Nepali Times Asian Paints
State Of The State
A nation in hard labour


The day Siamese twins Ganga and Jamuna arrived as two independent babies in Kathmandu, one in every ten children born in their homeland died before completing their first birthday. It may look inopportune to talk about this silent catastrophe amidst the celebration of a glorious medical achievement but it is in times of joy that we must not forget the sorrows of the less fortunate.

The maternal mortality rate in Nepal is also one of the highest in the world. More than one quarter (27 percent) of all deaths of women between the ages of 15 and 45 are the result of childbirth complications. In most families, pregnancy is managed according to practices passed down from generation to generation. Almost all deliveries in rural areas are attended by sudenis in the hills and chamains in the tarai-women who have learnt their craft of midwifery by apprenticeship, and have no knowledge of modern medicine or tools. The use of rusted razorblades to cut umbilical cords, and the application of cow-dung to treat birth-wounds are not uncommon.

But between the bleak picture of utter neglect in the hinterland and national attention given to the extraordinary in the metropolis, there is an expanding middle ground where the definition of \'minimum level of service' is slowly changing. Sutkeri Samagri (a packet of bare necessities to help sudenis do their job) and training of women paramedics at the village level are slowly improving the services available to the newborn and mothers alike. While it is true that most health posts in the country lack enough trained personnel and essential supplies, their role in delivering basic health care cannot be denied.

Then there are medical practitioners in urban areas who render valuable service, even though only to those who can afford their fees. It limits the reach of some outstanding physicians, but that still doesn't reduce the importance of their services. After all, every one life saved, or every moment of agony reduced, is an important service. Each human being is unique and deserves the best treatment. This justifies the tortuous hours of surgery by an international team of doctors in Singapore on Ganga-Jamuna, and the generous donations made by the citizens of that affluent city-state.

As long as specialised medical services aren't being provided at the cost of general health care for every one, public investment in advanced medical facilities need not be questioned. It is a grim reality of this country that a poor sudeni in Achham or an illiterate chamain in Mushaharniya cannot even buy a subsidised packet of Sutkeri Samagri, either because she is unaware of it or because it isn't available there at all. Even so, this does not mean that famous gynaecologists like Dr Jun Thapa and Dr Supatra Koirala should stop examining expecting mothers in Kathmandu, and fly away to some faraway land where they can practice their profession with a clear conscience.

But what is it that makes people like Dr Thapa and Dr Koirala get up in the morning and face another gruelling day, often full of frustrations? Money can't be their sole motivation, because they can make more of it almost anywhere else. Serving society is a high-sounding motive, but such altruism falls flat in front of the compelling argument that when you cannot provide clean water to drink, a caesarean surgery is no social service. If their urge was professional excellence, they could have chosen the company of equally competent professionals at state-of-the-art facilities in more developed countries. There must be something more, something personal, that motivates them to do what they do day after day, against seemingly insurmountable odds. Supatra once revealed her fount of inspiration quite unintentionally about nine years ago.

In those days, Om Nursing Home was a modest establishment, quite unlike the huge private hospital that it has grown into today. Supatra's consultations were often more like counselling sessions for nervous couples. Sometimes she would call expecting mothers and their husbands together and talk calmly about the challenges of parenthood. Sadly, all that is history now. These days, she rushes from one patient on the examination table, another standing on the weighing machine, one more in a chair, and manages to ward off repeated calls for her presence in the ward. She doesn't even have the time to look at the faces of those who come to her more for reassurance than anything else. Supatra hasn't changed, it's just that now she has become a victim of her own professionalism. But that is a different story.

On one of those earlier leisurely days, she once cared to ask a would-be father: what would he like his son or daughter to be. The man pretended to be witty and intoned in mock-seriousness, if it's a son, he would want him to be a BP, and if it were a daughter he would want her to be another Supatra. Between the moment the sentence was uttered and when Supatra gathered her composure, a world of emotions passed through her face. "Don't ever wish BP's fate on any one, much less on an unborn," she said slowly, her
eyes welling up. "Nobody deserves to endure the pain BP went through."

Whenever I think of Dr Supatra Koirala, these are the first two sentences that come to my mind. In the economy of those few words lie hidden the sum of the physical pain, emotional turmoil, intellectual hunger, political frustrations and social rejection that BP Koirala went through in the last years of his life. Like others born never to die, BP lived through all that, but never budged from his ideals.

Dr Shashank Koirala is an erudite eye specialist, he talks loftily about Koirala legacy, and likes to quote Kant to clarify a complex theory of vision. Supatra may be his wife, but she has no such pretensions. Instead, she is much more compelling with her natural simplicity, sincere smile, and earthy wisdom. In the labour-room of Om, attendants aver that Supatra knows best how to make babies cry as they enter the world. Her touch makes the little ones rend the room with the music of a new human life. What her colleagues probably don't know is that she is equally capable of making grown men cry too.

Koiralas are something akin to royal commoners in Nepal, much like the political dynasty of the Nehru-Gandhis in India. Supatra could have easily chosen to bask in the glory of her surname alone, particularly after 1990. Or she could have gone into social service mode. Instead, she chose to remain what she trained to be-a consulting gynaecologist for the urban middle class. There is only one lament however: her dedication has bred a popularity that has turned a counsellor of human souls into just another famous physician with a high market value. Wonder if BP would have approved. Or, whether Supatra still remembers what she told a would-be father about her illustrious father-in-law.

(11 JAN 2013 - 17 JAN 2013)