invite you to discover and follow our project in the next pages.
If you wish to join us and help, please get in touch !
Hari Krishna DHAKAL, his long way to become a doctor.
Hari Krishna Dhakal was born April 4th, 1982 in a village of Gorkha district, central Nepal. At the age of 12, having no more school around his home, his dream was to go on studying and become a doctor to take care of his fellow villagers. We met on some path. He seemed so bright and his determination so strong that we formed an association to give him the opportunity, in studying hard, to fulfil his wish.
To do so, he had to leave his village. A Nepalese friend became his guardian and found him a good boarding school at the capital Kathmandu where he completed his four years of secondary classes. Then, in order to have a better graduation, he left to New Delhi in India, to follow classes of preparatory scientific education during two years. Despite loneliness being in a foreign land, his humble roots, health problems and the tragedy of his mother’s death, Hari kept on studying hard with constant efforts and proved that his childhood determination remained intact. After ending High School at the age of 19, Hari began in February 2002, five and a half years of Medical Studies at USTC, University of Science and Technology of Chittagong in Bangladesh. After steady progress and permanent success in the several exams he had to undergo, he graduated as a doctor in MBBS, among the first of his class in October 2007.
Soon after being back to his land, he had to do one year compulsory Internship in order to get registered as a doctor. He then served in several national hospitals of Kathmandu, among which, Bir Hospital. To improve his knowledge in rural medicine, he then went to work for one year at the government hospital of Bharatpur Chitwan medical college. At the end of that contract, Hari went for a specialized course in obstetrics. Wishing to improve and deepen his experience in management, he engaged himself as a manager in the coordination of a hospital staff: as a senior doctor in the western province of Rukum, at Chaurjahari. He is at present (by September 2011) finishing his one year engagement there, managing a staff of 40 people including 3 doctors, 5 nurses, 5 assistants : handling together daily an average of 250 consultations, 7 major surgical interventions and caring 50 beds. Such flexibility and availability make such medical structure very rare in Nepal: on a large area, it can locally care for 700000 patients. Hari does not count his working hours and stays often at duty till midnight and seldom takes his day off. His salary is a mere 270 Euros/month.
PROJECT
This project is the consecration and the culmination of a long engagement from our two following associations, “A doctor in his village” then “A dispensary in his village”, during 17 years up to now and Hari himself.
After completing his MBBS in Bangladesh and coming back to his dear land, Hari went through his residency in Kathmandu then followed various courses of specialization, as in obstetric surgery for example. Now in 2011, he is currently manager of a large hospital in Western Nepal. Despite his young age (29 in 2011), he already developed a deep and wide experience in most cases.
His initial wish to settle his activity in a remote mountainous place, at the confluence of several villages, far from already medical existing structures, has not changed the least. His dream is still intact and as strong as when we first met. He deliberately chose not to settle in a city, as many of his colleagues have already done to make a comfortable living, but stay in the countryside to fulfil his childhood goal, care for his fellow villagers.
Now, Hari, confident in his abilities and knowledge looks forward to the next step: build a dispensary or (depending upon our possibilities) a small hospital in a Himalayan village to care for about 60000 inhabitants. Our aim is, a medical structure which, after some years, will target the capacity of 40 beds and a daily consultation of 150 patients, with a wide offer of services (outpatient, maternity, paediatrics, surgery, emergency and intensive care).
We are therefore looking for people sharing our HOPE and willing to establish strong collaborations with patrons and sponsors sensible to the development of our project.
We allow ourselves plenty of time to find patrons, sponsors and well wishers to finance this project, find the land and start the construction.
During this time, of course, Hari will not stay idle: he will use that necessary time to complete his studies and go for a post graduation, if very possible in Nepal.
We are at present looking for possibilities and costs to do so.
Presentation of the Board of Directors.
Gérard NAIGEON : one of the two founders and President of the Association.
To better discover, deepen and enrich his human interests, he started travelling our planet and living abroad quite young. In wandering journeys or settling down sometimes for several years, he went first trough Asia, up to the Far East, then South America. His primal passion for Hinduism involved him to work in India for an uncompleted quest, then resting here and there to restore his energy, the historical road of Buddhism progressively dragged him to Japan, where the encounter with the Zen phenomenon achieved to persuade him forever. A family life brought him lately to work as a guide for a Tour Operator, which he has not left since then. Sent to share his passions on his favourite lands, mainly in Asia and South America, he was nevertheless given the great chance to enlarge his knowledge of new areas of the world, which seemed till then too far for him, in deserts of Africa and Arctic. The encounter of the Inuit people was, among others, an unforgettable stunning discovery. During all those years of sincere and deepening interest for the people and the societies of our planet, his passion for the ethnical patchwork which dwells in the Nepalese Himalaya never ended but pushed him again and again to go back to it. Forever grateful of being enriched with the human qualities of those mountain people, he felt the necessity to show and prove them his gratitude. In those highest lands of our globe, he soon got involved in long lasting friendships, sponsoring and helping people as much as he could, to get free from a certain so called fatality. The creation of our Association “A dispensary in his village” and his concomitant project HOPE are then, an evident consequence of that long but sure maturity.
Bernard MOLLIET : the second founder and Treasurer of our Association.
From the mountainous district of Savoy (France), he is managing a large company in Annemasse, near Switzerland. On his way for a long trek in Tibet, he discovers and falls in love with the magic of Nepal. Ardent and unconditional admirer of the journey on foot, he fully appreciates being among local populations and away from his too busy and very comfortable daily professional obligations. Sensible to the severe local conditions of life lived by the Nepalese, deeply concerned by the lack of medical structures, that traveller met Hari during a second trek to Nepal and became strongly involved with our association, helping him during all his medical studies and never stopped ever since.
Laurence ORSINI : secretary of the Association.
Her passion for foreign languages took her abroad very young. Then, after studies in Tourism she started working for a well known Travel Agent. Since then, she has not stopped discovering our planet and particularly Nepal, to which she is very dedicated. Faithful to our cause since the first moment, she strongly encouraged Hari from the beginning of that great adventure.
At first, finding a piece of land.
The development of such a project will, of course, need several years and our first most important step will be to acquire an important piece of land where to start building and settle our medical structure later on.
In order to be completely independent in our future choices, decisions and orientations, without having to be submitted to certain local influences, so to be free from the various pressures that are commonly happening in Nepalese society, the best option is to buy such piece of land and to be full owners of it.
Regarding its size, we have to consider the possibilities of future development that our dispensary or (depending upon the progress our project has taken) hospital might take. The area should be big enough to welcome additional related medical structures and even, for example, some accommodation for families and external pharmacy. It should also allow further constructions, especially those generating sources of income to our project (solar equipment, farming and cattle productions) and, in doing so gradually enabling us to become financially self sufficient in some years. That financial independence from external incomes (patrons, sponsors) and possibility to assume by ourselves our targets is mostly important to us. That piece of land, at the best, should include a stream or a source of water, should be the flattest possible in a well exposed valley as to store the most solar energy possible. Then, it should be located at the confluence of several valleys or paths serving isolated and remote villages which do not at present possess any medical structure.
The estimation cost of such a land is very delicate and approximate because inflation is very important in Nepal (could be 20% in two or there years). So, such cost should be, depending upon the time it takes, revised regularly and reset up to date. At present, the estimation is 20000 Euros.
MEDICAL INFRASTRUCTURES
Our first minimal option should be the smallest possible structure, so more similar to a DISPENSARY than a so called HOSPITAL.
We shall after some time, in the second part of our project, consider our final goal, building THE HOSPITAL.
Our first option : A DISPENSARY.
Considering the fulfilment of our goal in future (a possible expansion of our structures), our first building should be built as a part of the global structures and included in the general project. We shall continue to use it, even when the extension towards a bigger structure is taking place.
In such a dispensary, only a department for “Out patient” facilities can be given and up to 2 very serious cases only could be admitted. The rooms of such “Dispensary” should at first be used for modified purposes. When it will become possible to build a second or more buildings, we could give back the first building to its original purpose, only as an “Out Patient” department.
The building will be on two levels of respectively 222 m2 and 111 m2 for a total of 333 m2..
Ground floor : Outside treatment 222 m2
-4 consultation rooms of 38 m2, used for the following purposes.
Room 1 : Doctor’s consultations
Room 2 : Procedure room (for minor surgery)
Room 3 : Sterilization of instruments
Room 4 : Laundry
+ 2 toilets for 9 m2
+ Emergency room for 35 m2
+ Pharmacy for 12 m2
+Cash counter for 4,5 m2
+Store room for 12 m2. Since we do not need a room of this size simply for storage at first, we will use it initially as a laboratory
+Reception for 4,5 m2
+Waiting room for 42 m2. At first, this waiting room can be separated and partitioned (plywood) for the serious cases which cannot go back home or need closer supervision.
1st floor : Administration area 111 m2
-4 offices of 38 m2 as follows.
Office 1 and office 2 : communication and record keeping
Office 3 : storage of medicines
Office 4 : storage of laboratory chemicals and other items
-Meeting room 33 m2 : since doctors and other staff members would not have initially any accommodation, we could use this room as a common one.
-2 restrooms for 8 m2.
Cost of construction: as for the cost of the land, it is not easy to give a correct estimation in such a country where the yearly inflation is so high. Nevertheless, we can at present, seriously take for granted a cost of 250 Euros/square metre so a total cost of 83250 Euros.
Needed equipment for the above Dispensary :
As much as possible, it will be bought locally then whether in India or in China.
The cost of the necessary medical equipment and furniture for our dispensary is totally 26900 Euros.
Among many, the main costly items will be as follows :
1 oxygen concentrator = 1250 €
1 washing machine = 1200 €
1 microscope = 1000 €
1 analyser = 600 €
1 pulse oxymeter = 450 €
1 computer = 400 €
1 suction machine = 300
In the future, our second and final goal : A HOSPITAL.
Depending upon our financial possibilities and the time it might take to gather such means, our most important aim is to enlarge our capacity in treating patients and cases from the basic dispensary of the beginnings to the multi functions and treatments of a real hospital. We would then pass from 1 to 5 buildings. Of course, in doing so the surface would be much expanded, about four times, from a mere 333 m2 of one dispensary building to the 5 buildings of 1302 m2 for a real hospital.
Such hospital structures will consist of 5 buildings for a total area of 1302 m2, distributed as follows.
Our 1st building, already constructed as a dispensary on two levels, would stay the same and keep its initial duty for the outpatient care : on the ground floor, 4 consultation rooms, 2 toilets, emergency room, pharmacy, cash counter, store room, reception and waiting room. On the first floor, as before, there will be the administration 4 offices and 1 meeting room + 2 toilets. These 2 floors will stand for an unchanged surface of 333 m2.
Building 2 : on one level of 279 m2 for hospitalization and intensive care (ICU, common separate rooms for children, men and women, nurses, 4 private rooms with own toilets, preparation and quarantine rooms, 4 rest rooms).
Building 3 : one level of 233 m2 for analysis, diagnostics and surgical procedures (2 labs, x-ray room, endoscopy, preparation room, operating room, delivery room, sterilization, 4 toilets).
Building 4 : one level of 112 m2 standing for resting quarters and technical services (cafeteria, laundry, maintenance, generator, 2 toilets).
Building 5 : one level of 344 m2 for physicians lodgings (accommodations of 3 rooms with separate toilets and showers for 3 Nepalese doctors and 2 foreign visiting doctors).
Depending upon the choice and quality of the chosen materials, the estimated cost of construction will be 242000 Euros.
As for the land and our first building, we have to point out that such price should be regularly revised, in accordance with the yearly rate of inflation. 20% increase in the coming years is a reasonable perspective.
The purchase of a large area of land, to be fenced, will maintain a quiet buffer space between the hospital and the various activities that will develop around such as small businesses, which can generate noise and poor hygiene. The extra land will be needed for technical improvements (covered walkways to walk from one building to another during strong rains, space for installing telephone and internet communications, protected space for recycling trash and securing medical waste, warehouse with storage and repairing equipment where a local team will take care of mending the hospital). This space will also help to develop activities leading to incomes and tending to our financial autonomy in the coming years (organic gardens, solar and hydro energies, low cost pharmacy, etc...).
The needed equipmentfor the above hospital.
Locally bought or in India and China, such equipment and furniture is of course much more important than in our first option (dispensary). Its cost is then of 70000 Euros and, among many, the most costly items are :
Ultrasound scanner, X-ray machine, 4 units of oxygen concentrators, anesthesia machine, microscope, pulse oxymeter, suction machine, 6 stethoscopes, 5 otoscopes, washing machine, 40 beds, mattresses and chairs, 4 wheelchairs, 2 computers.
OPERATING COSTS
The resources of the local people are extremely small and often nil : the surrounding villages are populated by poor farmers whose main activity is agriculture and trade through barter. Therefore and that is the reason why our project was created, the costs of care and treatment cannot be borne by the villagers. However, locals can participate to operating costs by providing an exchange of services (keeping cattle, gardening, helping maintenance of premises etc...) or provide a supply of food from their crops and even contribute in hand labour for various jobs. It will not be very important and never a sufficient source of income to fully cover our operating costs. Thanks to the additional activities, sources of food, energy self sufficiency and incomes we plan to have right from the construction and the beginning of our activity, we should tend as soon as possible towards a financial autonomy in operating costs. Of course, that will only be possible after some time, which length we cannot know with precision. We therefore wish to find partners, patrons or sponsors who engage themselves to sustain us steadily during the first years of our activity. Without such commitment and stable financial help, we will not be able to continue our duty of treating thousands of local patients.
Among our annex activities to generate incomes, a very important initiative is the “Voluntary medical tourism”, described on the next page.
Our two main operating costs are wages for our staff and the various supplies, medical equipment, food for the daily needs.