Kidney Stone Treatment in Nepal

 A blogpost by 64 year old kidney stone patient about his treatment in Nepal through PCNL (Percutaneous nephrolithotomy) technique. This post is just for experience sharing. Consult a registered doctor before taking a medical decision, do not take any decision based on this post. Medical charges mentioned here are likely to change in future and can be more depending on the hospital.

Image by Mohamed Hassan Pixabay

Background

I started feeling sudden pain in the back, belly and side, pain and burning during urination, sometimes blood in the urine and smelly urine, and urine passing a small amount at a time, sometimes nausea and vomiting, fever and chills. I did not know what was causing this. I thought gastritis, a disease which was common among many people of my age was the reason behind it. Then I went for a health check-up at Manipal Teaching Hospital, Pokhara. Through stool, urine and X-ray analysis the doctor found out that it was kidney stone which was the culprit in my case. At that time the stone was not so big perhaps (around 7mm). So, doctor did not immediately recommend surgery and prescribed medicines. Post that, I did not feel much discomfort and I ignored the issue altogether.

Reoccurrence of the problem

But after a couple of years, I started feeling similar pain. This time too I thought it was caused by gastritis. The pain was kind of unbearable and I felt dizziness so went for a health check-up at nearby polyclinic. The polyclinic was not so well-equipped, so and therefore it was unable to diagnose the exact problem. The doctor there thought it would be due to high blood pressure so prescribed the medicine for the same. I spent like NRS 3500 for all tests, but all in vain. The pain was still there. I should have gone to a better-equipped hospital. During that time, I would feel severe pain and the pain would radiate to lower abdomen and groin and also would come in wave and in varying intensities. I lived with it for almost 5 months. Covid crisis was rampant at that time and I was a little afraid of visiting a big hospital, thinking that it was not safe to go to there. But my situation worsened and I began losing appetite. I would not feel hungry and did not feel like eating most of the time. and feel cold all the time. And also, I had fever sometimes and felt very weak. I remember many instances of vomiting and having severe fever this moment and being normal the next.

Visiting TU Teaching Hospital

After many months of living with this problem, I decided to go to TU Teaching Hospital for treatment. I was thinking it was due to gastritis even up until this point. So, I went there early in the morning took token at the gate for the same issue. At exact 9am, they started selling tickets (we need to take tokens early on because people start queuing up from as early as 6am)  and I purchased one, taking my turn for gastro department. It is a very crowded hospital, and my health condition was very poor. It was very uncomfortable for me to even wait in line. After 3/4 hours of waiting I got to see the gastro doctor. He learnt everything about my case and ordered stool and urine analysis, ECG and other tests, then he told me to visit C12, B5 and other blocks at TUTH to book an appointment for the same. But when I went there,  the individual there asked me to come after 15 days for stool test in empty stomach. I was away from home, and feeling very weak. So, I decided not to wait for that long,  and rather have it tested from the private hospital. So, I came back home without paying for any test in TUTH, where cost would have been reasonable/cheap but I was in a difficult situation so I did not think it was a good idea to wait for that long. 

...then In a Private Hospital

Photo credit:-Aastha Kidney Hospital

So, I decided to do all the tests in a private hospital even if meant paying more. The pathologists there analysed my stool and urine and did all the tests ordered by TUTH's doctor and immediately they found out that there was a cyst measuring 16mm in my left Kidney, which was quite large and my kidney was swollen. So, the medical officer immediately told me that I would need a surgery and asked us to consult a senior doctor. He prescribed a liquid a medicine which he said would stop more stone from forming. We asked them to call a senior doctor paying NRS 1000 consultation charges, and the doctor told us that, we need a CT Scan and we need to do surgery. A normal surgery is reasonable but in that we need to cut open the kidney and stomach. It is painful for the patient and takes long to recover. So, he suggested us another option i.e. PCNL (Percutaneous nephrolithotomy) which he said was a minimally-invasive procedure to remove stones from kidney and patient can be discharged soon and the wound also heals quickly even-though it is a little expensive. The estimated cost as per him was NRS 60-70 thousand for surgery alone and we needed to buy surgery materials ourselves like saline water and stuff. We also needed to pay for operating theater (OT-where PCNL is performed under general anaesthesia) charges, and then after operation patient is kept in ICU for few hours. I had felt severe pain when I was in ICU, after medication it was relieved,  and after ICU if the doctor deems the situation is normal he then keeps us in general ward for 1 day and next day I was discharged from the hospital. In my case total PCNL cost was almost NPR 1 lakhs including medicines and other costs. We also need to to CT scan, I did it from Sooriya Lab Lazimpat, they have pretty well-equipped lab, they had asked me NRS 12,000 for CT scan but after long bargaining, I had paid  NRS10,000. Moreover, pathology lab charges for stool, urine analysis should also be taken into account. So, doing PCNL to remove kidney stones from a private hospital can cost well above NPR 1 Lakhs 20 thousand. Depending on the hospital and facility they provide the total cost could reach 2 lakhs and more. 

National Social Health Insurance Provided by Nepal Government

So it is always better to do regular health check-up. Purchase insurance plan provided by Nepal government named (National Social Health Insurance ) which covers up to NRS 1 lakhs at many public hospitals. We can get the list from NHSSP's website. We can purchase it at Rs 3500. When I had called to see my chances of getting insurance, the official told me that I need to renew or buy the government insurance plan  by end of Chaitra and I can claim from the beginning of Jestha. 

Prevention is Better Than Cure

I think it is always a good idea to have regular health check-up. If you suspect you might have kidney stone, have your health checked-up because if it is diagnosed early on, you will not need to undergo surgery. From quick google search I found out that if the stone is smaller than 5mm, chances are high that it will pass through urine after sufficient water intake. If you do not require surgery, it will save you money and a lot of hassle. I also found out from Youtube that Ajambari (Pattharchatta in hindi) plant is good for kindey stone. There's a process to consume it and it must be done rightly. If we do not use it rightly it could have negative consequences, so consult a doctor before resorting to do anything on your own. Everybody's health situation is unique and only the authorised medical practicers can tell what is the best thing to do.

Treatment atTU Teaching Hospital (IOM)

 

Photo Credit: Krish Dulal (Wikimedia Commons)

TU teaching hospital (IOM), established in 1982 with the support of JICA, is a well known public hospital in Nepal with 663-bed facility. It is the premier medication institute of Nepal.  Tribhuwan university hospital is the largest hospital in country providing tertiary-level health service. The hospital is the site of teaching and research activities of IOM ( Institute of Medicine).

When visiting TUTH for treatment or diagnosis, we need to purchase a ticket. It costs NRS 60 for new patients and NRS 30 for the old ones now. For morning session we can take tokens (we need to take tokens first and wait for our turn for the tickets) from 8:15 am onwards. They sell tickets from 9 am till 11 am for the morning session. There are separate windows for old and new patients, it is mentioned on your token which window you should visit.

Now we can also purchase the ticket online to avoid the hassle of waiting in line for a long time. Google the link for online tickets of TU Teaching Hospital. 

For Ear, Nose, Throat, Head and Neck Surgery there's a separate department called Ganesh Man Singh Center for Ear, Nose, Throat, Head and Neck Surgery. We can get tickets for ENT in this department. So, ENT patients should directly visit this building, not the main ticket counter. Ganesh Man Singh Center is behind the main ticket counter building.

For Dental patients Dental building is near the main gate of the TUTH. They start selling tickets one hour later than other departments.

In order to get tokens we need to ask the guard or other staff over there. They'll hand us a tokens asking our problems and we then need to wait for our turn.

There's a Counter of HImalayan Bank in the main ticket counter buildling marked number 100 where we need to pay the charges of Stool, Urine and other costs of the  pathology lab. If you're told to go to 100 just remember the Himalayan Bank Counter near main entrance of main ticket selling building.

In TUTH if you are referred to LAB for stool, blood and urine test, which in most cases you will be, it will take time. In my personal experience they had asked me to come after 20 days for stool and urine test. So, I had to go to the private hospital to get it sooner.

Even in the Dental department, when I had visited they said that their X-ray machine was out of order, hence my Dentist recommended me to visit Norvic Hospital for X-ray. I was having excruciating toothache so I decided to go to a private dental hospital in the city, where they did everything in one day, and my toothache was gone after first RCT.

TUTH is definitely a good hospital but due to high patient flow and maybe due to lack of proper management, patients are made to wait for fairly long period of time, which is doubly painful for those patients who are visiting the hospital from outside the valley and have no place to stay in Kathmandu.

Narayanhiti Palace Museum

 

Photo credit:Suraj Belbase 

Narayanhiti Palace Museum was the residence and workplace of reigning monarch of Kingdom of Nepal.It was built in 1961 by King Mahendra. Architect of this grand palace was Benjamin Polk based in California. After 2006 revolution it was turned into public museum.

This palace complex showcases courtyards, gardens, taxidermy heads of tiger, deer, Arna Buffalo (Bubalus Arnee) tiger and other wild animals' skin, and different rooms used by the monarchs for various purposes. Before the entry fee to visit the museum used to be NRS 100 for Nepalese. For foreigners it's higher and South Asians are entitled to some discount. Now museum visitors can see Shree Sadan too which was previously unavailable so the entry fee is NRS 200 for Nepalese. Shree Sadan is three-storied and  King Birendra's family home. 

However, as per traditions crown prince needed to stay separately from parents as he turned 18, so crown prince Dipendra did not live in Shree Sadan. He actually lived in Tribhuwan Sadan, where royal massacre took place in 2001 and Tribhuwan Sadan was later demolished. We can still see the debris over there. As a matter of fact, Shree Sadan is built by King Birendra himself after he moved out of his father's home. 

On the way to Shree Sadan we can see a plane,  a helicopter  and expensive bullet-proof Mercedes and other cars used by ex-royals. There's also a car gifted by Adolf Hitler himself. 

NARAYANHITI PALACE WEBSITE states that it's closed on Tuesday. It opens on Wednesday through Monday from 11am onwards till 4pm.

There will be museum staff to guide us and they also ensure the safety of the things that are there. Put aside at least one and half hour to see everything that's there and probably more depending on how deeply you want to observe things. Narayanhiti Palace Museum has got a high rating on Tripadvisor too.

There's also a washroom there which visitors can use, in the garden area behind the main palace building and resting benches for old age people.

Nepali traditional units of land measurement. (Ropani / Dhur / Kattha / Bigha / Paisa /Daam etc.)

Image by King-H from Pixabay (edited).

Nepal still uses traditional units of land measurement, although in 1998 the metric system has been made the official standard.

In hilly and mountainous regions of Nepal, Ropani / Aana measurements are commonly used and In the Terai region, Biga / Katha /  Dhur units of land measurements are used. Below I have listed the conversions so that you can have a better grasp of traditional units and how they compare with modern measurement units.

1 Bigha  = 20 Kattha  = 6772.63 m² = 72900 sq.ft. = 13.31 Ropani

1 Ropani = 16 Aana = 64 Paisa = 508.72 m², = 5476 sq. ft. = 256 Daam = 4 Ilka

1 Aana = 4 Paisa = 16 Daam = 31.80 m² = 342.25 sq. ft.

1 Paisa = 4 Daam  = 7.95 m² = 85.56 sq. ft
.

1 Daam  = 1.99 m²  =  21.39 sq. ft.

1 Khetmuri = 25 Ropani