Beyond the constitution hoopla something substantial and of lasting importance is going on behind the curtains in the health and medical education sector in Nepal. A major confrontation between those for and against reform in the field is looming as a deadline nears. That deadline was given to the government by Dr Govinda KC, the crusader against corruption and criminality in the field, for implementation of Mathema Committee report that has some groundbreaking recommendations for reforming the sector.
Among others, the report recommends a stringent guideline for seat allocation and fee structure for medical courses in the country. A college should be allowed to admit no more than 100 students for MBBS and 50 students for BDS with maximum allowable total fees of 3.5 million and 1.8 million rupees respectively. A common and mandatory entrance examination for all Nepali students entering the courses both inside and outside Nepal as well as foreign students trying to enter the same courses in Nepal, with a cutoff mark of 60 percent for eligibility, has been proposed to ensure only qualified students enter the courses. The report also recommends de-affiliation of those colleges which fail to attain a minimum 75 percent points in evaluation yardsticks to be devised by Nepal Medical Council (NMC).
It is thus understandable that the existing medical colleges in the country have objections to these measures. Why indeed should they be forced to limit the number of students to 100 now that they have apparently invested in infrastructures and manpower for 150? Why should the state bother with capping the fees while the country has been following a liberal economic model for more than two decades? Why should it force new provisions, as recommended by a new body, while the existing regulatory bodies like NMC and universities are already doing their job?
As early as 2010, a high-level committee set up by the government in the aftermath of a 19-day strike at Tribhuvan University Teaching Hospital had pointed that the collusion between the regulatory bodies and the owners of private medical colleges had reached an unacceptable level. The colleges which threatened the external examiners with dire consequences if they failed their students were being rewarded with more seats instead of being penalized. The colleges which had practically admitted that they had no capability of running a Post Graduate (PG) course were given permission for PG courses.
The collusion between the two sides was so brazen that, after the number of eligible students seeking admission to those colleges fell below their capacity, a repeat entrance exam with 10 percent lower pass marks was taken. The committee pointed as the culprits those Institute of Medicine (IOM) officials who went as far as publicly shaming one another after there was dispute while distributing bribe money from the students. But they were never punished. Instead, when their regular tenure ended, they were about to be re-appointed for another four years as they had the right political connections and the ability to please every side.
It was in this backdrop of total lawlessness in the field that Dr Govinda KC started his first hunger strike demanding appointment of clean officials in the IOM not based on political affiliation. What was achieved through his four subsequent hunger strikes is something we can all be proud of as Nepali citizens. There is no longer absolute impunity in the field and even the private medical colleges have been forced to welcome, albeit with reservations, most provisions of Mathema report.
What kind of medical education did we have when the for-profit medical colleges called the shots regarding its quality, not the regulatory bodies? Does the availability of rich parents ready to invest any amount to make their children doctors of questionable quality mean that we actually have to let them do that? That may make sense in strictly economic terms in a liberal economy, but is the resulting hazard to public health acceptable?
The colleges that now claim to be equipped to teach 150 students in a batch take theory classes for all of them in a single classroom and hands-on training at bedside is woefully inadequate. Dozens of students are often allotted a single patient and a number of departments have only incompetent or dummy teachers. An MBBS doctor is licensed to do a post-mortem examination but none of the private medical colleges trains them for it. Private hospitals are not legally allowed to conduct those tests and the colleges are unwilling to make an arrangement to send students to nearby government hospitals.
The situation of PG training is worse than even what a pessimist can imagine: Even the departments without a single competent faculty are taking PG residents with an intention to 'abuse' them as two in one: teachers for UG programs and cheap substitutes for PG-holding specialist doctors for patient care.
Now that even the idea of NMC and university doing their job honestly seems laughable, there is no alternative to a shock measure like recommendations of Mathema report if we are to contain the damage to public health resulting from the criminal neglect of both the regulatory bodies in past two decades.
If indeed the private medical colleges keep meddling in this long overdue process of rectifying past mistakes, they will be the biggest losers. After all, how long will the students and parents keep being misled or duped into purchasing degrees of questionable quality paying a hefty sum? The number of unemployed and semi-unemployed doctors is already swelling and without radical measures, the whole system is sure to crash. The most they can now do—with the help of sympathetic (and corrupt) politicians—is to postpone that crash. But the latter the crash happens, the more painful it will be for them and other stakeholders including students and parents.
So, the moment of reckoning has arrived. Let all of us admit the follies of the past, from greedy officials at regulatory bodies to the colleges out to make quick bucks by compromising quality, from parents hurrying to make their children doctors to the students duped by photo-shopped advertisements of the colleges. They should feel lucky that a crusader named Dr KC and the Mathema report—which was the outcome of Dr KC's struggle—promise to make the crash more ordered, manageable and less painful. Indeed the only win-win solution for everyone is the unconditional and total implementation of Mathema Report. If the government does not do so, it will be forced into it once again by Dr KC when he sits for his next hunger strike.
The author is a medical practitioner and afreelance writer
Twitter: @jkshetry
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