Without political will, Dr KC’s demands cannot be fulfilled
- Dr Sharad Onta
Apr 5, 2015-
Last Thursday, after 12 days of a hunger strike, Dr Govinda KC signed a deal with the government, ending his protest that drew national attention towards government apathy. Thousands of doctors, who had halted all out-patient services to express solidarity with Dr KC, went back to work and the nation heaved a sigh of relief. This was Dr KC’s fifth fast and his condition had deteriorated rapidly, prompting mass protests across the country. His principal demand has been consistent: an end to political interference in the health sector, especially medical education. In the agreement signed, the government has pledged to hold off providing affiliations to new medical colleges, a number of them backed by political interests, until a formal policy is drafted. Manish Gautam and Pranaya SJB Rana spoke to Dr Sharad Onta, assistant dean for academics at the Maharajgunj Institute of Medicine (IoM), about the government’s commitment to fulfilling Dr KC’s demands, the quality of health education in Nepal, and the social accountability of medical professionals.
We were here last year and here we are again. How positive are you that Dr KC’s demands will be fulfilled by the government this time around?
The government has agreed to a number of conditions that it cannot fulfil. It should have evaluated whether it can comply with those conditions before agreeing to them. It is not that they are impossible but these commitments are not easy to fulfil as they require a great deal of political will. The Prime Minister himself might have committed to Dr KC’s demands but is he in a position within the current government to actually pursue those demands? For one, take the commitment to establish a medical college in the Mid West in the next fiscal year.
You seem to be hinting that the government’s agreement is just a temporary stopgap with no real intention of fulfilment.
First, let me make it clear that I am not saying that Dr KC’s demands are not legitimate. Because they were extremely justifiable, they received so much support from various quarters. But like I said before, does the required political will exist? Do Dr KC’s demands align with the government’s health, education, or economic policies? For example, there is the commitment to open medical colleges in all five development regions within the next five years. I am not saying these colleges are not needed there, but the prospects of this happening are very slim. A medical academy was established a few years ago in the Mid West but it has ceased to function because of a lack of support from the government. In this context, will it be wise for the state to establish more colleges that it cannot sustain?
How do you view Dr KC’s protest and what does it mean to the larger medical fraternity?
No doubt there are differing perspectives, but the fact is that the state’s standard operating machinery is not sensitive to the people’s concerns. It does not take action until and unless there is a crisis. You can write articles in the newspapers, press your demands at various government bodies, and even hold a rally for a day or two, but the state will not take notice. This is why Dr KC had to resort to such an extreme move. This kind of protest will definitely establish an agenda, but I am not too certain how helpful this approach is, though there is no questioning the legitimacy of his demands.
So realistically speaking, what exactly can the government do?
The state must fund public colleges so that they are capable of competing with private colleges. I don’t know whether it is wise to completely prevent the private sector from entering medical colleges but there must be policies and guidelines that govern and monitor the private sector. As of now, the private sector dominates; it doesn’t have to compete with state schools. And this is not just in medical education; it applies to all sectors. Perhaps this is because the state hasn’t been able to control or properly manage the private sector and make it more responsible. To combat this, the state will have to increase funding for public schools and increase their capacity.
Another aspect here is that Dr KC’s protest focussed largely on medical education but this alone will not secure the health of Nepal’s citizens. We might have colleges but where are the medical professionals that these colleges are producing? We have yet to find a way to make these doctors more responsible towards society. The state must think on its larger goals for ensuring the health of its citizens. Where does the state see the private sector in this goal? Geography will also have to be taken into account. Where are the private hospitals in rural areas? The US once practiced the ‘saturation theory’ where it believed that once hospitals and doctors reached saturation point in urban areas, they would move to rural areas. But that never happened. In cities, the demand keeps rising.
The debate around medical education seems to have coalesced around affiliations. Aren’t we missing the bigger picture of the quality of education that is being provided?
Yes, we are not talking about the social accountability of medical colleges and doctors. Last year, we had come up with a report where we stated that a medical college must comply with three uncompromising conditions. First is quality control. Quality, however, does not just mean technical skill; it means technically competent and socially accountable. Second, a medical college must be established on the basis of social justice and equity. This includes some of Dr KC’s demands, such as the establishment of colleges in areas that are deprived, as medical colleges facilitate development. Medical education also should not just be the province of those who can afford it; deserving students, no matter their economic status, must get a chance to study medicine. Finally, medical colleges need to be responsible and accountable to society. If a doctor is guilty of malpractice or if all doctors produced by a college congregate in urban areas, the college must ask itself what its responsibility is and what kind of education it is imparting.
There seems to be a vicious circle in medical education. The initial costs of studying medicine are so high that they prompt doctors to try to recoup this investment later in practice. This has led to unnecessary tests, malpractices, and unethical behaviour.
This definitely exists but I think it is bigger than just the cost of education. We have many doctors in Nepal who have studied on scholarship. Proportionally, there might be fewer of them, but they are out there and a number of them too seem to be motivated by making money. And there are doctors who have spent much out of their own pocket and yet, are some of the most responsible doctors. So more than the cost of education, it is that we don’t have a proper protocol in place to control malpractices. We need guidelines, rules, and regulations, and laws to prevent such profit-seeking behaviour.
Do you think this also has to do with the societal perception of doctors, where parents still seem to believe that being a doctor is the highest professional achievement?
Yes, exactly. But it is not just parents who are guilty of this. Medical schools are also to blame, as they teach their students that they are the cream of society, that they are more talented and more brilliant than the rest. This is part of what I mean by social accountability. Doctors are also a part of society, just like any other profession. Everyone must fulfil their responsibility. Different jobs require different skills and competencies. There should be no hierarchy of which profession is higher and which one is lower. But even within the medical profession, cardiologists and neurologists are valued more than say, a dermatologist. But for a patient of a skin disease, the dermatologist matters most. This kind of paradigm has continued since very long and it is also the responsibility of medical schools to change this perception. But our debates on medical education have not addressed these issues; we have had a very narrow discussion.
Published: 06-04-2015 08:43