"I could be a change maker here, not in the West," Dr. Ashok K Banskota
“You have to see this photograph,” exclaims Dr Ashok K Banskota as his swift feet excitedly lead us to the children’s library at the Hospital and Rehabilitation Centre for Disabled Children (HRDC). Amidst the colorful alphabets and drawings that decorate the walls of the room is an old black and white photograph that he points at and says, “This is a boy I’ll never forget. This is Sajan.”
The photograph shows Sajan playing badminton. The upper half is a pretty picture of the young boy with his bright eyes fixed on the racket that just made a hit or is expecting one, his smiling mouth slightly and eagerly open in anticipation.
The lower half, though, shows a gloomy side of his frail bare body exposing the white cotton patches dressed over the incisions in his thighs.
A piece of cloth around his waist fastening him to a metal contraption with big wheelchair tires; and his small feet strapped to resting footpads. All this to help him stand upright and play.
“He had spinal tuberculosis which had paralyzed his lower body and he used to stay curled up. After treatment, though, he could at least stand up and walk around with the help of crutches,” says Banskota, still gazing at the photograph. “Our staff built him this contraption during his recovery, just so he could play badminton.”
Sajan’s is one of the many success stories and lives – 43,000 so far – that Dr Banskota and his team of orthopedic professionals have made possible over the years.
Recognizing his contributions, the World of Children Award (considered the Nobel Prize for child advocates) had honored Dr. Banskota as their Health Honoree last November. You’ll see posters of him receiving the award hung everywhere in the hospital building.
The center, its staff and patients, all seem to take pride in his achievement. However, as he walks us through the facility, greeting his patients and staff with a smile, there’s not a hint of conceit you would expect that a worldwide acclaim could have brought on him but his humility.
“Here’s another photograph of us during our initial days,” he says, now showing us a photograph of an operation theatre. “You see the lamp hung up there? We fastened it there ourselves with ropes. The old suction machine was donated by a German friend.”
Right beside it is another photograph of a different operating room, the size of a narrow corridor. “I always believed that we could start from simple things,” Dr Banskota shares, “So I made do with anything we could find. Borrowed, donated, used – anything that could help us mend those children.”
The planned 100-bed HRDC facility now sited atop a peaceful hillock in Banepa also had a humble beginning elsewhere. Around 1984, the Swiss organization Terre des Hommes (TdH) was looking to help physically disabled children in Nepal and they needed a leader to take charge of their program.
When Dr Banskota, who at the time was volunteering and working in different hospitals, came into the scene, he took their simple idea of post-operative care for children to a whole new level.
“Seeing the condition that the hospitals were in back then, I was insistent that if they really wanted to help, things had to be done properly. I mean, follow-up care wouldn’t make any sense unless it was provided with actual care or treatment in the first place.”
Soon, as the program went into its planning phase with Dr Banskota leading the team, they realized the importance of a comprehensive treatment facility.
Most pediatric cases he attended to were from very poor families who couldn’t afford follow-up care. So he shouldered the responsibility of building a complete unit of not just orthopedic surgeons but caretakers and community workers for overall care as well.
By September 1985, patients were admitted to the facility built inside the Khagendra Nawa Jiwan Kendra in Jorpati.
“Most of these old photographs are from back then. We were there for eight years,” says Dr Banskota and adds, “But we had to move out of there because of the way government organizations functioned. There was a lot of bureaucracy which we couldn’t deal with. We were thinking very big but they were just bound to rules.”
After that, they ran a temporary facility in Dhobighat for another seven years. “During that time, we tried hard to sort out our goals. We had to find a way to collect a lot of funds or just close down. That was a period of severe soul searching for me,” he shares.
However, the work had shown well and people trusted him. Support came, and in 1997, they could finally settle at their current location in Banepa.
Now the facility that provides treatment for needy children below 16 years of age is recognized as one of the best in the world for treating clubfoot, a congenital foot defect where it turns inward and downward, and many other physical deformities in children.
In the physiotherapy section, a health worker applies cast on the legs of a child stretched out on a table.
Overseeing the procedure, Dr Banskota explains, “This is the Ponseti Method where we apply the cast over time to correct the alignment of feet in cases of clubfoot.
This has been very effectual and feasible in Nepal because it’s a non-surgical and cost-effective method.”
As you walk around the center, you’ll notice many children having received treatment with such casts, metal contraptions, different types of orthotics or braces that assist movement of limb or spine, prosthesis or artificial limbs and other assisting devices.
While many children recover fully after some treatments or surgeries and are able to live normal lives, Dr Banskota points out that a many of them still have to wear or use certain devices for life.
“From the very beginning, I had realized the need of having our own workshop to make assisting devices, prosthetics, orthotics and special shoes for our patients,” he shares as he walks us though the garden to the workshop. “We’ve always had a workshop since our days in Jorpati but only after coming here were we able to set up a well-equipped one.”
The workshop smells of leather, plastic and metals. The first thing you see are artificial legs, shoes and a variety of limb supports on display.
Inside, different sizes of black leather shoes with an opening in the front line up on a long table. In the adjoining room, workers are busy making orthopedic supports, most of which has to be custom-built according to the measurements and requirements of the patients.
“Apart from children, this workshop also makes orthopedic supports to sell them at my other hospital, B & B,” says Banskota. “This generates some 600,000 Rupees every year for the operational costs of the center.”
The workshop tries to reuse old materials to make the devices. Pipes and scrap aluminum metal are evident from the heaps of water pipes stored outside the workshop.
“There are many challenges in running this facility,” says the Doctor. “We need to constantly think about maintaining enough funds to keep it running.”
As the center provides its services to their needy patients almost free of cost or charge minimal amounts, it has been running with the support of a few donor agencies and top orthopedic surgeons and health professionals from Nepal donating their time and hard work.
He ends the tour after a final inspection of the three busy operating rooms. In the waiting room outside, Doctor Banskota then settles down with his doctor son Bibek Banskota, just through with a surgery.
Joined by another colleague and second in-charge Dr Babu Kaji Shrestha, they start discussing some cases and administrative details. Often, their talks sway into load shedding and politics but always come around to their patients and the center.
“The children we treat here come from very deprived families, many from far and remote villages,” shares Banskota. “They come from such hardship backgrounds that if you listen, each one has a beautiful sad story to tell.”
Khum Bahadur Pandey, 12, from Baglung has been at the center for six months after his surgery. Abandoned by his father, Khum has his old mother as his attendee who can’t even remember her own name sometimes.
“Her name is Thum Kumari Pandey,” Khum answers for his skinny mother who stammers and shies away from most questions.
He then shares that his legs were previously bending frontward from the knees, due to which he could not stand and had to crawl on his four limbs. The surgery transformed him as he is now able to stand and walk upright with the help of crutches.
Then there are the Mandal siblings – Dukhi and Lalita. Both were operated on for their clubfeet at the center. Though they are fit to be discharged within two weeks, Tara Badan Sedai, educator at the center, informs that their father is worried about having to take them back to their village in Siraha.
“Here, they are guaranteed their daily meals. Back home, even that becomes a challenge,” says Sedai “We’ve seen cases where children with disabilities are abandoned and have to face a lot of criticisms from the society.”
Sedai, who herself was operated on by Dr Banskota for her joint infection when she was 16, still walks with a limp. “As I was bedridden and walked with crutches for years, I know the hardships and discriminations people with disabilities have to encounter everyday,” she says.
Now involved with the Disabled Human Rights Center Nepal (DHRC) and HRDC, she says she is content to be working with and for disabled people in the society.
Rasial Pariyar is another former patient at HRDC who now works there as a nurse. She was treated at the center for her bone disease when she was a fourth grader.
Later, when she was in the eighth grade, she started working in the center as a helper. A hardworking girl, she wanted to study further but her economic condition was quite poor. With the help of some organizations which had been in good terms with the Center, she could complete her school and nursing course.
“There was a time when my family members and the sisters (nurses) had to help me day and night for even simple things like walking and going to the toilet,” recalls a soft spoken Pariyar. “Now, that I get to work as a nurse myself and take care of children like me, the sense of joy and fulfillment I get is something you can’t explain in words.”
Sedai, who like many at the center call Dr Banskota “Baa” or father, says his efforts and hard work over the years have not just helped patients improve their physical condition but opened their doors to whole new opportunities and possibilities.
At his office in the B & B Hospital which he shares with his friend and business partner Dr Jagadish Lal Baidya, he looks through an x-ray of a patient as he slowly settles down in his chair.
“I used to work from six in the morning till midnight in my initial years,” says Banskota. “Though I still juggle between operations and administrative work between my two hospitals, seminars, preparing journals and reading research papers, I take time to relax now. I have a strong spiritual focus, a well balanced life, follow the teachings of my Guru Paramahansa Yogananda to meditate and rejuvenate myself, and I love my work. All this still keeps me going strong.”
Over at HRDC, he says, they now have a team of young doctors specialized to deal with most complex and complicated cases, dedicated Community Based Rehabilitation (CBR) workers, staff and well wishers who should be credited for the present success of the center.
With an MS program in orthopedic surgery and several training programs, it has also been generating more skilled health professionals in the field.
“With our CBR program, we’ve developed additional links with organizations outside Kathmandu to keep track of patients for follow-up care as well as identifying children who need assistance,” says Banskota. “At any given time, our network of activities includes minor surgeries in some70 districts of Nepal.”
Moreover, they also work to create awareness and educate families about the preventive aspects of several diseases.
“Almost 50 percent of the cases we deal with are preventable. Late report has been the major challenge. With early identification and a certain level of awareness, many children can be prevented from suffering and disabilities,” he says and adds with an unfaltering passion in his voice, “Seeing children suffer is completely another level of pain and I knew I had to do something about it.”
For Banskota, who returned to Nepal in 1977 after completing his studies in the US, his initial years were a complete chaos and he often thought he made a mistake by coming back.
As he couldn’t stick to mainstream government jobs, he kept himself busy with volunteer work. But his family was being driven to a state of almost poverty.
“My basic goal in coming back was to use my skills and work. But I always ran into trouble with the authorities for their bureaucratic ways of working,” says Banskota. “You see, I wanted to work, not just hold a job.”
More than three decades down the line, though, he says he now knows he made the right decision as he could never have had this sense of fulfillment had he been somewhere else.
“I had realized from the very beginning that the state of healthcare in Nepal was very poor. And because the work was so challenging, it was more interesting for me as I knew I could be a change maker here, not in the West. There, you’re just some other guy.”
Employing hundreds of people between his two hospitals and mending the lives of thousands of children from all over Nepal, Dr Ashok K Banskota now stands tall as a figure of inspiration and hope for many. And there is no denying he has been a change maker here – in its truest sense.