unfortunate that, despite the fact that all the technology that could save her life was present right there in that room, the woman wouldn’t have a chance at life. Although continuing to keep her on a ventilation machine might not have fully assured that she would get her life back, the chances were good that she would. But she was denied that chance as her family couldn’t afford it.

More equal than others

Five years into my training as a doctor, this was probably one of the most disturbing sights I witnessed. This situation adequately illustrated the prevailing inequality of health services for underprivileged people in Nepal.

And I knew this was only the tip of the iceberg.

The developments in health services in the Capital city have been praiseworthy. From a normal appendectomy (one of the simplest surgical procedures where you remove the appendix) to super-specialised heart and neurosurgery, we are not far behind in modern medical practice. But you will have to go outside Kathmandu to assess the real situation of Nepal’s health care. In theory, our healthcare facilities seem good enough, with at least one medical officer and a health assistant in each primary healthcare centre. But everyday, I speak to patients coming from rural areas, who say that medical officers are often absent and primary healthcare centres are run by peons, who do all the work, from prescribing simple medication for cough and cold to carrying out deliveries.

With around thirteen medical colleges producing around 1,400 medical graduates every year, one might be tempted to think that the country’s health problems will soon be over. But around half of the graduates migrate to western countries for further study and practice while the rest work mainly in urban areas. Hence, only a few medical graduates serve the needy population of rural Nepal.

Rural problems

Being a medical trainee myself, I don’t blame doctors who are hesitant to go to rural areas. Although the government has built a primary health centre in every corner of the country, basic instruments and medications required for even simple treatments are lacking. Even if a doctor is interested to go to rural areas and work, they cannot do so efficiently, as they often lack proper equipment and medication to provide good medical services to the people. There have been instances where due to a lack of morphine, a basic drug which helps relieve excruciating pain in conditions such as heart attacks, patients have had to endure severe pain until they were brought to a district hospital.

Another illustrative example that I recall concerns a 32-year-old woman from Khotang who had severe vaginal bleeding for around 12 hours. Since the only good emergency health service she could get was in Kathmandu, she was brought down to the airport in Lamidada after a 15-hour ride on a stretcher and finally flown in to Kathmandu. This lady was lucky to have the resources to be flown to Kathmandu but not all rural Nepali women are as lucky as she was. We cannot forget that gender disparities exist even in the accessibility of health services. In already limited health facilities, even less importance is given to the female population. As many as 170 women in 100,000 still lose their lives during childbirth, according to a 2012 World Bank report. This in itself speaks volumes about the grim health conditions of Nepali women.

Robbed of rights

Even now, pneumonia, diarrhea and other minor diseases are among the major killers in Nepal. These conditions are very easy to treat if intervention is timely and they are also easy to prevent. But with so few human resources and a lack of medications and services in the rural areas where these diseases are most prevalent, the list of common killer diseases doesn’t seem to be changing.

Health is supposed to be a basic right for every human being. But in Nepal, with the unavailability of services in rural areas and the increasing cost of services and medication in urban areas, it seems that Nepalis are being robbed of this basic right. Millions of taxpayers rupees are supposedly spent every year in health. Every year, at least one new medical college is established and hundreds of medical graduates produced. But for most of the Nepali population, this all might seem like a fairy tale. It is not that we lack a good policy regarding healthcare.

What we need is strong political commitment and better utilisation and decentralisation of human resources so that every Nepali’s access to healthcare is ensured.

Sharma is currently interning at the Kathmandu Medical College