The only medical school in Nepal designed specially to train doctors to serve in rural areas has been paralysed by the political appointment in August of a new chief. Angry staff at the Patan Academy of Health Sciences (PAHS) have partially shut down the hospital in protest for the third week running.

Nepal's private and government medical schools produce 1,500 doctors each year, but half of them migrate overseas and the ones that stay in Nepal choose to work in urban areas. But PAHS was designed to train doctors to serve in district hospitals. Sixty per cent of the students are from underprivileged families, and their scholarship requires them to work for up to four years in rural areas after they graduate.

However, political appointment of new vice chancellors this year have plagued both PAHS and TU Teaching Hospital (TUTH) in Maharajganj which were set up with similar philosophies of training rural doctors at a time when private medical schools are being commercialised and have political protection.

A fast-unto-death hunger strike in July by Govind KC, a TUTH doctor, forced the government to cancel the nomination of a political appointee there. In PAHS, there is deep concern among doctors and international partners that the appointment of the politically connected new Vice Chancellor Sangita Bhandari to replace founder, Arjun Karki, will undermine the hospital's mission to train rural doctors.

"The new VC has not respected the abilities of the founding faculty members," says Bharat Yadav, professor and chair of the Department of General Practice at PAHS. "We have built this academy from the ground up, but she and other recruits do not understand our mission."

BIKRAM RAI

Bhandari, who is related to powerful Madhesi politician and former minister Sarat Singh Bhandari, has told media that she faces opposition in PAHS because she has tried to clean up the hospital of corruption. Her appointment of Soumya Bajracharya as rector prompted PAHS staff to stage sit-ins and lock-outs of the hospital. Bhandari brought in the police to break the protests. Stakeholders convinced agitating staff on Sunday not to let their struggle affect medical treatment and care of patients.

Kedar Baral, professor and chair of the Department of Community Health, says PAHS' entrance criteria and curriculum are designed to bring out motivated doctors. "The current VC wants to change the entrance criteria, and recruit more students who pay huge fees," says Baral, "this will turn PAHS into just another medical school. It will no longer be a school for rural physicians."

Shrijana Shrestha, professor of paediatrics, says PAHS staff had initially given Vice Chancellor Bhandari the benefit of doubt, but the new chief showed scant regard for the hospital's mission, and has been disrespectful of faculty. "The current dispute risks the mission of service of PAHS, and Bhandari is a bad role model," Shrestha adds.

PAHS has tried to change the trend of Nepali medical students migrating abroad or gravitating to private clinics in cities. Its International Advisory Board took a strategic and difficult approach different from traditional medical education in Nepal by selecting competent and compassionate students using IQ and personality characteristics testing, and teaching an innovative curriculum that is strongly community orientated.

"PAHS actively recruits capable students from rural and remote Nepal with the view that these students with existing ties will more likely want to serve in those areas," says Katrina Butterworth, professor of General Practice at PAHS.

Over the past decade, the International Advisory Board has involved over 200 educators, scientists, doctors, and other health care providers from all over the world. One such volunteer doctor is Darren Nichols from the University of Alberta in Canada.

Says Nichols: "We are volunteers who share the vision of building peace in Nepal through health equity. PAHS has a brave and visionary mission of serving the neediest people of Nepal, a mission that has attracted a global following."

The dispute has threatened ten years of work by PAHS founder, Arjun Karki, and his team to develop the institute as a role model not just for Nepal but for other developing countries.

A private medical school in Nepal charges more than Rs 6 million for an MBBS education. PAHS costs less than half of that for applicants, but 60 per cent of its students are on full or partial scholarships. More than 80 per cent of students are from outside Kathmandu, more than half of the students are women, and many are from marginalised communities.

Associate Professor, Sabita Rana, says the political appointment of an inappropriate vice chancellor threatens to unravel PAHS' achievements. "We risk losing local faculty who have sacrificed better salaries to teach PAHS' more demanding course, we risk loosing the trust of district hospitals, we risk losing our essential international partners, and most importantly, we risk disappointing our students who have come to learn that medicine is a social service, not a way to get rich quick," she explains.

Read also:
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See also:
Why some doctors stay and others go away
New study finds factors that make Nepali doctors more likely to practice in rural Nepal instead of moving to Kathmandu or migrating abroad

Missionary zeal, MICHAEL COX
New Nepal medical school aims to motivate students to serve in rural areas