Report from Nepal
I haven’t been active on DailyKos this year, but I still check it frequently and my usual reaction is “Sheesh, I leave the USA for just a little while – and – next thing you know it’s all messed up! Can’t I trust them with ANYTHING!?!?!?!?!”
Actually, It’s been about a year, though I cheated and took a short holiday to visit relatives in November. While there I cast an “expatriate vote” – the straight D ticket – though my candidates lost.
There are two Nepals. The one for the tourists and the one where the Nepali people live and work. The western media will quickly focus on events at Everest or Annapurna Circuit, but these stories are not actually about Nepal - they are about western "rock jocks" and they don't give any background on the country itself.
Here in Nepal I work with nurses and doctors and I teach critical care skills. As you might imagine I get an inside view of how the medical system is working in this country, especially with the training of doctors and nurses. Nepal does not have a functioning elected government in the sense of being accountable to the people.
I read a statistic in a tweet recently that said “78% of the country is under 35 years of age, and 50% is under the age of 18 – why is it that all the leaders of the Constituent Assembly are over 70?” There is permanent gridlock and the youth are fleeing the country. I am constantly asked how to get to USA, which is viewed as the land of milk and honey….. I was so sick of answering that question that I started blogging on it and now I refer all queries there....
But the main message is to describe a way we can help....... so follow me below the squiggly orange sample of doctor's handwriting - if you dare
Corruption is a problem
Up until about fifteen years ago, there were only a few medical schools in the country of Nepal. The government decided to change the policy for granting medical school affiliations, and now there about 18. The system to establish a new medical school is supposed to follow a model in which there is “provenance of authority” to insure quality. By that I mean, one of the longer-running medical schools is a sort of sponsor to the new medical school and it’s faculty. So, for example, every medical school is either affiliated with T.U. ( Tribhuwan University) or K.U. (Kathmandu University). The people from the sponsoring school are supposed to guide and inspect and mentor the new school. This is all well and good, and the medical authorities in Nepal are to be commended for establishing this system.
The problem is, they are stretched very thin.
An even bigger problem is, the political pressure to establish even more medical schools, including some medical schools that are very small. The rumor has it that if you are connected to the politicians in the Constituent Assembly, and you pay enough money, you can be authorized to have a medical school. ( and start collecting tuition).
Corruption is not unique to the medical industry here, and the UK government has taken notice. http://www.ekantipur.com/...
Byzantine?
I have been wondering if there is a Nepali word for “Byzantine” – if not, there should be……
The same phenomenon is true for nursing schools here. There are multiple tracks for a nursing education, and when a hospital is built, the owners of the hospital invariably want to start a nursing school, because the students are a source of cheap labor. In the case of nursing students, many of them enroll in nursing school as a means to get out of the country with a skill, and it’s not until later they discover their education is not transferable to another country. The tantalizing prospect of international migration as a skilled worker is a beacon for many Nepalis. I have written many entries on my own blog about how this impacts nurses.
Back to medicine.
The system of medical education is based on the British Model, not the American one. Here is the career path: You can get admitted to MBBS program (“Bachelor of Medicine and Surgery”) at the age of eighteen, as an undergraduate course of study. Then you are expected to be an intern for a year; then go to a rural area and practice for a year; then a year as a “Medical Officer” and finally go back for a Master’s Degree in Medicine…. After which you can be an official “Medical Doctor.”
This system is also under siege in Nepal. When it was set up, the only place authorized to grant the MD degree was N.A.M.S., the National Academy of Medical Science, located at Bir Hospital. Fifteen years ago, the main medical school was at T.U. in Maharajganj, a neighborhood of Kathmandu. These days, with all the medical schools, there is intense competition for slots at N.A.M.S., and rumors that bribery is required for admission.
The Nepal Medical Council has proposed a plan to convert the campus at Maharajganj into a second MD-degree-granting institution, and focusing on that. (i.e., no longer doing MBBS education there). As you might expect, the medical students from T.U. Maharajganj are now protesting this decision….. they are fighting for the status quo. From here, it looks logical that the second tier of education needs a dramatic expansion, one which will allow all the MBBS graduates of the other sixteen medical schools a chance to compete with the ones from T.U.
Nepal has an agency named “C.I.A.A.” – Commission for the Investigation of Abuse of Authority. You would think that this would be a good thing. The CIAA recently indicted the entire membership of the Nepal Medical Council over the issue of newly-authorized medical schools. To me, it is very curious that the people fighting to keep the standards are themselves being investigated....
So, there is nobody here in any leadership position who has not also been targeted by somebody else.
And within this overall context, there is now a “hunger strike unto death” taking place to dramatize the situation of government interference in establishment of new medical schools. A senior doctor named Govinda KC who is an orthopedic surgeon has undertaken this. It’s not his first time; on the other occasions the government acceded to his demands but seems to have reneged.
The hunger strike is serving as a focal point for protests by medical students around the country, with candlelight vigils. Also, the interns and residents of T.U.’s Teach Hospital ( “T.U.T.H.”) just had a one-day strike. Doctor GKC has been given a bed in what seems to be a hospital corridor, with nearby posters explaining the issues.
The Nepali Medical Council has endorsed the goals of the hunger strike. http://new.myrepublica.com/...
On social media, there are pictures of Dr. GKC in bed, wearing an oxygen mask. These accompany older pictures of Dr. GKC at rural health camps serving the poor of Nepal. Most of the publicity is taking place on FaceBook, if you go to the Nepal Medical Students Society you can see the updates. A lot of the mainstream media coverage of this is in Nepali. Because of the language issue, I don’t think it has gotten the international attention that it deserves.
There is also a petition on change.org https://www.change.org/...
For me, I generally stay out of Nepali politics and just do my thing, which is teaching critical care skills to nurses and doctors. But I think that enlisting some international attention to this issue is worthwhile, and I hope that others will take up the cause and join the chorus for improvement of this situation.
I could write a one-million-word blog on this, but I believe in TLDR.
And finally, for more info as to what it is like to be a medical volunteer in Nepal, you are welcome to read my second book.