Infrastructural needs for Nepal’s radiotherapy services
Year 2016 has been a significant year for cancer treatment in Nepal. Nepal Cancer Hospital and research center (NCHRC) in Lalitpur will soon start radiotherapy services with Varian Truebeam machine while Kathmandu Cancer Care and Research Center (KCCRC) in Bhaktapur has already started the services with Elekta Synergy machine recently. Both of these machines are modern medical linear accelerators from two different companies. Previously, only BP Koirala Cancer Hospital (BPKCH) in Bharatpur and Manipal Hospital in Pokhara had medical LINACS. NCHRC is also going to start High Dose Rate Brachytherapy with 24 Channel Gammamed ix plus machines to treat gynecological malignancies. With the addition of these two new external beam radiotherapy machines in Nepalese Health Care system and one HDR Brachytherapy machines, we are now capable of performing modern cancer treatment techniques like 3DCRT, IMRT, VMAT/Rapid Arc, Stereotatic Radiosurgery & Stereotatic Body Radiotherapy, Total Body Irradiation in the country.
Previously, cancer patients who had indication for such treatment techniques had to go abroad to receive treatments. That would put tremendous financial, psychological and practical difficulties for cancer patients and their families. Hence, the new medical facilities in the country are sure to relieve such pressures from patients and their families.
However, with the addition of new facilities in diagnostic radiology and radiation therapy, there is a rising challenges on the part of the service providers and government of Nepal to establish adequate radiation infrastructure for smooth functioning of such facilities in the country.
Firstly, since radiation therapy machine produces ionizing radiation to cure malignancies, proper handling of such equipment is important. There should be a quality assurance mechanism to ensure quality treatment with these machines. Proper treatment outcome of radiotherapy requires the joint effort of Radiation Oncologists, Medical Physicists, Radiation Technologist, Oncology Nurses and others involved. Nevertheless, Medical Physics, Radiation Technology and Oncology Nursing courses are not offered in the country. So there is a shortage of these professionals in the country. GoN should take actions to prepare such human resources in the country.
Secondly, radiation monitoring is an important aspect of radiation safety. But a lack of radiation law, radiation regulatory body and infrastructural arrangement pose challenges in adopting proper guidelines and dose audits. Therefore, it is important to draft radiation law, establish regulatory body and make infrastructural arrangement as soon as possible.
Thirdly, most radiotherapy machines and related equipments are specially designed highly advanced machine. Establishing radiotherapy facilities requires huge investment. The government of Nepal should facilitate in all possible ways to encourage health service entrepreneurs and hence increase access to specialized health services for cancer patients within the country. This will ultimately appease cancer patients and their near ones by minimizing their financial burden, psychological pressure. In addition, fund worth millions of rupees is retained in the country which would otherwise be spent aboard to get the radiotherapy services there.
The rise in the number of radiation facilities, particularly megavoltage radiotherapy facility, can provide most effective and smooth service to patients only if basic and additional infrastructures for quality radiotherapy services are put into place.
(Poudel is Medical Physicist at Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur)
Challenges for reconstruction
One of the major challenges faced in the reconstruction process of Nepal is the absence of elected local government. Lack of government in local level was reflected in the major pre-disaster and post-disaster events, where it took months to reach the affected region and still no widely-accepted data is available. In the absence of an elected local government, top-down approach of governance has its own accountability deficit.
Apil KC/Keshab Sharma
Making sense of Adityanath's rise in Modi's India
The most notorious incitement of communal hatred by Adityanath was his exhortation to 'kill ten woh log ['them' meaning Muslims]' rather than knocking the doors of legal system 'if one Hindu is killed' in riots.
Kathmandu means so much to me, and it looks like for people who promise to be the agent of change for the better, their own names mean a lot. A lot more than Kathmandu it seems.
Identity and nationhood
Whoever says nationhood is not important would be lying. For example, belonging to a particular nation may give certain advantages to a person that one belonging to another nation would not get.
Traffic Police in Kathmandu
As busy and hassling as the traffic system in Kathmandu is, the Traffic Police here have to handle an equally strenuous job. Over 1,400 traffic officers in and around the Kathmandu Valley battle against the pestering traffic and air pollution each day.
Menstrual taboo outdated
I have seen my sisters and friends isolated and treated in discriminatory manner during their first menstruation cycle. They were not allowed to look at the sun, to touch water source, flower, fruits, any male family member, nor even hear their voice. The activist may claim the situation has changed and I do agree but still during every month my loved ones turns into untouchables beings.