friends of tansen 20081€¦ · tansen mission hospital country, it was decided that god was...

Friends of Tansen 2008 1

Friends of Tansen 20082

Hospital ActivitiesHospital ActivitiesHospital ActivitiesHospital ActivitiesHospital Activities

Editorial Team: Roshan Kharel, Rosemary Gin, Rachel Karrach, and PK Rai


Dear Friends,

We are now enjoying a relativelypeaceful period in the country,although the situation on the plainsto the south is still volatile. We arealso hoping that our newemergency department building(currently under construction) willbe operational by early May 2008-thank you for your help in this.

Our transition to HumanDevelopment and Community Services(HDCS) came very close tohappening but then the processstalled again. Despite all the workput in by HDCS and UMN toachieve this, the transition has notbeen possible.

In view of the very long delay andthe continued uncertainty in the

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country, it was decided that Godwas closing this door for now andthus, the Memorandum ofUnderstanding (MOU) with HDCSwill not be renewed after July 2008.A separate support office for bothTansen and Okhaldunga Hospitalsis needed now in Kathmandu.

In the coming months, we will beexploring other options fortransitioning from UMN by 2010-please pray for this process.

Despite the continuing uncertainty,we are working on our next five-year Strategic Plan and we areconfident that this hospital still hasan important role to play for manyyears to come.

Our vision is to be givingwitnesses of God's love as weaim to provide holistic, qualityhealth services withcompassionate care andappropriate training.

We are grateful to all the friendsof Tansen who have written to us,prayed for us, knitted blankets andbaby clothes, and helped usfinancially. It is so encouraging tosee the support we receive fromall over the world.

Thank you!

Rachel KarrachHospital Director


It is my privilege to be able to write to you-theFriends of Tansen. Your continued prayers andsupport have enabled the hospital to minister to thepeople of the surrounding areas.

This past year has been a difficult one for allconcerned in the transition process. In March 2007,agreements for HDCS to operate the Tansen,Okhaldhunga, Dadeldhura, and Lamjung Hospitalswere presented to the cabinet of the interimgovernment. To our delight, the agreements wereapproved and sent back to the Ministry of Healthand Population for signing. Since then, agreementsfor Lamjung and Dadeldhura hospitals have beensigned thereby allowing HDCS to continue to operatethese hospitals.

But agreements of Tansen and Okhaldhungahospitals have not been signed till date, causingconcern to staff members and other stakeholders.

Dr Olak JirelDirector

Health Services DirectorateHuman Development and Community Services

An Update onHospital Transition

After amicable consultations between the LeadershipTeams of Tansen and Okhaldunga Hospitals andUMN, it was mutually decided that UMN wouldnot renew its MOU with HDCS regarding themanagement of the two hospitals, which will expirein mid-July 2008. The central support beingprovided till date to both hospitals by the HealthServices Directorate (HSD) of HDCS will thus ceasefrom this date.

While UMN will still continue to support expatriatepersonnel, both Tansen and Okhaldhunga hospitalswill form a central support unit in Kathmandu totake over some of the functions of the presentHSD.

None of us knows what will happen in the future.Our prayer is that these hospitals will continue toserve the needy people in a holistic manner whilststill maintaining the values of UMN which establishedTansen Mission Hospital in 1954.

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


Serious and Intensive at Work-Dr. Ed Tegenfeldt and his Team

In Him, All Things

are Possible

This led me to wonder,“Just where in the world wouldthey find a monkey-bite expertsurgeon than in Tansen?”

It all started one morning inSeptember 2007 in a small villageroom in nearby Tansen where a tinysix-week-old baby lay asleep.

Two monkeys suddenly jumped inand prowled menacingly aroundher. When the baby’s aunt chasedthem away, one of the monkeysdoubled back behind her andbit the sleeping baby on thehead, causing a hole in herskull. She was then rushed toTansen Mission Hospital byher mother and aunt via along journey by foot.

Barely occupying a quarter of thetable’s length, the tiny infant nowlay quietly on the operating table.Blood oozing out of an ugly headwound denoted significant bloodloss, as did her passive lack ofresponse that suggested possiblebrain damage.

We were heartened when sheawoke from her stupor, cried withsome vigour, and waved her tinyarms and legs about. The bleedingwas slow so we decided to organisea blood transfusion and delaysurgery.

With the blood transfusion running,the baby anaesthetised, and herhead wound cleaned up, a piece ofskull bone came away immediately.Some delicate inspection onlyconfirmed our worst fears-thewound was deep and dirty.

Dr. Ed Tegenfeldt, the surgeon, thencarefully cleaned the wound andmade some hard decisions.

From the child’s leg, he removedsome tissue lining from the thighmuscle and fashioned a patch thatwould repair the defect caused bythe monkey’s bite. Into the samehole he had created to remove thispotential patch, he placed thecleaned-up skull bone piece to keepit alive. Some more intensiveminutes later, the muscle-liningpatch was finally sewn over thehole.

Finally, the baby’s head was swathedin bandages and she was slowlyallowed to recover consciousnessfrom the anaesthesia. Much toeveryone’s delight, she awoke withvigour, cried, moved, and put up agood fight. Any child that tries toremove its bandages after surgeryis definitely fine!

Later on, Dr. Ed was to makeuse of a handy piece oftechnology (where advice issought from experts worldwidevia the internet) as he searchedfor tips on how to proceed with

the operation. He then removed theskull piece from its hiding place inthe thigh and replaced it in itsoriginal place.

This led me to wonder, “Just wherein the world would they find amonkey-bite expert surgeon than inTansen?”

Indeed, with God, all thingsare possible.

Steve PickeringAnaesthetist


M

Annual government statistics revealthat almost 700 women in thetownship of Tansen deliver childrenand that over half of these womendo so at home, many of them inthe absence of a skilled birthattendant.

Monitoring these women andnewborns during this precarioustime, when mother and child bothundergo drastic physical changes,is thus the focus of the CommunityHealth Department’s (CHD)Postpartum Programme (PPP), aproject that began two years ago infour neighbourhood areas ofTansen and has now expanded to15 Tansen neighbourhoods whereover 26,000 people live.

Naturally, we could not run thisprogramme alone, thus, wecurrently have 30 local FemaleCommunity Health Volunteers as

well as 30 other women volunteers.In the last six months alone, thisteam of 60 professionals hasconducted 331 visits to 184 newmothers and infants and identified124 women and babies with healthissues-seven of whom neededhospitalisation and special attention.

We are truly grateful to have sucha committed and willing group ofwomen to work with us.

From the beginning, it has been theCHD’s desire to have volunteersassuming control and direction ofthe programme in the future. Theywill soon be the ones responsiblefor visiting and evaluating mothersand infants.

In the next year, we will begin theprocess of handing the programmeover to the volunteers who help usin running it. Our new role will beto act as the coach on the sidelines

and encourage and guide them whenand if the need arises.

The future of this programme liesin these very women that we havetrained to take control. We areexcited as we ponder upon thefuture of mothers and infants asthey are monitored and cared forby the volunteers who live close tothem.

Please remember to pray for thestaff of the CHD as they seekto identify groups andcommunities that want toaddress their health needs.

Indeed, there is still muchwork to be done here in Palpa.

Glen AndersonChief of Community

Health

A Tansen Staff teaching avolunteer

A child’s faint cries can be heard as we enter the house.

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”

Helping Hands for Tansen's Women


I first arrived in Tansen in April 2007as a practicing General Surgeon fromKamloops, British Columbia,Canada, and was immediately struckby the remarkable similaritiesbetween my previous medicalexperiences in India and Guatemala.

I suspect those of you who havespent time in the developing worldwill feel the same. I have lived inTansen twice in 2007, once for sixweeks and a second time for eightweeks, and have been touched by itswonderful uniqueness. The followingis a personal perspective during mytime in Tansen:

I arrived at the Mission Hospital andwas greeted by the guest housemanager and felt welcome byeveryone–the hospital staff,physicians (both local and foreign),and the people in general. One gets areal sense of community here andthe expatriate community is warmand welcoming too. I enjoyed ourmany evening meals out which helpedus to know each other better.

Working with the Nepali staff is noless fun and pleasant for they arehappy, capable, and committed totaking good care of patients. I, thus,quickly adjusted to my newcircumstances for the people heremade this transition easy and care-free.

I did not immediately start studyingNepali but spent my spare timereading surgical textbooks,particularly older ones, to learnprocedures I had never seen or rarelypracticed before! Doing suchsurgeries can be quite stressful butalso very rewarding when one seespatients recovering and doing well. Italso reminds one of the remarkableability of this god-given human bodyto heal, even from some devastatinginsults.

Working with the interns, residents,and junior surgeons is challenging,rewarding, and occasionally

frustrating when theyseem reluctant to adoptthings that seem self-evident to our way ofthinking. It is also apositive experience as onesees them learning and

absorbing information, improvingupon their skills, and progressivelybecoming more independent.

Early morning, all physicians meetfor a short devotional, which followsa review of the cases admitted after5 p.m. the night before. An internreviews medical and paediatricadmissions and the other, the surgicaland obstetric cases. Initially, the oftenrapid-fire patient reviews can bedifficult to understand until your earadjusts to the Nepanglish flow oflanguage!

Ward rounds also allow for collegialitybetween junior medical staff andmedical colleagues.

As one proceeds with morningrounds of Surgery, one is witness toa vast number of patients andproblems. I initially found the internsto be a bit timid and only graduallyunderstood why-our approaches tolearning were just so different.Fortunately, we soon found ourrounds growing to be a very usefulinteraction: an opportunity to providegood patient care and helping tomould some of these young, eagerphysicians.

The type of patients one sees here isamazing. There is a large amount oftrauma cases and a very widespectrum of infections. I foundmyself seeing pus in places I neverwould back home! In some ways, itis a bit like going back in time, bothin the array of problems one seesand in the ways they are managed.

Renal stone disease complications area frequent problem and often verylarge and advanced. The combinationof heat, hard work, impure (and oftenhard to acquire) water, little fluidintake, and, I suspect, geneticsusceptibility, all lead to these oftenlarge stones. Even small children canbe affected and require surgery.

Of course, there is no lithotripsy(extracorporeal or otherwise) and,until recently, no adequately workingcystoscopes!

Memories of Tansen

Working with the Nepali staff isno less fun and pleasant for theyare happy, capable, andcommitted to taking good careof patients.

ching a


Removal of obstructing stonesrequires open operations, which arequite challenging not only because weno longer experience theseprocedures in the developing world,but also because they are usually seenat such a late and complicated stagehere.

One of the areas I found mostdifficult to adjust to was the BurnWard. Unfortunately, burns are quitecommon here–people rushing intotheir barns to save their livestock, gasstoves exploding, attempted kerosenesuicides, and small children scaldedfrom pulling down boiling pots orrolling into a cooking fire.

Often, children below the age of twoare left in the care of an older, butstill very young, sibling while theparents go to work in the fields. It isheart-wrenching to see these babiesin pain.

One particular case will always stickwith me: She was a nine-month oldwho had rolled into a fire and severelyburned both of her lower limbs andpart of her lower torso. She presentedlate and had to have parts of one legand other foot amputated.

We nursed her through the initialcritical stages and also gave her a skingraft. She was beginning to do well;but after three weeks of diligenttreatment and dressings and manyoperations, she developed a severeinfection that resisted all treatmentand ultimately led to her untimelydemise.

When one puts a lot of energy–physical, mental, and emotional–intopatients and is witness to their heart-wrenching suffering, only for it allto end in vain, it is a heart-wrenchingmoment.

As I leave Nepal after my secondshort-term mission, I leave with manynew fiends, experiences, andmemores. I don’t know when I willbe back next as I have otheropportunities and commitments inother parts of the world (and there ismuch need, as well), but I will nodoubt be drawn back to Tansen.

The people, the quiet hillside, the sightof the Annapurna Mountain Range,and the collegiality of the peopleworking here are powerful andrewarding. I leave Nepal havinggained much more than I have given.

I am truly thankful to God forthe opportunities He hasprovided for me here and Hisguidance and safe and lovinghand.

Dr. Jon JustShort-term Surgeon

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

by Elizabeth Gin

Elizabeth, 8, is the daughter ofDr. Davey, General Practitioner at

Tansen Mission Hospital, andRosemary Gin


The operating theatres at TansenMission Hospital are a busy cornerof a busy institution.

The kinds of surgery performed hereare often much more complex thanin a similar-sized hospital in adeveloped country. Goodtransportation and referral servicesalso help make this a viable option.

However, it is an entirely differentmatter in Nepal where transportationis more difficult and costly for simplevillage folk. In most cases, patientsare simply too sick and poor to moveanywhere.

Dr. Indra Napit, our long-time Nepalisurgeon, has headed the SurgicalDepartment for the past 3 years. Hissubspecialty is orthopaedics, but likeany surgeon in Tansen, he can alsobe found performing general surgery,caesarean sections, and whatever elseis needed!

Surgery-A Team Effort inTansen

The x-rays hanging on the viewingbox in his office tells many a taleabout falls, fractures, and splinteredbones spread about in ways thatlooked too painful to evencontemplate.

Such high quality work in a remoteand poor country does not dependon surgeons alone. A singleoperation is possible only througha team effort where administrativepersonnel procure resourcesnecessary for surgery, hospitalworkers sterilise and organiseequipment and clean the theatre

areas, scrub nurses and scoutnurses assist the

surgeon, and juniormedical staffare constantlybeing taught by

their seniorcounterparts. Also,

visiting surgeons fromwithin and beyond Nepal work

long hours and teach withenthusiasm.

Many of these short-term surgeonsreturn for a second visit or refertheir colleagues.

One essential component of goodsurgery is a good anaesthetic. Onereason that our hospital is capable

of 24-hour emergency surgery isbecause it has a capable 24-houranaesthetic service.

The head of the anaestheticdepartment, Mr. Durga Pahadi, wastrained by an English anaesthetistmore than 20 years ago and hasworked exclusively in anaesthetics eversince. The rest of the anaesthetic staff,like him, is comprised of nurses andhealth workers who have been trainedin anaesthetics.

Tansen is, thus, one of a handful ofsites in Nepal that has been approvedas a training location for anaestheticworkers. A mix of classroom theoryand on-the-job training under thesupervision of a doctor anaesthetistand constant exposure to the largesurgical load allows the trainees tomaster the skills necessary foranaesthesia.

Without the dedicated work ofthese people-surgeons,anaesthetic staff, administrators,nurses, and the supporters ofTansen-the life-saving andchanging work of surgery inTansen just would not bepossible.

Steve PickeringAnaesthetist

Surgery-A Team at Work

Tansen is, thus, one of a handful

of sites in Nepal that has been

approved as a training location

for anaesthetic workers.


Life in the Maternity WLife in the Maternity WLife in the Maternity WLife in the Maternity WLife in the Maternity WardardardardardA new-born child brings a smileto its mother, hope to its father,and joy for the family. What awonderful gift from God!

It is truly amazing to see wonderfulnew lives coming to this world.Unfortunately, this is not always thecase for there are times when thenew ones cannot make it. We thenfeel privileged to share their griefwith the families.

Life in the maternity ward is verystressful and busy at times.Sometimes, I sense that we nursesare not meeting the expectations ofthe mothers, as the nurse-patient

the child breathing the next day! Wethen praised God for allowing usto be a part of His miracle.

Lastly, I would like to put in a verywarm ‘Thank You’ to all who prayfor us and support our work here.

I would also like to thank theladies of Kangaroo Flat BaptistChurch and Ms. ShirleyMainstone and her friends whohave, most faithfully, beensending woolen knitted wears,rugs, and cards for all ournewly-born babies. Your caringheart truly encourages us!Thank you!

Esther Kharel Maternity Ward Nurse

ratio in our department is only 1:10.We want to do the best for ourpatients; yet unfortunately, we areunsuccessful sometimes. Thus, thehigh mortality rate here as most ofour patients come from outsideTansen and mostly present verylate.

An incident occurred a few monthsago during my night duty: apremature baby was born withsevere complications and lay in bed,breathing with difficulty. Thispainful scene moved us all-doctorsand nurses-into a prayer. Howrelieved and glad we were to see

Ms. Shirley Mainstone, third from left, and friends ofKangaroo Flat Baptist Church

The author, second from left

The inpatient and outpatient cash offices, previously located indifferent areas, are an integral part of Tansen Mission Hospital.and are responsible for processing financial transcations for patientinvestigations, surgeries, procedures, and hospital stays for around300 and 40 outpatients and inpatients respectively each day. As thenumber of patients has gradually increased, so has the need tocentralise these two offices.

And centralise is what we have done now-both offices are able tohelp one another during busy times and as a result, reduce the longqueues that were previously present.

A New Location for our CashiersA New Location for our CashiersA New Location for our CashiersA New Location for our CashiersA New Location for our Cashiers


Shyam Lal came to Tansen MissionHospital like so many - in need ofurgent medical care.

On his way back home to Nepalafter a frustrating job hunt in Delhi,India, Shyam met with anunfortunate bus accident when hewas run over by a bus whilewitnessing a fight between busdrivers. Some locals urgentlyrushed him to a hospital whereShyam lay unconscious andbleeding. Fortunately, someonefound his diary and called hisfamily in Nepal.

His father received the call and afew days later, saw his son in amost miserable state: the crushedright leg had been attacked bygangrene and now smelled awful. Asocial organisation then arranged forthe two men to make it to the India-Nepal border, from where theywould then arrive here at theMission Hospital.

Immediately after their arrival,Shyam was sent to the operatingroom for surgery on his broken armand an above-the-knee amputationfor his right leg. Shyam continued tostruggle, pleading with the doctors to

kill him as he called himself'unworthy' of living with his ‘uselessbody’. Even after the operation, hecontinued to pester the nurses to endhis life.

In the 35th day of Shyam’s stay, asurprise visitor arrived and left as soonas she came-his wife! Thus, no onefrom the Pastoral Care Team was ableto meet and talk to her. Shyam latertold us that she was leaving him andgoing back to her parents’ house ashe was ‘useless’ now that he had losthis right leg.

Naturally, Shyam was moredevastated, “Why did I evensurvive?"

Shyam’s family of seven has a smallpiece of land which provides foodfor only three months of the year.For the rest, the family has to rely onmanual labour.

It was but obvious that his treatmentexpenses needed to be borne bysomebody else so our MedicalAssistance Fund took care of this. Hisentire bill of Rupees 150,250.00(Around US $ 2385) for his 111-day

stay was thus covered. In total, hevisited the operating room 23 timesfor dressings, skin grafting, and othertreatments.

It was truly hard for Shyam, just23, to come to terms with the lossof his dreams and hopes for thefuture.

The postoperative period was criticalfor Shyam for he needed a great dealof emotional support and prayer tohelp him cope with his new physicalcondition. The Pastoral Care Teamspent time with him, continuing topray for and with him, all the whileencouraging and counselling him.

As he started to improve, heopened up emotionally. His gloomy

expression slowly lightened and weslowly saw joy in his eyes.

Three months later, he was able tostart walking with crutches. He startedattending chapel services and evenshared his story one day. Aftercompleting his treatment, he wasthen referred to Green PasturesHospital in Pokhara for artificial limbfitting.

The Pastoral Care Team continuesto play a vital role in the mental andspiritual healing process of suchunfortunate patients like Shyam.

Shyam Lal is just one moreexample of how we see the Lordworking in the lives of thebroken-hearted here in Tansen.

Pun Narayan ShresthaPastoral Care Team In-Charge

A New Life for Shyam Lal

Shyam Lal continues tothank and praise God

for bringing him ‘backfrom the dead’ and also

adds, “At least, I have alife now, even without

my leg”.


An Update on our NewEmergency Department Building

Can you guess how manypatients visit us each year?

At Tansen Mission Hospital, we seeapproximately 10,000 patients everyyear!

Some of these patients are fromsurrounding towns and villages whowalk for days to receive medicalcare.

Our currentemergency room isa small roomthat canaccommodatetwo patientsat a time.

Inside it isthe nursingstation, a privateexam area, andstorage shelves formedical supplies. If thereare more than two patients ina time, they are often placed ontrolleys in the outpatient departmentcorridor for observation and care.

As you can imagine, it can bechallenging to care for patients whoare not within sight of the caregiver!

Construction for a new emergencydepartment building began in April2007 and is progressing well. Weare anticipating completion of thebuilding by end-April 2008.

We thank you for your prayersfor this project and appreciate allthe support we have receivedthus far.

This building will have three floors,with the emergency departmentlocated on the third floor. Vehiclesw i l l

supplies, and a waiting area forpatients’ families and visitors.

The second floor of this buildingwill comprise various outpatientclinics which will be accessible toall outpatients from the currentwaiting area. This floor will housethe Dental Clinic, the Occupational

Therapy Department, the SocialService Department and

specialty clinics, whichinclude ENT,

Tuber cu los i s,Leprosy, andthe HIVclinics.

The groundfloor willfunction as agarage forstaff and

hospital vehicles,including an area

for the securityguards.

The estimated cost for thisproject is approximately$250,000 US dollars.

We trust that God will continue toprovide the remaining resources inHis time.

Jeena John,Engineer

be able to drop patients off directlyoutside the emergency department.

Within this spacious and well-litemergency department, we plan tohave ten patient beds, a nursingstation, a procedure andconsultation room, staff and patienttoilets, a store room for medical

If you would like to support this project,enclosed in this publication is an insertwith all the details, in Page 15.


Many of you will have heard the news with regard to the ongoing future of both theTansen and Okhaldhunga Hospitals but I thought I would use this opportunity to fillyou in on some of the details.

Three and half years ago, UMN sought Government of Nepal approval for HDCSto take over the legal responsibility for Tansen and Okhaldhunga Hospitals through anagreement with the Ministry of Health and Population.

The Government agreed, and while the agreement between HDCS and the Ministry ofHealth was being negotiated, we handed over the management responsibility of the Hospitalsto the Health Services Directorate (HSD) of HDCS. HSD has been efficiently providing themanagement 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, hasremained 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 wouldhave completed our partnership, aimed at Capacity Building, with HDCS.

Despite three years of extreme hard work by HDCS, including intensive negotiations with the Government, theGovernment has made it very clear that it will not hand ‘all the hospitals’ to one non-government organisation andnot from a Christian INGO to a Christian NGO. We, HDCS and UMN leadership, agree that it is extremely unlikelythat 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 bythe Directors of both Tansen and Okhaldhunga Hospitals, the decision was made not to renew the MoU withHDCS 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 throughwhich 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 hospitalsunder the ownership of Nepali organisations.

* The Leadership Team should endeavour to preserve the mission values of all three (Patan was the third)hospitals.

UMN will continue to provide that legal framework up to mid-2010, which is when our current General Agreementwith 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, whoare in agreement with this step, and in discussion with HDCS – although, of course, they are disappointed. UMN isin no way dissatisfied with the work HDCS have done on behalf of the Hospitals and UMN–in fact, it is theopposite. But we feel for the long-term sustainability of the hospitals and the best outcome for the people thesehospitals 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 thesedecisions.

In His Service

Dear Friends of Tansen HospitalDear Friends of Tansen HospitalDear Friends of Tansen HospitalDear Friends of Tansen HospitalDear Friends of Tansen Hospital

Jennie CollinsExecutive Director

United Mission to Nepal


Standard Chartered Grindlays BankPO Box 80, 13-15 Castle StreetSt Helier, Jersey, JE4 8PT, Channel Islands, UKPhone: 0044 (0) 1534 704000Fax: 0044 (0) 1534 704600Sort Code : 60-91-99Swift Code: SCBLJESHIBAN Code: GB24 SCBL 6091 99 10078177 (Sterling)

GB75 SCBL 6091 99 10615512 (Euro)GB37 SCBL 6091 99 10385142 (US $)

Account Name: United Mission to NepalAccount Numbers : 1010078177 (Sterling)

1010615512 (Euro)1010385142 (US Dollar)

You may make bank transfers through your local bank to:

NepalStandard Chartered Bank Nepal LtdGPO Box 3990Nayabaneswar, Kathmandu, Nepal

Account Name: United Mission to NepalAccount Numbers:01-0488798 01 Nepali Rupee01-0488798-51 US $Phone: 977-1-4 229333Fax: 977-1-4 226762SWIFT Code: SCBLNPKA

PPPPPlease lease lease lease lease SSSSSupport upport upport upport upport RIPERIPERIPERIPERIPEFrom last year, we started a newhospital training department tocoordinate all our trainings. RIPE, orRural Inter-Professional Education, isan attempt to reflect our goal to be a‘training hospital with a clearmission to train medical, nursing,and paramedical professionals,both for the immediate needs ofthe hospital and for wider servicein Nepal’.

Also, we have initiated a newpartnership with the Nick SimonsInstitute (NSI), which helped fund thesetting up of RIPE and alsocoordinated some of our governmenttrainings. RIPE will now coordinateongoing medical education for ourhospital staff, including courses fordoctors and nurses in resuscitation ofnewborns and dealing with accidentcases and palliative care.

A long recognised training location forGeneral Practice, Tansen MissionHospital continues to train juniorNepali doctors, recently-qualifiedinterns, and residents.

We currently have three traineesundergoing a six-month anaesthesiaassistant training and are also in theprocess of becoming an accreditedskilled birth attendant training centre,which is a part of the government’sSafer Motherhood Initiatives to ensurethat every Nepali woman receivestrained help for childbirth.

We also provide clinical placementsfor student nurses from TansenNursing School and physiotherapyassistant students from Kathmandu,along with short on the job trainingsfor x-ray assistants and dental assistants.

We are now on the map for juniordoctors to come and gain experiencethough we are still struggling to retainsenior Nepali doctors for Tansen. Itis not as easy as in cities where thereare many private teaching hospitals,which, as profit-making organisations,can pay higher salaries for senior staff.Parents also prefer to send theirchildren to reputed urban institutions.We need to retain our doctors if weare to continue as a training hospitalwhilst still maintaining our standardservices.

The number of overseas missionvolunteers, and their servicedurations, has also decreased overthe years. Consequently, we findthat we have to rely more on short-term volunteers and junior doctors.

One way of keeping our Nepalidoctors is to be able to offersponsorship for their ongoingpostgraduate training. We now havethe opportunity to send candidates toKathmandu's Institute of Medicine’spost-graduate programmes for certainspecialties, in addition to sending adoctor for the Obstetrics andGynaecology MD programme lastyear. We also plan to send anotherdoctor for surgical training this year.

The tuition fee is about $2400 for thethree-year course and the hospital alsopays them half salary for the time theyare away.

Our present training funding isrunning short and we now have aPostgraduate Training Fund forwhich we continue to pray fordonations and support.


With your help and the help ofothers:

• A record US $ 154,434.00 was given in free care tothe poorest patients

• 3304 patients in total received financial support

• We were able to start building a new emergencydepartment

• Outpatient clinic renovations were completed

How we spent your contribution:How we spent your contribution:How we spent your contribution:How we spent your contribution:How we spent your contribution:During the last year (2006-2007),

We were able to purchase:

• 2 patient monitors• An oxygen concentrator• A pulse-oxymeter• A suction machine• An exercise table quadriceps

73,501 patients were seen in our outpatient clinics, 10,140 patients admitted, and 9,831 emergencycases treated, and 7,199 operations performed, and 1,629 babies delivered, and 78 percent was ourbed occupancy rate, based on our increased bed numbers this year.

Upcoming Projects: Can You Help?The construction of the emergency departmentbuilding is due to finish by end-April 2008.However, there is still a need for funding torenovate the old emergency room, x-ray, andsurgical consultation areas.

We continue to appreciate donations to ourMedical Assistance Fund (MAF) which providescharity for the poorest patients.

The new postgraduate training fund will enableus to send junior Nepali doctors for further

training. This important fund will also providesenior staffing for the hospital in years to come.

With sometimes up to six hours of power cutsper day, our generator is working overtime andmay need to be replaced soon.

Our Land Rover vehicle is very old and needsreplacement.

Thank You Again for Your GenerousGiving

Medical Assistance Fund(which provides care for needy patients)Capital Fund including finishing of ER DepartmentMedical EquipmentWhere it is most neededRequested a transfer to the United Mission toNepal bank account (see previous page)I would like to receive further _____ copies ofFRIENDS OF TANSEN to share with friends andcolleaguesDoctor Training Programmes

Name: ____________________________________

Address: __________________________________

_________________________________________

City & State: _______________________________

Postcode: _________________________________

Country: __________________________________

E-mail Address: _____________________________

Please complete and return to: Office of the Executive Director, United Mission to Nepal, P.O.Box 126, Kathmandu, Nepal

Enclosed please find a gift of ________________ forTansen Mission Hospital to be used as below:

For Euro cover at Standard Chartered Bank,37 Gracechurch Street, London, EC3V0BX

For tax efficient giving in the United Kingdom, please contact:United Mission to Nepal Health Services, Finance Office

Church House, Belfast, BT1 6DW.

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