04 Aug 2017
5 min read
1854 words
Dr Rajendra Koju, who looks after the management and academics at Dhulikhel Hospital, is no less than a white-coat messiah to the many people who frequent the hospital—probably the first community-led, community-based hospital in Nepal

Brimming with positivity and a soothing demeanour, Dr Rajendra Koju is no less than a white-coat messiah to the many sick people who frequent Dhulikhel Hospital--probably the first community-led, community-based hospital in the country. Founded by Dr Ram Kantha Makaju Shrestha in 1994, Dhulikhel Hospital has provided not only affordable healthcare to the people, but also helped spur economic growth in the surrounding areas of Dhulikhel.
Dr Koju currently looks after the management and academics at Dhulikhel Hospital, and his greatest asset is perhaps his humility, and desire to learn from others. Talking to Alok Thapa of M&S VMAG, he is quick to brush off the title of a trailblazer, and adds that oftentimes, it's not about being a hero--it's all about making a difference.  

What is the best thing about what you do?
The best part about being a doctor is getting to go to work every day and making a difference in the lives of my patients. Having said that, being a doctor is not easy. In fact, the long hours, the pressure and the emotionally charged environment can take its toll on anyone; and even though practicing medicine is a challenge, I love being a doctor and am thankful for the privilege of doing it every single day.

Can you talk about your childhood memories.
I come from a modest, humble family from Dhulikhel, and I'm the youngest of six siblings. My father was not highly educated, but he was a stout believer in education. He was determined to make sure his children received the education he didn't. My mother, a housewife, took care of us and made sure all of us went to school and did well in our studies. 

One of my most memorable incidents of when I was young was the time when I won a brand new geometry box. As I was the youngest, I always had to make do with hand-me-down stuff from my brothers. And when I won the box in class 10--because I'd done well in a class test--I finally had something that was completely new. I was ecstatic. I still remember that moment like it was yesterday.

What led you to choose a career in medicine?
After I completed my SLC, my father fell fatally ill. He needed regular blood transfusions, his feet would be constantly swollen, and he would have difficulty breathing. It was much later that we found out that both his kidneys were failing. My father had always urged me to become a compounder--a health assistant. So, to fulfil my father's wish, I came to Kathmandu to study medicine. 

Because dialysis was not as easily available then as it is these days and
kidney transplant was next to impossible--even if it were, we didn't have the
money to afford it--my father passed away when I was in the first year of my college. My only regret was, and still is, that my father couldn't see me become the doctor that I am today.

What were the defining points in your career?
The first has to be my two-year stay in Baglung, where I worked in the capacity of a health assistant. It was while I was working there that I got to see how deprived the villagers in Nepal were of basic health facilities--it was a reflection of the state our country was in. I witnessed people suffering from infectious but easily treatable diseases like diarrhoea and pneumonia. I saw kids that were severely malnourished. And lest you forget, Baglung was one of the more developed districts in the western region of Nepal, so you can just imagine the plight of the people living in other, more remote, places. My experience in Baglung made me want to pursue medicine more. Upon returning to Kathmandu, I applied to the Institute of Medicine and got a full scholarship--this completely changed my life's course. 

The second turning point of my life happened when I met Dr Ram Kantha
Makaju Shrestha. One of the reasons why I agreed to join the hospital, which
didn't even have a building back then, was so that I could serve underprivileged people of my hometown.

Let's face it, doctors have always been blamed for not going to rural areas and practicing only in cities, in order to make money. How was your decision taken by your friends?
In those days, working in Teaching Hospital as a full-time doctor was a huge deal, and there I was, ready to leave a well-paying job and come to Dhulikhel, where they hadn't even erected pillars for the building of the would-be hospital. Many people didn't support my decision to follow Dr Shrestha, and I was often told I was sabotaging my career. But for me, health care has always been a service-oriented task, not a business venture. 

Tell us more about how Dhulikhel Hospital came to be.
When Dr Shrestha, a qualified surgeon from the University of Vienna, Austria, returned to Nepal, he couldn't find even one hospital that matched his vision--to provide good medical services to the underprivileged. When he set out to establish Dhulikhel Hospital, the community helped him; they provided the land to build the hospital, the Dhulikhel Municipality gave some funds, and people also raised money to aid the construction of this place. When I joined Dr Shrestha, we only had 35 beds for our patients--beds that were always occupied with women in labour or patients suffering from problems ranging from stomach aches and dislocated joints to high fever. Dr Shrestha would perform the surgeries, and I would administer anaesthesia. We both also attended to OPD patients. We tried to treat every single case, as far as possible, at our hospital. However, for more complicated surgeries--neuro and cardiac cases--we had no choice but to refer patients to hospitals in Kathmandu. From time to time, we would invite orthopaedic and kidney surgeons here so that the villagers who needed such treatments wouldn't have to go to Kathmandu.

How did you manage in the initial days? 
When we started this place, there were only a handful of government hospitals and health service systems in Nepal, all struggling with various levels of bureaucracy and challenges. Our aim was to serve the community first. The ethos that informs our practice stemmed from social equity, no matter the cost. We wanted to work beyond the hospital's walls, supporting projects that were community-focused. The community too supported the establishment completely as they were in dire need of a healthcare post. We started out with a three-roomed doctor's practice in 1994. We had never thought that after two decades, Dhulikhel Hospital would be the type of non-governmental, not-for-profit community-based hospital it is today. Today, besides providing healthcare facilities to the people at affordable rates, we also run the Department for Community Programmes (DCP), which have provided good health services and education to the poorest people in the rural parts of Nepal. 

Yes, the initial days were tough. There were many who were sceptical of our vision, and there were many challenges, but we stood by our dream, and here we are today, successfully running a full-fledged hospital that now uses state-of-the-art equipment.

What were some of those challenges?
When we started, Dhulikhel was just a small village. One of the main challenges we faced had to do with infrastructure; we didn't have any x-ray machines, and lab facilities were inadequate. Often, during surgeries, we'd be worried about electricity outage. And then there was the challenge of human resources. But we never regarded finance as our main hurdle; it's always been about developing this place. We did not start the place in the pursuit of personal gain, and we have never let our individual interests interfere with the ideals of this place. Dr Shrestha never expected a salary, nor did I ever expect any perks. We were just so busy with our work that all the challenges did not seem like challenges. There was not a single doctor here that had a private practice; in fact, the doctors here are discouraged from engaging in private practice. This is a problem here in Nepal. People are always seeking individual growth, but hardly anyone seeks inclusive growth that provides equal opportunities of growth for every section of society or enterprise. 

What is the secret to the success of Dhulikhel Hospital?
People might think that all this happened overnight, but it didn't. It took a lot of hard work. Dr Shrestha has always been a man with a vision, someone who never gives up. Dhulikhel Hospital is where it is today because of his vision, his  team-work mentality, and the support structure he has created here. When he gives someone a job, he also trusts that person 100 per cent--that they will complete the task to the best of their abilities. When there is understanding, compassion and cooperation among the team members, the outcome is bound to be unbelievable. At Dhulikhel Hospital, we work towards strengthening everybody's capacity, strengthening their craft and also boosting their confidence. We feel we are just starting our journey, and we are looking forward to doing much more in the future.

(Photos by Nirnit Tandukar)