Dilemmas of a young Doctor in Nepal

How dark are our futures? What can be done? Some reflections in light of current developments.

What is a doctor to ordinary people? A man or woman who earns a lot with little work.

And to the young people who aspire to become doctor, doctor is a person who has realized the coveted dream.

But what is it like to become a young doctor in Nepal today? Ask the young doctors and they have a tragic story to tell.

I usually put off writing when overwhelmed by emotion and disturbed through core. But this issue is urgent and cannot wait.

What are the problems a young doctor faces today?

I need not discuss here the pain and labor involved in getting entry to a medical college: be it coaxing the parents to invest huge sum or compete in often-not-so-fair entrance exams for limited seats. From the moment one gets entry into a medical college, the money that is paid is only one among many investments. Spending 6 years with hard work and stress nearing breaking point, he/she gets a degree. With the MBBS/BDS degree, a medico exits a medical college thoroughly demoralized and most of the gloss associated with the profession has already been lost.

The reason: the prospects of working as a medical officer endlessly are gloomy as such in a country where the government allows a medical college to extort Rs 30 lacs and even more for MBBS but pays a meager 20 thousand monthly to a medical officer; the salaries in private hospitals are no good either. 

Now begins a draining fight for PG entrance. Here a young doctor is harassed and humiliated so much that it is common for people to regret for choosing the career.

The reason? There are just too many. From the beginning, I am excluding the select few who have their parents/relatives in lucrative posts in different offices or those who are so wealthy as to already own hospitals and nursing homes, from this discussion. For others, it is the harrowing tale of cheating and egregious injustice by institutions whose powers are unlimited.

To start with, the seats are utterly limited compared to a rapidly swelling ranks of the medical officers. It can take years of preparation to appear in the so-called merit list. And even doing well in entrance exams is not enough to get admission and you have to pay hefty sum for the course.

What if you are cheated even after scoring well and being ready to pay a more than reasonable amount? This problem is haunting many friends now.

It is extremely painful to see grown up people crying. But what can one do when cornered by circumstances? When frustration, anxiety and sense of powerlessness overwhelm, what can one do but torment oneself and cry? What would you do when, in you plain view, somebody snatches a career that you deserve? This is the tale of hundreds of medicos who have been cheated in different medical entrance exam over years in every institution in the country. How does it feel when a clumsy and lousy boy or girl who consistently performs badly and scores a solid 5% or so less than you gets away with the seat that actually you deserve?

And when you are listed among the students to be enrolled in a medical college for PG, that does not end the agonizing story of harassment and humiliation. You are now in the foot of the owner of a medical college who can kick or dribble you as he wishes. This thing I realized just now with disturbing news coming from friends who have been attempting to get admission in KU colleges after the recent exams. It was reported last year that the private medical colleges under both KU and TU had literally auctioned PG seats to highest bidders with total disregard to the farce known as entrance exam. As a result some young doctors who will likely be employed for a pittance (about 6 lacs annually) were forced to pay as much as 70 lacs to secure the seats. This year it was supposed to be different and merit-based allotment of seats in KU colleges with a uniform fee of 22.5 lacs were supposed to take place. But as things unfold, some medical colleges are understood to have kept some unacceptable preconditions before admission of students in the merit list.

How much does an average medical officer earn and save in two years or so? Few lacs at best. Where is he supposed to get the mammoth sum of 22.5 lacs? By selling the ancestral property or by withdrawing the lifetime savings of the parents, putting their retired lives in jeopardy. And what happens when he is illegally demanded more money, just to get admission? You may say rules/law should apply. But the problem is rules in Nepal for weak and the powerless; the powerful people have the capacity to make their own rule.

As it seems, the young medicos in Nepal have been trapped in a vicious cycle from which there is no exit.

But what does crying and wailing achieve? Nothing. Frustration only deepens our problem. A sense of worthlessness and apathy only reinforces the system.

What are we to do then?

Please note that I have never said from the beginning that the medicos themselves are entirely innocent. Fault lies in us also and more heavily so than most of us imagine.

Recently, the renowned thinker Noam Chomsky responded to the query as to what he had changed in his life that ‘nobody really changes anything alone’. We have forgotten this and are focused on reaching our own goals so much that we do not give much thought to the problem till a moment when it blocks our own way, like a giant king cobra cocking its head. At this moment also we fail to behave sensibly as panic takes hold. We often yell and shout in platforms where it matters little but when it comes to facing the formidable foes, most of us like to hide behind the few ‘leader’s who are then expected to solve all the problems for everyone and let us know.

It is this pathetic level of organization that has made it impossible to face the adversaries effectively. On the other hand, all the medical colleges in the country are being increasingly monopolized by few people and their level of organization and collusion with the authorities has reached unprecedented levels. 

I suggest a simple course of action. We cannot afford to make a plan that magically wipes all the problems at a time. The constraints with academic or other duties of medicos make it impossible for us to gather everyone and protest. Also lofty and overarching goals to achieve everything with a movement are also not realistic.

Instead what is reasonable and possible is this: organize everywhere, to the extent possible and try all means at our expense like seeking the help of larger bodies like NMA and NMC. For example, the PG aspirants in different KU colleges who plan to get admission after everything is sorted out by others should forget the idea and come forward to protest. Those who fall in the trap themselves by accepting the unacceptable term of those medical colleges (like agreeing to a bond even after paying 22.5 lacs) are sure to strangle their friends also by helping the medical colleges to play 'divide and rule'. They should be thoroughly discouraged from the practice. And when the protesting students approach KU office with their grievances, everyone of us should be behind their demand of fairness. 

While trying to abruptly end this article, I appeal all the doctors or medical students who read this, to think this as their own problem. I see the future of present generation of MBBS/BDS students even darker than ours, going by the evolution of things in the country. If we do not think for the remote future now and let things proceed as they are doing, it is sure to invite disaster in our lives. While I cannot prescribe a plan of action, a debate among all of us will seek a viable way forward, I hope.

I will be in touch again with today's developments. Please generously share your ideas. Future looks grim so far but it is not yet a foregone conclusion and can be changed for better.