Nepali Times
Bad prescription


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."


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:
Making us sick, ANURAG ACHARYA
Unhealthy politics is turning into an epidemic that has infected hospitals and schools

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

1. Sajin
While working in patan hospital I was motivated to do my best. Most Senior doctors and staff members were very willing to help and guide junior doctors, their dedication and motivation rippled through the entire patan hospital family. I believe their action was a result of their love and affection towards the patients and the institute. Although I spent only 1 year at the respected hospital i felt i had been part of the family for a long time. I am saddened by the current state of events, and ask for more respect for the founding members of the institute. 

2. Get that woman out of PAHS, NOW!
I have been a quiet spectator of the political goings-on in Nepal but this appointment of a political candidate to the one institution in the country that has set a shining example of how a Nepali educational institution needs to be run, angers me no end. Like all Nepali political candidates, I have no doubt in my mind that she will use her position as the VC to make some good money for herself and will seek to get her own relatives admitted into the school, regardless of whether they are deserving students or not. All the sweat and effort of Dr. Arjun Karki and the hard working and selfless staff members at PAHS is going to go down the drain if this lady is not removed immediately. The politicians have robbed the country of every good thing it had going for itself. They're now going to ransack whatever little is left. Shameful!  

3. Pasikot
Keep on providing service to the people. Keep on fighting against the "political trade" in health and academic institutions! 

4. Patanite
It sounds very fair to shout against political appointment.  If PAHS has the written regulation that VC should be appointed by chancellor that is PM it will always be a political appointment. The regulation was formulated by none other than dr Arjun Karki who was again a political appointee by late GP Koirala. So if you want to keep educational appointment free from politics, oppose the system that draws politics into institutes not a single person in particular. Why not change the system that allows ministers n PMs to appoint these top posts in all the institutes of Nepal. These issues never get a room in intellectual discussions. What tops the list is federalism n ethnicity these days. Isn't this high time that we talk about keeping politics and corruption out of PAHS than asking just for resignation of dr bhandari? 
There are two questions I want to ask agitating medicos. If dr bhandari resigns, is there any guarantee that the new VC will be a fair, no political n who understands patan philosophy? If you are agitating against political appointee, there are few other political appointee too in PAHS like dr cp maskey as chief of service commission PAHS. Why his resignation is not being asked. If service commission is politicalized, all new appointee will be politically biased. So patan agitators have some soft corner for this man?

5. Tashi Lama
Politicizing everything in Nepal sucks everything of Nepal, that is why Nepal is not moving ahead. More importantly in these health care sectors and in the educational institutes of Nepal, all these stupids acts are caused by narrow minded, hardhearted and uneducated politicians of Nepal. As for them politics becomes a vessel to eat more for the their selfish gains, I mean " Neta haru ko lagi Rajniti Khaaney Bhanro ho" Nepal will only move ahead once these stupid politicians are replaced by smart broadminded, warmhearted and well educated politicians, otherwise there is no chance of reform and progress in Nepal, if Nepal is always ruled by these bloody foolish politicians! Look at Bihar of India, how much it is changed after by Nitish Kumar after the long reign by Lalu Yadav, this is just an example to look at.

Down with all these Goosekhori and Khaobati politicians in Nepal!

(11 JAN 2013 - 17 JAN 2013)