Doctors, politics and the fluteMedical education should create humans who serve those in need, but politics challenge that very spirit today
I travelled to BP Koirala Institute of Health Science (BPKIHS) Dharan to face a minuscule creative hurricane at the invitation of medical students organised under the now established name Parikrama Samuha, on November 17, 2017. The location was the self-same Ghopa Camp, familiar to us, the denizens of that area, as a British Gurkha recruitment enclave. I remember returning late after seeing English films at one British friend’s invitation through a scary countryside with angry dogs strolling around and guarding Dharan’s famous black pigsties. I find it hard to believe that this entire open countryside is now a beautiful, modern town. After failing to attend the programmes in previous years, I was happy to have made it this time. The students who came to talk and give the invitation immediately struck me as a crop of youths whom I could see as harbingers of a new era in medical engagements in Nepal. Suresh Dahal, Nabin Bhatta, Bharosa Bhattarai, Amrit Jaisi, David Thapa, Swotantra Gautam and others who communicated gave me that impression. At the conference itself I met many erstwhile Parikrama students, now established as doctors like Madhur Basnet, Sapkota and others. They were doctors who were physically committed to work within frontiers but with the spirit of “doctors without frontiers”. I am not alluding to the trend of exodus of young, talented doctors to America. I am writing about their spirit.
At the two-day conference, I was struck by the diverse combination of people who came and gave talks. To name a few, famous comedian Madankrishna Shrestha, theatre director Sunil Pokharel, and former minister Lalbabu Pandit, all had something to say. A perfunctory film based on the autobiography of writer Jhamak Kumari was also shown on the occasion. What impressed me deeply was the medical students’ passion to link their medical education to the alterity, to the other, that includes the arts, literature and even political thoughts. One moving occasion came when they took us to see their collection of books about literature and philosophy, none focused on medical subjects. Asked why they had set that up, one bright senior medical student Bharosa Bhattarai said that was a corner where they turned to fill their souls. I immediately wrote in the visitors’ book that they were creating what the English poet John Keats called a “valley of soul making”. Their initiative was symbolic, inspirational and humane. As a literary writer, my position regarding medical education is that it should create humans who serve those in need of help, in earnest. But politics precisely challenges that spirit today.
My topic of the discourse was somewhat complex. It was about body, medical subjectivity and humanised education. I did not dwell on all those topics in detail. I said how medical education in Nepal is triggering discussions not so much on the subject as on the management, or in turning medical education into a lucrative business by charging exorbitantly high fees and making it less transparent so that what goes on behind the management screen remains a secret. The results of that will come out not as information, but as affect, when badly trained doctors come out and use medical practice as an urban indulgence geared to a system that makes money on public health. The needy or poor people sadly remain outside the sphere of that game. It is not a bad thing for the state or the political parties to take interest in public health education, but only if it is done properly. In one big South Asian Association for Regional Cooperation (Saarc) country, a citizen’s right for treatment is not enshrined in the constitution, but it is included in the Nepali constitution, which makes it mandatory for all to abide by that spirit, not flaunt it.
I tried to explain the question of subjectivity, which is a complex topic. By mentioning some clinical theories, I said doctors should be creative and human. And the people whom they serve should be remembered as the important recipients of such treatment. A good relationship between the doctors and the patients can be established by training doctors who understand the human dimension of medical or clinical service. There are instances of doctors serving and opening up new grounds of education. By citing the casualties of six natural calamities and six wars of the 21st century, including the Nepali earthquake of 2015 and the ten-year war of Nepal, I said humans have killed more people than nature. The six natural calamities killed 1,016,790 people, whereas the six human wars of the same period killed 4,053,000 people. The human impulse to dismantle bodies is alarming. The ratio was the same even in the previous centuries. So doctors’ focus on saving bodies has always been the greatest dharma in all cultures, civilisations and centuries.
I cannot write the gist of the entire paper here, but what must be mentioned is that in modern times the debate about who should prevail, the authors or the readers, the doctors or the patients, the leaders or the people, has drawn everybody’s attention. I would only say that we could do miracles by working together.
Nepal’s medical managers should learn from India, from whose experiences we have received medical education management patterns. From 1835 onwards Calcutta Medical College and Madras Medical School started producing doctors after an education of four to six years. Additionally, we came closer to Western medical education after Banaras Hindu University (BHU) opened the medical education section in 1920. Rushing to establish medical colleges without full preparation and commitment will have harmful side effects. Even in India, as claimed in a report published in J Postgrad Med 2016, there were about 579 medical institutions and hospitals established over a period from 2005 to 2014, where they tackle problems like “asymmetric rise in…medical schools, …questionable...student selection policies,…curriculum…removed from national health care…declining quality of teaching in medical schools”. Lessons to learn here.
The Parikrama Samuha of students appear to be saying that we can do better, not by dabbling in politics but by bringing medical knowledge closer to art. Dr Suryaprasad Rimal’s long rough bamboo flute was producing that very resonance at the opening of the seminar.