https://www.youtube.com/watch?v=Czp7hVr4LTkHenry Marsh is a pioneering English neurosurgeon and the author of two widely acclaimed memoirs, Do No Harm: Stories of Life, Death and Brain Surgery and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/book-review-Admissions-Henry-Marsh-Neurosurgeon,4055" target="_blank" rel="noopener">Admissions: A life in brain surgery</a>. He was a colleague and friend of the <a href="https://www.nepalitimes.com/here-now/upendra-devkotas-lives/" target="_blank" rel="noopener">late Upendra Devkota</a>. Nepali Times caught up with Marsh at the <a href="http://www.neuro.org.np/" target="_blank" rel="noopener">Upendra Devkota Memorial National Institute Of Neurological And Allied Sciences</a> in Kathmandu, where he teaches post-retirement.Excerpts:Nepali Times: How did your involvement in Nepal start?Henry Marsh: Professor Devkota and I were neurosurgical trainees together in London more than 35 years ago. We became quite good friends then, and when I retired from working fulltime for the <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nhs.uk/" target="_blank" rel="noopener">National Health Service in Britain </a>four year ago, I really wasn’t ready to stop working. I wrote to the professor, who’s known to all his English friends as Dev, and I said, “Would you like me to come out to Kathmandu and help train some of your team?” and he said,“Please come”. This is now my fifth visit over the last four years. <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/from-the-nepali-press/i-want-to-live-my-last-among-friends/" target="_blank" rel="noopener">Tragically he died last year</a>, and everything therefore changed profoundly.Why were you drawn to Nepal?I was drawn because I like seeing the world. A lot of the potential privileges you have as a doctor is that you have a specialised set of skills which transfer over the world and English is really the international language of medicine.The great privilege of working in a cooperative professional way is that you get a much better insight into the country than if you are merely a tourist. For me, it is true travel but it is work – it is not easy always, and if you come to a country like Nepal to help your colleagues, you have to come again. You can’t just sort of dive in and then dive out again. It calls for a fairly major commitment, both in terms of time and financially and sort of emotionally as well.What do you remember most about Dr Upendra Devkota?The man was just this little ball of fire – he was extraordinarily energetic. There was never a dull moment with him. He was an extraordinarily dynamic person and to create an entire specialist neurosurgical hospital more or less from scratch was a quite extraordinary achievement.The problem with great dynamic individuals is the succession problem and of course none of us expected him to die at the relatively young age he did and really quite suddenly. I remember before his illness, sitting down with him in his beautiful garden and saying “What happens if you drop dead tomorrow? What will happen to the hospital?” Fortunately, he had some very good trainees and in recent years he had been giving them more and more, not exactly independence, but they were doing more and more of the work so they were fortunately able to take over the workload when he fell ill and they’ve coped remarkably well.I was involved a bit in helping them get better and training them. I take some personal pride in that as well. I was watching one of the senior ones here doing a very difficult operation a few days ago and it really was a joy to watch. He was using a microscope and he was doing a very difficult case – I was watching on a computer monitor and he really did it very beautifully. As a trainer, any senior doctors will tell you in a funny sort of way you get more pleasure from all the people you’ve trained and seeing their success rather than all the, in my case tens and thousands, patients I’ve treated over the years of my career. <figure><img width="2622" height="1612" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664a9c7e80680e059972jpeg.jpg" alt=""/><figcaption>Henry Marsh. Photo: SAKINA ABIDI</figcaption></figure>What are the challenges of specialisation in Nepal?It’s not unique to Nepal by any way, but the problem is this: if you have a relatively impoverished government and if people are reluctant to pay taxes, it’s very hard for the government to be able to afford good quality healthcare.Therefore, doctors working in expensive specialist areas like neurosurgery end up setting up their own private hospitals. This has happened in India, in Sudan which I know well, it’s happening in Ukraine and it’s happening here. You then end up with all these separate private hospitals which are basically locked in economic competition against each other. They all profess to be all working happily together for the greater good but it’s very difficult – they have to make a profit to survive and this sets doctors against each other.Now all surgeons, we all know that the more we do of a particular sort of surgery the better we get. If that workload is divided up and split between many different departments and different surgeons, no one person is really going to become very good at dealing with it.If you look at what’s happening in Europe and America, super specialisation is the game. I trained along with Professor Devkota in what’s called general neurosurgeon – I could do everything. But in recent years, we all stopped doing that, we became more and more specialised. I ended up specialising mainly in brain tumour surgery and even then, in particular sorts of brain tumours, which means I became very, very expert in that particular sort of case. That is not happening in Nepal.Do you have any solutions?I’m not here to tell people what to do because I don’t know. What I do know is that all healthcare systems reflect the underlying culture of the country. If there is a solution – it has to come from the people living in that country.Could you touch on the over-commercialisation of healthcare in Nepal?With all medicine, there’s a problem – is medicine a vocation or is it a business?Our judgement is easily distorted, unconsciously, and if you know you’re going to make a lot of money by treating the patient, or if you know your hospital needs to make money to survive, that’s probably on an unconscious level going to distort your judgement of whether to operate or not. Ultimately, with commercial healthcare, the patient becomes the means to the end of making money. With the other extreme, if doctors are only paid fixed salaries in a state system, in theory at least, the end of everything you’re doing is for the wellbeing of the patients and making money is not relevant.Read Also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor Health,</a> Editorial <figure><img width="500" height="574" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664d9c7e80680e059973jpeg.jpg" alt=""><figcaption>Henry Marsh training Nepali surgeons at the Neuro Hospital in Bansbari, Kathmandu in 2017. Photo: ESCAPMEDIA</figcaption></figure>What has your experience been like working with the hospital here?I think it’s a wonderful hospital. I love coming here. It’s not always easy for me, for various reasons, but I have absolutely no hesitation in wanting to help as much as I can. Clearly the transitional period following Professor Devkota’s death was very difficult. He was very famous, and it was like a magnetic attraction: patients came from all over Nepal to see him, often without neurosurgical problems. Inevitably now, with the change of staff, it’s been a difficult transitional period. What strikes me is the way the hospital’s survived. One might have thought it would completely collapse once he had gone but that’s not the case at all. How do we implement affordable and accessible healthcare in rural areas in Nepal?I’m not a public health expert. A major problem in Nepal, apart from the poverty, is poor infrastructure. In Europe, you can get patients fairly quickly from rural areas to central hospitals. That is often impossible in Nepal. You have to compromise, and you have to have more peripheral small hospitals out in the rural communities than you would in wealthier countries with more favourable terrain.Nepal has many problems. If you wanted to design a country to have difficult problems, Nepal is that. We all know being landlocked is a major problem for economic development. Having all these mountains and <a href="https://www.nepalitimes.com/here-now/environmental-destruction-is-a-medical-emergency/" target="_blank" rel="noopener">adverse geographical features makes life difficult </a>as well.Read Also: <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/Policies-for-the-people,3640" target="_blank" rel="noopener">Policies for the people</a>, Marty Logan<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">Is free health care possible in Nepal?,</a> S P KalauneeWhat are some of the values you want to pass on to the younger generation of surgeons?Firstly, to ask for help and not try to think you know everything because we don’t know everything. As young doctors, we’re often very anxious and frightened and we have to pretend to patients that we’re better than we are. We often end up pretending to ourselves as a way of boosting our self-confidence. It can be easier. I speak from personal experience; I can think of many patients who came to harm because I made this mistake. I didn’t ask for help from someone more experienced than myself.My message to young doctors is it is OK to feel frightened. That’s the nature of the work. You can’t be a good doctor, particularly when you’re young and fairly inexperienced, without being anxious and frightened. Don’t feel ashamed to say "I don’t know", not to the poor old patient, but don’t feel ashamed to say to a senior colleague “I need your help”.The other advice I give to young doctors, apart from ask for help, is listen to patients. So many doctors, including myself when I was younger, just sort of talk at patients rather than talk with them. Purely in terms of making a diagnosis and making the right decisions, listening to the patient’s story is very important. I’ve worked all over the world and medical systems vary all over the world. Doctors vary all over the world. As far as I can tell though, we’re all the same as patients: we’re frightened, we’re anxious, we want to be treated with respect. We want to be treated with respect and doctors are often bad at doing that – particularly in rather hierarchal societies like Nepal.

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Henry Marsh returns to the institute created by his neurosurgeon colleague Upendra Devkota

https://www.youtube.com/watch?v=bWTvesQmPVAR aharman Tamang was using a circular saw to cut a steel rod at a metal shop in Bhaktapur when a section of the rod snapped off and pierced his head.The rod entered through his left forehead just above his eyebrow, crossed the brain in the midline, and exited from behind the brain on the right side. (See CT scan, below) While doing so, it damaged the basal ganglia and internal capsule, the conglomerate of neurons controlling the movement of the left half of his body. Half of his body became paralysed immediately. Tamang, 20, lost consciousness and went limp.Relatives rushed him to a nearby hospital in Bhaktapur, which said it was not possible to treat him. They then took him to TU Teaching Hospital at Maharjganj, where he was turned away because there were no beds in the ICU.By the time they got to the emergency ward of Upendra Devkota Memorial National Institute of Neurological and Allied Sciences in Bansbari it had been four hours since the accident.Doctors were shocked — they had never seen a case like this. They were doubtful at first that the patient would live. Quickly the team reviewed literature to guide the patient’s care and management. Neurosurgeon Pratyush Shrestha found an article in Pubmed about a similar case in a hospital in Mumbai.Read also: <a href="http://archive.nepalitimes.com/news.php?id=7376#.XYNT_i4zbIU">Two out of 200,000</a><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58749c7e80680e054837jpeg.jpg" alt="" width="1400" height="933"/>“We did not have much time: the dirty rod could lead to brain infection,” Shrestha recalls.Any foreign object that enters a head has to be  taken out from the direction opposite to its entry, since removing it from the same side could inflict additional damage on vital nerves.An 11-member team, including resident doctors Suvas Lohani, Ranjan Lamichhane, Madhav Gautam and neurosurgeon Shikhar Shrestha took part in the operation. They also consulted Professor Laxmi Pati and Terence Hope. First, they performed a craniotomy and carefully pulled out the rod to prevent infection and bleeding.Read also: <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/book-review-Admissions-Henry-Marsh-Neurosurgeon,4055">The English Surgeon</a>, Niraj Shrestha<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58789c7e80680e054838jpeg.jpg" alt="" width="434" height="500">The only reason Tamang survived the delicate operation was because the rod miraculously missed by arteries that supply blood to the brain by millimetres. It also did not touch the brain stem and the vital organs regulating respiration and cardiac activity.Three weeks after his treatment, Tamang’s health is improving and he has been shifted to the general ward of the hospital (picture, below). He can talk, and is not suffering any major side effects, but needs to take his medication to avoid infection, and do physiotherapy. The doctors involved are working on a paper to be published in a peer-reviewed journal so the experience can help in treating other patients. “Just like we were guided by a paper, we hope our experience will also be useful to others,” says Shrestha.Tamang’s accident is an example of the sorry state of industrial safety in the country. He would not have been as severely injured if he was wearing a helmet.Sunil Kumar Joshi, a physician at Kathmandu Medical College, says that though the government has rules about safety in the workplace, they are not enforced.“Workers do not know that they can ask their employers to ensure safety and security,” he says.Read also: <a href="https://www.nepalitimes.com/here-now/upendra-devkotas-lives/">Upendra Devkota’s lives,</a> Kunda Dixit

Man survives steel rod piercing his head

<figure><img width="780" height="776" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903f09c7e80680e037cf2jpeg.jpg" alt=""/><figcaption>HOME IN THE MOUNTAINS: Ted Atkins in Khumjung below three of the mountains he had climbed: Mt Everest, Lhotse and Ama Dablam.</figcaption></figure>Ted Atkins, a British mountaineer, entrepreneur and frequent contributor to Nepali Times on climbing safety in the Himalaya died on Tuesday while descending Civetta in the Dolomites.Atkins was an aerosystems engineer and a member of the Royal Air Force Mountain Rescue Service and led the Mt Everest North Ridge Expedition in 2001. He summited Everest later from the Nepal side, and went on to climb Kangchenjunga, Makalu, Lhotse and Ama Dablam.He also set a world record for the highest ever boat ride by paddling a raft on a glacial lake at 6,300m below Everest. Colleagues remember him as a man who pushed the limits to get the job done, and was always trying out new adventures like <a href="http://archive.nepalitimes.com/page/everest-skydive-nepal" target="_blank" rel="noopener">high altitude freefall diving</a>.After leaving the RAF, Atkins ran a thriving business selling bottled oxygen to Himalayan expeditions at a time where there had been several fatalities caused by faulty equipment. His cylinders had a new kind of delivery system that he invented himself. “Everything Ted did was to the max, he had so many adventures and epics it is hard to believe he fell on the way from a via Feratta near his home in Italy,”<a href="https://heavywhalley.wordpress.com" target="_blank" rel="noopener"> wrote a friend in a blog tribute</a>. <figure><img width="1500" height="1167" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903f39c7e80680e037cf3jpeg.jpg" alt=""><figcaption> </figcaption></figure>The <a href="https://www.nepalitimes.com/opinion/the-oxygen-of-mountaineering/" target="_blank" rel="noopener">article he wrote for Nepali Times this year in May</a> recounted a close brush with death when his oxygen cylinder exploded before a climb. Many expeditions reported <a href="https://www.nepalitimes.com/latest/new-records-oxygen-failure-on-everest/" target="_blank" rel="noopener">malfunctioning cylinder regulators</a> procured in Kathmandu this year. In the article he blamed it on greed of unscrupulous businessmen. Atkins was working to make it safer with his company, <a href="https://www.gasworld.com/everest-oxygen-plant-first/2014746.article" target="_blank" rel="noopener">Top Out Oxygeneering</a>.Atkins often lamented the <a href="https://www.nepalitimes.com/opinion/outside-in/shooting-ourselves-in-the-foot/" target="_blank" rel="noopener">commercialisation of mountaineering in Nepal in his columns</a> and also had suggestions for improving Nepal’s tourism image. For instance, he thought <a href="http://archive.nepalitimes.com/regular-columns/Outside-In/business-customer-relationship,388" target="_blank" rel="noopener">Kathmandu Airport gave a very bad first impression of Nepal to visitors</a>.Atkins seemed to have a premonition of his death when <a href="https://www.nepalitimes.com/opinion/the-oxygen-of-mountaineering/" target="_blank" rel="noopener">he quoted in his last coluimn in this paper</a> the words of <a href="https://www.nepalitimes.com/from-the-nepali-press/i-want-to-live-my-last-among-friends/" target="_blank" rel="noopener">Upendra Devkota</a>, the neurosurgeon <a href="https://www.nepalitimes.com/here-now/upendra-devkotas-lives/" target="_blank" rel="noopener">who passed away in June after battling terminal cancer</a>: “Death is not so important. What is important is what the dead person leaves behind”.Atkin’s last words in that piece were: ‘Wise words that make me wish I knew the doctor. What do we leave behind, did we make anything better, what will our children say about us? Think about the future, their future.’ <h2>“Always make things better”</h2> <figure><img width="778" height="545" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903f79c7e80680e037cf4jpeg.jpg" alt=""><figcaption> </figcaption></figure>Ted was killed while descending a mountain near his home in the Italian Dolomites. A mountain that he had climbed many times before.As a true engineer, his outlook on life was always to make things better. His contribution to Nepal, especially as a pioneer in the field of mountaineering oxygen systems, is immeasurable. He was always a patient teacher to me and humored me always in my ignorance. Many were the times we shared a plate of chips and a beer or sat in his ‘mad scientist lab’ and talked about the purpose of our lives. You always lived your life to the fullest, making the best of each day. In that same spirit, you have left us so very suddenly doing what you loved doing.Ted was more like family to all of us here at ASTREK. His zest for life always energised us and his incredible stories could put a smile on anyone’s face. You may be gone but you will never be forgotten. I will miss you sorely. Dhanyabad for the memories MeroSaathi. Rest In Peace My Friend.<a href="https://www.facebook.com/dawasteven" target="_blank" rel="noopener">Dawa Steven Sherpa</a>, mountaineer and partner with Atkins in Top Out Nepal. <h2>“Spread positive energy”</h2> <figure><img width="855" height="570" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903f99c7e80680e037cf5jpeg.jpg" alt=""><figcaption> </figcaption></figure>Ted was an integral part of the mountaineering community in Nepal, greatly contributing to the development of oxygen systems and masks. With his Topout oxygen masks, he enabled hundreds of people reach the top of an 8,000m-peak in Nepal and fulfilling their dreams. Ted shall be greatly missed, not only for his incredible ability to come up with solid solutions to technical problems, his vigour to improve things and his expertise in many fields, but also for the amazing positive energy he spread around the streets of Kathmandu. It was always a pleasure to meet up with Ted, philosophise about life and the universe with him, listen to his adventurous stories and have a good laugh with him.Ted certainly lived his life, which sadly ended less than three months before his 60th birthday, to the full and enjoyed every moment of it. Thanks Ted for giving so much to Nepal and its mountaineering community. You have made your mark and you shall be greatly missed.<a href="https://www.facebook.com/profile.php?id=100009403310129" target="_blank" rel="noopener">Billi Bierling</a>, mountaineer and convener of the Himalayan Database

Kunda Dixit

Ted Atkins killed in climb

Upendra Devkota knew the end was near. He returned from London after doctors at the King's College Hospital where he was being treated for five months gave up hope of curing his cancer of the bile duct.He said he wanted to die in his own motherland, and he touched the tarmac with his forehead after landing in Kathmandu airport in April to pay respect to the Nepali ground. He showed signs of improvement after being admitted to his own Neuro Hospital in Bansbari.“<a href="https://www.nepalitimes.com/from-the-nepali-press/i-want-to-live-my-last-among-friends/" target="_blank" rel="noopener">I returned because I wanted to live my last in my country among my friends</a>,” he said.However, the cancer proved too powerful, and even Devkota’s iron will could not battle it. He asked one last time two weeks ago to be taken to his parents' village in Gorkha to drink water from the spring next to the house where he was born. <img width="640" height="779" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107111152/6368e3799c7e80680e033385jpeg.jpg" alt=""/><figure><img width="640" height="912" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107111152/6368e37c9c7e80680e033386jpeg.jpg" alt=""><figcaption> </figcaption></figure>As a doctor, Devkota seemed to know exactly when his time was up, and asked to be put on sedatives two days ago. He did not want his family to suffer on seeing him suffer. He never regained consciousness and the end came at 5:35 pm on Monday.Read also: "<a href="https://www.nepalitimes.com/from-the-nepali-press/i-want-to-live-my-last-among-friends/" target="_blank" rel="noopener">I want to live my last among friends</a>"Devkota was a brilliant student at the missionary school in Gorkha where he was <a href="http://archive.nepalitimes.com/news.php?id=2690#.Wye51i0Q0Wo" target="_blank" rel="noopener">classmate and rival of Baburam Bhattarai</a>, the Maoist ideologue. It was 1983, when Devkota, straight out of medical college, went to the renowned Glasgow Neuroscience Institute to fulfil his lifelong dream of becoming a neurosurgeon. Not just any surgeon, Upendra Devkota wanted to be the best neurosugeon in the world. Under the guidance of professor Graham Teasdale, and with the dint of hard work and fierce ambition, Devkota soon proved himself. But even as he learnt the craft, Devkota used to dream about building a hospital as good as the one in Glasgow some day in Nepal. He returned to Kathmandu 20 years ago, and set about making his dream come true. The <a href="http://archive.nepalitimes.com/news.php?id=11493#.Wye45y0Q0Wo" target="_blank" rel="noopener">National Institute of Neurological and Allied Sciences</a> was opened in 2006, and he brought Prof Teasdale to Kathmandu to inaugurate it. Asked by this newspaper why he returned to Nepal, Devkota had replied: "My philosophy is that it is more satisfying to grow vegetables in your own garden than to buy them at Sainsbury."Pioneering British neurosurgeon Henry Marsh, and a colleague of Devkota from his London days, writes in his book, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/book-review-Admissions-Henry-Marsh-Neurosurgeon,4055" target="_blank" rel="noopener">Admissions</a>: ‘Dev does almost all the major operating himself. In six weeks working in Kathmandu I saw more major operations than I would have done in six months in London … in the outpatient clinic he is like a king surrounded by courtiers and petitioners.’Among his more famous patients were <a href="http://archive.nepalitimes.com/news.php?id=7921#.Wye5-S0Q0Wo" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?hl=en&amp;q=http://archive.nepalitimes.com/news.php?id%3D7921%23.Wye5-S0Q0Wo&amp;source=gmail&amp;ust=1529465127615000&amp;usg=AFQjCNHT-TtUA9EQKlnir8kerPwz4vLvSQ">Ganga and Jamuna</a>, the conjoined twins whom Devkota tried to operate and save in 2002 before they were taken to Singapore. He saved Editor Kanak Mani Dixit from being a quadriplegic from a shattered spine in a trekking fall in 2000 by performing a seven hour operation in the neurosurgery ward he had created at the government-run Bir Hospital.Devkota served briefly as Health Minister in the Gyanendra government in 2005. His pet project of setting up a national insurance scheme could not be realised because Gyanendra was sidelined in a street uprising in April 2006. But he did establish the National Academy of Medical Sciences at Bir Hospital during his tenure.Devkota was one of the few who got to witness up close the aftermath of the royal massacre of 1 June 2001, when Crown Prince Dipendra killed nine members of his family and then himself. At a time when the truth was unbelievable and unpalatable to many, Devkota wrote a <a href="http://archive.nepalitimes.com/news.php?id=8252#.Wye55C0Q0Wo" target="_blank" rel="noopener">forthright piece</a> in this paper, recounting what he saw that night at Chhauni military hospital.He wrote about seeing the lifeless body of King Birendra, a monarch he admired, at the hospital amidst a row of corpses: ‘I had flashes of memory of having met him during a big international neurosurgical conference in Kathmandu three years ago: he was a perfect gentleman, and he felt deeply for the country. It was difficult to accept that he was gone, it was as big a loss for me as when I lost my father and mother.’ And now the great neurosurgeon and great Nepali, Upendra Devkota, is himself gone — ahead of all the lives he saved.

Upendra Devkota’s lives

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