30 Sep - 6 Oct 2016 #828

Unhealthy politics

Govinda KC is once more using hunger to strike at the heart of the mafia that runs this country’s medical industrial complex.

Devaki Bista

Dasain is a time to eat, drink and be merry with family. But there is one person who is not eating and drinking in the coming weeks — Govinda KC, Nepal’s crusading physician who is using hunger to strike at the heart of the mafia that runs this country’s medical industrial complex. His only family are his patients. Even in the tiny room at the Teaching Hospital where he is fasting, the orthopaedic surgeon was examining patients peering at x-rays of children with broken bones. 

There are those who ridicule KC for being a ‘serial hunger striker’ because this is his ninth fast unto death. They are saying what kind of fast unto death is this if he isn’t dead yet. This is the flippancy of cynics, an apathetic state and those who profiteer from sickness and disease.

However, even some of his supporters say the tactic doesn’t seem to work because successive governments have never fulfilled any of the promises they made to KC in order to convince him to give up his past fasts. KC defends his action saying there is no other way to put moral pressure on the government to fulfil his ultimatum. 

His demands have remained the same: Stop further affiliations for medical colleges in Kathmandu and spread them out across the country, streamline the medical exam system and make medical education free. For the past three years, KC has also been vocal about the Commission for the Investigation of the Abuse of Authority (CIAA) overstepping its mandate to directly interfere with the medical education sector in order to protect the family-business ties of its commissioners. It has tried to influence the licensing of new medical colleges, forcing out functionaries of the Institute of Medicine who stood in the way.

Outsiders may be puzzled why medical education is such a big deal and why KC should be risking his life repeatedly to reform it. The fact is that in a country where government hospitals are understaffed, underfunded and decrepit, setting up new private hospitals is lucrative business. The return on investment on medical education is so high that businesses with political protection are deeply involved. With a downpayment of ‘donations’ of more than Rs 10 million per student, the mass production of doctors is a business that can make you rich overnight. 

Nepal is run by a political cartel whose members own many of these medical schools. The political parties have infiltrated their cronies from the private medical sector into Parliament on the proportional representation quota to push legislation favourable to them.

KC called off his eighth fast in July after the UML-Maoist coalition government assured him that they would address his demands to have parliament pass the Medical Education Reform Bill, the impeachment of CIAA Chief Lokman Singh Karki and Commissioner Rajnarayan Pathak, and to follow the recommendations of the Kedar Mathema Commission.

The Medical Education Reform Bill has been registered in Parliament, but various interest groups are trying to have it dropped from the current session of the House. Govinda KC says that despite assurances to him, Prime Minister Pushpa Kamal Dahal who now heads the Maoist-NC coalition, is lobbying to license yet another private medical college in Kathmandu. He also accuses MPs in parliament of not acting on evidence of corruption by the CIAA in the medical education sector because they are afraid of repercussions.

It is clear to KC that Nepal’s medical sector has a serious chronic condition which cannot be cured with a simple surgery. The malignancy has spread, and it can only be treated by excising powerful political interest groups and putting public health in the hands of independent and professional regulators with integrity.

Given contemporary Nepali politics that is a tall order. But there is hope that Health Minister Gagan Thapa will use his first tenure in government to show that he is a man to be trusted to set things right. Thapa has toned down his activism since he became minister, but even so he is in the right place at the right time to address the unhealthy politics in the medical sector.

We know what the problems are: Unaffordable and inaccessible medical care because of over-commercialisation and political protection. KC is offering us solutions, and he is on his ninth hunger strike to push for them. Let us hope Gagan Thapa doesn’t make the same hollow promises like his predecessors. His political career, and Govind KC’s life, depend on it.

Read also:

Kleptocracy kills

Fear and loathing

Impatient patients, Editorial

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