After nearly a decade of focusing on disaster response, Dr. Aban Gautam had a new, ambitious goal: a hospital.
It would be the beginning of a sustainable approach to disaster resilience and accessible healthcare in rural Nepal, he explained.
Mountain Heart Nepal, the medical organization Dr. Gautam founded in 2015, was his and his colleagues’ response to a devastating magnitude 7.8 earthquake that devastated many Nepali communities, killing more than 9,000 people and destroying huge amounts of the country’s rural healthcare infrastructure.
Since then, Mountain Heart Nepal has responded to a number of emergencies, including repeated flooding and the Covid-19 pandemic, with a focus on rural health.
Many of Nepal’s medical facilities and providers are concentrated in Kathmandu, its capital city. In the remote communities where Dr. Gautam and his fellow physicians worked, mountainous terrain and a lack of local infrastructure made it difficult for patients to access even basic primary health care. A serious emergency might mean days of travel by foot or a perilous airlift out of the mountains. And a disaster like a flood or earthquake could make routes entirely unpassable, cutting people off from medical care
While the organization’s physicians provided care through health camps and temporary clinics, “it was only for a short period of time,” Dr. Gautam said. Moreover, patients often had medical needs that couldn’t be fully addressed in a health camp: “We couldn’t do more in that setting because of the limited resources.”
For Dr. Gautam and his colleagues, a permanent facility in central Nepal, accessible by surrounding communities even in the aftermath of a severe disaster, was an ideal solution.
“We had this dream of having our own hospital,” Dr. Gautam explained.
Last year, in June, that hospital opened, supported by a Direct Relief grant of more than $700,000.
The Siddhasthali Rural Community Hospital, founded by Mountain Heart Nepal in the central municipality of Makwanpur, provides emergency, outpatient, and inpatient care; radiology, laboratory, and pharmacy services; dentistry, and other healthcare to rural and marginalized communities throughout the surrounding municipalities.
A carbon-neutral model
Siddhasthali’s facilities are powered by a solar photovoltaic system that ensures an uninterrupted power supply for hospital operations. Dr. Gautam explained that hydropower, Nepal’s main energy source, is prone to interruptions during the monsoon and dry seasons, forcing many healthcare facilities to rely on diesel generators. The hospital has also established an oxygen plant, ensuring a reliable, resilient supply of high-quality medical oxygen – an under-addressed health need in Nepal, as in countries around the world.
Sophisticated cold-chain equipment enables the hospital to store temperature-sensitive vaccines and other essential medications in ideal conditions.
Resilient power and on-site medical oxygen protect and bolster high-quality healthcare, but in Dr. Gautam’s eyes, there’s another important benefit: The carbon-neutral Siddhasthali Rural Community Hospital acts as a model for state-of-the-art care and sustainability for health facilities throughout Nepal.
“Hospitals are a major source of carbon emissions,” Dr. Gautam pointed out. In climate-vulnerable Nepal, where extreme weather events like heat and flooding are a growing concern, a sustainable model matters.
Dr. Gautam said the hospital routinely receives visiting physicians and other providers who are eager to observe and learn from Siddhasthali’s model.
Both local and national
When Mountain Heart Nepal’s physicians began scouting for a hospital location, accessibility was a high priority: They wanted a central municipality that could be easily reached by patients throughout Nepal – what Dr. Gautam called “a gateway region.” The hospital needed to be easily accessible, so providers could provide emergent care if rainfall or damage blocked roads into Kathmandu.
Makwanpur fit the bill. In addition, Dr. Gautam said, the municipality is home to a high number of members of traditional communities, including the Tamang and Chepang people. The latter – a semi-nomadic group that collects root vegetables for the forest and is historically marginalized – often has little access to health care.
An early patient at the hospital, a member of a Chepang community, had fallen from a tree, severely injuring his leg. The traditional medicine he’d been given at home – hot oil poured into his wounds – had exacerbated his injury, and the leg needed amputating.
Providers from the hospital frequently visit patients in their homes to describe the hospital’s offerings and explain the importance of preventive care. “If we counsel them well, and with the help of local community leaders,” many are willing to trust the hospital with their care, Dr. Gautam said.
“This hospital is unique: We take time to address the patient,” he explained. “I think that is lacking” in much regional healthcare.
In the Siddhasthali’s first few months of operation, a boy of about twelve came in with a fractured leg. A local hospital, using an outmoded X-ray machine, had missed the fracture, and the boy was in severe pain. An orthopedic surgeon found the break on the hospital’s digital X-ray machine and referred the patient for surgery. Without a nearby facility, “he could have faced difficulty for the rest of his life,” Dr. Gautam remarked.
An older woman whose stroke was previously undiagnosed was quickly diagnosed and treated by a cardiologist at Siddhasthali, who noted that the patient would previously have had to travel to Kathmandu, where she would have waited a long time for care, and the cost would have devastated her family. Dr. Gautam explained that families frequently lose their homes to pay for specialist or more complex care.
A vision realized
Because of Siddhasthali’s rural location, Mountain Heart Nepal at first had trouble recruiting healthcare providers and staff members.
“Everyone wants to work in the city,” in part so they can have appointments at multiple Kathmandu hospitals, Dr. Gautam said.
However, the hospital’s fast-growing reputation for sophisticated medical care and equipment, and its focus on sensitive, patient-centered care, have led to a huge uptick in applications.
Physicians “come into this rural area to dedicate [themselves] full time to this hospital,” Dr Gautam said.
Even in expensive private hospitals in the city, “the doctor doesn’t have time to look at the face of the patient,” he explained. “We need hospitals that are for the people.”
A focus on strict protocols designed to increase accountability and improve patient outcomes has also brought doctors and administrators to Siddhasthali, so they can learn from the techniques and training the hospital employs.
High-quality medical equipment and medications – many of them, including a portable ultrasound, EKG machine, non-communicable disease medications, analgesics, and prenatal vitamins, provided by Direct Relief – are also indispensable, Dr. Gautam said.
“We can go to rural communities and screen with our equipment,” he explained.
Even the solar project and medical oxygen plant help keep Siddhasthali self-sufficient. Surplus solar power can be sold for credits that then pay for patient care. Medical oxygen canisters can be distributed to the larger community, and the proceeds used toward hospital costs.
New dreams
State-of-the-art, carbon-neutral, and culturally sensitive medical care has all been achieved. Next for Siddhasthali Rural Community Hospital is a vital role in a larger vision of reliable, extensive, and widespread disaster response.
In the past, “every response we did was more related to donor funding,” Dr. Gautam said. Donors’ missions, and their willingness to fund response work, significantly affected Mountain Heart Nepal’s ability to care for patients.
With Siddhasthali as a permanent facility, “we’re better prepared to respond to emergencies from our side. We don’t have to wait for any resource.”
Having realized one dream, Mountain Heart Nepal’s physicians have developed one even more ambitious: a network of facilities across Nepal providing state-of-the-art care and efficient emergency response that are tailor-made for the country’s propensity to earthquakes and flooding, and its beautiful, but hard-to-navigate, mountainous terrain.
“We want to be in all seven provinces of Nepal, from the mountains to Terai,” a lowland area in the country’s south, Dr. Gautam said. “It will help us in reaching those unreached people, just to be close to the homes of the people.”
Dan Hovey contributed reporting to this story.
Since 2017, Direct Relief has provided $2.9 million in aid to Mountain Heart Nepal. In addition, Direct Relief last year helped equip the Siddhasthali Rural Community Hospital with medical-grade refrigerators to safely store vaccines and other temperature-sensitive medications, following the founding grant of more than $700,000.
