part 1 of 3: #IamwithDrGKC revives after New Constitution, January 2016


Executive Summary

Start here with a video by Subina Shrestha. It’s titled “Nepal doctors Back Hunger-Striking Colleague”

Doctor Govinda KC is an orthopedic surgeon from Kathmandu who has been a champion of reform for medical education in Nepal.  He is a professor at TU IOM.

Dr KC has made treks to bring medical services to remote areas of Nepal.

Dr KC has made treks to bring medical services to remote areas of Nepal.

He has been willing to dramatize this issue by going on hunger strikes, five times in the past. He’s been able to mobilize medical students at TU IOM. His effort  have led to  investigational journalism to expose the “medical mafia” of Kathmandu, and also led to the government-appointed Mathema Commission” which produced the “Mathema Report” named after the Chairperson.  The journalists have pointed to the involvement of political figures in “buying” the license to run these colleges.

From a previous effort in support of hunger strike of Dr KC. - As of Sept 15th, with all that has happened, it seems so "tame."

From a previous effort in support of hunger strike of Dr KC. – As of Sept 15th, with all that has happened, it seems so “tame.”

Dr GKC’s most recent hunger strike was September 2015, and he suspended it when the government agreed to an eleven-point list of demands.

Here, as reported in the Kathmandu Post, are the eleven points:

The agreement
1)    Form Health Profession Education Commission in the next Cabinet meeting. This Commission will
(a) Formulate Health Profession Policy; (b) Will not renew LoI of Medical Nursing and Dental colleges inside Kathmandu Valley;
(c) Gradually decrease the MBBS seats to 135 then 115 and 100 in next three years; (d) Set Rs 3.5 million fee ceiling for MBBS course; (e) Foreigners should also sit for common entrance examination. For Nepali students they should mandatorily sit for the common entrance before obtaining No Objection Letter and Eligibility Certificate from Ministry of Education and Nepal Medical Council
2)    Form a legal commission to probe abuse of authority in KU and TU
3)    Form a ‘search’ committee without political representation to appoint office bearers in universities and other health councils.
4)    Make the Post-Graduate education free and implement it from this session
5)    Take action against owners of Janaki Medical College and properly manage students
6)    Government medical college should have 50 percent free seats that should be eventually increased up to 75 percent
7)    The government should probe into the extended programme of Dev Daha and Birat Medical College and take action against KU officials.
8)    Halt the process of establishing Medical University
9)    The ratio of government to private medical colleges should be at least at 1:3
10)    Dispatch a letter to KU stating the representation of professors in KU senate.
11)    All the above mentioned agreements will remain accordingly, while the rest will be implemented from the action plan endorsed by the Cabinet from: http://kathmandupost.ekantipur.com/news/2015-09-05/drkc-signs-an-11-point-agreement-with-the-government.html

Response by Private Medical Colleges

In September 2015, there was a surprising twist. Within a day, “The Association of Private Medical and Dental Colleges of Nepal” held a press conference, and presented a five-point plan of their own, saying that many medical colleges in Nepal would go bankrupt if the eleven-point plan was implemented. This has been hinted at in the past,  but now has been stated more forcefully.

infographic of medical education in Nepal 5

Half the population of Nepal lives in Terai. All the medical schools in Terai are non-governmental, i.e., “private” – and I should add, in this region of Nepal there is a higher per centage of Hindi speakers.

The only  list of the five points is in Nepali. Here is a summary from Aug 8th:

Aug 9, 2015-An organisation of private medical colleges has expressed concerns over some of the points in Mathema-committee report, arguing that it would weaken the existing medical colleges and might be detrimental if it is implemented in haste.

The Association of Private Medical and Dental College of Nepal on Saturday asked the government to review the Health Profession Education Policy in such a manner that the ‘fate of private medical colleges are also secured’.

In a statement, association President Dr Bhola Rijal, a senior gynaecologist, has objected to the panel’s recommendations to limit the number of medical seats to 100;  MBBS course fee to Rs3.5million; entrance examination for foreign students and to set minimum requirement of 60 percent in common entrance examination to secure an admission……

–    The Association of Private Medical and Dental College of Nepal demands a policy review to secure ‘fate of private medical colleges’

–    Objects the panel’s recommendations to limit the number of medical seats to 100;  MBBS course fee to Rs3.5million; entrance examination for foreign students and to set minimum requirement of 60 percent in common entrance examination to secure an admission

–    It will automatically put curbs on students going abroad for medical education. From:http://kathmandupost.ekantipur.com/news/2015-08-09/private-med-colleges-call-for-policy-review.html

For me, this caused a re-evaluation. Problems in Kathmandu are one thing. There is a distinctly different set of problems faced by medical schools in the Terai.

infographic of medical education in Nepal 6

From Nepali Times. There twenty one medical colleges in Nepal, one third are in the Kathmandu Valley. This map does not include Karnali Academy of Health Sciences in Jumla.

How can the proposals be decided so as to promote medical education around the entire country? The petrol crisis has highlighted the needs of Terai.

Suspended

All of this was put on hold during the Petrol Crisis. But in January 2016 a bill was put up for discussion in the new Parliament that would authorize “Man Mohan Medical College” in Kathmandu to begin construction of a teaching hospital in Kathmandu. This was exactly against the prior agreement with Dr GKC and his supporters and the Mathema Commission.

Doctor GKC has now met with the Prime Minister, and will begin a new hunger strike in two weeks (January 20th) if progress is not made.

This is the first of a three-part series of diaries. The next part will review the current status medical education, and the third part will address some other concerns specific to the Terai.

About Joe Niemczura, RN, MS

Experienced nursing educator and problem-solver. I have fifteen years of USA nursing faculty background. Add it with fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. I travel outside of Kathmandu Valley as well. When the recent violence happened, I knew the cities - I had trained people in those locations. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011. Global Health Nursing is not all sweetness and light; not solely milk & honey and happy moms and babies.
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