BIKRAM RAI

One of the hallmarks of Nepal's prolonged transition is that it has led to a crisis of legitimacy at all levels. The system of checks and balances is weakened and contending claims of authority and legitimacy within institutions of the state are breeding contention and conflict.

The endemic corruption at the national level has trickled down to the grassroots where the absence of elections has eroded accountability. Deteriorating law and order, impunity, and political interference are all indications of an ailing state, and nowhere are the symptoms more glaring than in the country's universities and medical institutions.

Tribhuvan University is now so plagued by politics that it is closed more days in a year than it is open. Kathmandu University, which was spared such interference, last week saw the unceremonial removal by the government of its long serving founder, Suresh Raj Sharma.

In the last six months doctors, staff, and students of two leading hospitals in the country have been on a war path. Govinda KC of the TU-affiliated Institute of Medicine (IoM) went on a fast unto death in July against political interference in the hospital administration. Top positions at the hospital had been vacant for almost a year because the political parties competed to put up their own candidates.

"This is no place for politics. We take life and death decisions here," a doctor at the Teaching Hospital told me. However, last week's appointment of Bhagwan Koirala, one of the country's leading and most respected
surgeons to the top job has been universally welcomed.

However, on the other side of town, at the Patan Academy of Health Sciences (PAHS) a similar protest against the high handed appointment of a Madhesi minister's sister as the new vice chancellor has affected services. The new chief has sought to undermine PAHS' mission to educate motivated doctors who are trained and willing to serve in Nepal's rural hospitals.

In Maharajganj, Dhulikhel, and Patan, the motivation of the politicians installing their cronies and relatives is clear: to lay their hands on the Rs 3 million or so 'donations' that students have to pay for their medical degrees.

"Patan Hospital is among very few government institutions which does not lose money, we have proved that over the years. There is no need to fix something that isn't broken," says Lila Raj Acharya of the hospital management.
Students got involved in the protest after the new management allegedly threatened to cancel admission of the first year students and suspend the scholarships of others. Sixty per cent of students in PAHS are from remote districts studying on scholarships who will serve in the villages when they graduate.

A student from a remote mid-west district told me that she had already given up on her dream of becoming a doctor when PAHS provided her with an opportunity. "When I graduate and go back to the village, my people won't have to travel for days for treatment," she told me.

Corrosive national politics has infected government medical schools and now threatens to undermine the commitment and motivation of students like her who see a medical degree not in commercial terms but as a public service. A recent UN report has lauded Nepal's efforts in achieving the Millennium Development Goals, particularly in reducing child and maternal mortality. Another survey conducted by the Nick Simons Institute (NSI) on doctors who graduated from IoM between 1983-2004 suggests doctors with rural background or those with paramedical experience were more likely to serve in rural areas.

Enrolling more students from remote areas may not guarantee that they will all go back to serve in the villages, but institutions like PAHS also made radical changes in their curriculum to ensure that the new breed of doctors not just learn medicine, but take a rights based approach to public health.

A thoroughly disgusted PAHS adviser told me the other day: "The new vice chancellor was appointed as a fund raiser for her brother's party. She is incompetent and untactful, she must go."

Read also:
Bad prescription, KIM LAMA
Political appointees threaten medical schools with mission to train rural doctors

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

In an ailing state, ANURAG ACHARYA
If this is the state of city hospitals, imagine what it is like in rural areas