Kedar Bhakta Mathema was head of High Level Committee on Medical Education set up to suggest reforms in medical education. The committee submitted its final report to the government back in August, 2015. The report remains largely unimplemented. The government of KP Oli, if anything, seems intent on subverting the report as it prepares to grant teaching license to Kathmandu-based Manmohan Medical College.
Related story
Nobel-worthy
Dr Govinda KC, meanwhile, has threatened to start yet another fast-unto-death starting against the government decision on Manmohan college. Why is the government ignoring the Mathema report? What happens if Dr KC stages another hunger strike? Biswas Baral, Mahabir Paudyal and Deepak Dahal had caught up with Mathema at his Sanepa residence Wednesday afternoon.
Why is the Oli government ignoring your report like it doesn't even exist?This troubles me as well. The thrust of our report is that quality of medical education should be enhanced and it should be pro-people. Acting on our recommendation will affect various interest groups. The government wants to please them and so it does not implement the report. Meaningful reform calls for strong political will and commitment. This government has neither. Nor does it seem interested in serving the people. And the concept of conflict of interest seems alien to our lawmakers. I sometimes wonder whether I should call them lawmakers or businessmen. The government is powerless before these interest groups.
Do you think there is political support for the kind of reforms in medical education that you propose?
Politicians agreed to reforms in medical education due to the pressure from Dr Govinda KC. We need reforms not only in medical education but in the fields of engineering, management and all higher education bodies. We prepared this report on the recommendation of the government after six months of detailed studies and field visits. But a report prepared so painstakingly and with the expenditure of government money is now being conveniently ignored. In the last six months, policymakers should have passed an Act and constituted a (Medical Education) Commission by now. But nothing has happened. Now instead of implementing the report, the government is trying to grant affiliation to one college through the backdoor.
The government has been saying that it's ready to implement your report if you make exception for one medical college.
A doctor advises his patient to abstain from drinking. But the patient says 'sorry doctor, I have been gifted a Scotch by a friend. Let me drink it first and then I will abstain.' Likewise, the government seems to be saying that we should let it grant affiliation to one medical college and then the Mathema report could be gradually implemented. This is cheating. If they are not happy with our recommendations, why not refute our points with logic? If not, they must implement it.
Private medical college operators argue that if all your recommendations are implanted, they might as well shut shop.
Medical establishments in our country are concentrated only in one region. There is one medical college or hospital for every 800,000 people in central region. In Mid-western region, there is one for 3,600,000 people; and there is none for more than 2,500,000 people of the Far-west. Our other concern is that medical education has been commercialized. There are so many colleges that government is not able to properly regulate and monitor them. Medical education is nothing like Baba Ram Dev giving yoga lessons. Medical education is based on clinical observation and first-hand experience. You need actual patients to practice.
A chairperson of a nursing college was recently telling me that there is as much as 60 to 70 percent knowledge gap between students of private and public nursing colleges, largely because of the paucity of patients in private colleges. There are many medical colleges with no patients, and nearly not enough teachers. This means students will lack clinical experience during learning. This is the reason we recommended limiting class size. As far as our proposed fee ceiling of Rs 3.5 million for MBBS is concerned, it was set with the help of Nepali medical students who have studied in prestigious universities in the West.
But however the fee was set, what if it really is too low for sustainability of medical colleges?
Medical college operators are against our fee ceiling because they are looking to recover their investment in one or two years, instead of 10 or 20 years. Moreover, medical education should not be solely guided by profit motive. But if you read our report carefully, you will find that we have made enough leeway for these private medical colleges to survive. What we are saying is that even if you need to increase fees, you should follow certain standards. The medical colleges cannot do it arbitrarily.
So nothing has been done to implement your report in the past six months?
The government had formed a committee under Yagya Bahadur Karki to study the report and suggest a way forward. The committee came up with a plan that completely ignored the main points of our report. For example we had recommended formation of a Health Profession Education Commission as an overarching body to take care of medical college accreditation, quality assurance and entrance examination. But the government instead formed the committee, which is now defunct. So they wasted six months doing nothing.
How do you view this endless dillydallying?
The government clearly doesn't want to alienate some of its friends. Many politicians and even private sector professionals back our recommendations. In private conversation youth leaders tell me that our recommendations are the best and that they must be implemented. Even private college operators say they have no issues with the Mathema report, except for its recommendation on fee ceiling. The way I see it, some policies may serve the interests of the government and other stakeholders but not necessarily the interest of the people. In such a case, the leadership should dare to side with the people.
Will it be right to say that your recommendations have not been followed because they are drastic?
Not really. We have categorized reforms into three groups, ones to be implemented right away, ones that can be done in mid-term and others that can be implemented on long-term basis. So you don't need to do everything all at once. Besides, there can be no justification for opening new medical colleges in areas that are already saturated with them. Even the existing ones need to be merged, as they are doing in the case of banks these days. Again, like I said, our report is not rigid.
How do you see the proposal in the parliament for the accreditation of Manmohan Medical College?
First we have to be clear if it's a profit-making institution. If it is, how can the parliament draft an act for a profit-making institution? If you grant affiliation to one college through the backdoor now, another government tomorrow will also look to do the same. This will set a wrong precedent.
Dr Govinda KC is all set to resume his fast-unto-death. How do you view his fight against the state?
Dr KC has been fighting against a seemingly invincible nexus single-handedly. The question is how long can he hold on, against considerable odds. I sometimes wonder if the country is going to be run like this for the rest of our lives. How many times does a noble soul like Dr KC have to put his life on the line? This is too much.
Why did we fight against the Panchayat rule? We had hoped that the rule of a handful of elites would end and people would be their own masters. We hoped there would be law and order and government would be accountable to the people. It is for this that we fought for democracy and republic. But the situation today is worse than even during the days of the Panchayat.
Time has come to change the modality of the crusade for health reforms. Dr KC has high moral integrity and huge support. But how long can he hold on? Now the civil society should stand for his cause. It is not right to leave Dr KC to fight alone for this worthy cause. I believe the civil society will rise up this time. A number of people call me to express their support for our recommendations. The public is aware of how the government is fooling Dr KC. They will stand up for him.
