Nepali Times
Guest Column
Diagnosing Nepal


I have been coming to Nepal annually for the last decade in an attempt to improve surgical services in remote district hospitals. This gives me snapshots to make comparisons and the most significant one last month was the construction boom in Kathmandu.

As a medical doctor and a student of population health, I am amazed at how many under-employed doctors there are in Kathmandu, as well as how many brand-new under-utilised disease palaces there are that together tempt the well to become sick. Medical schools and various colleges of so-called health sciences abound to produce even more resources to treat the worried well.

There are few practitioners in Nepal who minister to the sick, but instead there are surgeons who cut, physicians who diagnose, endoscopists who look around, urologists who probe and neurosurgeons who suck out brain jelly. The construction boom in hospitals, nursing homes and research centres ensures that medical harm will become a leading cause of death in Nepal, as is the case in developed countries.

The most troubling discovery is how little discussion there is about the conflict here, or any consideration of what to do about it. I found lots of published works on the Maoist conflict, especially documenting its history. Even Baburam Bhattarai's PhD thesis is available. But there is precious little on potential solutions.

Yes, everyone wants peace. But how are we going to get there? No one even has a clue about how to start. Many see the need for a republic, which locally means Nepal no longer having a monarchy, and having some semblance of democracy. Others want a benevolent despot to rule them. Some fear the army is in control of the non-Maoist part of the country.

There are signs and stickers advocating peace. Maybe they want the exploitation that existed before the troubles began to continue peacefully. If you don't know where your ship is going then any port you end up in is fine. Only the students are marching, but they have no answers either. They just want change. Politics here is almost a dirty word, suggesting only partisan discussions.

Nepal's burgeoning media are weapons of mass distraction, as they cater to prurient youth in a society that is considerably more salacious than a decade ago. Bent on creating a consumer society, with a service-oriented culture, the media offer no choices for a healthy society.

So what kinds of solutions might be considered? To begin with, the massive concentration of royal wealth is not conducive to justice. When three of the most luxurious cars in the world are purchased with public funds, what kind of message does that send to Nepalis?

Then perhaps an emergency needs to be declared to provide basic needs as enunciated by King Birendra decades ago. The focus of such programs have to be in Mugu, Bajura and Kalikot, the three least-healthy districts. The average length of life in Kathmandu is 30 years more than in remote Mugu.

Nepal can take cues from Kerala state in India or Sri Lanka and pursue an social-welfare led development program. Those have been incredibly successful in producing a healthy society, despite a protracted civil war in Sri Lanka. Both countries have a health status close to America's.

Discussions on peace must begin with vibrant discussion of the primordial problem: increasing relative poverty, the astronomical gap between rich and poor and what to do about that. Nepal had peace from 1951 to 1996, but that wasn't enough. The guiding principle, should be John Rawl's Theory of Justice in which inequalities are limited to those which benefit the least advantaged. Begin by canceling the royal order for Rolls Royces and Jaguars.

Stephen Bezruchka worked in Nepal between 1976 and 1986. He is now senior lecturer in the International Health Program of the School of Public Health and Community Medicine at the University of Washington in Seattle.

(11 JAN 2013 - 17 JAN 2013)