To the good doctor

  • I do not support Dr KC’s cause if the final aim is to halt affiliations for new medical colleges at any cost
- DR SUBHASH LAKHE
To the good doctor

Mar 26, 2015-

I agree with the views of Dr Govinda KC. We do need quality trained health workers in Nepal, but we also need the institutions that produce them.

The cost of medical education in Nepal is increasing exponentially every year and a very limited number of government or private scholarships are available. Medical education costs millions of rupees in a country where the per capita income hovers around $700 and one-fourth of its population lives below the poverty line, earning less than a dollar a day. Most expenses in medical education are met by parents whose only dream is to see their child who achieved distinction in their SLC become a doctor and enter a noble profession. Many times, they have to sell off their land and property to support this expensive education.

What is wrong here?

The tragedy is that many of these qualified doctors leave Nepal for further trainings and settlement abroad, which often times is due to the fact that the salary of doctors in Nepal is low, compared to the effort they have to put into their education and professional work. The exploitation of health workers has corrupted the medical system. Doctors and other healthcare workers bear the brunt of this. This system needs reform. My point here is, does Dr KC’s protest attempt to address any of these issues?

I recently met a middle-aged man who had worked in several INGOs in western Nepal. He was a Health Assistant and had a Bachelors in Public Health. However, he had opted to join health services as an Auxiliary Health Worker (AHW). When asked why, he answered that it was due to security. These days, it is becoming a trend to enter government health services. Doctors and many health workers alike, with many years of experience and post-graduate degrees, are entering the government health system as medical officers, an entry-level position. A government job provides job security, no doubt, but people are also attracted to the other benefits of working in a system that is fragile, corrupt, and unaccountable. These vices of government health services are well documented, as when the government failed to provide vaccines for many months this year, when its leaders were charged with massive corruption in health development programmes, and when news of health centres being run by office assistants are becoming increasingly more common. Does Dr KC’s protest attempt to address these issues?

The commercialisation of medical education has discouraged many students from pursuing post-graduate education in Nepal. I joined public health because I love working with the community, helping them out with good plans and programmes. But it was also due to fact that that it was very difficult to get a post graduate medical education in Nepal. Dr KC, the problem is huge. This goes beyond doctors or the medical institutions that produce them. This is about strengthening the health system to provide quality health services to the people of Nepal. Does Dr KC’s protest attempt to address these issues?

We need more schools

Ten to fifteen years ago, it would be difficult to see a doctor in a district hospital and it is so even now in some places. These days, fresh medical doctors and specialists are eager to go to remote districts, as it is getting competitive in the capital and the big cities. This trend also correlates with the rise in the number of medical doctors that are produced and also with the number of medical institutions that have been established in the last 10-15 years. We should continue this trend as long as we can reach all districts with a doctor and trained specialist. Opening more medical institutions that meet the standards set by the government is one way to achieve that.

In urban settings, a surgeon can order emergency surgery and within an hour, he can operate without any problem, or a radiologist can diagnose a blood clot in the brain with the help of advanced scanning equipments. However, even the same skilled surgeon cannot perform a simple procedure like lumbar puncture in many district hospitals due to the lack of an autoclaving machine or spinal needles, or a radiologist cannot confirm a simple bone fracture due to the lack of an x-ray machine or x-ray film. There are long lists of procedures that a qualified doctor cannot perform at many district hospitals. It is now time to improve the overall health system of the country, rather then focussing only on doctors and other health workers.

Health system must improve

Imagine the scenario if you, Dr KC, and a coalition of our colleagues are able to block the affiliation of new medical schools. As we know, the lines for students sitting for the entrance exams at the Institute of Medicine, Kathmandu University and the Patan Academy of Health Sciences (PAHS) are getting longer every year. If we limit our capacity to intake students into Nepali institutions by blocking affiliations, many students will definitely be going abroad, sending millions of our hard-earned money to foreign countries. These students are going to return, pass the Nepal Medical Council (NMC) licensure exam and start working. Eventually, we are going to have an influx of medical students anyhow, even if affiliations to these new medical colleges are not granted.

Dr KC, I value your life and admire what you have achieved and all that you have contributed to the medical field in Nepal. If your final goal is to halt affiliations for new medical colleges at any cost, I do not support your cause. But if your goal is to finally improve the health system of the country, let’s get wise and do something together that will profoundly impact the health system in a positive way.

Dr Lakhe is a public health professional working in the development sector in mid-western Nepal

Published: 27-03-2015 13:46

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