Politics Of Medical Education
Dr. Narad Bharadwaj
The negotiation with Dr. Govinda KC for ending his prolonged hunger strike appears to have hit a yet another snag after raising some expectations that it is closing in towards a positive conclusion. What is disconcerting about the whole thing is that the anguish and agony of the orthopaedic surgeon is being capitalised by the opposition politicians for the deification of Dr. KC and disparagement of the sovereign parliament. In this situation, the agreement, even if it does take place, is going to be no more than a pleasure in self-affliction.
In democracy, Satyagraha has been accepted as a tool of resistance against oppression. It is one of the forms of peaceful movement which has been adopted in various countries where authoritarian regimes suppress people’s legitimate aspirations for reform and change. Ironically, however, there are instances in which democratic norms are often misused to hamstring democratic institutions by unscrupulous people by misusing the influence of some popular personalities.
There is no proof that KP Oli-led government is against reform in the medical education and health services in the country. This government has been in power for a little more than five months and commands a sweeping mandate of the two-thirds majority. In the entire history of democratic transition, this is the government which is best placed for initiating deep going reform measures in entire gamut of socio-economic fields including medicine.
The hunger strike of Dr. KC is a very sensitive issue and a large majority of people have empathised with his cause. But the way he is being cashed to inflame the situation appears that his strike is being used not to dismantle the authoritarian regime but to hinder the march of the elected democratic government towards modernisation, stability and prosperity.
Dr. KC has raised serious question of reform in medical education in Nepal. His concern for growing anarchy in this field and declining quality in medical education reflects common anxiety of the Nepali society. Despite this, the onus of responsibility for bringing medical education back to the track is not on an individual. It is an institution of government which should do it. This issue is under consideration of sovereign parliament which is the only legitimate authority to effect any changes in the policies and acts on which the reform has to be introduced. If an institution makes erroneous decision, discerning individuals can point out where it has gone wrong. But the responsibility of correction of erroneous decision does not lie on an individual even if institutions take time to realise the mistake and initiate rectification.
Today, a section of intellectuals and some fringe parties are depicting Dr. KC as a crusader for reform in medical education in Nepal and are inciting people. It has encouraged mobocracy and street passion is being used to subvert democratic institutions and hold even the sovereignty of the parliament at ridicule. In a democratic country, all the aspirations and convictions of an individual are subject to collective judgement of the people and these judgements emanate from the constitutional principles, legal norms and universal conventions.
By undertaking repeated hunger strikes, Dr. KC has not only evinced his attention seeking and egoistic attitude, he has also distorted the hallowed tradition of peaceful articulation of dissent against the suppression of democratic rights of the people. At the same time, he appears inclined to an exaggerated projection of his own role as a saviour. To try to override the privilege of the sovereign parliament by adamantly sticking to an extreme measure of hunger strike is to try to institutionalise dictatorial culture in the name of seeking justice for a perceived prejudice and the violation of democratic rights.
Another point of objection about Dr. KC’s penchant for a repeated hunger strike is that he appears to have taken hunger strike as a panacea for all ills. In a democratic country, there are certain democratic norms to express dissent and channelise opposition. However, if an individual resorts to measures like hunger strike to get his views prevail against certain policy decisions of a duly elected government; it will weaken democratic institutions promoting a culture of a personality cult.
Dr. KC has started hunger strike purportedly to maintain the quality of medical education. There is no second opinion about the need of quality in that branch of study. However, if the proposed medical colleges which have met all the infrastructural requirements for opening and operation, they cannot be denied of their right because of the adamance of an individual.
The issue of the quality of education in general and medical education in particular is the concern of all the people. There is no differing opinion about the need of reforming medical education and health service in Nepal. It is known to all that quality medical service is becoming inaccessible for the common people and medical education is exorbitantly expensive for the deserving and diligent students. The inequality that exists in the access to medical service in Nepal is appalling. Those in power and possess wealth go abroad for the treatment of even minor health conditions. But the poor people find it difficult to get medical treatment even in the government hospitals which are at a shabby and derelict condition.
The saga of the indifference of the concerned authorities towards provincial or district hospital is all the more appalling. The district hospitals which are considered vital nodes of essential public health services are in a pathetic state. They are either sorely understaffed or lack even the basic infrastructures, and medicines needed for basic health care to the people. In such situation it would be more constructive on the part of the striking orthopaedic surgeon to pay attention to the upgradation these hospitals instead of putting so much effort on preventing new hospitals from opening.
Dr. KC travelled all the way to Jumla to start his hunger strike. But why did he not demand the up gradation of the medical services for the people living in the remote Karnali region? Now even the government has realised that the trend of opening medical colleges without proper infrastructures, that too only in the capital cities, is not going to be helpful for improving the quality of medical services. The academics of the medical discipline should instead work to help the government in formulating proper policies.
Dr. KC has completed 27th day of his hunger strike on Thursday to press for his demand for stricter regulation on the opening and running of medical colleges. Naturally, he has mustered sympathy of a sizable population of the country including this scribe. However, the striking doctor should think that preventing a couple of medical colleges, which have met requirement for necessary infrastructures, from running at the cost of losing sight on the need of addressing host of other anomalies besetting existing medical facilities will not help bring about a drastic reform in medical education and health services in Nepal.