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Tuesday, March 18, 2014

Why don't they open private medical colleges in remote Karnali? interview with Dr Govinda kc

Senior Professor at Institute of Medicine (IOM) and Orthopedic Surgeon at Tribhuvan University Teaching Hospital (TUTH) Dr Govinda KC has devoted his entire life in the service of mankind. He visits remote districts each year to offer free medical services to the poor and needy. He reaches disaster-ravaged places like Haiti and the Philippines to offer his help. In recent times, he has been in the news for his fast-unto-death against political meddling in
Photo: Keshab Thoker /republica
health and education sectors, and particularly at IOM. He broke his latest hunger strike, his fourth, in February after the government promised to address his demands like greater autonomy for IOM and vital appointments on the basis of seniority. Have his demands been made? How far has the government gone to honor its promises? Mahabir Paudyal and Arjun Poudel caught up with Nepal’s philanthropist physician inside TUTH premises on Wednesday morning.

Can you give us the current status of the government process to address your demands?
So far as I know, the (government appointed) taskforce has been working to develop Institute of Medicine into a Medical University. They have three months to prepare and submit a report on this. I have heard that TU officials have prepared a proposal to address the demand of functioning autonomy for IoM, so long as it is not developed into a university. This proposal will be studied by doctors, nurses and professors here who will give their feedback to TU. The final report incorporating these feedbacks will be sent to TU Senate for final approval. If this is passed, IoM will get a working autonomy. It will keep IoM free from political meddling. As for action against TU officials like Vice-Chancellor, Rector and Registrar who have time and again meddled in IoM functioning, I don’t understand why the government cannot sack them. Are they above the government and prime minister? People like these are making me sit on hunger strikes time and again. They are playing with the country’s health sector. The government promised action against them. But I don’t know if it is doing anything in this regard.

Will IoM be able to sustain itself economically if it is granted the kind of autonomy that you want?
I don’t know much about the economic part because I am a health professional. But IoM is a government health institute, so is TUTH. The government is liable to bear the economic burdens of this institution, as it should bear the burdens of any other government institution. In fact, this is what happens in all other countries. The government invests and funds in government medical colleges. Nepal should do the same. Yet IoM, in my reckoning, should be able to sustain itself economically if it utilizes its resources judiciously.

Why are you against granting affiliations to new medical colleges? Aren’t we desperately short of qualified doctors even today?
I am not completely against granting new affiliations. But unless we have clear policies to regulate the conduct of private medical colleges, there should be no further affiliations. So far all affiliations have been granted on grounds of political connections and money. In developed countries, government medical colleges outnumber private colleges. But our case is the exact opposite. We have only three government medical colleges, but 15 private ones. Around a dozen more are in the pipeline. Besides, private medical colleges have much higher number of seats. So they produce more than 2,000 health professionals each year, whereas government medical colleges produce only about 400 professionals. This is more than the country needs.

Are the locations of the proposed private colleges also problematic?
Yes, medical colleges are located in big cities, which are home to about 20 percent of the country’s population. By concentrating medical colleges in the cities we are depriving 80 percent people of health services. It’s essential to produce competent health professionals by offering scholarships so that they are obliged to go to the remote places and serve. Those graduating from private medical colleges have no such obligation. Private colleges are extremely expensive as well. Students are required to pay as much as 0.4 million for MBBS degree and 10 million if they pursue higher degrees. I don’t think more than five percent of the population is in a place to afford that kind of money. Even if they do, it will keep 95 percent out. Among the 95 percent left out might be many capable candidates who couldn’t study simply because they didn’t have money.

What do you propose should happen?
My point is there should be a clear policy to address this state of inequality in health sector. We need to study the existing situation, estimate the population for the next 40 years and determine the number of health professionals accordingly. Then we will have a clear idea as to whether we need more private medical colleges at all. If we are to open new medical colleges they should be public, not private. If the private colleges must be opened, they should open up in the remotest regions of Karnali.

A number of students go to China and other countries for medical studies. Private colleges could help retain these students and the enormous sums they spend abroad.

Many foreign students study in Nepal’s private colleges, just like our students go to other countries to study. Why can’t we formulate a policy to retain our own students in these colleges? In a democratic society, one cannot stop students from going abroad for studies but we also don’t have any policy to retain them as of now. We need to determine proper fee ceiling, the right infrastructure and the carrying capacity of proposed colleges before granting them affiliations. The problem with us is IOM has already given affiliations to more private colleges than we can handle. As a result, we have been producing substandard doctors.

TUTH Director Bhagawan Koirala resigned when you decided to sit for another hunger strike. He is rumored to be against your hunger strike.

Bhagawan Koirala introduced several reforms, though some of them ended up becoming window dressing. I had asked him not to resign. His resignation is the proof of how political meddling is still rife. They took days to appoint a new dean but accepted Bhagawan’s resignation overnight and appointed another person in his stead. They are against retaining good people in public institutions.

Why do you think medical malpractices are rife?
You want more public hospitals, but their doctors often refer patients to private hospitals, reportedly for commissions.

You cannot generalize from a few cases but I admit such practices exist. All these ills are products of politicization of health sectors and the rise of mafia. If we can stop this, government hospitals will be the best place for treatment. Political parties and the government need to take up the responsibility for this.

You often refer to “medical mafia”. Who are they?

Medical mafia is a tendency which is rampant in all sectors. It’s a tendency to serve only handful of rich people and leave the rest in a lurch. It’s a tendency that has crippled entire health and education sectors.

Noted doctors from this hospital also work in expensive private hospitals. Is that problematic?

So far as I know, none of the doctors here serve in private hospitals during duty hours. They leave at 6, after which they are free to work wherever they like. If we appoint the best and honest professionals such problems won’t arise. Rampant politicization has bad people working in government hospitals who in turn defame government hospitals.

If your demands aren’t addressed this time as well, will you again go on a hunger strike?

I had to sit for hunger strike for the fourth time after government authorities cheated me. They agreed to address my demands but they did not. Yet I did not carry on with the fourth strike for long because it was putting patients in discomfort. If I had persisted, maybe TU’s VC, rector and registrar could have been dismissed. Things are a bit different now. Some of the demands have been addressed. Others are in the process of being addressed. The government and the political parties should ensure that a situation is not created where I have to sit for yet another hunger strike. I believe the new government is sensitive enough not to repeat past mistakes. After all they have received the mandate of improving things on health and education fronts.

It is alleged even TUTH does not treat people from remote regions with respect. They find themselves completely at sea when they arrive at the hospital and no one helps them.

I have also realized this. We need to create a separate department targeting the people coming for remote regions and ensure fast service for them. I am aware of the plight of these people because I have visited Karnai many times. They come to Kathmandu thinking they will rid of all ailments but once they reach the hospital, they don’t get expected service. Hospitals should create a separate department to cater to this population. Such special services should be provided at each and every hospital.

Where will you go for your annual medical sojourn this time?
Hunger strikes have disrupted my work schedules. I have taken some time to recover. I still have to ensure that I cover my course (taking classes of medical students) on time and attend to all my patients. I cannot tell you when and where I will go but I am thinking of visiting the remotest parts this time.

source: republica,13 march 2014

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