Operation Quack

(First published in The Kathmandu Post )

The identification and arrest of 36 doctors possessing forged academic certificates, mostly of school and intermediate level, and using them to pursue their medical degree have come as a shock to many. Everyone was dismayed by the fact that people with fraudulent certificates thrive in the medical sector that has profound effects on the life and death of a person. As a result, nakkali daktar became a household phrase overnight.

This is indeed a reminder of the dishonest practices prevailing in our society. Not long ago, a professor accused of plagiarism was appointed as the vice chancellor of Tribhuvan University. And despite protests, he continues to occupy the coveted position. Doctors too are products of the same society, and one cannot expect them to be very different from the rest.

Felony or misdemeanour

The majority of the arrested doctors are found to have fake school leaving exam certificates or higher secondary level certificates. However, the surprising thing is that they have been successful in completing their MBBS or MD courses from recognised universities. On the one hand, it raises some serious questions about how they were able to get through the tough courses; on the other hand, it gives us reason to assume that they have the requisite clinical knowledge and surgical techniques to practice medicine. In fact, some of them have been practicing medicine for years and have established themselves as professionals in reputed hospitals. Contrary to the general belief, they are not even ‘quacks’ in the literal sense. But we must admit that no matter how good a clinician they may be, the moral bankruptcy demonstrated by those fake credentials makes them unfit to practice as doctors, for whom this society has the highest regards. After all, doctors are more than technical beings; they have their own set of guiding principles and moral values which they should strictly adhere to.

Worse are those who possessed fake MBBS and MD certificates, the ones practicing without licensing certificates or those who passed the licensing examination with the help of fake examinees. Such doctors pose a great threat to the public health and this amounts to a felony without a doubt.

Parents are often seen encouraging or sometimes even forcing their kids to become doctors without taking their capabilities and interests into account. Because of the supposedly rich and easy life coupled with glamour and social prestige, the profession is hard to resist. So people do get tempted and resort to foul means in order to fulfil their goal of becoming a doctor. So the Indian state of Bihar, just across the border, emerges as their favourite destination to buy all the phony documents.

One can present many such reasons behind this crime. But there should be no excuse; a crime is a crime and it should be condemned no matter what. If such misdeeds go unpunished, it will only encourage more people to follow suit and the medical field will get further polluted. As such, this is the time to set a precedent by punishing the culprits and pushing for similar reforms in other sectors.

Stained white coat

It is not the first time when questions have been raised about the country’s medical profession. Only last December, two fake examinees were found appearing in the Nepal Medical Council’s (NMC) licensing examination on behalf of others who had repeatedly failed to get through. It was in fact this incident that pushed the officials to dig deeper. A big question had arisen—why are doctors failing to clear the medical licensing examination despite repeated attempts? Officials suspected something was wrong and that was how the ‘operation quack’ started. Moreover, the exam is widely believed to be too simple by every standard. Many have even advocated a review of it as it only tests theoretical knowledge and not the skills required of a doctor.

This operation should go beyond punishing the guilty. It should help establish a mechanism by which frauds will not be able to enter this noble profession again. Why did the concerned university not bother to verify the certificates before admitting them to such a sensitive course?

Was it negligence or a deliberate act? Why was the NMC, formed with the sole objective to regulate medical education and profession, in deep slumber for so many years? And, how did the counterfeiters manage to pass the MBBS and MD exams or the licensing exams?

The credibility of the country’s medical sector is at stake. People have begun to doubt their doctors. This also does not bode well for all the honest doctors out there who have worked really hard to get where they are. Therefore, the investigation should be completed as soon as possible and the public should be assured once and for all that the medical sector is clean. From now on, each and every certificate needs to be verified before allowing people to pursue further education, especially in sensitive fields like medicine. Last but not least, the humble but spirited effort of Dr Govinda KC to bring about much-needed reform in medical education is gaining recognition, and we as citizens need to contribute from our side by supporting him.

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DOCTORS UNDER THREAT

(First published in The Kathmandu Post )

Dr. Guna Raj Awasthi, Medical Superintendent of District hospital, Baitadi was busy with a line of patients in the hospital on June 5 when a group of women smeared black soot on his face. It was later understood that they were incited by a local Nepali Congress leader Ramesh Koli who badly wanted to settle scores with this hugely popular doctor. Several weeks down the line, Koli is still at large.

The larger story

In order to justify their inhumane act, the assailants had this to say: the hospital did not provide free ambulance service to Hira Bhul, a pregnant with triplet who was referred from there to the higher centre. In contrast, the larger story was: Hira was examined by Dr. Awasthi a couple of days before the incident and as he found out that the condition of one of the fetuses was quite abnormal, she was instantly referred to the higher centre where any ensuing complications could be managed. In fact, upon learning that the patient was poor and helpless; Dr. Awasthi even managed to collect the fund for them. He contributed Rs. 1000 from his side and Rs.1500 from the hospital committee. As for the ambulance, he had personally requested ‘Dasarath Chand Pratisthan’ to avail it as the hospital’s ambulance was out of the town.  

It goes without saying that this is a despicable act in its entirety and needs to be highly condemned. But it has also provided us an occasion to introspect: Why are doctors routinely facing threats and attacks in the workplace? Sadly, this assault is far from an isolated incident and thus this news did not come as a surprise. News of doctors being beaten, verbally abused and hospitals getting vandalized are surfacing every now and then.  Besides, Nepalese doctors are not unique in facing this situation. Even countries like China and UK are going through all this. Why?

There are reasons aplenty. Doctor-patient relationship is at an all-time low. With the mushrooming of private medical colleges, medical education has been hit hard and the crucial ‘quality factor’ in the newly produced numerous doctors is under question. The public can be blamed for their low health literacy but there have been several occasions in the recent past when the failure in effective communication with the patients has led to gross misunderstandings and subsequent unfortunate incidents. With the continued commodification of healthcare, patient satisfaction has sharply plummeted with doctors significantly losing their trust. And if the state fails to regulate the medical education and leaves it in the hands of Mafioso as in the present, one can only expect the cases of medical negligence to rise. Add these all, and you get a sense of why the incidence of violence against once highly regarded professionals is bound to increase in the days ahead.

Now the question is: Can’t this be averted?  Of course, yes. Dr. Govinda KC has been in the forefront of the campaign to reform the health sector and if the citizenry backs him up to change this ugly underside of medical education, things will definitely get better.

Omnipresent Impunity

However, if we try to construct Dr. Awasthi’s case around the argument that negligence had compelled them to do so, we are wrong. He is a doctor par excellence with stellar track records, both on technical and humanitarian grounds. This is, no doubt, a politically motivated pre-meditated attack. Unnerved about his growing popularity, local party leaders with vested interests were seeking to transfer this doctor elsewhere. It is against this backdrop that few relatives of the patient were coaxed and provoked to manhandle him.

Under the leadership of Dr. Awasthi, Baitadi has witnessed a remarkable progress in health sector. In the health ranking done by Nepal Government based on various health parameters, Baitadi was one of the 5 worst performing districts. But once he assumed the office, it has now become fourth climbing up 65 positions. Even a cursory look at the statistics will reveal how much he has worked for the overall improvement in the health care delivery system of Baitadi. For this outstanding performance, he has been already felicitated with the Health Service Award. Among health workers, he has a reputation for endless service to the people of rural areas and is thus seen as a constant source of inspiration for scores of doctors working in the hinterlands.

In a nation where the culture of impunity has been institutionalized, it is no wonder that the party hooligans who orchestrate such attacks are offered political protection. We have little hope that the culprit will be brought to book, because anyone under the garb of political party is above the law in this land.

Until and unless we end this culture of treating the politicos as more equal, medical reforms alone will not bring about the desired working environment for medics. At least this is what the Awasthi case has proved. Bringing more security guards in the hospital is not the answer, strict enforcement of the law and ending the omnipresent culture of impunity is.

Let us allow to work with only the patients’ best interests in mind. By resorting to hooliganism upon the slightest pretext, we are not only harming the health care environment but also demoralizing the bright young minds from choosing medicine as their career. We are pushing them to the folds of the U.S and Australia.

It is high time the general public understood the costs of unsafe working environment.

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छाउपडीले निम्त्याएको मानसिक विक्षिप्तता

(First published in सेतोपाटी)

अछाम जिल्लाको सदरमुकाम मंगलसेन नगरपालिका बस्ने १४ वर्षकी कमला ढुंगाना (नाम परिवर्तन) स्थानीय स्कुलमा कक्षा ८ मा पढ्दैछिन् | हालैको एक दिन दिउँसो १ बजेतिर कमला मंगलसेनस्थित जिल्ला अस्पताल ल्याइएकी थिइन् | एक्कासी पेट दुख्ने, हातखुट्टा बाउँडिने, घाँटी थिचिएजस्तो हुने, घरीघरी मुर्छा परेजस्तो हुने भएपछि आत्तिएर सोही स्कुलमा कक्षा १० मा पढ्ने उनकी दिदीले ल्याएकी थिइन् उनलाई अस्पताल | हामीले समस्या बुझ्न खोज्दा उनी केही पनि बोलिनन् तर हाम्रो कुरा भने बडो ध्यानपूर्वक सुनिरहेकी थिइन् | स्वास्थ्य परीक्षणका साथै अस्पतालमा उपलब्ध सामान्य ल्याब जाँचहरु गर्दा कुनै खराबी पाइएन | अन्ततः अंग्रेजीमा ‘कन्भर्सन डिसअर्डर’ भनिने एक प्रकारको मानसिक समस्याबाट उनी पीडित रहेको बुझ्न खासै समय लागेन |

कारण छाउपडी गोठ

कमलालाई अस्पताल ल्याइपुर्याउने उनकी दिदीलाई सोध्दा उनको अहिले रजस्वला  भइरहेको भन्ने कुरा थाहा पाइयो | हुनत रजस्वला आफैंमा प्राकृतिक कुरा हो, जुन प्रजनन उमेर समूहका हरेक महिलामा हर्मोनहरुको उतारचढावका कारण हरेक महिना हुने गर्छ | तर अछामलगायत सुदूरपश्चिममका पहाडी भेगमा योसँग जोडिएर आउने छाउपडी गोठले यसलाई अस्वाभाविक ढंगले त्रासदीपूर्ण बनाएको छ |

छाउपडी गोठमा बस्दा महिलाहरु बलात्कारलगायत विभिन्न खाले हिंसाको सिकार भएका, सर्प र अन्य जंगली जनावरको आक्रमणमा परेका, चिसोले कठ्याङ्ग्रिएर मरेका समाचारहरु नौला होइनन् | छाउपडीमा बस्दा भोग्नुपर्ने सम्भावित यही त्रासदीबाट कमलामा तीव्र डर, चिन्ता अनि तनाव उत्पन्न भयो जसको विष्फोट भयो- ‘कन्भर्सन डिसअर्डर’ का रुपमा | उनकी दिदीका अनुसार अविवाहित किशोरीलाई रजस्वला शुरु भएको सात दिनसम्म अनि विवाहित ‘आइमाई’ लाई पाँच दिनसम्म घरभित्र छिर्न सख्त मनाही छ – यही हो रे यहाँको अघोषित नियम | यसप्रकार कमला सात दिनसम्म आफ्नै घरभित्र छिर्न अयोग्य थिईन् | माघको यो कठ्यांग्रिदो जाडोमा छाउ भएकै कारण गोठमा बन्दी हुनुपर्ने नियतिले यी भर्खरकी किशोरीको आत्मसम्मानमा हुनसम्म ठेस पुग्यो | तर ‘म गोठमा बन्दी बन्दिन’ भन्नसक्ने हिम्मत उनमा थिएन | उनकी दिदी पनि छाउ भएको बेला त्यसैगरी गोठमा बसेको उनले देखेकी थिइन् | उनकी आमाको कथा पनि भिन्न थिएन |

भन्न वा गर्न चाहेको कुरा अभिव्यक्त गर्न नसकेपछि गुम्सिरहेको कुरा कतै न कतैबाट बाहिर आउनु त थियो नै | कमलाका हकमा त्यो यही एकप्रकारको मानसिक विकारका रुपमा बाहिर आयो | हामीले उनलाई सोध्यौं- ‘बहिनी, तिम्रो छाउ शुरु भएको हो ?’ उनी मुन्टोसम्म हल्लाउँथिन्, तर बोल्ती भने बन्दप्राय: नै थियो | हामीले उनलाई सात दिनसम्म अस्पतालमै भर्ना गर्ने निर्णय गर्यौं ताकि उनी गोठमा बस्नु नपरोस् अनि गोठमा बस्नुपर्ला भन्ने तनाव र त्यो तनावबाट सिर्जित हुने ‘कन्भर्सन डिसअर्डर’ बाट मुक्त हुन सकून् | अस्तिमात्र सात दिन पुगेसँगै उनी अस्पतालबाट ‘डिस्चार्ज’ भइन् | सातौँ दिनका दिन उनी आफैंले हामीसँग डिस्चार्जका लागि अनुरोध गरेकी थिइन् | तर त्यो दिन पनि उनी हामीसँग धेरै खुलिनन् |   

कमलाकी दिदीसँग कुरा गर्दा एउटा कुरामा भने ढुक्क भइयो- स्कुल जाने यी किशोरीहरुलाई राम्रोसँग थाहा छ कि रजस्वाला भएको बेला यस्तो गोठमा बस्नुहुन्न भनेर | उनीहरुलाई भलिभाँती यो पनि थाहा छ कि यस्तो बेलामा सरसफाईमा बढी ध्यान पुर्याउनुपर्छ अनि प्रशस्त मात्रामा पोषिलो खानेकुरा खानुपर्छ भनेर | तर थाहा हुँदाहुँदै पनि उनीहरुलाई गोठमा नगई सुखै छैन | समाजले मात्रै होइन, आफ्नै घरपरिवारले जबर्जस्ती गर्छ | त्यसैले जहाँ देउता रिसाउँछन् र अनिष्ट हुन्छ, त्यसैले परापूर्वकालदेखि मान्दै आएको कुरालाई सहरका मान्छेले भाषण गर्दैमा रोक्न मिल्दैन भन्ने जबर्जस्त मान्यताले घर गरेको समाज छ, त्यहाँ कमलाकी दिदी र उनको पुस्ताका किशोरीहरुले बुझेर मात्रै पुगेको छैन, कमलाको आमा र हजुरआमा पुस्तालाई पनि बुझाउनु छ |

घोषणाहरुमा त धेरै गाविसहरु समेत छाउपडी गोठमुक्त भइसकेका छन् | तर सदरमुकामकै एक स्कुले किशोरीको यो हाल देखेपछि हामीले अस्पतालमा भर्ना भएका अरु सबै महिलाहरुलाई एकै प्रश्न सोध्यौं- ‘के तपाईं रजस्वलाको बेला छाउपडी गोठमा बस्नुहुन्छ ?’ उत्तर पनि सबैको एकै थियो- ‘डाक्टरलाई के ढाँट्नु, हामी त बस्छौं हजुर’ ! किन बस्नुहुन्छ त त्यस्तो नारकीय खोरमा भनी प्रतिप्रश्न गर्दा सबैसँग केही न केही बहाना थियो | एउटीले भनिन्- एकचोटी त म ‘आ, जे पर्ला’ भनेर छाउ भएको बेला पनि घरमै बसें | तर त्यसको दुई दिनमै बाघ आएर हाम्रो बाख्रो लग्यो | अनि सासु रिसाएर ‘तँ गोठमा नबस्दा देउता रिसाएर यस्तो भएको हो’ भनेपछि म पनि डराएर अरु के के अनिष्ट हुने हो भन्दै अर्कोपालिदेखि फेरि गोठमै बस्न थालें | यस्तै (कु)तर्क सबैसँग थिए | स्यालले कुखुरो खाइदेको, बच्चा बिरामी परेको आदि | फलानोले नमान्दा उसको यो दुर्गति भयो, ढिस्कानोले नमान्दा त्यसको यो बेहाल भयो, उनीहरुसँग सुनाउनलाई किस्साहरुको कमी थिएन |

पूर्वका ठाउँहरुमा त यस्तो मान्दैनन् क्यारे, त्यहाँका देउता पनि रिसाएका छैनन्, झन् तिनै ठाउँहरु कहाँ पुगिसके, तपाईंहरु भने देउता रिसाउलान् भन्दै बस्नुस् भन्दै हामी केही झोक्किंदा एकजना अधबैंसे महिला धारे हातले छ्याक्क हावा तास्दै कुर्लिन् - अरुले घोडा चढे भन्दैमा हामीले धुरी चढ्न सुहाउँछ कहीं, नहुने कुरा गर्छौ तमी पनि ! म बक्क परें | मेरो ताल देखेर उनले मलाई सम्झाइथिन् - देउतालाई रिसाउन दिनुहुन्न | देउता रिसाइहाले भने त तमी पनि फुस्स मर्न के बेर ?

हरे देउता ! देउता पनि कतै माथिबाट यो सब देखेर बक्क परिरहेका होलान् |

समाधान के ?

निसन्देह मान्छेको सोचमा परिवर्तन | हो, यो समयसँगै हुने कुरा हो | नयाँपुस्ताका किशोर-किशोरीहरुमा यो भइसकेको पनि छ | तर शनै:शनै हुने प्रक्रिया हो, आफैं भइहाल्छ नि भनेर हामीलाई हात बाँधेर बस्ने सुविधा भने पक्कै पनि छैन | आ-आफ्नो ठाउँबाट मानिसको त्यो पुरानो सोच बदल्ने काममा लाग्नुपर्छ | उदाहरणका लागि मिडियाले जनचेतना फैल्याउने काम गरेकै छ, यसलाई अझ घनिभूत ढंगले अघि बढाउनुपर्छ | हाम्रो बुवा पुस्ताले पनि कुरोको चुरो बुझेको त छ तर कहिलेकाहीं बाघ कराउनु र बाख्रा हराउनुको संयोगलाई नबुझेर ‘होइन, साँच्चै देउता रिसाएकै हुन् कि, कतै यो मान्नैपर्ने रिती पो हो कि’ भनेर उनीहरुको मनमा पनि डरको बादल मडारिन्छ | बाजेपुस्ताको त कुरै नगरौं, यो हाम्रो धर्मसंस्कृति हो, यसलाई हरहालतमा मान्नुपर्छ भन्नेमा उनीहरु दृढ छन् | तर खुसीको कुरा- कमलाको पुस्ता प्रष्ट छ | उसलाई यो कुरीति नै हो भन्नेमा कुनै सन्देह छैन | यो प्रथाले गर्दा महिलाहरु पछि परेका छन् त्यसैले यसलाई जरैदेखि उखेलेर फाल्नुपर्छ र यसो गर्दा कुनै देउता रिसाउँदैनन् भन्नेमा उनीहरु एकदमै सचेत छन् | कमलाकी दिदीलाई उदाहरण बनाएर भन्न सकिन्छ- छोरीलाई शिक्षा दिएर मात्रै यो मानसिकतामा पुरा परिवर्तन ल्याउन सकिन्छ |

अर्को उदाहरणका रुपमा कमलाका आमाबुवा ठीक त्यहीबेला ज्वरोले थला परेर घरबाट अलिक टाढाको गाउँमा धामीलाई देखाउन गएका रहेछन्, नकि नजिकैको अस्पतालमा | उनीहरु घरमै भएको भए त देउता लाग्यो भनेर कमलालाई पनि उतै लग्ने थिए, अस्पताल ल्याउन दिने थिएनन् | १० कक्षामा पढ्ने दिदी थिइन् र त अस्पताल ल्याइन् |

अब आउने पुस्ता गोठमा बस्न जानेछैन भन्नेमा ढुक्क हुन सकिएपनि अहिले कमलाको पुस्ता अनि कमलाका आमाको पुस्तालाई छाउपडीबाट कसरी मुक्त पार्ने- समस्या त्यहाँ छ | तर घोषणाहरुमा रमाउने बानी परेको सरकारले समस्या जति एनजीओ र आइएनजीओका थाप्लामा सुम्पेको छ र आफू कुम्भकर्णको पारामा मस्त निदाएको छ | छ महिनापछि बिउँझेछ भने पनि बिउँझेको बेला उसले गर्ने काम एउटै छ- अर्को एउटा गाविसलाई छाउपडी गोठमुक्त घोषणा | रुढीवाद र अन्धविश्वासको जगमा उभिएको पुरानो मानसिकताको यो समाजमा कमलाजस्ता किशोरीहरुलाई अर्कोपटकको छाउको बेला ‘कन्भर्सन डिसअर्डर’ हुनबाट कसरी जोगाउने, हामीसँग कुनै योजना छैन | 

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