1. Anesthesiologist.

On the occation of 25th. anniversary of Nepal Orthopedic Hospital I would like to extend my “Warm Greetings " to all well-wisher, hospital staffs, patients and wish for further progress of the hospital days ahead.

I feel very much greatful to have had opportunity to work in this hospital for more than 20 years since beggining. Though I'm not physically present now, emotionally always within it.

25 years ago Dr. Anil Bahadur Shrestha and myself were working together in different hospitals of Kathmandu. One day he asked me to take responsibility of anesthesia department of this hospital. Next day I visited the hospital. It was difficult to accept his request to run orthopedic surgeries and anesthesia services in the space and facilities that he had shown me. But I know the difficulties to run new hospitals at the beggining. At that time I had five years experiences of working at difficult situations in regional hospitals and conducting surgical camps in remote villages of Nepal. So I planned how to start safe surgery and aneshesia with available space and equipments. With the views of,

Diversities:- Most of the orthopedic patients are extremes of ages, like neonate, children, geriatric patients with multiorgan failure or young healthy athelitic group of patient.

Most of the orthopedic surgeries could be done under regional anesthesia

There was no intraoperative monitoring devices except sthesthoscope and manual blood pressure instrument. The most dependable intraoperative monitoring device is contineous presence of anesthesiologist himself.

So decided to start with young healthy aged group of patients under regional anesthesia and contineous presence of anesthesiologis beside operating table palpating patients pulse and manual BP monitoring regularly.

Three months after opening hospital we started surgeries in the month of October 1998 once a week. After few months, the number of case increased, we were forced to do all the pediatric, geriatric cases also under all types of anesthesia. Hospital bought a second hand ECG monitor for contineous monitoring during surgery. In addition we made a oesophageal sthesthoscope monitor in Rhyl's tube with a glove's finger piece. This device could monitor heart rate as well as respiration contineously during surgery under general anesthesia for patient safety. Operating days increased gradually three days to six days a week. Additional part time anesthesiologists managed. Anesthesia assistent nurses trained on our own.

After few years we got huge container containing hospital equipments including anesthesia in donation from abroad.

Modular Pierre Sout operating theater construction complited and OT shifted in 2004. Then Different specialitis of orthopedic surgery from abroad organised like, Foot and ankle, Hand surgery, Opertion walk teams for total knee and hip replacement and orthopedic surgical camps at remote zones of the country every year. Several times full time anesthesiologists appointment was unsuccessful. In 2013 I was retaired from government job. I got five years contract appointment. One full time freshly passout anesthesiologist was also appointed.

During operation walk team visit they brought portable USG for regional block. It was not available in Nepal at that time. They demonstrated us guided regional blocks. Later on two times similar type of USG machines were donated by Dr. Katerine Heaggan. We were very much oblised with her.

In the year 2015 there was major earthquick disaster in Nepal. There were severl panicked episodes. I would like to mention few few amog them.

1, It was not possible to run our orginal operation theaters for trauma cases at second floor. So we prepared emergency operating room at ground floor. Second day of major earthquick we were operating two case simultaneously. Middle of operation there was big earthquick vibration again. Since that was temporary emergency operating room oxygen supply to the patients were from big errected oxygen cylinders started vibration with sounds as if it was going to fall down in the ground. Patient anesthetised operating table started mooving, every one of us were also panic, with great patience some of us hold oxygen cylinder and some operating table. After cesation of vibration we completed the operations.

2, The flow of trauma cases were increasing in the hospital. It was not possible to manage in the emergency operating room. We shifted to our second floor orginal operating room. A case of first day earthquick victim was operating under regional anesthesia. A big earthquick vibration was stared with different sounds. She was fully conscious started crying and attempted ran away. We assured her and complited her operation.

3, Now everyone of us including patients were panic for operation. Fortunately hospital got a huge operating tent from Canadian government, in which we can operate four cases at a time simultaneously. With great obligation we errected the tent in front of hospital premices and operated there for several months safely, fairlessly.

By the end of 2018 I had complited my twenty years long services at this hospital including five years fulltime contract and then handed over my department to younger generation anesthesiologists. They are running the department nicely. Thank you all.

Dr. Chhatra Krishna Shrestha