Opinion
A dark chapter
Dr Govinda KC has prevailed for now but make no mistake: the ‘medical mafia’ will mount a strong pushbackAkhilesh Upadhyay
At the least, his protest has uncovered the deep nexus between the political establishment and the medical fraternity. There are some disturbing facts out there.
A medical college that is awaiting affiliation, Kathmandu’s Manmohan Memorial Institute of Health Sciences, allegedly has investments from CPN-UML leaders. Doctors who are acquainted with the goings-on in the Biratnagar-based Nobel Medical College say the hospital owners have in the past used Maoist party goons to silence their critics. It also has strong links with the senior-most Nepali Congress leaders, whose political base is Morang. The medical college, next to Biratnagar airport, is ill-equipped to handle its rapidly swelling number of MBBS seats. How did it even get such a high number of seat allocations?
Just compare these figures and the scale of corruption hits you hard: Nobel Medical College gets to admit 150 MBBS students each year while only 120 MBBS students get into Dharan’s BP Koirala Institute for Health Sciences (BPKIHS), arguably Nepal’s best medical college, both in terms of human resources and infrastructure for MBBS studies. Even the visiting faculty members from India’s premier medical institutions, not least Delhi’s All India Institute of Medical Sciences, marvel at BPKIHS’ spacious campus and impressive facilities. The country’s second-best college for MBBS studies, IoM, takes in 100 students a year.
Under the huge public pressure generated by Dr KC’s two-week vigil, the government has for now agreed ‘in principle’ to provide autonomy to the IoM, stop new affiliation of medical colleges without a proper review and appoint a new dean to head the IoM. It also sacked the controversial appointee, Dr Shashi Sharma, as IoM dean.
But one swallow hardly makes for a summer. Indeed, political patronage has plagued just about all professional institutions, with meritocracy taking a back seat. What has happened in medical colleges and hospitals is merely a manifestation of the larger malaise that now plagues all walks of life—the bureaucracy, the police, all kinds of professional groups and even the media.
Yet, the good doctor is well aware of the limitations of his kind of occasional social movements: the IoM orthopedic surgeon was involved in a similar fast last year against political interference.
The money trail
Corruption in medical studies is deeply entrenched and it’s a high-stakes affair. Even by conservative estimates, private medical colleges make billions every year. Every single MBBS student pays more than Rs 30 lakh in tuition fees alone, except those 10 percent who are given scholarships. So the medical mafia is constantly at work to get: a. affiliation for new medical colleges; and b. additional MBBS quotas.
Even assuming that the country’s 18 medical colleges admit only 1,000 students a year, it’s still a multi-billion rupee industry. And if you add up the profits you make from hospital services, a decent-sized medical college makes at least Rs 30-35 crores a year in profit. This makes the business of running medical colleges perhaps the most profitable risk-free industry in Nepal.
It all begins with the battle for affiliation from one of the two accredited universities—Tribhuvan University and Kathmandu University—and the regulatory government body, the Nepal Medical Council (NMC).
The NMC not only oversees the first-time affiliation process but also monitors regularly for quality control. Nine of its members are elected by the country’s licenced doctors while the other nine are government appointees, including the chairman. Dr Damodar Gajurel, who resigned last week during Dr KC’s protest, was appointed by the Baburam Bhattarai Cabinet.
When a new medical college wants affiliation, the process begins by sending a proposal to the Ministry of Education (MoE), which is considered by NMC and one of the two universities with whom the new medical college looks to be affiliated with. The MoE then issues a Letter of Intent inviting the medical college to draw up a detailed work plan. NMC has a set of guidelines on requirements, such as infrastructure and human resources. The college authorities need to work on both establishing their infrastructure (for example, the number and quality of classrooms or library and laboratory facilities) and hiring staff (whether there is an adequate number of faculty members in each subject to be taught).
Once the NMC is happy that its guidelines have been adhered to, it takes a final call on affiliation and seat allocation—the number of MBBS students the college in question will be allowed. It is a time-consuming process. Preparations for the Nepal Army’s medical college at Chhauni, for instance, started in 2008 and it took two long years before it started its MBBS intake.
Then, every year, NMC also conducts ‘quality control’ inspections on these institu-tions. Not all the colleges have vast resources at their disposal, as the Army, and they begin humbly and grow over time—for example, Nepalgunj Medical College and Manipal College of Medical Sciences in Pokhara.
The khade baba phenomenon
NMC obviously enjoys sweeping discretionary authority, which leaves a lot of room for interpretation when it comes to ascertaining the quality, both in infrastructure and human resources.
Doctors say Nepal’s biggest handicap in running good medical colleges is not so much the infrastructure. It is more the steady supply of human resources. There’s a dearth of teachers for basic sciences—anatomy, physiology, biochemistry and forensic medicine, for example.
To meet this, Indian doctors are hurled in just for the supervisory period (anywhere between a few days to a little more than a week) to ‘stand up’ (hence their khade baba nickname—the dummies) at the colleges. Most of these North India-based experts see paid travel to Nepal as a welcome family vacation, with mutually agreed fees to boot.
All the paperwork is handled well, though the supervising doctors (assigned by the NMC), the khade babas (the Indian dummies) and the college authorities all know that the whole inspection is a sham. It’s an extreme form of corruption. This has had severe impact on the quality of education delivered. Veteran doctors trained in top Indian colleges and Nepal’s own IoM and BPKIHS attest that the new breed of Nepali doctors coming out from some of these private colleges are “not up to it”, a trend that, they fear, could get worse in the days ahead.
Although less an issue, infrastructure has its own problems too. Fake bed capacities and hospital occupancies are recorded during inspection tours. A 70-80 percent bed occupancy is a must for a medical college hospital.
The need for constant vigilance
The renewed level of vigilance will also hopefully reinstate Dr Prakash Sayami (or at least someone with his level of gravitas) as the IoM dean. He stood firm against giving affiliation to four new medical colleges and chose instead to leave office when faced with intense political pressure. One of the prospective colleges is under the CPN-UML’s patronage while a second one (a dentistry hospital in Kathmandu) is being run by the all-powerful patrons of Biratnagar’s controversial Nobel Medical College. The good have prevailed over the unscrupulous for now but make no mistake, the deeply entrenched ‘medical mafia’ will again mount a strong pushback.