I had gone to meet a consultant psychiatrist at a reputed hospital for advice for a family member who suffers from anxiety and depression. What I encountered there made me question the state of our healthcare system. The consultant rudely rebuffed my request in front of other patients. I feel this incident is a reflection of the declining ethical and moral values of medical professionals. Once, I read an article about Dr KC’s selfless service who postponed his 11th hunger strike to go help flood victims in the Tarai despite his poor health. He is a true human and deserves honour and respect for his strong ethical behaviour towards humanity. 

Tragic cases

In Nepal, most patients trust doctors so implicitly that it is considered rude to question what they are doing, what treatment is being planned or if there are other options. I believe that the biggest failure of the healthcare system in the country is that there is no public health system to speak of.

In our system, medical education should be promoted by prioritising volunteer and social services instead of incentives. However, most private hospitals which want to run medical colleges are driven by the inducement of profit from the sale of medical certificates to candidates without any skill, knowledge or experience. The motivation to increase profit margins comes at the cost of ethics in medical education. This creates big challenges in public health in terms of morals and quality of medical education.

This reminds me of a newspaper article I read about a fake academic certificate scandal where doctors from reputed hospitals in Kathmandu had been arrested by the Central Investigation Bureau (CIB) of the Nepal Police for medical malpractice. I also read some time ago that a 32-year-old woman who had been admitted to a reputed hospital for thyroid surgery had her uterus removed instead. The removal of her healthy uterus is an incident of gross medical malpractice. 

Similarly, a few days ago, I read about a tragic instance of malpractice in a reputed hospital which resulted in an infant’s death. In this case, the doctors mistakenly inserted a tube which was too large into the lungs of the child, causing excessive bleeding which later resulted in death. Likewise, one of my colleagues, Krishna Dai, 35, was struck by tragedy when he lost his wife due to malpractice by a doctor. His wife had been admitted to a nearby hospital after the onset of fever followed by nausea, vomiting and a decrease in appetite. His wife was 34 weeks pregnant, and was a regular patient at the hospital. 

After she was admitted, the shocking news came when she was diagnosed with critical jaundice. A medical examination done when she was 32 weeks pregnant had shown that everything was fine. However, the lack of vigilance in detecting jaundice during pregnancy resulted in complications, which proved to be fatal. Early detection could have saved her life.

Better services

There has been a steady rise in such cases in Nepal in the past few years. When a doctor misdiagnoses a condition, or fails to diagnose a serious disease for some time, the patient might miss treatment opportunities that could have prevented serious harm, including death.

It is also distressing to know that more than a dozen medical colleges running across the country have failed to upgrade their quality of education, infrastructure, faculties and human resources as per the standard set by the government, universities and the Nepal Medical Council. This means they cannot produce capable human resources. Furthermore, the standards presented by medical colleges across the country are poorly monitored and evaluated, meaning they are not penalized for not making any effort to improve the quality of education. Some medical colleges are found to have enrolled many students who scored poorly in their entrance tests, which leads to patients and their caretakers being exposed to medical malpractice and negligence. 

Therefore, the laws need to be amended to ensure that medical colleges provide quality education and standards of service. It’s the primary duty of our government, political leaders and concerned stakeholders to look into the issue of public health.

Among other things, the government should also take proper steps to control irregularities in medical education and the health sector. It should work to create a good public health system by approving affordable financing rules and endorsing good ethics in medical education.

Khatiwada is a teacher and child counsellor