PERHAPS there is hardly a person in Kathmandu who at one point has not been a victim of medical malpractice. Consider the case of a 48-year-old working woman in Ratopul. After two days of high fever, her physician prescribed a blood test for typhoid. A day later, the test report, prepared by a pathology lab in Maitidevi, showed that she indeed had typhoid. But she was not convinced. When she retook the same blood test at one of the better known pathology labs in Dillibazaar, there was no evidence of typhoid in her blood sample. Compared to some of the truly horrendous cases of misdiagnosis, the aforementioned lady’s case was pretty pedestrian. As reported in Republica’s weekend edition The Week (Sept. 28), Bichari Rai, 45, a resident of Khotang district, spent half a million rupees in needless tests before landing in Tribhuvan University Teaching Hospital (TUTH), Maharajgunj, where he was told that both his kidneys had been damaged owing to the long delay in diagnosis. It was only then that Rai realized he had been had by all the doctors he had consulted and the pathology laboratories where he had undergone countless tests over many years.
These two cases represent just a tip of the iceberg of the problems that bedevil the country’s medical establishment. A common practice for medical doctors affiliated with government hospitals is to refer their patients to private laboratories even when the hospital labs can carry out the prescribed tests. According to Nepal Medical Council, the government entity to regulate the professional practices of more than 12,000 doctors in Nepal, this constitutes ‘malpractice’. But while NMC can point at a problem, it seems it cannot take any corrective measure. So far, it has failed to act on any of the complaints against practicing doctors. As a result, cases of misdiagnosis, often buttressed by faulty lab reports, has been steadily on the rise. A recent study carried out by Nepal Association for Medical Laboratory Science (NAMLS) on the ‘Status of Private Clinical Laboratory Medicine Service in and around Kathmandu Valley’ showed that 84 percent of pathology labs did not meet the core criteria outlined in national regulation. Another study on the performance of health professionals across 22 districts found that approximately 90 percent of technicians in medical field are unskilled.
Problems with the country’s medical establishment galore. For one, there are no appropriate laws to take action against health institutions working without proper manpower and equipment. The Ministry of Health and Population’s policy to regulate private health institutions and laboratories has been in the works for quiet sometime; no one knows when it will come into effect. Existing measures like the Muluki Ain 2007 and the Consumers Protection Act 1996 provision for steep fines and prison terms for offending healthcare personnel and medical establishments, but these provisions are more noted for their violation than their implementation. Through this thicket of failures, a few clear trends emerge. One, the few legal measures against malpractice and substandard medical services in place are toothless. Two, in Nepal’s health machinery one body does not seem to know what the other is doing. Three, the state has over the year shown a blatant disregard for the health of its people. There is so much amiss. Unless there is genuine political commitment to clean up this muck, with the firm support of the medical community, heartbreaking cases like Bichari Rai’s will continue to emerge with troubling frequency.
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