BACKGROUND

DI Skin Health And Referral Center (DISHARC) was registered as the first skin hospital and research center in Nepal, established in 2009 at Maharajgunj, Kathmandu, Nepal. DISHARC was established under the leadership of Prof. Dr. Anil Kumar Jha, founder chairman and the first prof. of dermatology of the country as well as a prominent international personality in the field of dermatology. DISHARC is the center of excellence in skin, hair and nail diseases. DISHARC facilitates a wide range of services like out patient consultancy, dermato pathology, dermato-surgery, laser and light therapies. Patients from all 75 districts visit DISHARC for consultancy. Apart from Nepal, DISHARC also extends its online service in more than 50 countries. DISHARC is devoted to serve the deprived and unreached grass root level community through telehealth services in Nepal

Overview

DI Skin Health And Referral Center (DISHARC) is the first skin hospital of Nepal and is one of the best skin health care provider of Nepal. DISHARC since 2009 has been continuously improving the quality of care in terms of consultation, infrastructure and technology in order to satisfy the patients and meet the international standards. DISHARC incorporates well known and proficient team of 11 dermatologists, pathologists and physicians well managed by a dexterous team of management. DISHARC has an area of 15000 square feet at present located in the embassy area of Kathmandu. The hospital has an OPD capacity of 300 to 400 patients per day served by a team of 15 doctors and 30 management staffs. It has be been fully functional since 2010. DISHARC has alreadry served more than hundred thousand patients till date and has performed more than thirty thousand minor and major dermatosurgeries.

Mission

Provide quality skin care service in dermatology to all patients.  Start post graduate and derma nursing with the affiliation of internationally recognized universities.  Publish research articles based on scientific research to improve the quality of Dermatology care in this region.

Vision

DISHARC has responsibilities to provide quality dermatology care/community dermatology service to all citizens of the country in affordable price.  There is a big demand of qualified doctors in the field of dermatology and DISHARC has to play important role to fulfill the need of such manpower (medical, paramedical) by starting post graduate degree in dermatology with the affiliation of internationally famous institute and focus on research on relevant subject and publish in different journals to provide better care in dermatology.

Objectives

To start collaboration with other institution inside and outside the country to offer high quality individualized diagnosis and therapy of skin disease, as well as patient education in skin care and prevention of skin disease. to provide a high level of teaching and training in dermatology at the pre- and post-graduate level. To perform innovative basic and clinical research with the ultimate aim of contributing to improved patient-care. To foster constructive collaboration and networks with private practitioners as well as primary and secondary institutional care providers. By fulfilling this mission we aim to position our department among the leading Dermatology Departments in South East Asia.

Goal

To complete construction of DISHARC Building 2019. To start a derma nursing and PG program till 2020.

To start to publish scientific journals from 2018. To organize a international conference on e-health in 2018 successfully. To establish different departments within dermatology/ dermato surgery, leprosy, dermapathology, std department, paediatric dermatology department etc. To establish the first a well equipped e-health center in Nepal.  To serve  400 plus patients per day in New DISHARC building from its opening in 2019. Provide optimal, ethical and patient-centered medical care, Establish and maintain clinical knowledge, skills and attitudes appropriate to dermatologic practice. Perform a complete and appropriate assessment of a patient and use preventive and therapeutic dermatologic interventions effectively. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic and seek appropriate consultation from other health professionals, recognizing the limits of one’s expertise.

Additional goals are :

  • Patient Experience: DISHARC staff’s goal is to make feel all the patients that they meet best physician visit ever. We hope to elevate the bar in delivering an authentic patient experience. We strive to treat every patient with respect, value, and privacy. We feel privileged that you have entrusted your care at DISHARC and take that responsibility very seriously.
  • Patient Safety: Your safety is our highest priority. DISHARC has committed to an education and staff resources to exceed current standards for patient safety. DISHARC will have a board-certified dermatologist and completed a cosmetic surgery fellowship as a commitment to patient safety during aesthetic procedures. DISHARC will utilizes minimally invasive techniques and local anesthesia to avoid the risks associated with procedures performed under general anesthesia.
  • Patient Education & Communication: Our goal is to explain treatment options, risks, benefits, and alternatives of treatment for each of patients concerns. Patient education leads to treatment success. Our staff and Doctors are available to answer patient questions in clinic and after hours. Patients care does not end once you leave our clinic, it continues with complete follow-up care.

DISHARC is committed to providing comprehensive and unparalleled dermatologic care in a welcoming and engaging environment. DISHARC seeks to make each patient experience unique by combining superior patient safety and privacy standards in treating dermatologic and cosmetic concerns. DISHARC strives to combine the best of the art of medicine with the latest advances in research and technology in formulating individualized treatment plans to achieve a unique, desired, and aesthetically-pleasing result.

 

 

Teaching Elective Goal

The purpose of the dermatology elective is to provide a learning environment for the student to develop basic dermatology skills.

Objectives

  1. Recognize the clinical manifestations of common dermatologic conditions.
  2. Demonstrate familiarity with common diagnostic procedures.
  3. Identify 1st and 2nd lines of therapy for common dermatologic conditions. (U,R,E)
  4. Demonstrate understanding of basic epidemiology and risk factors for malignant melanoma and nonmelanoma skin cancer. (U,R)
  5. Identify clinical situations in which a dermatologist should be consulted and other clinical situations which may be managed without referral. (U,C,S)

Furthermore, we expect that rotating students and residents will:

  1. Interact with patients, their families, our office staff and other health professionals in a manner that is culturally sensitive and appropriate to the resident’s dual role as healthcare provider and student of dermatology. (B,A)
  2. Communicate with patients, their families, our office staff and other healthcare providers in an effective fashion in spoken and written English. (B)
  3. Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, sensitivity to a diverse patient population, and dress and deportment appropriate to a physician. (B,A)
  4. Wear neat, clean clothing, a white coat and identification badge when seeing patients. (A)

Elements of patients care in DISHARC

  • Core medical knowledge
  • Patient problem identification
  • Diagnostic reasoning
  • Clinical judgment
  • Clinical decision-making
  • Application of appropriate therapies
  • Procedural skill proficiency
  • Humane care
  • Application of ethical principles for patient care
  • Functioning as a consultant
  • Knowing limits of expertise
  • Maintenance of competence
  • Principles of patient safety and avoiding adverse events

Key Competencies

Physicians are able to…

  1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centered medical care;
  2. Establish and maintain clinical knowledge, skills and attitudes appropriate to their practice;
  3. Perform a complete and appropriate assessment of a patient;
  4. Use preventive and therapeutic interventions effectively;
  5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic;
  6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise.

Enabling Competencies

DISHARC Physicians are able to…

  1. Function effectively as consultants, integrating all of the Roles to provide optimal, ethical and patient-centered medical care
  2. Effectively perform a consultation, including the presentation of well documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional
  3. Demonstrate effective use of all competencies relevant to their practice
  4. Identify and appropriately respond to relevant ethical issues arising in patient care
  5. Effectively and appropriately prioritize professional duties when faced with multiple patients and problems
  6. Demonstrate compassionate and patient-centered care
  7. Recognize and respond to the ethical dimensions in medical decision making
  8. Demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony or advising governments, as needed
  9. Establish and maintain clinical knowledge, skills and attitudes appropriate to their practice
    • Apply knowledge of the clinical, socio-behavioural, and fundamental biomedical sciences relevant to the physician’s specialty
    • Describe the framework of competencies relevant to the physician’s specialty
    • Apply lifelong learning skills of the Scholar Role to implement a personal program to keep up-to-date, and enhance areas of professional competence
    • Contribute to the enhancement of quality care and patient safety in their practice, integrating the available best evidence and best practices
  10. Perform a complete and appropriate assessment of a patient
    • Effectively identify and explore issues to be addressed in a patient encounter, including the patient’s context and preferences
    • For the purposes of prevention and health promotion, diagnosis and or management, elicit a history that is relevant, concise and accurate to context and preferences
    • For the purposes of prevention and health promotion, diagnosis and/or management, perform a focused physical examination that is relevant and accurate
    • Select medically appropriate investigative methods in a resource-effective and ethical manner
    • Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans
  11. Use preventive and therapeutic interventions effectively
    • Implement an effective management plan in collaboration with a patient and their family
    • Demonstrate effective, appropriate, and timely application of preventive and therapeutic interventions relevant to the physician’s practice
    • Ensure appropriate informed consent is obtained for therapies
    • Ensure patients receive appropriate end-of-life care
  12. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic
    • Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to their practice
    • Demonstrate effective, appropriate, and timely performance of therapeutic procedures relevant to their practice
    • Ensure appropriate informed consent is obtained for procedures
    • Appropriately document and disseminate information related to procedures performed and their outcomes
    • Ensure adequate follow-up is arranged for procedures performed
  13. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise
    • Demonstrate insight into their own limitations of expertise via selfassessment
    • Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care
    • Arrange appropriate follow-up care services for a patient and their family

Specialties

The clinical experts at DISHARC specialize in cosmetic and laser treatments for a wide range of aesthetic and dermatologic issues, including:

  • Acne scar treatments
  • Facial rejuvenation
  • Hair removal
  • Leg vein treatment
  • Non-invasive fat removal
  • Rosacea treatments
  • Scar treatment (burn scars and surgical scars)
  • Stretch mark treatments
  • Treatments for broken blood vessels and red spots
  • Treatments for brown spots
  • Treatments for skin discoloration
  • Wrinkle and fine line treatment

Technology

  • Botox : Botulinum toxin, or botox, injections may ease symptoms in some patients with motility disorders.
  • Dermatologic Fillers : Used to reduce wrinkles and signs of aging on the face. Brands used include Restylane®, Perlane®, Radiesse®, and Juvederm®.
  • Cool Sculpting : An innovative, non-invasive, and clinically proven method to reduce body fat in areas that aren’t responsive to exercise or dieting.
  • Laser therapy : This is a medical treatment that uses focused light. Surgeons can focus on a small area and damage less of the surrounding tissue. Patients who have laser therapy may experience less pain, swelling, and scarring than with traditional surgery. Including: VBeam®, StarLux®, GentleMax®, UltraPulse®, Alexandrite, and others – for safe, effective and state-of-the-art laser treatments. Many of the Center’s lasers work on all skin tones.
  • Photodynamic Therapy : Photodynamic therapy (PDT), also called photoradiation therapy, phototherapy, and photochemotherapy, has existed for about 100 years and is a type of cancer treatment that uses light to kill abnormal cells. A special drug called a photosensitizer or photosensitizing agent is circulated through the bloodstream.

Achievements

  • Many experts on the same subject can work together in one compound and it is very useful.
  • It is possible to do educational activities in addition to large medical colleges and government institutions.
  • It is possible to operate approximately 355 days in each year since last 8 years.
  • Although the leadership is not profit oriented, the service or business can be continuously smooth.
  • The concept of sub- department has also been developed in various fields within dermatology.
  • CME program has been conducted regularly with the participations of National and International experts.
  • Public awareness program is continue through audio video and print materials since its establishment.
  • Computer knowledge system and skill should be used to update the records of the patient since the first day of the establishment. As per the need, we should analyze all facts of the hospital and help us to determine the future work schedule.
  • For the first year of the operation, the provision of chartered account accounting auditor audits and the instructions received by the Directorate were considered as an Instruction. In the fifth year of the establishment, the Government of Nepal awarded DISHARC as the best taxpayer of this area in health.
  • Most of the employees (including security) are still working and maintain their faith in the hospitals
  • Two doctors are trained in abroad. One in dermatopathology from Switzerland and Paediatric dermatology from USA and both of them are providing expert service in DISHARC.