Senior Neurosurgeon Prof. Dr. Rajiv Jha Discusses Surgical Challenges and Nepal's Healthcare System

Kathmandu. What goes on in a surgeon's mind before operating on a patient?

When asked this question at the outset of Ratopati podcast 'Talk Forward', Prof. Dr. Rajiv Jha, a senior neuro and spine specialist, who had just finished consulting with about a hundred patients that morning and operated on some the previous day, became serious for a moment. This seemingly simple question delves into profound depths for Prof. Dr. Jha.

After thinking for a while, he powerfully stated, 'Surgery is like a war.' He continued, 'People might think, what's the big deal for someone who has been doing this for 26 years? But the reality is different. For me, no operation is minor. No matter how experienced we are, no matter how minor it's called, we treat it as major. Surgery is like a war. Just as a soldier goes fully prepared for war, we also prepare ourselves mentally and technically.'

It's unpredictable when complications arise during surgery. For that, in his words, a surgeon must be prepared to fight an 'invisible enemy.'

He was asked again - what goes through your mind before surgery? 'As I get older, emotional aspects affect me more than technical ones. While the patient is lying on the operating table, I think about their family,' says Prof. Dr. 'If something goes wrong, what will happen to this family? Is he the main earner? Does he have small children? These thoughts bring a greater sense of responsibility.'

The consultation between a surgeon and the patient's relatives before surgery is crucial. Dr. Jha, who has performed over 23,000 surgeries in his 26-year medical career, sometimes attributes incidents of vandalism in hospitals due to patient deaths to a lack of necessary communication and counseling.

'Problems and vandalism occur where 'counseling' is weak. If we spend 10-15 minutes with the family before the operation, clearly explaining what we are doing, the risks involved, and the possible outcomes, 99 percent of problems can be avoided,' he shares his experience. 'An environment of trust is built through communication.'

He consults with hundreds of patients daily. He performs an average of 5 to 8 operations daily. Some challenging situations arise during operations. 'I will never forget a recent incident. A 20-year-old college student came to me. She had an AVM (arteriovenous malformation) problem in her brain. This was discovered when she showed symptoms of epilepsy. When I explained this to her, she cried uncontrollably. I felt very bad too,' he recounts.

The family of the student, who was preparing to go to India, was advised by doctors there to have the operation done by Dr. Jha. The surgery, which lasted six and a half hours, was successfully completed. 'That six-and-a-half-hour operation was extremely risky. A small mistake could have led to paralysis. But it was successful. Today, that girl is completely healthy. The happiness derived from such successes cannot be expressed in words,' he shares.

Dr. Jha comes from a farming family background. His grandfather owned considerable land in Mahottari. His grandfather was very conscious about educating his children. His father completed his postgraduate studies from Scotland and worked in various organizations in Nepal. His father's wish was to make Rajiv a doctor and his brother an engineer. Following their father's wishes, both brothers entered their respective professions.

Dr. Jha studied medicine in Russia. After returning, he worked as a Medical Officer at Bir Hospital.

'But when I was transferred to the Neurosurgery department, Dr. Upendra Devkota was there. At that time, Neurosurgery was an extremely demanding department requiring a lot of work. There was a crowd of patients, and some died while waiting for their turn,' he explains the reason for shifting to neurosurgery. 'Dr. Devkota's dedication and discipline towards work attracted me. He guided me, saying, 'You must become a neurosurgeon.' Becoming a neurosurgeon in Nepal requires a lot of struggle. I spent 12 years for a five-year degree.'

Prof. Dr. Rajiv Jha is the head of the Neurosurgery department at both Bir Hospital, the oldest and largest government hospital in the country, and at the well-equipped and expensive private hospital, Norvic International Hospital. He was asked the common question: What is the difference between the treatment methods at these two places?

'There is no difference in the quality of treatment. The same hand that operates at Norvic also operates at Bir. Bir has state-of-the-art technology and skilled manpower. The difference is only in facilities and experience,' he shares. 'Bir has a large crowd, patients' relatives have to sleep on the floor, and sanitation is a challenge. Everything at Norvic is organized and well-equipped. But in terms of saving lives, both places are the same.'

He further adds, 'People criticize government hospitals, but they also trust them more. The patient load at Bir signifies the trust in the doctors and services there.'

During the interview, Prof. Dr. Jha also provided some information about brain and nerve-related problems. 'Head injury' and 'spinal injury' are quite common problems in Nepal. Road accidents are considered the main cause. However, he states that this problem is decreasing due to adherence to traffic rules and increased public awareness. The problem that is increasing alarmingly now is 'brain stroke' (cerebrovascular accident).

'Brain strokes are increasing alarmingly now. This is a consequence of diet, stress, and a chaotic lifestyle,' he says. 'People take medication for pressure and sugar but do not improve their lifestyle. 90 percent of strokes can be prevented with discipline and a balanced lifestyle alone.'

Dr. Jha's experience also indicates that nerve compression in the spine and neck is widespread. This problem is more common among those who sit at a desk for long hours.

He was asked an interesting question: We all say emotions come from the heart. But science says the brain does everything. Why do common people focus on the heart rather than the brain?

'The brain also directs the heart to beat. Emotions like increased heart rate, love, or hate are all play of brain chemicals and hormones,' Prof. Dr. tries to explain scientifically. 'If the brain is dead, the person cannot remain alive even if the heart is beating. Therefore, the brain is the real center and commander of the body.'

In most developing countries, the healthcare system is often criticized for being disorganized. Nepal is no exception. For treating sensitive diseases like neurological and spinal conditions, it's not enough for doctors to be skilled; infrastructure and technology are also involved. For this, Prof. Dr. Jha offers some suggestions, mixed with his dreams, to the government.

'First of all, we need a National Neuro Science Institute where neurosurgery, neurology, psychiatry, and all services are available in one place. Secondly, it is necessary to bring modern machines like radiosurgery into Nepal, which can treat tumors without opening the head,' he says. 'Due to the lack of these facilities now, patients are forced to go to India. Additionally, there is a great need for 'rehab centers' (rehabilitation centers) in government hospitals. Stroke patients require long-term physiotherapy after surgery, which is very expensive.'

Towards the end of the podcast, he also spoke about the work needed to bridge the class divide in Nepal's healthcare system. He believes that health insurance is the single, definitive solution for this. 'As soon as a patient reaches the hospital, they should not have to check their pockets. There should be a guarantee that insurance will cover their treatment costs,' he says. 'As long as healthcare is linked to money, discrimination will persist.'

Indeed, if insurance is made effective and hospital management is improved, world-class treatment is possible in Nepal. Prof. Dr. Jha says, 'We doctors are soldiers, ready to fight the war; the state just needs to provide the appropriate battlefield and weapons (equipment).'

Video/Photo: Manoj Khadka, Ayush Dhami/Ratopati