Print Edition - 2014-05-10  |  On Saturday

A healthy economy

  • Building hospitals in rural areas will not only provide much-needed health care to the people who don't have it in today's Nepal, but will also spur economic growth in those regions
- Manish Gautam, Kathmandu
A healthy economy

May 9, 2014-

Dharan grew substantially after 1953, when the British Gurkha Headquarters were established there to recruit youths into the British Gurkhas. And the city slowly developed into a major hub of eastern Nepal. Following the closure of the headquarters, in the 1980s, the premises that housed the recruiting centre fell into disrepair, and the surrounding businesses that had mushroomed around it started to feel the pinch. That slide came to a halt in 1993, when the BP Koirala Institute of Health Sciences (BPKIHS) set up shop in the vacated premises. Today, the area around the hospital is a buzzing beehive of commerce.

It's not difficult to see why. As the only specialty care hospital in the region, BPIKHS attracted patients from more than 15 districts, and as the patients and their attendant patient parties started pouring into the hospital, the vicinity started seeing small tea shops, khaja ghars,  and guest houses sprouting up. The economic growth was underpinned by the simple equation of suppliers coming in to meet the demands of the people who visited the hospital. The guest houses, for example, provided much-needed room and board facilities for the patient parties, as they waited for the patient they'd accompanied to recover in the hospital. The tea shops catered to everyone: patients, visitors, doctors and the drivers and others employed by the institution.  The number of pharmacies also grew slowly, and some of them even served up lucrative offers to doctors who wanted to start their private practice outside the hospital, in rooms adjacent to the pharmacies. Hospital staff who planned to work for the rest of their lives at the hospital started buying houses and apartments near the hospital area and the shops in the surrounding markets started diversifying to provide all manner of services and products. When the institute started offering medical courses in 1998, it attracted students from India and other nations. Because the students lived on campus for the better part of the year as they attended med school, their presence contributed not just to the growing economy but also added a cosmopolitan character to the city.

Dharan certainly needed that shot in the arm. Dr Madan Upadhyay, founding director of BPKIHS, remembers how desolate things were after the Gurkha recruitment centre had closed and when the hospital had just started. The area around the campus had been reclaimed by nature and there were supposedly routine sightings of jackals and other wild animals on the premises. By the time Dr Upadhyay had completed his tenure of four years at the hospital, the place had turned into a thriving nerve centre of commerce and activity. 

The establishment of a medical college is not a small undertaking. It's a multi-billion rupee investment, but one which when done right leads to a win-win outcome for the locals. Colleges have to be built in spacious areas, and the hospital has to be well-equipped. Such projects create thousands of job opportunities—right from the time that the foundations for the institution are being laid, and things just grow from there. The townships that burgeon around hospitals oftentimes turn into residential enclaves because the doctors and other allied health staff like to live within easily commutable distances from their place of work. And many locals also prefer to move into houses that are not too far from a hospital. The knock-on effect is that the value of the land around hospitals also increases.

In his book Chikitsa Shikshama Fadko, Dr Sita Ram Adhikari quotes a news report from Kantipur daily, published in August 8, 1995. The context of the news report was the establishment of the medical, dental and engineering college by the Dr DY Patel Educational Foundation in Chisapani, Nepaljung. The report compares how things were when the classes were running and how things started to fall apart with the closure of classes during an affiliation row. The news report looks into the social and economic aspects of the fallout, and quotes a local, Narayan Prasad Sharma Neupane, who mentions how people used to make their living selling milk to the hospital canteen and to shops that had opened up outside the hospital. Their businesses quickly ceased once the college stopped its operations, and the closure also adversely impacted the lives of the people residing in the area and beyond, says Neupane. More importantly, the people who were largely optimistic about their town had started to live in an atmosphere of pervasive pessimism.

Many experts see the setting up of hospitals in rural areas as a great all-in-one package for helping with decentralisation of development:

in a country like Nepal, whose denizens need both jobs and quality health care, hospitals are the ideal engines to spur growth. And unlike other business industries whose products and services are more susceptible to the vagaries of the marketplace, the services provided by hospitals—healthcare—is something that will always be in demand. And using a hospital, especially a teaching hospital, as a cornerstone for spurring development in a rural area makes sense.   

At present there are 21 medical colleges in the country, but the majority of them have been established in areas deep in the heart of the Capital or in outlying areas surrounding the metropolis. Experts point to how, for example, Sinamangal grew by leaps and bounds after KMC was built in the neighbourhood. And they would like to see such success stories get replicated in the less urban areas in Nepal—areas that need such an impetus for growth.

Dr Ramesh Kant Adhikari believes that establishing medical colleges in rural areas can also help stop the disproportionate migration of people from the peripheries of the country to its centres. "We are used to buying into the fallacy that regulating medical colleges means that the government should curtail the establishing of more medical colleges. That's the wrong vision. We need medical colleges—but in the rural parts of country," says Dr Adhikari.

Dr Jagdish Agrawal, a professor at Teaching Hospital, Maharajgunj, already has an idea about which areas would benefit from such plans. To start with, says Dr Agrawal, medical colleges should be established in Ilam, Surkhet, Dhangadi and Dipayal. "If the government takes the lead and invests in medical colleges, that would be great. But the government can also get things going by providing subsidies to private medical colleges," says Dr Agrawal. 

He would be happy with the developments now taking place in the Far West: the Karnali Academy of Health Sciences recently opened in Jumla. And just as BPKIHS did for Dharan, the academy should help in revitalising the erstwhile moribund economy in one of the country's most backward regions. 

 

Published: 10-05-2014 14:35

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