Medicosnext
Mr. Milan Gurung
He is the Chief Executive Officer of Upendra Devkota Memorial National Institute of Neurological and Allied Sciences and the Director of Programmes of Upendra Devkota Foundation dedicated to continuing the legacy of late Prof. Dr. Upendra Devkota.
I feel an immense sense of pride and honor to be a part of the management team of this very special institution, which is the dream project of Prof. Upendra Devkota. This is the first super-specialty hospital of its kind, dedicated to neuroscience and other related (allied) specialties. However, as brain is the central command of the body, it’s ailment affects all the organs and organ systems. The functioning of the heart and blood vessels, breathing and respiration, hormonal balance, digestive systems are all affected by it. This interrelationship warrants that the neurological conditions are not considered in isolation This interconnectedness demands a true multidisciplinary approach. At our institute, the neurologists, neurosurgeons and neuro-interventionists are supported by other consultants—cardiologists, endocrinologists, nephrologists, pulmonologists, psychiatrists, physiatrists, critical care specialists, physiotherapists, neurotologists and more. Each brings a vital perspective in managing the complex, often multisystem challenges that neurological patients may present with.
In recent years, the fields of neurology, neurosurgery and neuro intervention have witnessed rapid advancements worldwide. Robotic-assisted surgeries, AI-supported diagnostics to minimally invasive procedures like endovascular coiling and thrombectomy for stroke care, and advanced neurorehabilitation using AI. While we have taken strides and imported many of such cutting-edge technoloy to Nepal, the road is not easy.
Keeping pace with global standards involves more than just purchasing equipment. It requires trained human resources, regular exposure to international best practices, continuous medical education, and a sustainable model to operate such services in resource-constrained settings. Recruiting and retaining highly skilled neuro specialists—many of whom are drawn to opportunities abroad—is a persistent challenge. Moreover, the cost of updating our infrastructure with state-of-the-art technology is significant, especially in the absence of widespread health insurance and institutional investment in specialized care.
Despite these hurdles, we strive to bridge this gap. Our goal is to offer not just neurological treatment, but holistic, integrated care—right here in Nepal—so that patients need not travel abroad or compromise on the quality they deserve. At the core of our hospital’s philosophy lies the simple yet profound principal- “Patient First”. This is not merely a slogan—it is the compass that guides every decision we make, from the outpatient desk to the operating room.
Problems in our healthcare system
Inadequate Emergency Medical Services (EMS)
Nepal’s EMS infrastructure is underdeveloped. Many ambulances lack essential medical equipment and trained personnel. We have recently seen an increase in the number of ambulances and the government strengthening its work in emergency response via Nepal Ambulance service, whose services can be accessed via hotline 102. Even locals of some places have teamed up to come up with ambulances for the locality, to serve the needy in times of emergency. However, most of the patients arriving at emergency departments still rely on taxis or private vehicles. This lack of pre-hospital care can be detrimental, especially for neuro patients requiring immediate attention.
Misleading Advertising
In an attempt to attract patients, some hospitals in Nepal resort to exaggerated advertising, claiming to offer services and facilities that they are ill-equipped to provide. Such misrepresentation can mislead patients, resulting in suboptimal care and eroding public trust in the healthcare system.
Out-of-pocket expenses
One of the most pressing challenges in providing neuro-specialty care in Nepal is the staggering out-of-pocket expenses patients must bear. Nepal’s health insurance system, while expanding, remains inadequate for covering complex neurological procedures. Many patients requiring neurosurgical interventions face catastrophic out-of-pocket expenses that can bankrupt families. The lack of comprehensive coverage for rehabilitation services, crucial for neurological recovery, creates additional financial burdens.
Fragmented Referral Systems
Our referral system is rigged. We have witnessed multiple cases of people in rural villages often referred to bigger hospitals for consultations, only to be seen by medical officers and sent back home. The Health Insurance board referral system fares a little better with the referral system. The patients seeking health benefit from primary care set-ups are referred to the higher centers for further consultation and they do get the benefit with the government allowing multiple hospitals to function as referral centers. However, when it comes to the private hospitals the referral doesn’t work in the same manner. Most of the cases are handled by the hospital that sees the case first. The absence of a standardized referral system leads to inefficiencies and delays in patient care. Patients often face challenges in being referred to appropriate facilities in a timely manner, thereby worsening the health outcomes.
Unethical Referral Practices
\practices in Nepal’s healthcare system is the widespread culture of commission-based patient referrals. We have witnessed at different times the unethical practice of hospitals offering commissions to ambulance drivers and intermediaries for bringing in patients. Investigations have revealed that some hospitals pay ambulance drivers lump sum amounts or a percentage of the agreed patient’s total bill to secure admissions, especially for critically ill patients requiring intensive care. The practice, where ambulance drivers, general practitioners, and even hospital staff receive monetary incentives for directing patients to specific facilities, fundamentally corrupts the patient-provider relationship. This practice not only compromises patient trust but also leads to unnecessary financial burden and potential delays in receiving appropriate care. Families desperate for neurological care often find themselves directed not to the most appropriate facility, but to the one offering the highest commission.
Pathways to Improvement
To address these challenges and enhance the quality of neurological care in Nepal, the following measures are recommended:
Strengthen EMS Infrastructure: Invest in upgrading ambulances with necessary medical equipment and train personnel in emergency care. Strengthening the organizations like Nepal Ambulance Service can be beneficial.
Regulate Medical Advertising:
In Nepal we have strict policies with regards to medical advertisements and medicines advertisements in print and video media. But turn that FM on your way to work and you will be bombarded with advertisements of care centers that seem to heal everything. Remember the jingle “Hami kahaan mutu rog, baath rog, piles, stone, sugar, thyroid, asthma, bajhopan, netra rog, swas praswas ko samasya adi ko upachar garinchha, tyo pani bina operation, bina jhanjhat!” This is often misleading and the vulnerable patients often flock to these centers based on hope, not scientific credibility. There is minimal regulation of medical advertising in Nepal, and no requirement to prove that a service is actually available as advertised. We ought to introduce stringent regulations to ensure that hospital advertisements accurately reflect the services offered. Misleading claims should be penalized to maintain public trust.
Standardize Referral Systems: Develop a cohesive referral framework that facilitates timely and appropriate patient transfers, ensuring continuity of care.
Implement Ethical Referral Practices: Establish clear guidelines prohibiting financial incentives for patient referrals. Regular audits and strict enforcement can deter unethical behaviors.
Conclusion
The journey of establishing and operating a superspecialty neuro center in Nepal is full of challenges, but with concerted efforts, transparency, and ethical practices, it is possible to transform the landscape of neurological care in the country. By addressing systemic issues and prioritizing patient welfare, we can pave the way for a more equitable and efficient healthcare system.
