ITAHARI, July 9: Uttam Bahadur Magar of Shadananda Municipality-12, Bhojpur, arrived in Dharan on Monday and visited the B.P. Koirala Institute of Health Sciences (BPKIHS) for treatment on Tuesday. He had also sought treatment at the institute three years ago. While he received treatment without difficulty then, this time he said he had to go through numerous hassles.
"This time, I had to go from one department to another," Magar said. "They told me the doctor would only be available on Friday. When I explained that I had come from far away, they finally conducted my check-up, but there is still no indication of when the test report will be ready."
Magar, who came to the institute complaining of lung problems, said the delay had become a burden.
"It is the rice-planting season. I wish the treatment were faster. I don't know how many more days it will take," he said.
Ganga Bahadur Tamang of Tehrathum, currently residing in Morang, shared a similar experience. He said he had come to the institute for treatment for stomach problems.
"They told me my test report would be ready by 4 pm on Monday, but even half an hour after the scheduled time, it had not arrived," he said.
His son, Chetan Tamang, said the institute's procedures were difficult for people unfamiliar with the system.
"The staff do not provide clear information, which makes things even more difficult," he said. "It is especially challenging for patients with serious illnesses."
Padam Kumari Magar, a resident of Dharan, has been admitted to the institute's Intensive Care Unit (ICU) for the past four days with liver-related complications. Her granddaughter, Mamata Giri, said the family had been anxious because doctors had not provided clear information about her condition.
Nearly 3,000 patients visit the institute every day for treatment, including both outpatient department (OPD) and emergency cases. Around 80 percent of them receive treatment under the national health insurance program.
The heavy patient load has made it difficult to accommodate critically ill patients and pregnant women requiring intensive care. The Pulmonary ICU has 10 beds, while the Surgical ICU (SICU) and Neonatal ICU (NICU) have six beds each. The Pediatric ICU (PICU) and Medical ICU (MICU) have four beds each. Of the institute's 97 ventilators, 39 are currently out of service.
Cancer patients suffer in lack of tomotherapy machine
Institute spokesperson Dr Shamsher Shrestha said the ventilators are nearly 30 years old and cannot be repaired because spare parts are no longer available.
The shortage of ICU beds and functional ventilators has forced many patients to seek treatment in Biratnagar, Kathmandu or India.
"Many hospitals across eastern Nepal refer critically ill patients to this institute, which is one of the reasons behind the shortage of ICU beds and ventilators," Dr Shrestha said. "Despite following all ICU and ventilator protocols, it has been difficult to overcome the shortage."
He added that the overwhelming patient flow has also created management challenges.
"There is the problem of long queues and overcrowding," he said. "We have been working hard to improve patient management."
According to him, patients receiving treatment through health insurance also face stricter administrative procedures because of the Health Insurance Board's regulations.
Patients from Koshi and Madhesh provinces, as well as neighboring areas of India, regularly visit the institute for treatment.
Institute preparing to reclaim encroached land
The institute has begun preparations to reclaim nearly 10.5 bigha of land allegedly encroached upon by various organizations.
Following an inspection by Minister for Home Sudan Gurung and Minister for Health and Food Safety Nisha Mehta two days ago, during which they directed authorities to clear the encroached land, the District Administration Office and the institute's management initiated the process.
Chief District Officer Basudev Ghimire said land measurement has already begun and eviction will start once the survey is completed.
The institute owns around 268 bigha of land. According to institute officials, a country club has encroached upon around 10 bigha, while B.P. Sundar Bazar and a religious monastery (gumba) have each occupied four kattha. About one additional kattha has reportedly been occupied for religious purposes.
Following the establishment of the institute, Kathmandu Leasing and Housing Pvt. Ltd. had leased 10 bigha of land for 50 years to operate restaurants and guest houses. However, after the company's owner left five years ago, local residents reportedly began using the land.
Institute officials also said the gumba has constructed structures on the land and has been collecting fees. They claim religious activities, including Sakela celebrations, have occupied parts of the land since the institute's establishment.
Of the institute's total land, 84 bigha consists of forest area, which has remained intact despite surrounding the hospital premises.
CDO Ghimire said constructing physical infrastructure on the encroached land and collecting fees with the involvement of B.P. Sundar Bazaar and the sub-metropolitan city violated existing regulations.
He said that if the monastery and organizers of Sakela activities refuse to lease the land legally, they will be required to vacate it immediately.
Financial instability raises concerns
The institute is also facing growing financial challenges.
Its annual budget is approximately Rs 3.5 billion. Around 40 percent of its income comes from academic programs, while the remaining 60 percent is generated by hospital services and other sources.
Of the institute's total income, about 60 percent is spent on salaries and operational expenses. Monthly salary expenses alone amount to around Rs 160 million. The institute currently employs around 400 doctors and 1,500 other staff members.
Approximately 80 percent of patients receive treatment under the national health insurance scheme. However, institute officials say reimbursement payments are often delayed and, in many cases, reduced.
The government provides support for infrastructure development but does not cover salaries and allowances.
"On one hand, insurance reimbursements do not arrive on time. On the other, the institute must spend most of its income on salaries, creating serious financial instability," Dr Shrestha said. "If this continues, the institute could face significant financial difficulties in the future."
Procurement process for MRI machine begins
After receiving Rs 250 million from the government, the institute has begun the procurement process for a new MRI machine—the first such purchase in 15 years.
A technical presentation by prospective suppliers was held on Tuesday before the international tender was announced.
Previously, procurement involved biomedical engineers preparing technical specifications before tenders were invited. According to the institute, that process often resulted in restrictive specifications, inadequate consultation with doctors regarding the latest technologies, and repeated revisions to tender documents.
The institute is now procuring the MRI machine through an International Competitive Bidding (ICB) process.
Officials expect the ICB process to make procurement more cost-effective by exempting the institute from certain taxes, including value-added tax (VAT).
"The new MRI machine will help diagnose diseases that cannot be detected through ultrasound or X-ray examinations," Dr Shrestha said.
