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  Consented excesses  
 

MAHABIR PAUDYAL

My five days of stay in Patan Hospital as an attendant has turned me cynical about the health care system and mistrustful of doctors and hospitals in general. I had such unpleasant experiences there that I was not at peace until I decided to release my angst through writing.

My spouse was admitted to Patan Hospital one day before her delivery was due. Her labor pain began only next day. After about one and half hours of pain, a lady doctor called me and said “Your baby’s heartbeat is too low. If operation is not done both baby and mother will be at high risk. What do you suggest?” Well, the question did not leave me with any option.

Soon I learnt, however, that the hospital was infamous for conducting Caesarian births. Out of 50 mothers in the delivery ward, 45 had been operated. And during my entire stay I hardly met the visitors whose patients had had normal delivery. You can draw two inferences from this: One, the hospital encourages operation for pecuniary reason too. Two, modern mothers are built with such a physiological impairment that they cannot give births unless operated. I am not convinced by the latter.

After the operation, I was ushered in general ward. You cannot imagine the mess in there. It is like a dormitory. Recently operated women are crammed into one room and when the room cannot hold any more they are positioned on the corridors and hallways. Panicked by the sickening scene there I decided to shift to private ward.
Private ward is like a hotel, you can choose from semi private, private, and deluxe room with TV. I chose semi private. But just then the nursing desk told me that once I shifted to private ward, operation cost would double automatically. What a defective provision! I decided to talk to the administration. Ease in private ward was discernible. The big doctors (whom I had not had a glimpse of for eight months of regular checkup but in whose reputation the hospital has earned fame) began to frequent my wife. They asked her if she had any fancy and so on. Now I felt I had been able to buy some of humanity.

Yet there was operation cost issue about which I had to talk to the authority. Nowhere in the world may there be such a rule of charging double for the reason of taking up a bit better bed for the patient. I talked to Acting Medical Director Dr Prabin Kumar Sharma before discharge. “How come that you double the operation charge once I shift to private ward? You do not perform operation twice, do you? I will not pay double.” Dr Sharma with this deceptively polite smile explained that he could do nothing and that unless I paid ‘double’ I would be prohibited from taking my wife and child home. “It’s like this here,” he said. Finally I had to give in. Duplicity won my reasoning.
I find it queer that we have not been vocal on the need for sweeping reforms in the whole of the medicine sector. We seem so immune to misuse and abuse of authority by doctors and hospitals. A politician charged of corruption has faced a jail term. Government officials implicated in embezzlement have been tried in the court too. But never ever in the history of Nepal has any doctor faced a trial in the court for playing with public health.

Patan Hospital is but only a case in point. I am alarmingly particular about it because principally Patan Hospital ought to have been a charity hospital. The present set up of the hospital was funded by United Mission to Nepal (UMN) and the new infrastructure (Nick Simons Block) where the hospital runs the maternity ward was built by, and possibly, also funded by American couple Jim and Marilyn Simons in commemoration of their late son Nick Simon.

In Nepal hospitals have earned infamy in inflicting on patients and attendants a huge monetary burden for their service besides playing with patients’ lives. Doctors in Bir and Tribhuvan University Teaching Hospital (TUTH) have lost all credibility with their track record of going on repeated work stoppage. Disruption of service in BP Koirala Memorial Cancer Hospital, Bharatpur, last month killed four patients. Om Hospital and Research Center doctor cut through the child’s belly and had his entrails out while operating on a pregnant mother some few months ago. These are only known cases.

While private hospitals are targeting the middle class health wary population of the country, most of the public hospital doctors disregard their duty and call the patients in their private clinics. Worse still, public hospitals have begun to open private paying clinics (I know of this happening in TUTH and Patan Hospital). I am thinking of a friend of mine who had his mother at Bharatpur Hospital during the strike and who, therefore, had to suffer doctors’ atrocity: “You know Mahabir, the problem here is not political,” he unleashed his wrath with me. “The doctors of this hospital have their share in the private hospital nearby. By getting into strikes they force the patients to flock to their private clinics. There are no doctors these days. Either there are money mongers or there are butchers.”

The incidents of hospitals and doctors committing offense in public health and fleecing the public are no news in this country. But hardly ever have we openly decried this sort of corruption. We comply with every order and recommendation, just or unjust, pay every bill without questioning and do not brave to go against misconducts of doctors because we know (doctors are aware of it too), no matter how hoarse we cry against them finally we must summon them to our liberation when in illness.

So we have defied doctors. Time has come to degod doctors and question, argue, doubt and beg for fair treatment from them the way one mortal does it with the other.
In hospitals every patient and every attendant is so desperate that he would be ready to do anything if that saves a patient’s life. Say that a doctor tells you your patient needs surgery that costs you million. You do not question how. You rather think of how to obtain that money. We do not negotiate and bargain in the hospital because we do not value our health in monetary terms. Besides when a patient dies we ascribe the death to God’s wrath not necessarily to a doctor’s negligence. Such an attitude has left ample room for the doctors to play with our innocence and do business.

I find it queer that we have not been vocal on the need for sweeping reforms in the whole of the medicine sector. We seem so immune to misuse and abuse of authority by doctors and hospitals. A politician charged of corruption has faced a jail term. Government officials implicated in embezzlement have been tried in the court too. But never ever in the history of Nepal has any doctor faced a trial in the court for playing with public health. No hospital has ever been brought under scanner for draining out patients’ hard earned money unduly. This is outright corruption and people must start raising voice against it.

“What will your complaining in the media forum do?” My wife tells me “You will only annoy them.” I am not much hopeful of this article causing reforms in the crumbling Nepali health sector either. Hospitals will continue to cheat patients. They will continue to go on strikes and extract double charge for operations. Patients will continue to be robbed of all the money they have in the expectation of good health in return.

But is not it an achievement when a fraudulent medical practitioner reads this and exclaims (hopefully someone will surely do) “Damn it! He has uncovered our evil practices.” Is not it a success when a patient unduly duped by a hospital reads it and says “that’s it. He is right.” Or when an honest physician feels being drawn in the mess because of his money-minded colleagues. Is not that something? Hopefully, this article will succeed in one of these fronts.

mbpoudyal@yahoo.com
 
Published on 2011-05-19 01:10:09
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Let´s acknowledge that the failure of the health care system is a symptom of a systemic failure in Nepal. Above all, it is an institutional failure-- why there is no mechanism in place for an oversight of these hospitals? Who are the managers and the boards of these hospitals accountable to? Second, it is a professional failure-- training of physicians in Nepal apparently does not include critical components of ethics and social responsibility. Medicos have largely failed to self-regulate [more]
  - Anonymous
The question is how do we "channel the rage" of NATIONAlITY to good use?



Do not underestimate the power of free voice. Today one speaks, tomorrow ten...... and hopefully people will stop acting like sheep! [more]
  - HonestNepali
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