Sept 31st: The NMA hospital protest fizzles out


The hospital protest is over, and the question is whether it made any difference.

Here is the press release in Nepali from Nepal Medical Association.

deal inked

I sent out a general query as to whether it was a successful protest or not. I got one particular answer I will share. It is noteworthy because the author gave a direct opinion, something very few Nepali persons will do. I have removed the name because I am not sure he wanted to become famous.

Obviously, it has been a political agenda behind the scene. Hence, it (the agreement to end protest) is not a good thing.
Demands of the majority of the doctors across the country were:


1. Jail without bail for any abuse to the health workers on duty. (Not implemented)


2. Apologize in public by the government about what they had presented at a press conference before (doctors should be liable for compensation for any death during the treatment) (Not done)


3. Determine salary of doctors scientifically (Not done) (It costs almost 5 million Nepali currency as tuition fees for Medical graduation but the current salary of a medical graduate is 30 to 35K)


4. Relaxation of retirement age of government doctor to 65 years (now it is 60 for all govt employee; some exceptions apply) and Removal of 5% health service tax was not a demand at all but NMA was focused on these two demands only. They are not going to help any doctors. This demand is focused on particular people and private hospitals

Now, what next?
Almost all the doctors who do not benefit from point 4 above are furious with NMA. some are in the opinion of establishing a parallel organization. But, one thing we doctors do not have is unity, so it will not be easy to start a fresh movement immediately.

What do i think?
Continue your days as they were before. Be careful in selecting cases. Try not to get involved in high-risk cases. I urge all the youngsters to be a member of NMA. The election will be at 3 years from now. Select a team of youngsters. Then plan ahead.

I’m writing this from USA, not Nepal, and my reading ability in Nepali is poor. But I have followed the main issue, violence against health care workers in Nepal, closely for about ten years. This has been a problem for a long time, usually swept under the rug. This past year there seem to have been more media reports of inadvertent deaths in hospitals, sensational at times. It’s an election year (there haven’t been too many elections after all) and politicians are scrambling to respond to the media reports. The media reports are generally not complete or balanced or well-researched.

Specific background to the above

If you are not familiar with the points above, let’s go point-by-point and clarify.

1. “jail without bail” is a proposal based on a law passed in 2014 in Queensland, Australia.  During the Nepal protest, an internet meme made the rounds:

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2. The proposal made by the cabinet which prompted the immediate protest was one in which the responsibility for patient deaths would be more clearly shifted onto the backs of the doctor(s) involved. It has yet to be put into effect, but it has not been withdrawn either. This is an ongoing issue. In my own opinion, there is need to upgrade systems of responding to emergencies, but there is also clearly a situation in which the victim or family are often portrayed as blameless in the events leading up to a death when in fact they hold some responsibility. When the political parties get involved in negotiating on the family’s behalf, it takes on the aspect of extortion.

Charikot

Here is the infamous video from the Charikot incident a year back, in which doctors were paraded in front of a crowd:

Note how young they are. And yet, they were running the place.

Another from Charikot:

This one above, gives you the idea of how volatile the protests and threats can be. A crowd has gathered and they are angry. I’m not joking when I say that this is a threat and things can get out of hand.

Another showing the crowd at Om getting whooped up, with riot police present:

What would they be doing if the police were not present? and yet, in most regions of Nepal, the police are not quick to arrive on the scene.

Here is another  example of media coverage in Nepal:

The above deals with the death of a patient at Om Hospital. Let me emphasize that I personally have no any kind of inside knowledge of these specific incidents and my heart goes out the survivors. But I have in fact interviewed and worked with nurses and doctors when many other similar incidents have occurred. I firmly believe that this kind of publicity is not helping the goal to improve medical care. The doctors run away from emergencies when the family might act this way, when they ought to be running toward the emergency.

There is a definite need for more factfinding and an orderly process when an inadvertent death occurs.

3. “determine salary of medical doctors.” This needs more explanation especially for a USA audience. In Nepal they use the MBBS system. A MBBS graduate is a “doctor” after completing a Bachelor’s Degree, and they become a “Medical Officer” after completing a one-year internship. During their time as a Medical Officer there is no system to determine salary, with the result that many work three different jobs for low pay. They are continually scrounging for clinical work and under pressure to pay off medical college loans. This is one of the reasons so many wish to go to USA or UK.  In addition, the young MBBS doctor often gets very little continuing education and is trapped into the role of  indentured servitude, because they would need a new round of loans to enroll in the “M.D.” (i.e, master’s degree) level and finally become independent. The government sets the tuition for such graduate education but there are plenty of rumors that kickbacks are required outside the regular fee.  I eould be remiss if I did not mention the work being done by Dr, Govinda KC to keep a spotlight on the need for reform of tuition at medical colleges. For that matter, there is an active effort to prevent politicians from authorizing a zillion more medical colleges in Nepal. This too, is an important quality measure.

4.  retirement age of government doctors.  Not an issue I personally am familiar with. Somehow this got settled when the other stated goals did not resolve. Exactly how many such persons did this affect? hmmm…….

My own recommendations for future activity

  1. BLS, ACLS, PALS, etc need to be mandatory for all MBBS graduates during internship.

The CCNEPal project was started in an effort to improve the level of emergency care and critical care in Nepal.  CCNEPal got involved in teaching about situational awareness because the fear of thrashing has always been part of the reason why emergency care is a problem. We need to continue to elevate the standards of training in emergency care procedures. The young MBBS doctors throughout Nepal are the frontline of emergency care and courses like ACLS, PALS, ATLS etc need to be mandatory for all MBBS graduates. Until now, these have been limited to only those doctors going for the Master’s degree.

2. These same courses need to be required for all MBBS graduates from China, India, Bangladesh etc

There is a significant number of MBBS graduates from non-Nepali programs working in rural areas where the care is needed most. They too need this skills even though they may not have done an internship in Nepal.

3. Nurses need this training, and it should be required for all nurses in emergency room or ICU.

4. better training and organization of ghar dai and police is also needed.

I could add a few more, and I invite you to browse previous blogs on this subject.

 

 

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About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it 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. 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.
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5 Responses to Sept 31st: The NMA hospital protest fizzles out

  1. Anup says:

    Nicely written, Joe.

  2. Saroj says:

    For MBBS… ur parents need to pay here in Nepal. No loan available that can be paid after graduation. So MBBS is mostly for really rich people or those who agree to sell ancesteral property (land most often).
    A few meritous student get government scholarship (~10-15% of total seat).

    After graduation, the payment is too low. Again not a problem for rich kids.

  3. Reublica took note of the reaction of doctors. here is their link: http://www.myrepublica.com/news/28466/

  4. Pingback: Partial review of media reports of “thrashing” of doctors in Nepal and India. Please send more links | CCNEPal 2017

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