View of Bir Hospital's OPD facilities. Kathmandu

According to some historians, Bir Hospital was established by Bir Shumsher who, in his quest for recognition from the British, started providing social services for the welfare of the public. His efforts were rewarded when he was bestowed the Knight Commander of the Star of India in 1882 and subsequently became a Knight Grand Commander in 1887. Recognizing the limited capacity of the small hospital within the British Residency at Lainchaur to handle modern Western medicine, Bir Shumsher opened a hospital in Kathmandu, the capital city, in 1889 (1947 BS) and followed it up with another in Gahwa (renamed ‘Birgunj’) on the Indo-Nepal border in the Terai the following year. This led to the trend of naming hospitals after the reigning monarch and prime minister and establishing them in different parts of the country. Initially located at the National Theatre site on the North Western corner of the Ranipokhari, Prithvi-Bir Hospital (originally) had only 30 beds. The hospital's first recorded document from the Nijamati Kitab Khana dated 15th Asar, 1947 BS, included provisions for paying an Indian doctor named Dr. Ganguly. Later, the hospital was relocated to its present site on the South Western corner of Ranipokhari, the central water tank in the town. The hospital's architecture, featuring massive white columnar structures, was inspired by Victorian architecture in England, as observed by Jung Bahadur. Other health institutions bearing the name Prithvi Bir Hospital were established in Birgunj, Jaleshwar, Hanumanagar (Rajbiraj), Nepalgunj, and Taulihawa. Additionally, a leprosarium was constructed in Khokana during this period. Dr. Raj Krishna Mukherjee is believed to have arrived in Kathmandu during the later years of Bir Shumsher's premiership, which witnessed significant improvements in education, sanitation, hospitals, and bridge construction. Dr. RK Mukherjee, who played a significant role in the history of Bir Hospital, served as the Inspector of Hospitals before being appointed as a lecturer at the Nepal Medical College during Dev Shumsher's premiership, which lasted for 114 days. In an article published in Gorkhapatra on 11th Jestha 1985 BS, it was reported that Dr. Mukherjee had conducted a public dissection of a dead body and showed the internal organs to Prime Minister Dev Shumsher. This indicates the hospital's long-standing commitment to service and education. Over time, the hospital came to be known as Bir Hospital. During the premiership of Chandra Shumsher, the Bir Hospital saw significant developments including the establishment of the Chandra Sale Dispensary in 1917 and expansion of the Bir Female Hospital. The addition of pathology/bacteriology sections and an X-ray department also took place during this time. Initially, Bengali doctors dominated the medical staff, but over time, Nepali doctors began to work there. Dr. Ganesh Lal Maskey was the first Licentiate of Medical Faculty (LMF) followed by Dr. Indra Man Baidya and Dr. Yagya Man Baidya. The first person to earn a degree in modern medicine was likely Dr. Siddhimani Dixit, who graduated with MB (Calcutta) in April 1921.   Bir Hospital Then and Now

Figure 1: Picture, probably taken over 70 years ago shows the staff of the Bir Hospital of those days. Key to photograph: 1. Dr. Indra Man Baidya 2. Dr. Sushil K Haldar 3. ? Dr. Pinaki P Acharya 6. Dr. Suresh Dass Gupta 7. Dr. Debrata Dasgupta 8. Dr. Dhana Seth 10. Dr. Prakash B Basnyat 11. Dr. Devi P Upadhaya 13. Compounder Hira Nanda Vaidya 14. Dr. Jit Singh Malla 17. Dr. Yagya Man Baidya 19. Dr. Siddhimani A Dixit 21. ? Sushil Majumdar

During the premiership of Juddha Shumsher JB Rana, the bed capacity of Bir Hospital was doubled from 30 to 60. There were separate facilities for Bir Male Hospital, staffed with male compounders and dressers, and Bir Female Hospital, with a lady doctor as Medical Superintendent and female ward attendants. The Prime Minister was also dedicated to ensuring that medical personnel in Nepal were well-trained. In a letter dated 28th October, he expressed his desire to send Dr. Suresh Chandra Das Gupta LMS to Calcutta to learn the latest surgical techniques at a premier institution, citing his role as the Chief Medical Officer of Bir Hospital and his reputation as a skilled surgeon known to the British Legation Surgeon. Starting in 1934, the Civil Medical School served as a training center for basic health workers, such as compounders and dressers, and was located at Bir Hospital. Subsequently, Dr. Prakash B Basnyat became the first Nepali surgeon appointed at the hospital. However, his untimely death in Shrawan 2013 BS (1956) was a significant setback for the field of surgery. At that time, Dr. Devi Prasad Upadhyay provided anesthesia services, but he eventually transferred this responsibility to Dr. Bhabani Bhakta Singh, who had received anesthesia training and returned with a Diploma in Anesthesia degree from India in 1956. After the end of Rana rule in Nepal, significant changes took place in Bir Hospital. When Dr. Siddhimani Dixit assumed the position of Director General of Health Services, he had an office in the building that subsequently became the Medical Superintendent’s office. At first, the Bir Hospital compound was divided by the road leading to Mahaboudha, with the Civil Medical School, Chandra Sale Dispensary, and the Pathology Department located in the Northern section. The Bir Male and Bir Female Hospitals and the Radiology Department were situated on the Southern side. Eventually, all these facilities were consolidated into a single complex, with Dr. Mahendra Prasad assuming the role of Superintendent in 1957. In 1965, with the assistance of USAID, the hospital underwent renovation. The construction of the Surgical Block and a nurse's residence, as well as the merging of the male and female blocks into a single general hospital, were completed over a period of a couple of years. The Teku Hospital was also a unit of Bir Hospital, along with the Kanti Hospital at Maharajgunj. During this time, there were discussions about starting a medical college with the help of India. Dr. Bhandarkar, then Director General of Health Services in Maharashtra State of India, visited Nepal in connection with this matter. However, the plan did not come to fruition. Aerial view of the Bir Hospital compound showing its different components. In the Northern section of the Bir Hospital compound, there was a Kumari temple, but it did not have many worshippers. There was a belief that whoever performed puja there would be transferred. During my time there, the Medical Superintendent at the time performed a puja, possibly with the desire to be promoted to a higher position. In 1972, with the introduction of the New Education System Plan, the responsibility for medical education was transferred to the Institute of Medicine (IoM), which was one of the components of Tribhuvan University. The IoM provided training for the Basic and Middle grades of health personnel, and in 1978, when the MBBS (Bachelor of Medicine, Bachelor of Surgery) course was introduced, it also trained Higher grades of health personnel. Since the IoM did not have its own hospital then, the clinical or practical aspects of many programs, including the MBBS, were conducted at Bir Hospital. In November 1985, with the assistance of India, new outpatient department (OPD) facilities were inaugurated. The building's facade featured Hanuman, the Monkey God, carrying Sanjeevani in his upturned right palm.In line with the decision to establish various super-specialties at Bir Hospital, the ADRA Sydney Hospital Heart Project began there in 1987, providing closed heart surgery services. During Dr. Ram Baran Yadav's tenure as Minister for Health and Population in 1994, a Post Graduate Medical Education Co-ordination Committee (PGMECC) was established. The committee consisted of faculty and specialists from the Institute of Medicine and Bir Hospital. Various one-year diploma and three-year degree level programs were initiated under the guidance of the PGMECC. In 2002, after 114 years of operation, Bir Hospital was transformed into the National Academy of Medical Sciences (NAMS). It is now responsible for providing post-graduate training, such as Doctor of Medicine (MD)/Masters in Science (MS). Courses are conducted in various hospitals across the Kathmandu Valley. NAMS holds the status of a deemed university. Preference is given to doctors working in government service and remote areas for admission into the academic courses. Additionally, NAMS also conducts Master of Dental Surgery (MDS) courses in certain dental specialties, as well as Proficiency in Certificate Level (PCL) and Bachelor of Nursing Science (BN) courses. During his three-day visit on 7 June 1997, the Indian Prime Minister, Mr. IK Gujral, unveiled a plaque for the construction of a 200-bedded Emergency and Trauma Centre. The center was to be built with the aid of the Indian Government. However, construction of the hospital was not started until 2006, and it was finally completed in 2009. Current Indian Prime Minister Narendra Modi visited Nepal on 25 November 2014, to inaugurate the Trauma Centre in Bir Hospital. This visit, which took place one day before the 18th SAARC Summit, was viewed by many as a timely effort to bring to fruition a project that should have been completed and serving the population for several years. ACKNOWLEDGEMENT I would like to acknowledge the help of Dr. Dwarka N Regmi, Dr. Laxman Poudyal, and Dr. Moin Shah in trying to identify the people in the staff picture of Bir Hospital that was taken over 70 years ago. Also Dr. Siddharth Dixit, Mr. Nirmal Bista, Ms. Bindu Phuyal, and Mr. Kapil Thapa for their help in the preparation of the same. REFERENCE

1. Stiller LF. Nepal: The Growth of a Nation. Human Resources Development Research Center. Kathmandu: Human Resources Development Research Center; 1993.
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3. Dixit H. Nepal’s Quest for Health. 4th ed. Kathmandu: Educational Publishing House; 2014.
4. Sir Tuker F. Gorkha. The story of the Gurkhas of Nepal. London: Constable and Co; 1957.
5. Malla FB. A Few Lines on Bir Hospital. Bir HospitaL Centenary Souvenir, 1989-90. p107-08.
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10. Sharma VK. Bir Hospital and the Nepal Academy of Medical Sciences (NAMS): Their Relations need to be defined. 120th Anniversary Souvenir of Bir Hospital; 2009. p10-13.

Story by Hemang Dixit, Professor, and Head of Department, Medical Education, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal, and was first published in the Journal of Kathmandu Medical College.