Health service is a vague term and hematology is one of the wings that is yet to flap with freedom. Similar to other field of health service, the field of hematology replicates with the same stories that other fields have been going through. Without the needed investment and interest in hematology, many patients are left in despair.

Blood related diseases could be easily diagnosed and cured but they are still prevalent without much action being taken for it. But this is not an end of the world. How turbulent the times could be, change is always on the cards when people stand with all their might. Doctor Bishesh Poudyal is one amongst such beacons of hope during this time of turbulence.

Chief hematologist at the Civil Service Hospital and Nobel hospital, Dr Poudyal, can be mistaken as a man older than his age. After his formal education in Xian Jiaotong University of China and Christian Medical College of India, he along with a colleague had gone for Bone Marrow transplant training at the University of Illinois Medical Centre at Chicago, back in 2013.

At 36 years of age, he is already one of the treble makers in the hematology sector of Nepal. Recently awarded with the International Development and Education Award (IDEA) from the Conquer Cancer Foundation of the American Society of Clinical Oncology, he is the first Nepali hematologist to be recognised at this platform.

Accelerators and their significance

All one wants in life is to be significant; to be able to leave a mark. Being a doctor, you feel significant when you use your skills to cure an illness. Doctors put in constant dedication, zeal and courage for every patient that comes to them for help. To be acknowledged for this is an absolute encouragement.

“When I found out that I was the only hematologist to be awarded with the IDEA 2014, I felt that my work had some meaning to it. To be recognised for your work doesn’t necessarily boast your ego but makes you think about your caliber. In a way it challenged me, made me speculate on how far I need to go. It created an urge for me to hone my skills. In US, I got a chance to share knowledge with like minded doctors, share my stories and make their stories my own. This exposure and interaction is something that isn’t easily achieved. Sharing the growth Nepal is experiencing was a pleasure in itself.”

Other than accompanying us to the desired places, a vehicle also has the capacity to take us to the places where we have not been to — but a push of an accelerator is required. Individuals like Dr Poudyal are accelerators. Dr Poudyal is pushing Nepal’s health sector to the heights we are not aware of but it can make a positive impact in the lives of millions.

Intact with national roots

Dr Poudyal’s enthusiasm was sky-high when he began his medical practice in Bir Hospital in 2007 after completing his studies. But the odds were stacked against him. Monotony hit him at the OPD that seldom got patients and cases. The number of patients with blood related diseases were agonisingly low.

“Is this what I came back for?” he often questioned himself.

Pathology, in itself, was not a well established department back in the days and most of the pathologists were concentrated in Kathmandu. It severely cut off the chances to identify pathological illness overall. After the emergence of national health campaigns, pathologists were localised in every nook and corner of the country helping them to diagnose multiple blood related diseases.

“After this short interval of seven years, we constantly get cases of every kind of blood abnormalities, even the rarest ones. It clearly shows how dangerous it could be if there is no research. It is shameful that thousands of people who could have led a healthy life died without knowing what killed them," says Poudyal who now doesn’t have to live with the monotony.

Calmed by chaos

“Being a Hematology Chief is a daunting task which requires updates to the previous day’s reports, patients waiting to be checked on, new patients to be diagnosed, blood tests to be run and mostly diseases to be cured. Not only that, the whole department needs to function as a whole when you are the Chief.

I would be lying if I tell you that my job is not hectic. Blood cancers unlike other cancers, need intense chemotherapies which are highly toxic and can cause infection complications frequently making the immune systems weaker. Our treatments are not usually surgical but it is undoubtedly risky. If you lose focus, fail to attend a call or delay the lab reports, it would minimize their chances of survival. You can never just take a break. You live your life on the edge."

"But it helps that I have a good team here at Civil Service Hospital. With them around, work isn’t half as chaotic. But this chaos has become our relief. This chaos makes us happy; it has become a way of life. Sometimes chaos does go overboard. To shake it off, our hospital team goes over to play futsal during weekends. Before that, I tried yoga to calm my nerves. But I soon realised that flexibility was not my strongest suit.”

An inherited profession

Poudyal’s inclination towards the hematology was neither a fluke nor a long term plan. His father, Basudev, worked in blood banks for decades. He grew up watching his father working with blood. And the son was to follow his footsteps.

“Blood always fascinated me. He was in the executive committee when the first ever blood bank was established in Nepal. Born as a child to one of the pioneers in this field, familiarity was always there. Curiosity and fascination soon kicked in after listening to my father talk about everything — from blood flow system to hematology in Nepal. Had my father not worked in this field, I highly doubt I would have done it myself. He germinated the idea and gets all credit for what I have grown into.”

Boundaries that fence you in

Bureaucracy has always seemed to be organic in Nepal. A single policy needs approval from almost everyone who exercises certain power to come into the implementation phase. It is quite a daunting task to bring changes in policies in such a rigid policy making framework where changes are considered redundant. In this process, boundaries are built in every institution, even health. The branch of hematology has been a victim to such boundaries.

“A separate ward for hematology is not seen everywhere in hospitals here. The policies are neglected. As I mentioned before, rates of blood related diseases seems to be sky-rocketing but that is nothing but a white lie. It has always been there, always. Due to lack of identification and diagnosis, people confuse them with infections or even natural deaths. The conditions have improved but it is still below-par. Every hospital must have specialised doctors for blood related diseases and separate wards to work in order to bring tangible change.“

"The boundaries that Nepalese systems work within are doing nothing, but fencing us in. The strict rules which people dare not to bend are making them work in a same pattern. This is why doctors don’t specialise in unconventional fields like hematology and hospitals don’t invest in new wards for them. This boundary which is created to ward off all the anticipated problems acts as a fence that stops us from improving ourselves."

No vested interests

Doctors are often taken as jobholders in an attempt to make money through others’ illness. Many might even take Dr Poudyal’s interest in bone marrow transplants as a means to give boost to his own economy. But he has an answer to that.

“This is not about profit, it goes way beyond. My team is not working towards bringing this service in a private hospital to make money. Having a comprehensive bone marrow transplant unit in a government hospital doesn’t favour one over the other regardless of his power, money or prestige where everyone gets a better shot at life with his/her prestige intact.”

Capabilities to treat elites

Be it a simple diagnosis or a major surgery, the elites of Nepal often seem to be enticed by the facilities that provided abroad. Every now and then, high profile government employees, businessmen and actors cross borders for treatments. They are the ones who the country looks up to and their actions therefore create an air of mistrust between citizens and doctors of the same nation.

“People have money and it is their choice to spend it wherever they wish. Its understandable that they leave in conditions of complexities in disease or don’t get hi-tech equipments here. However, I will strongly defy the misconception that we are unable to treat anything. We have trained manpower, equipments and concepts with which we solve similar cases every day. Be it a minister or a common man, the cure for the disease is the same.”

A tiny nation making global mark

While Dr Poudyal was in the US to receive the IDEA award on June 1, 2014, he was unashamedly proud to represent Nepal at a global stage. Along with the award came a chance to interact with health experts from all over the world which led them to dissect the cultures of health services in each country.

“Nepal is a tiny nation compared to other places, African countries like Kenya for an example. With small landmass comes limited manpower which leads to inadequate services provided in hospitals. Regardless of the circumstances, hematologists in Nepal are getting their hands into bone marrow transplants which surprised many. They were quite impressed to learn that a third-world country like our’s is having successful transplants."

"If this process gains efficiency with more hospitals providing such services, we can wipe out the instabilities that we now face. This transplant can increase success rates of treatment for thalassemia and aplastic anemia. There is also a misconception that bone marrow transplant is the same as organ transplant, due to which the government has put them under the same act, making it difficult to get approval for bone marrow transplant which is not as complicated as organs. The procedure is as simple as blood donation. If government hospitals can provide this service around Nepal, people could get treatment at tentatively one third costs than in India. The only thing required is commitment from everyone involved: the government, the doctors and even the patients.”

With limited number of doctors working in blood related diseases, it is only obvious for people to think that we are experiencing nothing but a downfall. However, that doesn’t necessarily hold the truth.

Making hematology sustain

“For Nepal, the institution that can primarily strengthen the nation’s development has to be health. The improvement has to be focused on government hospitals rather than private ones because it has access to majority of the population. Majority of the people can’t even afford the private ones even if they want to. This is why the main vision that everyone should work towards is building a strong decentralized national network of health institutions with specialized hospitals. This way a doctor can intensively focus on his area of expertise and the patients can easily identify the places for treatment. I believe that this single idea can change everything.”

Dr Poudyal has chosen to travel a road which is patchy, rough and uneven. He has thrown down the gauntlet to everyone in the medical fraternity. The purpose is to walk away from the crowd and build another path for others to walk upon. It has always been harder to walk on but this makes the journey worth undertaking. Being one of the few doctors in a field that is fairly new, Dr Poudyal has been doing an incredible job. He has not only saved lives but also put in efforts to make this field sustainable by building a path that other aspiring hematologists can follow.

He has a vision for the medical field in Nepal, an achievable one. With zeal and enthusiasm, he has been working towards taking Nepal and its medical field to greater heights. A man of his caliber, expertise and vision could easily gain access to a higher standard of living in a place which offers him more rewards.

But, he is the one who believes that being a doctor is more than just making money. It is about using your knowledge to give others a better shot at life. He believes that Nepal is not only the place he belongs to but a place which is befitting to his expertise. When such important fields of medicine like hematology are engulfed in such ignorance and darkness, people like Dr Bishesh Poudyal are shedding lights on it; peacefully yet intensely and effectively. He has a lot to offer the coming generation which needs to emulate him.