Medical Education Ordinance certified, but continuing vigilance is needed. calling Doctor Narsingha….

narsingha changu narayan

Narsinga dispatching the unkillable demon, ” Hiranyakashyapu” as depicted in a stone carving at Changu Narayan Mandir. Using a median sternotomy incision, of course. What does it take to kill something that won’t die?

According to legend (with help from Wikipedia ), Hiranyakashyapu asked for the following boon from Brahma:

O my lord, O best of the givers of benediction, if you will kindly grant me the benediction I desire, please let me not meet death from any of the living entities created by you.

Grant me that I not die within any residence or outside any residence, during the daytime or at night, nor on the ground or in the sky. Grant me that my death not be brought by any being other than those created by you, nor by any weapon, nor by any human being or animal.

Grant me that I not meet death from any entity, living or nonliving. Grant me, further, that I not be killed by any demigod or demon or by any great snake from the lower planets. Since no one can kill you in the battlefield, you have no competitor. Therefore, grant me the benediction that I too may have no rival. Give me sole lordship over all the living entities and presiding deities, and give me all the glories obtained by that position. Furthermore, give me all the mystic powers attained by long austerities and the practice of yoga, for these cannot be lost at any time.[5]

Doing the right thing

This past week in Nepal politics was suspenseful in it’s own dreary way.  The back-and-forth decisions regarding a proposed additional medical college in Kathmandu were dizzying as described in The Kathmandu Post.

It seemed like Dr. Govinda KC needed to deliver a public tongue-lashing in order to move the process or else begin his fourteenth fast-unto-death; then finally the President of Nepal certified the ordinance governing medical education, placing a moratorium on new medical colleges in Kathmandu for the next ten years.


Um, no. Not exactly. The law promulgated is an ordinance, not a law. It is subject to confirmation when the new parliament is seated after the upcoming election.

The President of Nepal has now certified the Medical Education Ordinance.

from Republica:

….. The ordinance is a milestone in medical education reform, said Dr Singh. “This is one of the greatest achievements for which Dr Govinda KC was fighting since 2012, staging 13 hunger strikes till now,” he added.

The ordinance has provisioned setting up at least one government-run medical college in all seven provinces of the country within five years and places a moratorium on opening new medical colleges in the Kathmandu Valley for the next ten years.
Similarly, it has provisioned a common entrance exam system nationwide for MBBS.

Likewise, specialist doctors should serve for at least two years in remote areas or three years in the accessible areas after their completion of their studies, according to the ordinance.

Also, the government-run medical colleges should allocate 75 percent of the MBBS seats for scholarships. “Another major achievement of the ordinance is that it has provisioned formation of Medical Education Commission, which will monitor all medical colleges, and define criteria and infrastructures to operate medical colleges,” said Dr Singh. “If anyone snatches away the hard-won provisions of the ordinance from people, we will again launch appropriate movement against such move,” he added.

The Underlying Principle

The underlying principle is that medical education in Nepal needs to be supervised by doctors, not politicians, in order to maintain quality and ethical standards. Over the past five years it has seemed as though somebody is building a new medical college in Kathmandu Valley (or trying to) every few months.

If there were no limits, Kathmandu would have about twenty medical colleges, more than Delhi; London; New York; or many entire African countries.

Every young man or woman in the Valley who wanted an MBBS would be able to walk to school like they were in kindergarten.

And of course, such an MBBS degree would be of little value. The prestigious medical journal, Lancet, published an article about the problem in December 2016.

The increase in medical colleges—mostly private and urban-centric—has very little to do with the most remote and inaccessible communities. In a country where 80% of the population lives in villages,1 medical training needs to focus on the rural population. Of the 19 medical colleges in Nepal in 2012, 14 (74%) were private and eight (43%) were in Kathmandu Valley alone, serving only 1·7 million—6% of the total population.1, 6 Of the 11 medical colleges outside the Valley, almost all were based in the cities, largely depriving health care from those living in rural regions of Nepal.6

Doctors Society Of Nepal

The Doctors Society of Nepal organization published this letter:

congrats to gkc

The steps now being taken are logical and sensible but would never have happened without a champion and a movement of supporters.

Back to Vishnu

Vishnu has chosen here to appear in the form of Narasimha in order to be able to kill Hiranyakashipu without violating the boon given by Brahma. Hiranyakashipu cannot be killed by human, deva or animal, but Narasimha is none of these, as he is a form of Vishnu (a deva) incarnate as part human, part animal. He comes upon Hiranyakashipu at twilight (when it is neither day nor night) on the threshold of a courtyard (neither indoors nor out), and puts the demon on his thighs (neither earth nor space). Using his nails (neither animate nor inanimate) as weapons, he disembowels and kills the demon.[12]

It seems to me as though this tale of Narsingha is a parallel to the effort it has taken to set the path of medical education in Nepal on a proper course. Judging by the steps it took to get to this point, there will be future efforts to disregard the ordinance just like there have been efforts to ignore every previous agreement.

Addendum: Dr. GKC has warned the same thing – it’s a temporary victory…

Finally, I don’t usually comment directly on political matters nor do I interpret Hindu beliefs. My main objective for this blog has been to promote widespread adoption of advanced resuscitation principles and training. I encourage those with other viewpoints to comment.


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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