The civil servant adjustment process is affecting hospital services in a manner unforeseen. With the departure of its only anesthetic assistant, Suresh Thapa, to Province 5, the Bhojpur district hospital has halted all cesarean section deliveries indefinitely.

“We had requested the concerned ministry of the provincial government and the Ministry of Health and Population to not transfer our anesthetic assistant,” Rajendra Prasad Raut, spokesperson of the hospital told the Post over the phone from Bhojpur. “No one paid heed to our concerns and we were compelled to halt the services.”

District hospitals like the Bhojpur hospital do not perform large surgeries since they do not have adequate equipment or personnel. The only real surgery that they perform are cesarean sections with the help of an anaesthetic assistant.

With Thapa gone, doctors and health workers at Bhojpur district hospital have asked pregnant women with complications to not rely on the district hospital. It takes over 9 hours to reach Dharan and Biratnagar, where the nearest large hospitals are located, from Bhojpur in an ambulance.

The hospital administration has also informed all concerned agencies including the Provincial government, the federal government and local levels about its decision and also warned that it would not be responsible if anything happened during delivery or birth complications.

“Women in labor are brought here traveling five to six hours from remote villages,” said Raut, “Chances of death of new mother and infant will be high on the way to the hospital if we send them to Dharan and Biratnagar.”

The hospital had been conducting over 10 cesarean deliveries every month. The hospital had paid Rs 300,000 each month to an MDGP doctor some seven years ago to start the cesarean delivery service.

Alike to Bhojpur district hospital, cesarean delivery services have been affected in several other health facilities of hilly and mountainous districts. According to the Family Welfare Division under the Department of Health Services, the Health Ministry’s decision to implement the employee adjustment process immediately had jeopardised the lives of new mothers and infants.

“I have written a formal letter to the Health Ministry urging it not to transfer technical staff including anesthetic assistants, without sending the replacement,” Dr Bhim Singh Tinkary told the Post, “Death of new mothers and infants can increase if cesarean delivery services are halted in many places.”

Anesthetic assistants undergo several months of rigorous training prepared by the National Academy of Medical Sciences before entering the profession. Their role is instrumental in continuing surgery services at regional and district hospitals.

Dr Tinkery said that service at several birthing centers run by primary health care centers would be stopped due to transfer of anesthetic assistants, trained nurses and auxiliary nurse midwives.

The division said that it would take years to prepare technical manpower like anesthetic assistants.

Balaram Parajuli, the spokesperson at the Social Development of Province 1, said that his ministry had requested the Health Ministry not to transfer technical manpower like anesthetic assistants from health facilities.

Mahendra Prasad Shrestha, spokesperson at the Ministry of Health and Population, said that his ministry has been working to address the problem. “We have asked the anesthetic assistants to continue their services at the places they have been serving,” said Shrestha, “We are discussing to find a way out of this problem.”

The Ministry of Health and Population is also planning to keep all anesthetic assistants under the federal government and mobilise them as per the need of health facilities across the country.

“The government is serious about saving the lives of new mothers and their children,” Shrestha added, “We are working to find a solution at the earliest.”

As per the employee adjustment bill, endorsed by the federal parliament, health workers including doctors and anesthetic assistants serving in state run health facilities were given the option to choose the place to serve and the Health Ministry is implementing the adjustment process.