Why the MBBS docs are thinking twice about serving in earthquake zone

Guest post by Joe Niemczura, RN, MS 

(First carried in his blog; republished here with his permission.) 

The truth
I know a doctor here in Nepal who once spent a month trekking from village to village in his district, working with every VDC, to examine women and find the ones who could benefit from a specialized surgical camp set up by a German charity group.  And for every doctor and nurse in Nepal, going on a “health camp” to a rural area is part of normal practice.

The sacrament of the goddess: Book by Niemczura

The innuendo
On May 26th, there was a short article in Republica newspaper bemoaning the fact that 300 doctors are needed in the earthquake-affected areas of Nepal,  and only about 19 responded to the government’s call to work in the earthquake zone. The writer was heaping shame on the young doctors of Nepal.

The response
I wrote a quick response, since the volunteer project I do here in Nepal involves working with those very same doctors, at the beginning of their career.
Today on Twitter I see that the original article has been retweeted more than a hundred times, and seemingly refuses to die. I replied to the retweets offering to give more info as to why young docs might be reluctant but – the writer of the original article did not call me.

Don’t pay  attention to Twitter?
I am aware that Twitter is a bit shadowy. Many of these people who tweet are seeking sensational stories and false outrage. Any twelve-year-old with a mobile can tweet. We don’t know who is “serious” – so, often it’s best to ignore them.

But this time I will be a bit more direct.

Here is what the young doctors are being asked to do, from what it sounds like.

1) go to work in a recent earthquake zone where the houses, schools and health posts have been destroyed.

2) live in the same kind of temporary structure that the people they serve are living in, just as exposed to the elements as the others;


3) Use a temporary structure as a clinic, just like the one that they are living in. There will be no guarantee of a recordkeeping system, no X-ray equipment, no lab equipment, not even a microscope. Not necessarily an examining table, no medical supplies accumulated from the past. There will be no way to dispense drugs if they write a prescription. If there were supplies at that location in the past, they now lie in a heap under rubble that used to be a health post.

4) there is no security personnel. There are reports that the aid now being delivered gets hijacked by village strongmen. Even before the earthquake, there has been a problem with aggressive behavior toward doctors when things don’t go well; the problem with “thrashing” has not gone away and will most likely get worse – the doctor’s physical safety is in doubt.

5) there will be no guarantee of a senior doctor of any kind to supervise or provide advice.

6) In many cases, the young doctor has never lived in a village – they grew up in Kathmandu.

Does this list help? Do you get the picture?

You can’t provide the kind of medical care you were trained to provide, on a picnic. You need tools.
You can’t do it while you are on a two-year’s long camping trip. How does the doctor get food and water and laundry?

The young doctors who signed a commitment to serve and repay loans, could not have known they would be asked to serve in an earthquake zone. Not even Albert Schweitzer would work under these conditions. Many of these young doctors are the same ones who rushed to the affected areas to provide immediate relief in the first weeks. They are not lacking in patriotism. In fact, a few of them did grow up in a village setting. In my teaching I met one  young doc from Makwanpur who was expert at handling oxen when it was time to plant paddy. But for most? Kathmandu.

The doctors need equipment, a roof over their head, and  somebody to prepare rice while they work.
The Nepal Army is in the affected area, doing the backbreaking work to help the residents prepare for monsoon. But while the Army guys were doing physical training everyday and camping while on maneuvers, the young doctors were in the library. All of a sudden, for all intents and purposes, they are asked to join the Army on deployment.

The government needs to  work on these issues and make an effective plan. The article in Republica resorts to shaming and namecalling. This is not the time to browbeat the twentytwo-year-old MBBS graduates, nor is it time to shame the Nepal Medical Council for bringing up the elements of an effective plan.  With a few more questions  the journalist could have gotten to the other issues and provided a service to the reader.
Alas, he did not.