By Michael Vurens van Es
KATHMANDU, Nepal
A Nepali surgeon’s fast-unto-death against alleged corruption in the medical education system has galvanized civil society and sparked calls for wider reform.
When Nepal’s prime minister and chancellor of Tribhuvan University Sushil Koirala recently gave the green light for the national university to grant new affiliations to private medical colleges, he could hardly have guessed the backlash it would unleash.
Since the decision was made earlier in February to proceed with affiliations that will allow select private colleges to provide medical tuition, the protest of veteran orthopedic surgeon, professor and activist Dr. Govinda KC, who is currently in the 10th day of a fast-unto-death at Tribhuvan University Teaching Hospital, has gained support from a broad cross-section of Nepali society.
The doctor, whose condition is reported to be increasingly critical, has said that his fast will end only when the government implements past agreements and recognizes the ten demands he is making in an attempt to reform Nepal’s health education system.
“Dr. KC is raising genuine demands. He wants to change education in the health sector and he is raising important issues,” Dr. Mukti Ram Shrestha, general secretary of the Nepal Medical Association told The Anadolu Agency. He said that the focus of politicians should be changed to enforcing anti-corruption measures and to improving the health sector.
In support of Dr. KC, resident doctors at Tribhuvan University Teaching Hospital have refused to treat hundreds of patients seeking medical attention in the outpatient department, and have now boycotted all but emergency services, while the Nepal Medical Association has shut down outpatient services at hospitals across the country.
Students at the university’s Institute of Medicine, which is reported to be obstructing the affiliation process, have shunned classes and publicly burnt report cards.
Professional groups, including the Nepal University Teachers' Association, as well as human rights activists and civil society leaders, have also expressed solidarity with Dr. KC.
The prime grievances of the doctor and his supporters center on allegations of corruption within Nepal’s medical education sector, and what they claim is the pandering of universities to private medical colleges with deep pockets, through suspect credentials.
Critics of the sector argue that in recent years health education in Nepal has become increasingly commercialized, with colleges paying billions of rupees in set up and affiliation costs, which is then recouped by overcharging students and offering inadequate services to patients at on-campus health centers.
Badri Aryal, a Tribhuvan University student representative protesting in support of Dr. KC, says that irregularities and corruption have tainted the medical education sector, and have flourished amid a lack of political leadership.
“In Nepal, for decades, medical education has been only accessible for the rich,” he said, adding, “Establishing medical colleges has become a business no different to poultry farming.”
In a press statement released before the hunger strike was launched, Dr. KC accused the government of reneging on past agreements by moving forward with new affiliations without a national framework to ensure a uniform standard of education, as promised by the prime minister in early 2014.
“The situation has become even more serious after the government has taken dangerous steps that will have serious impacts on medical education and health services,” read the statement.
According to KC, political parties have succumbed to the interests of a powerful medical education lobby.
“Political leaders responsible for writing a new constitution are busy serving the interests of the medical mafia. My hunger strike is against all of them,” KC told journalists on the second day of his fast.
Despite KC’s protest and the broad support it has received, university officials say they will move forward with their plans.
Speaking in the capital last week, Tribhuvan University Rector Guna Nidhi Neupane told reporters that administrators would not halt the affiliation process as a result of KC’s protest, claiming that to do so would be irresponsible.
“We had issued notice about granting affiliation to medical colleges that have infrastructure and meet the criteria. So we cannot backtrack on the decision just because someone is protesting,” he said.
According to Neupane, the Institute of Medicine’s decision to obstruct affiliations would be legally scrutinized, and, if necessary, overruled.
Still, some health professionals have questioned the wisdom of Dr. KC’s protest.
Dr Subhash Lakhe, a public health professional working in the country’s mid-western region, has argued that given the demand for medical education in Nepal, if successful, Dr. KC’s protest would succeed only in driving students overseas. Dr Lakhe further claimed that the focus of KC’s protest is too narrow and fails to address wider problems within the sector.
Similarly, Dr Banshidhar Mishra, a Constituent Assembly member for the Communist Party of Nepal (Unified Marxist Leninist) and project director at Manmohan Memorial Institute of Health Sciences, a private institution currently seeking affiliation with Tribhuvan University, questioned Dr. KC’s integrity and labeled his actions as childish.
“Halting affiliation to four medical colleges, which had received the Letter of Intent from the Ministry of Education two years ago, in the name of new rules and regulations is not fair,” he is reported as saying.
The present turmoil has resulted in political leaders attempting to distance themselves from association with private medical education providers.
Though lawmakers from the ruling coalition partner Communist Party of Nepal (Unified Marxist Leninist) have canvassed within the Constituent Assembly to move forward with affiliations, some party leaders have reiterated their commitment to drafting a medical education policy, and have expressed support for Dr. KC’s protest.
Maoist parties, both within and outside of the Constituent Assembly, have likewise expressed solidarity with Dr. KC, with Baburam Bhattarai, senior leader of the mainstream Unified Communist Party of Nepal (Maoist), expressing regret for failing to deal with the issue adequately during his time in office. The Maoist-led 30-party opposition alliance is also supporting Dr. KC.
Leaders of the Nepali Congress, meanwhile, have visited the protesting doctor, and have publicly expressed flexibility regarding the activist’s demands, while the right-of-center Rastriya Prajatantra Party-Nepal have given their support.
After a period of inactivity, and what many have perceived as indifference, Prime Minister Sushil Koirala, who is from the Nepali Congress, has now sought to solve the crisis, engaging in a series of talks on Monday with professional bodies and industry insiders. A breakthrough is yet to occur, even as Dr. KC’s health deteriorates and he refuses to be transferred to the intensive care unit.
According to Aryal, the current protest is not leveled at any one party, but the general co-option of political leaders by what he calls the vested interests of the medical education industry.
“Whoever the ruling party is, they get involved in corruption,” he said.
Though the Nepali public has been tolerant of the endless delays in constitution drafting, if a political solution regarding the present crisis is not found, and Dr. Govinda KC succumbs to complications as a result of his fast, the government is likely to be held directly culpable.
As one social media user posted Monday, if the government fails to handle the crisis adequately, the public could soon be mourning the government, instead of the doctor.
