In common parlance it is sometimes remarked that the doctor ‘patched up’ a patient after s/he has been dealt with in the emergency department. Sometimes it is that the doctor fixed ‘him up’. I remember that my third health officer posting in the 1960s was at the Derbyshire Children’s Hospital in Derby. After I had treated a small child in the Emergency Department, the mother looked up and said ‘Thank you, Master’. This seemed unusual to me, but when I enquired from my colleagues I was told that it was a sign of respect for the doctor. That was years ago and I wonder if this still persists, even in England. Our elders who practised medicine in Nepal tell us that doctors in those days were treated with reverence and respect. I wonder is that situation is prevalent in Nepal now?
The Nepal Medical Council (NMC) Regulations were drawn up on the lines of the General Medical Council (GMC) of the United Kingdom. The GMC is the health care regulator for the medical profession in the country by maintaining a register of the medical practitioners. Its main function is to ‘protect, promote and maintain the health and safety of the public’. It also sets the standards of the medical schools in the country.
I was a member of the NMC for many years and maintained all along that the number of doctors that it says are practising in the country has never been correct. Doctors and dentists who have been out of the country for years are listed as also those no longer practising. Even those who are dead find a place! This is surprising for the simple reason that though elections for most of the various posts are held regularly, the list of members though updated with new members, is not corrected. One wonders therefore if it is to cast votes, sadly along party lines when electing office-bearers! Another reason for this state of affairs is said to be the fact that our government did not want to show a low number of doctors in the country. This reason is no longer valid with the many colleges in the country now. What a situation! One hears however that new re-registration is being done and hopefully such anomalies will be corrected. As per our new constitution it is said that registration in the future will be done by NMC Pradesh Committees. Is this advisable? After all the number of medical and dental practitioners is not that great.
About two years ago, our government split up the functions of the NMC by creating an additional new body to look at the educational aspects of programs of the workers in the health sector i.e. medical, dental & nursing and other service areas under the Medical Education Commission. The inspection, conduction and regulations of programs of two years after ten years of schooling in nursing and health sector were left under CTEVT. This was perhaps a good decision in view of the fact that the admission, training, accreditation, credibility and deployment of large numbers of human resources for health (HRH) are involved.
A large number of Nepalis are going out of the country for medical studies. Smaller numbers for dental and nursing. Surprisingly no action is being taken regarding permission for the starting of new medical, dental and nursing colleges to rectify this. Imagine the amount of foreign exchange that is being utilised for this purpose. Why the delay in starting new institutions if their standards are appropriate? Is the opposing force backed by educational concerns placing students in foreign countries? Should not such students be studying medicine in Nepal? There are number of institutions who have been trying to get recognition from the Medical Education Commission for a number of years. Have they improved their existing facilities by now? One institution vying for permission to start medical studies is the Khopna Medical College which claims that it can conduct the MBBS course by charging only Rs. 15 lakhs to the student!
Health facilities, though a constitutional right of Nepalis, is not a reality in real terms. As shown in the media, many health providing facilities were stated to be in the process of being built at the pressing of a switch by the PM. Obviously this is all a mirage, a ‘bhulaiya’ or perhaps a scam in process.
I remember the days whilst working in Bir and Kanti Children’s Hospitals that it was usually necessary to keen patients in the ‘Baranda Ward’ or even on the floor. This does not happen these days. Medical representatives entice doctors to write unnecessary tonics and vitamins for sale by the medical shops around the hospital. I remember that whilst working in the UK, doctors were obliged to prescribe medicines listed in the National Health Formulary. Doctors in the NHS prescribing unnecessary tonics were liable to pay for it!
One great worry is the large number of Nepalis going into kidney failure. I have an inner hunch that this is due to the rampant and unrestricted use of insecticide sprays now occurring in Nepal. Besides this there is no check on the state of fruits and vegetables being imported into the country.
Equipment and other accessories ordered and obtained, even at the time of the Covid –19 epidemic, were shown later to be sub-standard. Some of equipment delivered to distant health facilities was left in their packages as there was no one capable of using it there. Lastly even medicines provided have been have been found to be date expired or sub-standard when it reached the place of its use. Have those who were responsible been made to answer? What a scenario? During past years it was accepted that the way to provide service would be a public / private partnership as the government could not do it all. Why is not such a concept, working properly? Who is at fault?
Is the service currently provided a ‘make-believe’ one like the ‘Emperor’s clothes’? Is it simply a ‘Patch-up’ or ‘Tal tul’ effort to hoodwink the Nepali public and take us all for a ride?
It is likely in future years that a large number of Nepalis who have paid for their own tuition fields will be going out to serve elsewhere in the world. Whilst they have a right to do so, should not our government negotiate to receive compensation in the form of for some external aid as we are in the process of becoming a ‘developing country’ from the situation of a ‘least developed one’!
The author is a retired medical doctor and writes fiction under the pen name of Mani Dixit also. Website: www.hdixit.org.np. Twitter: @manidixithd