The term ‘Nepali doctors’ has always intrigued as well as fascinated me since my childhood in a remote Terathum village. The irony was that there were no doctors and no hospitals. Whoever treated a patient with whatever means they had were called doctors. The other day, a television news item triggered my memories and thoughts about doctors and doctrines. Nirakarman Shrestha, a senior medical doctor whom the people of my township Myanglung know as their native, was saying at the Medical Council’s meeting on 28 February that political partisan culture should have no place in the management of medical organisations. The people of Myanglung would have watched the news, I can imagine. The visual of senior doctors sitting in the front row struck me as a moment that combines the history, medical practices and confusion that surrounds the domain. At the back of the hall were doctors of younger generations. The doctors were calling for the overhaul of the medical organisation and for the repeal of the existing medical Act, as it cannot address the issues of the day. I thought I should write at least some words about these very important people and their karma—not to do so would be blasé.   

I have lived most of my life without properly knowing any doctors in proximity. My mother treated my illness with roots and herbs. I grew up similarly to how average Nepalis then grew up—without proper medical records and checks. A revelation came to me when I went to one ‘English speaking’ doctor in Tokyo seeking treatment for my bad sinus-related breathing problem that had been troubling me for months. He asked me about my medical records, documents and past history. I suddenly found that I had nothing to give him in written or xeroxed form. My only option was to resort to narratives. I guess that is what made me a literary writer. The doctor used that modus operandi to treat me.

Another revelation came recently at Gangalal Hospital. A young academic, Shiva Rijal, who is very close to me as a colleague, theatre worker and student, and who did his PhD under my tutelage years ago, suddenly became ill. He had terrible gastric pains. We did not have any noteworthy previous medical records of him to give to the hospital. One young doctor suddenly discovered that his vital heart arteries were bleeding, which was a very serious problem. On February 14, 2018, a large team of senior and junior doctors immediately operated on Rijal. After about seven hours of operation, they called me inside and said that the operation was a great success because the problem was identified in time. Such cases are complex because the patients do not know anything about internal bleeding. The doctors asked me to tell my students and acquaintances not to ignore high blood pressure for long, to check it regularly and to undergo medical treatment. After a fortnight, the doctors discharged Rijal and I drove him home. I had never realised that the doctors in Nepal were so competent, confident, benign, human and cooperative. One of the doctors in the team, who was a poet, recognised me as a literary writer who had commented on his poetry. I understand how doctors of the new generation are opening up new avenues of linking medical practice with humanism. I understand even better why the medical students of Parikrama Group BPKIHS Dharan keep wanting me to give them seminars on body, literature and the subjectivity of doctors and patients.

Misrepresented and neglected

Doctors and their doctrines occupy our thoughts in Nepal these days. The issue of good medical education and its power came only after Dr Govinda KC started his campaign of freeing medical institutes of the game of politics and using them as money making enterprises. Nepali doctors always have good track records. But the organisational aspect is running into difficulties because of the non-medical interests involved in this field. The committed medical or clinical doctors—not those who have misused it and have turned it into a moneymaking profession without proper training—have always served the patients quietly and sincerely. There are many examples to cite. But government leaders and political parties of all hues and classes who use money from the state coffer to go abroad for their own treatment have unfairly neglected the Nepali medical field. They see this field as something that opens lucrative investment opportunities. Demoralisation of Nepali doctors also happens as a result of the touting of the benefits of going outside for treatment. It is always fair and pragmatic to go to affordable hospitals outside at the advice of the doctors here, but to demoralise the entire medical practice in Nepal is suicidal. People related to politics and the governments made by their agreements should know how medical doctors have fought for political freedom here by protecting freedom activists and courting arrests en masse. That how king Mahendra’s doctor, Mrigendraraj Pandey, boldly recommended that BP Koirala be sent for cancer treatment to a proper hospital should be remembered with pride. This is a subject of different article.

Care for education and ethics

Medical practice in Nepal has moved to a world of profit, market and consumerism, which is a common process. But this process can lead to disaster also if the concerned agencies do not work with prudence and a sense of service. But the treatment of patients at hospitals is closely linked to other activities—mainly teaching and studies in the field. Nepal’s medical future lies in combining these processes and, as the creative minds of the medicos of the new generation suggest, by working towards achieving holistic goals in internal medicine, as well as in the care of hospitalised patients, which is always the main focus in Nepali medical doctrines, and essential one considering the circumstances.

Michel Foucault’s philosophy about the birth of the clinics has long occupied the minds of doctors and philosophers alike about the possibilities of use and abuse of the clinics for power and humanity. Nepal is no exception. Finally, this essay is dedicated to good, humane and creative doctors.