A paranoid schizophrenic man opened a fire in a public
gathering of US congresswoman Gabrielle Giffords in Arizona in 2011. Six
persons died, several were injured. Ms. Giffords was shot in the head;
the bullet passed through her brain. She received immediate medical care and
was operated emergently. She has made a remarkable functional recovery.
Dr. Peter Rhee, a trauma neurosurgeon who operated on Ms.
Giffords took up the stage daily to update the press and the nation about her
progress. However, he was an unconventional (almost exotic) character on the
television news screen. Some people found his character to be even abrasive.
Bottom line: this was a character not polished with the etiquettes of public
speaking. He knew his trade; he had outcomes to support that but not the
finesse of television talks.
We are also seeing our Nepali doctors on television screen
on an almost regular basis now. There is a distinct difference of our doctors
from Dr. Rhee. Their conversations on television screen are impeccable. They
speak in language totally indistinguishable from that of our politicians or bureaucrats.
There is a certain ease, smoothness and a natural flow. It is impressive!
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As a 16-year-old boy, when I first read “Satyagraha in South
Africa” by Gandhi, a knot formed inside my throat, my stomach churned, and tears
poured out ceaselessly from my eyes at some point in the book. A burly pathan
had thrashed Gandhi, bloodying him, because he had made a compromise with the
rulers. A heartbreaking agony seeped inside me upon learning this harmless
creature being beaten senselessly. I wanted to rather receive the beating, if I
could, to spare this saintly man.
Perhaps that was the power of Gandhi’s personal character
that formed the foundation of his non-violent movement. People felt Gandhi’s
pain as their own. The sheer passion evolved into a massive movement with means
revolving around self-sacrifice. Indians succeeded in ending the imperial
British rule.
Lately, we have seen revival of similar means in our region.
In India, a saintly man named Anna Hazare challenged the central government to
address corruption and a new party called Aam Admi Party (AAP) blessed by Mr.
Hazare came into power in Delhi. In Nepal, an orthopedic surgeon Dr. Govinda KC
has been using hunger strike to address political issues plaguing his
institution- Institute of Medicine (IOM). AAP is aiming to change Delhi government so
that it serves the people. Dr. KC is aiming to change IOM so that it is a
better institution. These movements gathered steam based on distinctive
personal characters of their leaders, especially their demonstrated track
record of self-sacrifice. Their personal characters have touched the chords of
people’s heart. Perhaps similar to how Gandhi’s character had. However, I feel,
there is a distinct difference in the struggles that Gandhi pursued and what
these folks are pursuing. Gandhi’s was of justice, theirs is of building
institutions. So we should ask: Is it likely to succeed?
AAP’s ascendency to the throne of Delhi government was
dramatic and filled with drumbeats of radical change. But looking from surface
now, their activity has turned into a circus. We have no idea if the end result is going to
make any difference in peoples’ lives the aspirations of which had buoyed AAP to the power. I have no in depth knowledge of Indian
politics and I would like to leave it there. But I would like dwell a little
bit more on Dr. KC.
Dr. KC is known to have a distinct personal character. He is
single. He lives a very simple life sustained by sole salary from IOM. He abhors private practice and earning extra money. He
spends long hours in patient care. He travels to remote areas of Nepal on his
own to care for sick people. He even travels overseas in disaster struck areas
to offer services for free. This compelling personality seems to have touched
the hearts of people. When he staged hunger strike recently, the passion people
had for him was apparent. The doctors closed outpatient services in majority of
the public hospitals throughout the country, there were parallel hunger strikes
in solidarity with Dr. KC, there were mass resignations from doctors, news
channels had the hunger strike as top story for several days and the government
heads had to scramble to address the demands this doctor had placed. After 14
days, the hunger strike ended with an agreement. It has been a few weeks since
that agreement. Now, Dr. KC is back to hunger strike because the government has
not implemented the agreement.
At the crux of Dr. KC’s struggle is the intent to have IOM
as an autonomous institution protected from the savagery of political beasts
that have incinerated a possibility of a decent society; although the language
of his demands also includes many other issues pertaining to the overall health
care of the country. If the media
reports are true, the extent of shameless savagery politicians, corrupt bureaucrats in government and officials at Tribhuvan University have exhibited in
pursuing their interests is extraordinarily disgusting. In that light Dr. KC’s
noble struggle is truly very welcome. And his means of using his moral
connection with other people brought together by the influence of his
extraordinary personal characteristic is praise worthy. However, before we get
swept away with this inspiring movement, it is important that we ask if it is
likely to achieve the end results.
What are those end results?
Based on the demands set by Dr. KC, it seems to be
achievement of autonomy of IOM, barring permit to open up new medical schools
(where there is allegedly a huge bribery going on under the table to get
approvals) and holding corrupt people in the system accountable. These are
clear demands that are possibly achievable by the means Dr. KC is using.
However, it would be a mistake to pin too much hope on the
dream of having a better IOM or national health care and health education system even if these demands were fulfilled. The real end
results that the public institutions have to deliver is: accessible, quality
health care and manpower trained to deliver such health care in responsible
manner to dignified citizens.
I am afraid, the top-down
structural change that Dr. KC is striving to bring about has to be met with
bottom-up institutional changes to succeed in achieving the ultimate goal. And,
I am afraid, his struggle hardly acknowledges that component. The political
component can rile up passions because it is so dramatic. But the mundane
day-to-day functioning of patient care where every patient interaction is
weighed in terms of fairness, justice, appropriateness, quality and dignity is
too banal, and too tying down. Holding everyone in the system accountable to
high standards of ethics and integrity in patient care is too tedious. Our
public institutions have considered those aspects dispensable. This was all too
apparent in Dr. KC’s 14-day hunger strike. Outpatient clinics were closed,
patients admitted to the hospital for surgery were discharged. The doctors
conducted clinics in open tents in some public grounds. It was a mockery to the
plight and dignity of sick individuals. They deprived sick patients of care or
threw them out of their care and to top it off rounded up a drama under the
tents. These doctors’ insensitivity to patients needs demonstrated during these
protests speaks of a larger problem in everyday functioning of these
institutions. That is how they are used to treating patients, that is how these
institutions have allowed them to treat patients and it’s just natural for them
to behave so. That is the component Dr. KC’s struggle will not address. And Dr.
KC’s political achievement will be meaningless without the corresponding
changes in the intrainstitutional behavior.
The same forces that are abusing the system now will find ways to
corrupt the system in the new setup unless the institution has that corresponding
bottom-up changes. It will just force them to use newer tactics. Dr. KC will have to continue his hunger strike
forever. Would it be more fruitful if the man of such integrity use more
creative ways to build institutions that would care for patients than doggedly
swim against the tide that will only be changed by collective transformation of
this society at peoples’ level and perhaps at intra-institutional level?
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Being a doctor is a political job (Virchow would convince
you on this). We want our doctors to be political. But there is succinct
distinction we have to make. Using prevailing political language is not equal
to the political cause that the doctors should pursue. Our political language
concerns the interests of our patients that are connected to the larger
society. This language has connection to issues like justice to our patients,
fairness, ensured access to health care, dignity, and quality of care. The
further our conversations go from these, we have to ask ourselves: are we
embarking on a different turf? That turf might still be extremely valuable. But
we have to get out of the illusion that it is the only thing holding up from
building our institutions.
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