Demanding our rightsOnly through provision of basic services can the cycle of poverty be broken and the marginalised given a voice
As the 65 year old orthopaedic surgeon, Dr Govinda KC is risking his failing health to resume a fast-unto-death in the demand for regulation of the medical education and health care system in Nepal, his five year protest has gathered momentum, with a large section of medical professionals and the civil society joining the movement.
One of Dr KC’s key demands is that the Health Profession Education (HPE) Bill be passed by Parliament in line with the recommendations made by a high level team of experts. Ironically, the process is facing restraint from some ‘communist’ lawmakers who are seeking to include provisions in the Bill that favour private investors. The fact that many of these lawmakers are themselves direct investors in medical colleges has naturally added greater moral strength to Dr KC’s case.
I am an outsider to the medical field, and as such, I may not be able to speak authoritatively on the system and procedures, but because medical education is critical in determining the status of the overall health care system of the country, the issue is of concern to everyone. Access to education institutions, curricula, ethics, and quality control of the medical profession should not be left in the hands of the market—this is what Dr KC is fighting for. In his public statements, Dr KC has said that although the Bill is not nearly enough to reform the entire medical education system in Nepal, it will at least pave the path to control haphazard privatisation, corruption and politicisation which have been causing massive irregularities in the sector and further hampering the country’s already poor and unequal healthcare system.
Fifty percent of the poorest Nepalis do not seek health care when they are ill because of problems of access and affordability. Furthermore, inequality in access to health care in Nepal is growing. This confirms that the health care system of the country is failing, despite qualitative and affordable health care being the fundamental right of the people as stated by the constitution.
As one of the poorest countries in the world with one fourth of the population living below the poverty line and 80 percent of the people still residing in rural areas, qualitative health care is neither affordable nor accessible for the poor and for those who live in rural areas. News media is filled with reports about mothers losing their lives in childbirth in the rugged hills and mountains, where reaching the nearest hospital takes days. Some families use their entire property as collateral to charter expensive flights to bring their loved ones to the city for treatment, only to be faced with exorbitant expenses in private hospitals. The more affordable public hospitals are either under resourced and cannot offer advanced medical services, or are overstretched with patients. There is chronic shortage of government funded free medicine, and the costs of other medicines are illegitimately high.
Bearing the brunt
Studies show that women are far more prone to diseases than men, not only due to biological reasons, but also owing to discriminatory social and cultural norms.
A report from District Public Health Office in Bajura in Nepal’s far west provides insight into how discrimination affects the health of girls and women. According to the report, girls outnumber boys in malnutrition. Out of 640 fatally malnourished children, 409 were girls. Mothers not only reported being neglected following the birth of a girl, they themselves also cared for their daughters far less than they would for a son.
In this way, girls are at a far greater risk of malnutrition and many other illnesses, which further restricts their mental and physical growth. They grow to become anaemic, suffer from uterine prolapse, and suffer injury due to domestic violence. Pulmonary disease is one of the leading causes of death for women in low income countries due to constant exposure to indoor smoke from cooking on an open fire and inefficient stove.
The list goes on. Health and education are also found to be positively correlated, but with almost 43 percent of the women being illiterate (as compared to 25 percent men), women suffer from poor health disproportionately. Being poor is already a disadvantage, but being poor and female is worse.
What is important to note is that, although women suffer from higher health risks, they are the ones least likely to get the necessary medical attention due to societally entrenched gender discrimination. Lack of economic resources and education also limits their access to health care. Studies have shown that women’s health is comparatively poorer in societies where the degree of discrimination is higher. This inequality in access to health care and education creates a vicious circle leading to ‘feminisation of poverty’, which means that women make up a majority of the impoverished population and they are the poorest of the poor. The only way to break through this poverty trap is for the state to increase intervention efforts and ensure women’s access to these critical services.
Women and girls have limited access not only to medical services, but also to medical education. Irregularities and excessive marketization of medical education has allowed for such exorbitant fees that studying medicine is next to impossible for an average Nepali, and if you are a girl, the chances are even less. Expected to primarily produce children and take care of the family, an average earning family rarely invests large amounts of their family wealth into the education of a female child. According to a 2015 Nepal Medical Council data, 11,010 doctors were male, while only 5,422 were female.
A man of unparalleled moral authority, Dr KC has further extended his movement to protest against all kinds of corruption and abuse of authority. Corruption is rampant in Nepal, and it has not only caused the development of the country to come to a complete stand still, it has also caused the steady deterioration of almost all state systems. Corruption of state resources ultimately affects the most marginalised sections of society by depriving them of their right to basic services and opportunities, and forcing them into the poverty trap. I hope this uniquely non-political movement builds up to become enough of a force to break this trap.
Parajuli is associated with the Nepal Youth Foundation