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Friday, January 24, 2014

An address to Nepal's medical fraternity: Where we stand after Dr. KC-led movement

In a thousand mile journey, the first step has been taken firmly: how shall we carry the journey ahead? An invitation for open discussion.

IT was unique experience for most of us. We were never prepared for such a situation but we have faced it and the whole episode has taught us many things. Over all, this spell of the movement has ended in a positive note despite the extremely zigzag course of the events.

The movement will have a lasting legacy if we learn from this and apply the insight in the future movements of any kind.

Dr. Govinda K C has given everything to this country that he could potentially give. Now it is our turn. He has shown the way and we'll have to walk now.

Nepal is neither a feudal, nor a capitalist society. It is a hybrid of many political experiments. There are no true democrats among our influential leaders; there are only kleptocrats. Our economy is not growing; it has stunted. Formal or legitimate part of the economy is being rapidly squeezed by the informal or black one. Our leaders, sensing the latter will soon rule the roost, are competing with one another to get hold of a bigger chunk of the black economy.

Whether with awareness or without, we as a people have condoned these deeds of the political leadership. At every rung of society, we have been compromising the future of this country for our own short term gains. We never cease to complain about things but do little to change things.

To summarize, we were born at strange time and we are living in bizarre moments. And this time has made us bizarre human beings: eager to complain, boast, ridicule or squabble but unable to do anything tangible for the greater good. We can organize headline-catching political movements that uproot the entire system but the other day, people feel no difference in daily lives.

This is the scenario where Dr. KC has been serving for decades yet he was not contaminated even by ordinary human greed of ensuring a 'happy and prosperous' personal life. That has been his strength and based on that, he has badly shaken the nexus of politicians and criminals (I mean financial criminals who govern the vibrant informal economy of the country). 

As a person, we cannot replicate him in this regard. My suggestion is let's not try to.

But there is scope for a spectrum of activities that a citizen is 'ordinarily' supposed to do. A different and much milder collective effort by all of us is the need of the moment.

Let's enter into the matter of acute concern now: the health and medical education sector of the country.

Practically speaking, the boundary between the formal and informal parts of economy in the sector is so blurred that we cannot make out one from the other for all practical purposes.

What KC sir did was insane by our standards; openly challenging a cartel of few super-rich who are capable of buying every single of the influential political leaders (please note the term 'influential'; not all the politicians are rotten but those who matter the most are). If we had not come to his support and solidarity led by NMA, there were substantial chances they would have simply let him die.

The point is, personally we are so weak that it is unwise to try to tackle them individually. Unity and organization is our best and only hope to change the situation.With these two things, however, the medical fraternity is one of the strongest communities in Nepal; that has been solidly proved with this episode.

What has been achieved now is a mere foundation on which our beautiful and secure future can potentially stand.

The problem is, the words will no longer do the tricks; we'll have to act. But there can be no action without appropriate plan and coordination, the tasks of an efficient leadership. So it is all about organizing, wisely planning and effectively acting.

Fortunately, we have a professional body with a very proud history named NMA which has steadfastly risen to the occasion at the moment of crisis in the fraternity when the state was in a mood to ignore Dr. KC and let him die, young doctors were desperate as there was none to hear their voice and the senior doctors were reluctant and divided at best.

This NMA will keep leading us in the future also. Given their diverse responsibilities, however, we should take initiative to work out things by organizing at a lower level and guiding the executive body on an issue-wise manner.

For now, a national level body of PG students is planned within this week. That will sort out the issues of acute interest like 1) ensuring the TU officials live up to their promise to appoint dean as demanded by KC sir  2) handling with a potential scenario in which a court decision upsets our gains at IOM, TUTH  3) forcing the IOM to establish a transparent and affordable fee structure for PG programs in TU as in case of KU 4) other issues to be brought about by the resident representatives from IOM, NAMS and BPKIHS

In the longer term, we have to constantly follow up the progress in the process of establishing the medical university, within the coming 3 months as the tenure of the task force. Once they submit the report, a follow up at the higher level will be necessary. The resident's body in coordination with NMA will be best placed to do such a follow up.  

The added advantage of the resident's body will be that it will be easier to mobilize the mass as and when required.


Let this common perception be over here and let me outline my vision for the future of a doctor in Nepal. The government controls the cost as well as the quality of medical education and both UG and PG courses becomes affordable to most students from lower and middle class families. Corruption at NMC, IOM, NAMS, BPKIHS etc. is cleansed and pure meritocracy thrives everywhere. Doctors are appointed fairly; enough of Loksewa doctors are appointed rather than those forced through contracts. Most importantly, government makes a realistic adjustment in the salary of doctors at all levels. An example would be, at current value of Rupee, a medical officer in cities gets 70-80 thousand monthly, a junior consultant around 1.5 lacs and a senior consultant around 2 lacs. Remote places get proportionate increase from these values. The private hospitals/medical colleges would then be forced to pay similarly. In such a scenario, I would prefer to outlaw private practice for doctors practicing institutionally, also because it has come at a huge personal, family and social price for everyone of us. The clinics can also have their own full-time doctors. Doctors then get chance to relax, write papers and what not. 

You can perfectly disagree with this and we can come up with a model acceptable to all of us; but my point is: let's think for the long term, not only as the doctors but also as human beings. Let's plan meticulously, organize and move ahead. Please, think, think hard, discuss and express your ideas. We should no longer leave our fate in somebody else's hands.

(Please note that I am no authority in myself; these are personal opinions but this can be a platform to start a serious discussion on the matter.)

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