Development of Use of Radiation in Medicine

New Radiotherapy Centers and Infrastructural Needs

Year 2016 has been a significant year for cancer treatment in Nepal. Nepal Cancer Hospital and research center (NCHRC) in Lalitpur will soon start radiotherapy services with Varian Truebeam machine while Kathmandu Cancer Care and Research Center (KCCRC) in Bhaktapur has already started radiotherapy services with Elekta Synergy machine recently. Both of these machines are modern medical linear accelerators from two different companies. Previously, only BPKCH in Bharatpur and Manipal hospital in Pokhara had medical LINACS. NCHRC is also going to start High Dose Rate Brachytherapy with 24 Channel Gammamed ix plus machines to treat gynecological malignancies.  With the addition of these two new external beam radiotherapy machines in Nepalese Health Care system and one HDR Brachytherapy machines, we are now capable of performing modern cancer treatment techniques like 3DCRT, IMRT, VMAT/Rapid Arc, Stereotatic Radiosurgery & Stereotatic Body Radiotherapy,Total Body Irradiation in the country.

Previously, Cancer patients who had indication for such treatment techniques had to go abroad to receive such treatments. There used to be tremendous financial, psychological and practical difficulties for cancer patients and their families to receive such treatment in abroad. With these new medical facilities in the country, cancer patients and their near ones will surely be relieved with such pressures.

However, with the addition of new facilities in diagnostic radiology and radiation therapy, there is a rising challenges in the part of the service providers and government of Nepal to establish adequate radiation infrastructure for smooth functioning of such facilities in the country.

 Firstly, since radiation therapy machine produces ionizing radiation to cure malignancies, proper handling of such equipment is important. There should be a quality assurance mechanism to ensure quality treatment with these machines. Proper treatment outcome of radiotherapy requires the joint effort of Radiation Oncologists, Medical Physicists, Radiation Technologist, Oncology Nurses and others involved. Nevertheless, Medical Physics, Radiation Technology and Oncology Nursing courses are not offered in the country. So there is a shortage of these professionals in the country. GoN should take actions to prepare such human resources in the country.

Secondly, radiation monitoring is an important aspect of radiation safety. But due to the lack of radiation law, radiation regulatory body and infrastructural arrangement, there is difficulty in adopting proper guidelines and dose audits. So it is important to draft radiation law, establish regulatory body and make infrastructural arrangement as soon as possible. Drafting radiation law and establishing radiation regulatory body with give basic guidelines in operating radiation facility and help to move further to prepare necessary documents to ensure quality treatment.

Thirdly, most radiotherapy machines and related equipments are specially designed highly advanced machine. Establishing radiotherapy facilities requires huge investment. So GoN should facilitate in all possible ways to encourage health service entrepreneurs and hence increase access to specialized health services for cancer patients within the country. This will ultimately appease cancer patients and their near ones by minimizing their financial burden, psychological pressure etc. In addition, millions of rupees is retained in the country which would otherwise be spent aboard to get the radiotherapy services there.

In conclusion, with the rise in number of radiation facilities, particularly megavoltage radiotherapy facility, there is an urgent need to prepare basic and additional infrastructures for quality radiotherapy services for cancer patients.

By Suresh Poudel, Medical Physicist, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur

National Training Program, United Hospital, Dhaka Bangladesh

Asking ourselves

Suresh Poudel

Following the promulgation of New Constitution, Nepal has been confronting the shortage of petroleum supply and other essentials for around two months now. Life is being more difficult due to the limited supply of petroleum and other basic needs. The constraint in supply has a political origin but it has affected all political and non- political beings in the country. Different sections of the society have different say in this regard which has resulted into the blame game between India and Nepal. The ongoing situation has given ways to debate on different aspects of Indo- Nepal relationships.

Nepal has virtually a unilateral trade relationship with India where the former depends heavily on the later for the supply of petroleum including other goods therefore the disruption of the supply from India has affected lives in Nepal. In the response, the government of Nepal is assuring its citizens to bring the situation to normal by saying it is working towards it. In this article, I am not going to add the issues on Indo-Nepal relationships. Instead I want to ask myself and countrymen a few questions which I believe they are supposed to ask themselves before indulging themselves in a blame game. 

The questions are: Have we ever created opportunities within the country? Have we ever thought of future energy demand? Have we ever accessed the potential of our human resources? Have we ever debated about our job market? Have we ever talked about building national infrastructure in tourism and other important sectors of the economy? Have we ever analyzed the future course of national economy and its interrelationship with rest of the world? Have we ever put our ideas in capitalization of remittance? Have we ever looked closely on the development of rest of the world? Have we ever encouraged learning science and technology to assure better lives for future generation? Have we ever followed norms as our ways of living? Have we ever done politics for the people and the nation? Have we ever thought of value addition rather than trading the same good at higher prices? Have we ever valued education for other than earning better wages? Have we ever followed ethics in our deeds? Have we ever respected work rather than ensuring the better position in job? Have we ever used the raw materials and natural resources we have to change them into finished products?  Have we ever explored our mother earth to find the hidden treasures? Have we ever produced the minimum we need to sustain if we have not ensured the supply chain smooth?  Have we ever debated logically in world forums to establish our significant presence in world stage? Have we ever formulated a tax policy compatible to our national need?

These are the sorts of questions that hit my mind when I see our people expecting other nations to build their nation and supply the essentials. We are the ones supposed to find the answers to all such questions and only then we will do justice to ones who are fighting for rights and opportunities. However, the tragedy is we never got prepared to find the answers to such questions, actually never explored the questions. In a true sense, the habit of skipping problems made us unable to stand on its own feet. Nevertheless, we should not forget the harsh reality that we are the citizens of one of the least developed countries in the world. I believe we have enjoyed all rights what a poor country can offer to its citizens but we often forget our basic responsibilities as a citizen. Had we realized our true self, we would have prepared ourselves to stand on our own. In fact, we have dementia, so we become ultra-nationalist at one moment (at difficult times) and the next day our aspiration looses practical basis which throws us into difficulty.

A poem for those who have gone abroad for work

तलाउ मा ढुङ्गा हानी 
अहिले तिमी कहाँ गएउ  
बर्षउ सम्मा गहिरी खेत बाझो बस्यो
बिउ लिएर कहाँ भागेउ
यहाँ हुँदा तिमी पनि रमाउथियौ
हिलो खेल्न, पानी छ्यप न 
सुक्का खाडी तिर छौ अ रे 
छिट्टो फर्क गहिरी खेत सिन्चाइ गर्न 
तलाउ मा फैलिएको तरङ हेर्न
छिट्टो फर्क गहिरी खेत सिन्चाइ गर्न 
तलाउ मा फैलिएको तरङ हेर्न

Suyesh @ Dhaka

टकुरेहरु

त्यो शहरमा

त्यो शहरमा
जीवन प्रती कुनै राग छैन
एउटा गर्जने बाघ छैन
बिरालाहरु खाटी दुध खान पौदैनन
मुसा मार्न दुला चाहर्दैन
फगत दिर्गायु को चिन्ता ले
सिन्थेसाइज्ड प्रोटिन
र
मुल्टिभिटामिन खान्छन
आयतित प्रोटिन र मुल्टिभिटामिन

अनी
लाउड स्पिकर अगाडि गएर
अरु स्रोता बिरालाहरु माझ
लाउड स्पिकरको पिच र बास
अड्ज्स्ट गरेर
एउटा बिरालो, म्यौ गर्छ
स्रोता बिरालाहरु को तालीले हौसिएर
आझ ठुलो स्वोरमा म्यौ गर्छ

एउटा गर्जने बाघ नदेखेका
बाँकी बिरालाहरु
ताली ठोक्दै
मन्च को त्यो बिरालो लाई बाघ भन्ठन्चन (2)

Suyesh @ Dhaka