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					Friends of Tansen 2008   1
                        Hospital Activities

                        Editorial Team: Roshan Kharel, Rosemary Gin, Rachel Karrach, and PK Rai
2   Friends of Tansen 2008
          Greetings From
          Greetings Fr
      Tansen Mission Hospital
Dear Friends,
We are now enjoying a relatively         country, it was decided that God
peaceful period in the country,          was closing this door for now and
although the situation on the plains     thus, the Memorandum of
to the south is still volatile. We are   Understanding (MOU) with HDCS
also hoping that our new                 will not be renewed after July 2008.
emergency department building            A separate support office for both       Our vision is to be giving
(currently under construction) will      Tansen and Okhaldunga Hospitals          witnesses of God's love as we
be operational by early May 2008-        is needed now in Kathmandu.              aim to provide holistic, quality
thank you for your help in this.                                                  health      ser vices      with
                                         In the coming months, we will be
                                                                                  compassionate care and
Our transition to Human                  exploring other options for
                                                                                  appropriate training.
Development and Community Services       transitioning from UMN by 2010-
(HDCS) came very close to                please pray for this process.            We are grateful to all the friends
happening but then the process                                                    of Tansen who have written to us,
                                         Despite the continuing uncertainty,
stalled again. Despite all the work                                               prayed for us, knitted blankets and
                                         we are working on our next five-
put in by HDCS and UMN to                                                         baby clothes, and helped us
                                         year Strategic Plan and we are
achieve this, the transition has not                                              financially. It is so encouraging to
                                         confident that this hospital still has
been possible.                                                                    see the support we receive from
                                         an important role to play for many
                                                                                  all over the world.
In view of the very long delay and       years to come.
the continued uncertainty in the

                                                                                  Thank you!

                                                                                                    Rachel Karrach
                                                                                                   Hospital Director

                                                                                              Friends of Tansen 2008     3
                An Update on
              Hospital Transition
    It is my privilege to be able to write to you-the      After amicable consultations between the Leadership
    Friends of Tansen. Your continued prayers and          Teams of Tansen and Okhaldunga Hospitals and
    support have enabled the hospital to minister to the   UMN, it was mutually decided that UMN would
    people of the surrounding areas.                       not renew its MOU with HDCS regarding the
                                                           management of the two hospitals, which will expire
    This past year has been a difficult one for all
                                                           in mid-July 2008. The central support being
    concerned in the transition process. In March 2007,
                                                           provided till date to both hospitals by the Health
    agreements for HDCS to operate the Tansen,
                                                           Services Directorate (HSD) of HDCS will thus cease
    Okhaldhunga, Dadeldhura, and Lamjung Hospitals
                                                           from this date.
    were presented to the cabinet of the interim
    government. To our delight, the agreements were        While UMN will still continue to support expatriate
    approved and sent back to the Ministry of Health       personnel, both Tansen and Okhaldhunga hospitals
    and Population for signing. Since then, agreements     will form a central support unit in Kathmandu to
    for Lamjung and Dadeldhura hospitals have been         take over some of the functions of the present
    signed thereby allowing HDCS to continue to operate    HSD.
    these hospitals.
                                                           None of us knows what will happen in the future.
    But agreements of Tansen and Okhaldhunga               Our prayer is that these hospitals will continue to
    hospitals have not been signed till date, causing      serve the needy people in a holistic manner whilst
    concern to staff members and other stakeholders.       still maintaining the values of UMN which established
                                                           Tansen Mission Hospital in 1954.

                             We commit ourselves to the One who holds the future in
                                  His hands and whose plans are perfect

                                                                                            Dr Olak Jirel
                                                                                Health Services Directorate
                                                                 Human Development and Community Services

4   Friends of Tansen 2008
     In Him, A  ll Things
     a re Possible
                                                              Serious and Intensive at Work-
                                                              Dr. Ed Tegenfeldt and his Team

It all started one morning in         With the blood transfusion running,    Finally, the baby’s head was swathed
September 2007 in a small village     the baby anaesthetised, and her        in bandages and she was slowly
room in nearby Tansen where a tiny    head wound cleaned up, a piece of      allowed to recover consciousness
six-week-old baby lay asleep.         skull bone came away immediately.      from the anaesthesia. Much to
                                      Some delicate inspection only          everyone’s delight, she awoke with
Two monkeys suddenly jumped in
                                      confirmed our worst fears-the          vigour, cried, moved, and put up a
and prowled menacingly around
                                      wound was deep and dirty.              good fight. Any child that tries to
her. When the baby’s aunt chased
                                                                             remove its bandages after surgery
them away, one of the monkeys
                                                                             is definitely fine!
doubled back behind her and
bit the sleeping baby on the     This led me to wonder,                          Later on, Dr. Ed was to make
head, causing a hole in her      “Just where in the world would                  use of a handy piece of
skull. She was then rushed to    they find a monkey-bite expert                  technology (where advice is
Tansen Mission Hospital by       surgeon than in Tansen?”                        sought from experts worldwide
her mother and aunt via a                                                        via the internet) as he searched
long journey by foot.                                                            for tips on how to proceed with
                                                                             the operation. He then removed the
Barely occupying a quarter of the     Dr. Ed Tegenfeldt, the surgeon, then
                                                                             skull piece from its hiding place in
table’s length, the tiny infant now   carefully cleaned the wound and
                                                                             the thigh and replaced it in its
lay quietly on the operating table.   made some hard decisions.
                                                                             original place.
Blood oozing out of an ugly head
                                      From the child’s leg, he removed
wound denoted significant blood                                              This led me to wonder, “Just where
                                      some tissue lining from the thigh
loss, as did her passive lack of                                             in the world would they find a
                                      muscle and fashioned a patch that
response that suggested possible                                             monkey-bite expert surgeon than in
                                      would repair the defect caused by
brain damage.                                                                Tansen?”
                                      the monkey’s bite. Into the same
We were heartened when she            hole he had created to remove this     Indeed, with God, all things
awoke from her stupor, cried with     potential patch, he placed the         are possible.
some vigour, and waved her tiny       cleaned-up skull bone piece to keep
arms and legs about. The bleeding     it alive. Some more intensive
was slow so we decided to organise    minutes later, the muscle-lining
                                                                                                 Steve Pickering
a blood transfusion and delay         patch was finally sewn over the
surgery.                              hole.

                                                                                         Friends of Tansen 2008     5
    Helping Hands for Tansen's Women
    A child’s faint cries can be heard as we enter the house.                                                              M
    We leave our sandals outside and duck low to enter the hallway. A
    newly-turned mother sits on a bed nursing her three-day-old son in the
    corner of a small, dark room. She smiles shyly and covers herself as we
    enter the room.
            “Children are a blessing from the Lord: Proverbs 17:6”
                                                                                               A Tansen Staff teaching a
    Annual government statistics reveal   well as 30 other women volunteers.       and encourage and guide them when
    that almost 700 women in the          In the last six months alone, this       and if the need arises.
    township of Tansen deliver children   team of 60 professionals has             The future of this programme lies
    and that over half of these women     conducted 331 visits to 184 new          in these very women that we have
    do so at home, many of them in        mothers and infants and identified       trained to take control. We are
    the absence of a skilled birth        124 women and babies with health         excited as we ponder upon the
    attendant.                            issues-seven of whom needed              future of mothers and infants as
                                          hospitalisation and special attention.   they are monitored and cared for
    Monitoring these women and
    newborns during this precarious       We are truly grateful to have such       by the volunteers who live close to
    time, when mother and child both      a committed and willing group of         them.
    undergo drastic physical changes,     women to work with us.                   Please remember to pray for the
    is thus the focus of the Community    From the beginning, it has been the      staff of the CHD as they seek
    Health Department’s (CHD)             CHD’s desire to have volunteers          to identify groups and
    Postpartum Programme (PPP), a         assuming control and direction of        communities that want to
    project that began two years ago in   the programme in the future. They        address their health needs.
    four neighbourhood areas of           will soon be the ones responsible
                                                                                   Indeed, there is still much
    Tansen and has now expanded to        for visiting and evaluating mothers
                                                                                   work to be done here in Palpa.
    15 Tansen neighbourhoods where        and infants.
    over 26,000 people live.
                                          In the next year, we will begin the
    Naturally, we could not run this      process of handing the programme
    programme alone, thus, we             over to the volunteers who help us                     Glen Anderson
    currently have 30 local Female        in running it. Our new role will be               Chief of Community
    Community Health Volunteers as        to act as the coach on the sidelines                          Health

6    Friends of Tansen 2008
            Memories of Tansen
          I first arrived in Tansen in April 2007   I did not immediately start studying
          as a practicing General Surgeon from      Nepali but spent my spare time
          Kamloops, British Columbia,               reading surgical textbooks,
          Canada, and was immediately struck        particularly older ones, to learn
ching a   by the remarkable similarities            procedures I had never seen or rarely    As one proceeds with morning
          between my previous medical               practiced before! Doing such             rounds of Surgery, one is witness to
          experiences in India and Guatemala.       surgeries can be quite stressful but     a vast number of patients and
                                                    also very rewarding when one sees        problems. I initially found the interns
          I suspect those of you who have           patients recovering and doing well. It   to be a bit timid and only gradually
          spent time in the developing world        also reminds one of the remarkable       understood why-our approaches to
          will feel the same. I have lived in       ability of this god-given human body     learning were just so different.
          Tansen twice in 2007, once for six        to heal, even from some devastating      Fortunately, we soon found our
          weeks and a second time for eight         insults.                                 rounds growing to be a very useful
          weeks, and have been touched by its                                                interaction: an opportunity to provide
          wonderful uniqueness. The following    Working with the interns, residents,
                                                 and junior surgeons is challenging,         good patient care and helping to
          is a personal perspective during my                                                mould some of these young, eager
          time in Tansen:                        rewarding, and occasionally
                                                             frustrating when they           physicians.
                 Working with the Nepali staff is            seem reluctant to adopt         The type of patients one sees here is
                 no less fun and pleasant for they           things that seem self-          amazing. There is a large amount of
                 are happy, capable, and                     evident to our way of           trauma cases and a very wide
                 committed to taking good care               thinking. It is also a          spectrum of infections. I found
                 of patients.                                positive experience as one      myself seeing pus in places I never
                                                             sees them learning and          would back home! In some ways, it
          I arrived at the Mission Hospital and absorbing information, improving             is a bit like going back in time, both
          was greeted by the guest house upon their skills, and progressively
                                                                                             in the array of problems one sees
          manager and felt welcome by becoming more independent.                             and in the ways they are managed.
          everyone–the hospital staff,
          physicians (both local and foreign), Early morning, all physicians meet            Renal stone disease complications are
          and the people in general. One gets a for a short devotional, which follows        a frequent problem and often very
          real sense of community here and a review of the cases admitted after              large and advanced. The combination
          the expatriate community is warm 5 p.m. the night before. An intern                of heat, hard work, impure (and often
          and welcoming too. I enjoyed our reviews medical and paediatric                    hard to acquire) water, little fluid
          many evening meals out which helped admissions and the other, the surgical         intake, and, I suspect, genetic
          us to know each other better.          and obstetric cases. Initially, the often   susceptibility, all lead to these often
                                                 rapid-fire patient reviews can be           large stones. Even small children can
          Working with the Nepali staff is no difficult to understand until your ear         be affected and require surgery.
          less fun and pleasant for they are adjusts to the Nepanglish flow of
          happy, capable, and committed to language!                                         Of course, there is no lithotripsy
          taking good care of patients. I, thus,                                             (extracorporeal or otherwise) and,
          quickly adjusted to my new Ward rounds also allow for collegiality                 until recently, no adequately working
          circumstances for the people here between junior medical staff and                 cystoscopes!
          made this transition easy and care- medical colleagues.
                                                                                                          Friends of Tansen 2008       7
    Removal of obstructing stones              One particular case will always stick      As I leave Nepal after my second
    requires open operations, which are        with me: She was a nine-month old          short-term mission, I leave with many
    quite challenging not only because we      who had rolled into a fire and severely    new fiends, experiences, and
    no longer experience these                 burned both of her lower limbs and         memores. I don’t know when I will
    procedures in the developing world,        part of her lower torso. She presented     be back next as I have other
    but also because they are usually seen     late and had to have parts of one leg      opportunities and commitments in
    at such a late and complicated stage       and other foot amputated.                  other parts of the world (and there is
    here.                                                                                 much need, as well), but I will no
                                               We nursed her through the initial
                                                                                          doubt be drawn back to Tansen.
    One of the areas I found most              critical stages and also gave her a skin
    difficult to adjust to was the Burn        graft. She was beginning to do well;       The people, the quiet hillside, the sight
    Ward. Unfortunately, burns are quite       but after three weeks of diligent          of the Annapurna Mountain Range,
    common here–people rushing into            treatment and dressings and many           and the collegiality of the people
    their barns to save their livestock, gas   operations, she developed a severe         working here are powerful and
    stoves exploding, attempted kerosene       infection that resisted all treatment      rewarding. I leave Nepal having
    suicides, and small children scalded       and ultimately led to her untimely         gained much more than I have given.
    from pulling down boiling pots or          demise.
                                                                                          I am truly thankful to God for
    rolling into a cooking fire.
                                               When one puts a lot of energy–             the opportunities He has
    Often, children below the age of two       physical, mental, and emotional–into       provided for me here and His
    are left in the care of an older, but      patients and is witness to their heart-    guidance and safe and loving
    still very young, sibling while the        wrenching suffering, only for it all       hand.
    parents go to work in the fields. It is    to end in vain, it is a heart-wrenching                              Dr. Jon Just
    heart-wrenching to see these babies        moment.                                                      Short-term Surgeon
    in pain.

                                                                           My Tansen
                                                                     Here in Tansen
                                                                       I can see the beautiful mountains
                                                                          The clouds are as fluffy as
                                                                        white cotton and the
                                                                          jagged mountains
                                                                      hide behind them
                                                                  The misty valleys lie at the
                                                                bottom of the tall mountains
                                                         From here, I can see the curvy rivers
                                                       The valley as green as the sky is blue
                                                                        My Tansen
      Elizabeth, 8, is the daughter of
     Dr. Davey, General Practitioner at
       Tansen Mission Hospital, and                                                   by Elizabeth Gin
              Rosemary Gin

8    Friends of Tansen 2008
Surgery-A Team Effort in
                                                                           Surgery-A Team at Work

The operating theatres at Tansen         The x-rays hanging on the viewing        of 24-hour emergency surgery is
Mission Hospital are a busy corner       box in his office tells many a tale      because it has a capable 24-hour
of a busy institution.                   about falls, fractures, and splintered   anaesthetic service.
                                         bones spread about in ways that
The kinds of surgery performed here                                               The head of the anaesthetic
                                         looked too painful to even
are often much more complex than                                                  department, Mr. Durga Pahadi, was
in a similar-sized hospital in a                                                  trained by an English anaesthetist
developed country. Good                 Such high quality work in a remote        more than 20 years ago and has
transportation and referral services    and poor country does not depend          worked exclusively in anaesthetics ever
also help make this a viable option.    on surgeons alone. A single               since. The rest of the anaesthetic staff,
                                        operation is possible only through        like him, is comprised of nurses and
However, it is an entirely different
                                        a team effort where administrative        health workers who have been trained
matter in Nepal where transportation
                                        personnel procure resources               in anaesthetics.
is more difficult and costly for simple
                                        necessary for surgery, hospital
village folk. In most cases, patients                                             Tansen is, thus, one of a handful of
                                        workers sterilise and organise
are simply too sick and poor to move                                              sites in Nepal that has been approved
                                        equipment and clean the theatre
anywhere.                                                                         as a training location for anaesthetic
                                           areas, scrub nurses and scout
                                                                                  workers. A mix of classroom theory
                                                      nurses assist the
                                                                                  and on-the-job training under the
                                                         surgeon, and junior
                                                                                  supervision of a doctor anaesthetist
      Tansen is, thus, one of a handful                     medical staff
                                                                                  and constant exposure to the large
       of sites in Nepal that has been                      are constantly
                                                                                  surgical load allows the trainees to
                                                            being taught by
       approved as a training location                                            master the skills necessary for
                                                           their    senior
           for anaesthetic workers.                      counterparts. Also,
                                                   visiting surgeons from         Without the dedicated work of
                                         within and beyond Nepal work             these        people-surgeons,
Dr. Indra Napit, our long-time Nepali   long hours and teach with                 anaesthetic staff, administrators,
surgeon, has headed the Surgical        enthusiasm.                               nurses, and the supporters of
Department for the past 3 years. His                                              Tansen-the life-saving and
                                        Many of these short-term surgeons
subspecialty is orthopaedics, but like                                            changing work of surgery in
                                        return for a second visit or refer
any surgeon in Tansen, he can also                                                Tansen just would not be
                                        their colleagues.
be found performing general surgery,                                              possible.
caesarean sections, and whatever else   One essential component of good
is needed!                              surgery is a good anaesthetic. One
                                        reason that our hospital is capable                               Steve Pickering

                                                                                                Friends of Tansen 2008        9
   Life in the Maternity Ward
  A new-born child brings a smile         ratio in our department is only 1:10.
  to its mother, hope to its father,      We want to do the best for our
  and joy for the family. What a          patients; yet unfortunately, we are
  wonderful gift from God!                unsuccessful sometimes. Thus, the
                                          high mortality rate here as most of
  It is truly amazing to see wonderful
                                          our patients come from outside
  new lives coming to this world.
                                          Tansen and mostly present very
  Unfortunately, this is not always the
  case for there are times when the                                                                                  ft
                                                                                                       ond   from le
  new ones cannot make it. We then        An incident occurred a few months                    or, sec
                                                                                     T he auth
  feel privileged to share their grief    ago during my night duty: a
  with the families.                      premature baby was born with            the child breathing the next day! We
                                          severe complications and lay in bed,    then praised God for allowing us
  Life in the maternity ward is very                                              to be a part of His miracle.
                                          breathing with difficulty. This
  stressful and busy at times.
                                          painful scene moved us all-doctors      Lastly, I would like to put in a very
  Sometimes, I sense that we nurses
                                          and nurses-into a prayer. How           warm ‘Thank You’ to all who pray
  are not meeting the expectations of
                                          relieved and glad we were to see        for us and support our work here.
  the mothers, as the nurse-patient
                                                                                  I would also like to thank the
                                                                                  ladies of Kangaroo Flat Baptist
                                                                                  Church and Ms. Shirley
                                                                                  Mainstone and her friends who
                                                                                  have, most faithfully, been
                                                                                  sending woolen knitted wears,
                                                                                  rugs, and cards for all our
                                                                                  newly-born babies. Your caring
                                                                                  heart truly encourages us!
                                                                                  Thank you!

  Ms. Shirley Mainstone, third from left, and friends of
                                                                                                      Esther Kharel
  Kangaroo Flat Baptist Church                                                                Maternity Ward Nurse

                            A New Location for our Cashiers
  The inpatient and outpatient cash offices, previously located in
  different areas, are an integral part of Tansen Mission Hospital.
  and are responsible for processing financial transcations for patient
  investigations, surgeries, procedures, and hospital stays for around
  300 and 40 outpatients and inpatients respectively each day. As the
  number of patients has gradually increased, so has the need to
  centralise these two offices.
  And centralise is what we have done now-both offices are able to
  help one another during busy times and as a result, reduce the long
  queues that were previously present.
10 Friends of Tansen 2008
                        A New Life for Shyam Lal
                                         kill him as he called himself               stay was thus covered. In total, he
                                         'unworthy' of living with his ‘useless      visited the operating room 23 times
                                         body’. Even after the operation, he         for dressings, skin grafting, and other
                                         continued to pester the nurses to end       treatments.
                                         his life.
                                                                                     It was truly hard for Shyam, just
                                         In the 35th day of Shyam’s stay, a          23, to come to terms with the loss
                                         surprise visitor arrived and left as soon   of his dreams and hopes for the
                                         as she came-his wife! Thus, no one          future.
                                         from the Pastoral Care Team was able
                                                                                     The postoperative period was critical
                                         to meet and talk to her. Shyam later
Shyam Lal came to Tansen Mission                                                     for Shyam for he needed a great deal
                                         told us that she was leaving him and
Hospital like so many - in need of                                                   of emotional support and prayer to
                                         going back to her parents’ house as
urgent medical care.                                                                 help him cope with his new physical
                                         he was ‘useless’ now that he had lost
                                                                                     condition. The Pastoral Care Team
On his way back home to Nepal            his right leg.
                                                                                     spent time with him, continuing to
after a frustrating job hunt in Delhi,
                                                                                     pray for and with him, all the while
India, Shyam met with an                    Shyam
                                           thank al continue
                                                                                      encouraging and counselling him.
unfortunate bus accident when he
                                                   a            s
                                          for br nd praise G to
was run over by a bus while                                                            As he started to improve, he
                                                 in             o                     opened up emotionally. His gloomy
                                         from t ging him ‘b d
witnessing a fight between bus
drivers. Some locals urgently                                                        expression slowly lightened and we
                                                h             ac
rushed him to a hospital where          adds, “ e dead’ and a k                      slowly saw joy in his eyes.
                                                A            ls
Shyam lay unconscious and
                                      life no t least, I hav o                       Three months later, he was able to
bleeding. Fortunately, someone                w             e
found his diary and called his      my leg , even with a                             start walking with crutches. He started

family in Nepal.
                                             ”.            out                       attending chapel services and even
                                                                                     shared his story one day. After
His father received the call and a                                                   completing his treatment, he was
few days later, saw his son in a                                                     then referred to Green Pastures
                                         Naturally, Shyam was more
most miserable state: the crushed
                                         devastated, “Why did I even
                                                                                     Hospital in Pokhara for artificial limb
right leg had been attacked by                                                       fitting.
gangrene and now smelled awful. A
                                         Shyam’s family of seven has a small         The Pastoral Care Team continues
social organisation then arranged for
the two men to make it to the India-     piece of land which provides food           to play a vital role in the mental and
Nepal border, from where they            for only three months of the year.          spiritual healing process of such
would then arrive here at the            For the rest, the family has to rely on     unfortunate patients like Shyam.
Mission Hospital.                        manual labour.                              Shyam Lal is just one more
Immediately after their arrival,         It was but obvious that his treatment       example of how we see the Lord
Shyam was sent to the operating          expenses needed to be borne by              working in the lives of the
room for surgery on his broken arm       somebody else so our Medical                broken-hearted here in Tansen.
and an above-the-knee amputation         Assistance Fund took care of this. His
for his right leg. Shyam continued to    entire bill of Rupees 150,250.00                        Pun Narayan Shrestha
struggle, pleading with the doctors to   (Around US $ 2385) for his 111-day               Pastoral Care Team In-Charge

                                                                                                  Friends of Tansen 2008 11
                               An Update on our New
                            Emergency Department Building

  Can you guess how many                   We thank you for your prayers           supplies, and a waiting area for
  patients visit us each year?             for this project and appreciate all     patients’ families and visitors.
                                           the support we have received
  At Tansen Mission Hospital, we see                                               The second floor of this building
                                           thus far.
  approximately 10,000 patients every                                              will comprise various outpatient
  year!                                    This building will have three floors,   clinics which will be accessible to
                                           with the emergency department           all outpatients from the current
  Some of these patients are from
                                           located on the third floor. Vehicles    waiting area. This floor will house
  surrounding towns and villages who
                                           will                                    the Dental Clinic, the Occupational
  walk for days to receive medical
                                                                                    Therapy Department, the Social
                                                                                        Ser vice Department and
  Our          current                                                                      specialty clinics, which
  emergency room is                                                                             include            ENT,
  a small room                                                                                        Tu b e r c u l o s i s,
  that       can                                                                                         Leprosy, and
  accommodate                                                                                             the        HIV
  two patients                                                                                            clinics.
  at a time.
                                                                                                            The ground
                                                                                                           floor will
                                                                                                           function as a
                                                                                                          garage for
  Inside it is                                                                                            staff       and
  the nursing                                                                                            hospital vehicles,
  station, a private                                                                                  including an area
  exam area, and                                                                                    for the security
  storage shelves for                                                                            guards.
  medical supplies. If there
  are more than two patients in
  a time, they are often placed on                                                 The estimated cost for this
  trolleys in the outpatient department                                            project is approximately
  corridor for observation and care.       be able to drop patients off directly   $250,000 US dollars.
  As you can imagine, it can be            outside the emergency department.       We trust that God will continue to
  challenging to care for patients who     Within this spacious and well-lit       provide the remaining resources in
  are not within sight of the caregiver!   emergency department, we plan to        His time.
  Construction for a new emergency         have ten patient beds, a nursing                                     Jeena John,
  department building began in April       station, a procedure and                                               Engineer
  2007 and is progressing well. We         consultation room, staff and patient    If you would like to support this project,
  are anticipating completion of the       toilets, a store room for medical       enclosed in this publication is an insert
  building by end-April 2008.                                                      with all the details, in Page 15.
12 Friends of Tansen 2008
Dear Friends of Tansen Hospital
Many of you will have heard the news with regard to the ongoing future of both the
Tansen and Okhaldhunga Hospitals but I thought I would use this opportunity to fill
you in on some of the details.
Three and half years ago, UMN sought Government of Nepal approval for HDCS
to take over the legal responsibility for Tansen and Okhaldhunga Hospitals through an
agreement with the Ministry of Health and Population.
The Government agreed, and while the agreement between HDCS and the Ministry of
Health was being negotiated, we handed over the management responsibility of the Hospitals
to the Health Services Directorate (HSD) of HDCS. HSD has been efficiently providing the
management and logistic support services for the UMN hospitals, as well as the HDCS hospitals.
However, the ‘legal ownership’, and therefore issues like overall liability, financing of support services and visas, has
remained with UMN. Our current MoU with HDCS runs out in July 2008 and the intention was that by that time,
HDCS would have the necessary Government permission (i.e., the signed government agreement) and we would
have completed our partnership, aimed at Capacity Building, with HDCS.
Despite three years of extreme hard work by HDCS, including intensive negotiations with the Government, the
Government has made it very clear that it will not hand ‘all the hospitals’ to one non-government organisation and
not from a Christian INGO to a Christian NGO. We, HDCS and UMN leadership, agree that it is extremely unlikely
that in the foreseeable future the Government will sign an agreement passing legal responsibility to HDCS.
Given the ongoing delay and uncertainty, at a recent meeting of the UMN Leadership Team, which was attended by
the Directors of both Tansen and Okhaldhunga Hospitals, the decision was made not to renew the MoU with
HDCS after July 2008. For the hospitals, the consequences are:
1. They will have to make alternative arrangements for the necessary logistic support they require.
2. With support and help from UMN, the hospitals will need to investigate and then choose another way through
   which they can obtain the necessary legal status, while fulfilling the UMN Board’s instruction, which is:
* The Leadership Team of UMN has the task to explore options to bring Tansen and Okhaldhunga hospitals
under the ownership of Nepali organisations.
* The Leadership Team should endeavour to preserve the mission values of all three (Patan was the third)
UMN will continue to provide that legal framework up to mid-2010, which is when our current General Agreement
with the Government of Nepal finishes.
I want to emphasise and assure you all this has been done with the involvement of the two Hospital Directors, who
are in agreement with this step, and in discussion with HDCS – although, of course, they are disappointed. UMN is
in no way dissatisfied with the work HDCS have done on behalf of the Hospitals and UMN–in fact, it is the
opposite. But we feel for the long-term sustainability of the hospitals and the best outcome for the people these
hospitals serve, we need to find another option.
Please continue to pray for us, the Hospitals and HDCS, as we work through the many implications of these
In His Service                                                                                            Jennie Collins
                                                                                                     Executive Director
                                                                                                United Mission to Nepal
                                                                                                Friends of Tansen 2008 13
   Please Support RIPE
  From last year, we started a new          We currently have three trainees              The number of overseas mission
  hospital training department to           undergoing a six-month anaesthesia            volunteers, and their service
  coordinate all our trainings. RIPE, or    assistant training and are also in the        durations, has also decreased over
  Rural Inter-Professional Education, is    process of becoming an accredited             the years. Consequently, we find
  an attempt to reflect our goal to be a    skilled birth attendant training centre,      that we have to rely more on short-
  ‘training hospital with a clear           which is a part of the government’s           term volunteers and junior doctors.
  mission to train medical, nursing,        Safer Motherhood Initiatives to ensure        One way of keeping our Nepali
  and paramedical professionals,            that every Nepali woman receives
                                                                                          doctors is to be able to offer
  both for the immediate needs of           trained help for childbirth.
                                                                                          sponsorship for their ongoing
  the hospital and for wider service
                                            We also provide clinical placements           postgraduate training. We now have
  in Nepal’.
                                            for student nurses from Tansen                the opportunity to send candidates to
  Also, we have initiated a new             Nursing School and physiotherapy              Kathmandu's Institute of Medicine’s
  partnership with the Nick Simons          assistant students from Kathmandu,            post-graduate programmes for certain
  Institute (NSI), which helped fund the    along with short on the job trainings         specialties, in addition to sending a
  setting up of RIPE and also               for x-ray assistants and dental assistants.   doctor for the Obstetrics and
  coordinated some of our government                                                      Gynaecology MD programme last
                                            We are now on the map for junior
  trainings. RIPE will now coordinate                                                     year. We also plan to send another
                                            doctors to come and gain experience
  ongoing medical education for our                                                       doctor for surgical training this year.
                                            though we are still struggling to retain
  hospital staff, including courses for
                                            senior Nepali doctors for Tansen. It          The tuition fee is about $2400 for the
  doctors and nurses in resuscitation of
                                            is not as easy as in cities where there       three-year course and the hospital also
  newborns and dealing with accident
                                            are many private teaching hospitals,          pays them half salary for the time they
  cases and palliative care.
                                            which, as profit-making organisations,        are away.
  A long recognised training location for   can pay higher salaries for senior staff.
                                                                                          Our present training funding is
  General Practice, Tansen Mission          Parents also prefer to send their
                                                                                          running short and we now have a
  Hospital continues to train junior        children to reputed urban institutions.
                                                                                          Postgraduate Training Fund for
  Nepali doctors, recently-qualified        We need to retain our doctors if we
                                                                                          which we continue to pray for
  interns, and residents.                   are to continue as a training hospital
                                                                                          donations and support.
                                            whilst still maintaining our standard

    You may make bank transfers through your local bank to:
    Standard Chartered Grindlays Bank
    PO Box 80, 13-15 Castle Street                                              Nepal
    St Helier, Jersey, JE4 8PT, Channel Islands, UK                             Standard Chartered Bank Nepal Ltd
    Phone:                   0044 (0) 1534 704000                               GPO Box 3990
    Fax:                     0044 (0) 1534 704600                               Nayabaneswar, Kathmandu, Nepal
    Sort Code :              60-91-99
    Swift Code:              SCBLJESH                                           Account Name: United Mission to Nepal
    IBAN Code:               GB24 SCBL 6091 99 10078177 (Sterling)              Account Numbers:
                             GB75 SCBL 6091 99 10615512 (Euro)                  01-0488798 01 Nepali Rupee
                             GB37 SCBL 6091 99 10385142 (US $)                  01-0488798-51 US $
    Account Name:            United Mission to Nepal                            Phone: 977-1-4 229333
    Account Numbers :        1010078177 (Sterling)                              Fax: 977-1-4 226762
                             1010615512 (Euro)                                  SWIFT Code: SCBLNPKA
                             1010385142 (US Dollar)

14 Friends of Tansen 2008
  How we spent your contribution:
  During the last year (2006-2007),
  73,501 patients were seen in our outpatient clinics, 10,140 patients admitted, and 9,831 emergency
  cases treated, and 7,199 operations performed, and 1,629 babies delivered, and 78 percent was our
  bed occupancy rate, based on our increased bed numbers this year.

         With your help and the help of
                    others:                                          We were able to purchase:
  •    A record US $ 154,434.00 was given in free care to •               2 patient monitors
       the poorest patients                               •               An oxygen concentrator
  •    3304 patients in total received financial support  •               A pulse-oxymeter
                                                          •               A suction machine
  •    We were able to start building a new emergency
                                                          •               An exercise table quadriceps
  •    Outpatient clinic renovations were completed

                         Upcoming Projects: Can You Help?
  The construction of the emergency department               training. This important fund will also provide
  building is due to finish by end-April 2008.               senior staffing for the hospital in years to come.
  However, there is still a need for funding to
                                                             With sometimes up to six hours of power cuts
  renovate the old emergency room, x-ray, and
                                                             per day, our generator is working overtime and
  surgical consultation areas.
                                                             may need to be replaced soon.
  We continue to appreciate donations to our
                                                             Our Land Rover vehicle is very old and needs
  Medical Assistance Fund (MAF) which provides
  charity for the poorest patients.
                                                                 Thank You Again for Your Generous
  The new postgraduate training fund will enable
  us to send junior Nepali doctors for further

Please complete and return to: Office of the Executive Director, United Mission to Nepal, P.O.Box 126, Kathmandu, Nepal
                                                             Name: ____________________________________
  Enclosed please find a gift of ________________ for
  Tansen Mission Hospital to be used as below:               Address: __________________________________
      Medical Assistance Fund                                 _________________________________________
      (which provides care for needy patients)               City & State: _______________________________
      Capital Fund including finishing of ER Department
                                                             Postcode: _________________________________
      Medical Equipment
      Where it is most needed                                Country: __________________________________
      Requested a transfer to the United Mission to          E-mail Address: _____________________________
      Nepal bank account (see previous page)
      I would like to receive further _____ copies of           For Euro cover at Standard Chartered Bank,
      FRIENDS OF TANSEN to share with friends and                37 Gracechurch Street, London, EC3V0BX
      colleagues                                           For tax efficient giving in the United Kingdom, please contact:
      Doctor Training Programmes                            United Mission to Nepal Health Services, Finance Office
                                                                         Church House, Belfast, BT1 6DW.
                                                                                                Friends of Tansen 2008 15

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