KC’s fast highlights Nepal’s Covid-19 failure

Last week, Nepal’s Health Ministry said it would recommend another lockdown if active Covid-19 cases crossed 25,000 mark.

Given that 5% of coronavirus patients are now requiring ventilator and ICU treatment, the decision reflected the government’s realisation that it was running out of hospital beds and health infrastructure. The Health Ministry has already decided to charge fees for PCR even in the government labs, citing its inability to pay for tests for all suspected cases.

“The government is no longer able to treat coronavirus patients and this pandemic has exposed Nepal’s fragile infrastructure,” says public health expert Sujanbabu Marhatha.

But for that Nepal needs fully-equipped and well-staffed hospitals providing services all over the country. This in turn requires medical colleges to produce sufficient health professionals. Which is what has been driving Govinda KC for the past 20 years to push for healthcare for all Nepalis.

His activism has involved treating patients in under-served parts of Nepal, and to push for specialist health care in remote areas, and setting up government medical colleges in all seven provinces.

The government has repeatedly promised to meet his demands just to get him to call off his hunger strikes, and then ignoring them. As a direct result of these lapses, the Nepali state has been unable to cope with the testing, tracing, quarantining and treatment necessary to control and manage the Covid-19 pandemic.

Instead, critics and supporters of KC say the state is entirely focused on destroying public health structure by supporting and protecting medical education mafia and profit-oriented private hospitals.

If there were government colleges across the country by now, the gap in service delivery and shortage in medical equipment would have been filled to a large extent, as each of these institutions would have adequate test kits and essential ventilators and ICU beds.

People could have got healthcare at the local level without having to travel to the cities during the pandemic. Instead, many lives have been lost unnecessarily not just due to Covid-19 but also from other chronic diseases because patients could not get to hospitals because of the lockdown, or because they were afraid to go there for fear of infection. Meanwhile, private institutions are overcharging for PCR tests.

KC’s activism has its roots in 2010 bribery case in the entrance examination of the Institute of Medical Education (IOM) that exposed the culture of sale and purchase of medical education in Nepal. The IOM is responsible for conducting medical exams, selects eligible students for admission in affiliated private colleges, and regulates the quality of teaching.

The dean of the IOM is a coveted position, but the appointment is political, which means lack of transparency in the admission of students. Medical colleges have been admitting pupils who pay higher fees over those who are eligible.

KC started his campaign in 2012, and since then has been demanding the government to end political appointments at the IOM and to ensure transparency in admissions and examinations.

The points from his first hunger strike eight years ago have still not been met even as he went on his 19th fast unto death on 14 September in Jumla. This time, he also demanded the decentralisation of medical care, priority for medical students in remote areas, and provision of health services in rural regions.

In his 19th fast, KC has demanded that government establish state-run medical schools with necessary infrastructure and resources in each province.

On 17 June, prime minister K P Oli’s personal doctor Divya Singh was made the Dean of IOM, a political appointment that was met with heavy criticism in the public sphere.

Medical education reform activist Jiwan Chettri says: “Most of the appointments at the IOM are of those who have political influence. This will surely bring down the institute and hospitals operating under it. The need to focus on building stronger health structure is more visible than ever during this pandemic.”

Achham’s Bayalpata hospital has been providing free health service for the Nepal’s poor with support from the non-profit Nyaya Health Nepal. But the hospital is struggling because of a funding crunch, and one of KC’s demands is that the government step in to support Bayalpata.

The government is more intent on supporting tycoon Durga Prasai’s B&C Medical College in Jhapa by bending the rules in the Medical Education Act.

The act stipulates that a university may not be affiliated to more than five medical colleges, that the university may not allow the college to operate as an expanded program, and that universities outside the Valley may be affiliated to other colleges only after conducting their own MBBS/BDS programs.

Following another hunger strike by KC two years ago, the government agreed to amend the Act such so that a university cannot be affiliated to more than five medical colleges. But there has been no progress there either. In fact, final preparations are being made to affiliate B&C Medical College to Kathmandu University.

Member of Nepal Medical Council Dhundi Raj Poudel says that Nepal’s universities are incapable of giving affiliations to more than five medical colleges.

"Regular inspections and examinations should be conducted to find out the condition of the affiliated colleges. But Tribhuvan University and Kathmandu University themselves don’t have sufficient faculty members," he said.

In yet another written only commitment, following an agreement with KC on his 15th hunger strike in 2018, the government formed a committee to set up an MBBS program at the Karnali Institute of Health Sciences. Nothing has happened.

“MBBS program at Karnali and from other government level will stop the business of private colleges, which is why the government hasn’t prioritised it,” explains Jiwan Chettri.

Not long ago, Sunil Sharma, the operator of Nobel Medical College in Biratnagar invested Rs1.7 billion in Kathmandu Medical College. Sharma is the same person whose Grade 12 certificate was found to have been forged during a Central Investigation Bureau (CIB) probe in 2016. Unable to arrest Sharma, the CIB had then placed him in the wanted list.

Last year, students accused Chitwan Medical College in Bharatpur, National Medical College in Birgunj and Noble Medical College in Biratnagar of charging more than the prescribed fee. But the promoters have such high level political connections that nothing happened to them.

Similarly, after students in Gandaki Medical College in Pokhara staged protests over high tuition fees, a Parliament sub-committee last year ordered an investigation, which eventually concluded that most medical colleges were charging illegally high fees. The report, however, did not recommend any action against the colleges. On the contrary, it suggested increasing fees and seats in colleges.

When Lokman Singh Karki was the head of the Commission for the Investigation of Abuse of Authority (CIAA), he openly favoured his brother Balman Singh Karki, who was the director of Kist Medical College when private medical education does not even fall under jurisdiction of the authority. In 2013, the CIAA under Karki directed the Medical Council to maintain the number of seats in nine medical colleges going against a government policy.

While KC repeatedly puts his life on the line for reforming medical education and making medical care affordable and accessible to all Nepalis, the government is out to back its cronies in the lucrative private healthcare sector.

Former Registrar of Nepal Medical Council Baburam Marasini blames negligence and corruption since the 1990s as the main culprit behind poor quality of medical education.

"Back then we couldn’t reform medical education under the pressure from the prime minister and education minister,” he says. “The Medical Council’s powers were cut, and now that medical care is commercialised the quality of medical education has deteriorated even further.”

Meanwhile, senior figures in the NCP government regularly pass disparaging remarks about Govinda KC, calling him “mad” and ridiculing his hunger strikes. Last week, KC was forcibly moved to the Trauma Centre when he flew in from Jumla via Nepalganj half-way through his hunger strike.

KC is on the 16th day of his current hunger strike, and doctors say his condition is deteriorating rapidly.