MOMENTS: A duty to country / Insight

(SEE BELOW FOR INSIGHT BY RABIN NEPALI)

A duty to country

Sky is there and so is horizon. I walk alone to cross the horizon to meet the sky. My dream is to reach the stars, leaving behind the moons far off. I have my dreams, yet to be fulfilled. He is there. His dream is to burst open the black clouds, to shower the magic of rainfall and to irrigate the whole world. You are there. You have your dream. And, they are there. They have their own dreams, and they, like us, are on their own way to fulfill their dreams. Our aims seem different; our roads are different; our interests are different, and we are different. Yet, we try to find some similarities among us, some relations among our interests and some links among our roads. The chain that keeps us bound is our identity, the identity of being a Nepali citizen, the identity of being born in this land. Amidst the heaps of dreams, we have love for our country buried inside.

Like every citizens of the country, the medical personnels also have duty towards the country. Indeed, they have more responsibility than anyone. Being an educated and respected group, what these people do become an example to others. Medical doctors and students belong to one of the most privileged groups at least in our country. What they say and what they do are considered important by all. With all these facts, it's not amazing that these people are and should be involved in the decision making process in the country. They should be able to direct the country towards good goal by active participation. They should stand as leaders for the change a country needs or demands. In every difficult situation a country faces they should place themselves among the responsible citizens. The dire need for the change should be respected. It can't be exactly said how far they have succeeded to address the country's needs, particularly political needs.

Politics is the process by which groups make decisions. Although the term is generally applied to behavior within governments, politics is observed in all human (and many non-human) group interactions, including corporate, academic, and religious institutions(1). This definition covers all people in all fields, from farmers to industrialists. Since it affects every aspects of life, the medicos need to be involved in it directly or indirectly. The history of the changes in our country is no too old. Let us forget about the great revolution of 1950. We don't know much about those days. But the public movements of 1990 and the recent movement of 2006 are the fresh ones. As the political events in 1990 escalated to the point of revolution, Nepali health professionals adopted what to them were the overtly politically and socially activist stances of Virchow and the Alma Ata Declaration, becoming revolutionaries for the sake of democracy. Backed by a history of political activism focused on establishing a multiparty elected government, doctors, nurses, and paramedical became catalysts for a movement aimed to bring down what they saw as a repressive panchayat system to end underdevelopment and the corruption that nurtured it, and to establish the basis for a healthy democratic nation with full rights to political freedom. In the process, the movement would also bring an end to the absolute rule of the monarch. The oppositional activities of Nepali medical professionals made a decisive difference in the People’s movement. The voices of Nepali physicians were heard partly because of their political actions, including dissemination of information, strikes, and assertions of professional authority at strategic times and places. They alerted the news media about what they surmised was the government’s use of bullets outlawed by the Geneva Convention; they protected leaders of the opposition from arrest by placing them under hospital bed rest; they made triage decisions which placed the lives of injured civilians above the needs and demands of soldiers and policemen by claiming medical expertise and by appropriating a moral and scientific high ground based on universal human rights. In doing so, health professionals were able to transform the revolutionary debate from a partisan one to one about universal truth. Their actions helped to inspire foreign democratic governments to threaten the withdrawal of aid unless the people’s demands for political freedom were met. The highly visible protests of this cohort of scientific professionals dashed the king’s hopes for a modern monarchial Nepal, for surely he recognized that a modern national could not exist without support from rising professional scientific classes like theirs. A hunger strike by the physicians and other health personnel during the final days of the revolution helped compel the king to agree to a multiparty parliamentary democratic constitutional monarchy(2).

The movement of 2006 was even more fascinating than that of 1990. The king had to bend in front of the people’s rights, and had to leave all powers, even those given by the people in 1990. Amidst various groups of people, the medical doctors and students were also in top ranks. They shouted the slogans for the country. They participated in the movement and actively denied curfew. On 9th April, 19 medical students and a doctor were arrested while taking part in peaceful demonstrations(3). On 10th April, around 30 armed police backed by the Royal Nepalese Army entered the hostel of the premier medical institution in Tribhuwan University Teaching Hospital and injured at least 7 medical students and a doctor, 3 of them critically. Just 4 days ago, 20 of medical students were arrested while they were in peaceful demonstration, following which around 30-armed police entered the teaching hospital hostel and beat indiscriminately around 20 students and a doctor and terrorised them in the night at 10pm. The army backed them. The next day, a few health professionals were threatened for treating the victims of the movement in a place around 500 were injured of which 150 were firearm victims(4). Helping the hurt people and treating the wounded ones weren't only difficult but also challenging. But they didn't turn back on their duties and their incessant efforts were of great value to humankind. The contributions they made in the strike called by the political parties were really precious. What they did was a part of liability they owe to the country. And, they proved that whenever such situation comes in the future, they will be ready to fulfill their duties. Now when the political situation of the country is towards the change and stability, it becomes a part of their duty that the support they gave for success of the movement be continued until the goal is achieved.

Midhan Shrestha, MBBS 4th year student, Maharajgunj Campus, Institute of Medicine.

References:
1. Politics: definition. http://en.wikipedia.org/wiki/Politics (Accessed 16 Nov 2006)
2. Adams V. Doctors for Democracy: Health Professionals in the Nepal Revolution.
Cambridge: Cambridge University Press, 1998.
3. More Docs, Health workers join protest. The Kathmandu Post 2006 Apr 11
4. Sign Petition: Health professionals and medical students under threat in Nepal.
http://www.petitiononline.com/lapendoc/petition.html (Accessed 17 Nov 2006)


Insight

The situation is dire……someday the fire will catch up and the echoes of its consequences will be heard…….. for long and gone.

A few days ago, a scenario though an everyday happening caught my attention and got me thinking ………the dynamics of the relationship between a doctor and a patient. The realism of it all… the situation that there really is and the idealism of it all……. the stuff that we read in literatures and hear in the lectures of our dignitaries. It got me thinking and reminiscing about the empty lectures and the tireless hours we put on the subject at the beginning of our medical profession.

The relationship as others, has two parties…. One who thinks it’s above of it all and the other so ignorant and naive to realize anything at all. As for the account of the daily happening…. a patient after a long wait in a tireless queue finally gets the chance to meet the doctor, the doctor does his routine checkup then writes something in a piece of paper and instructs the patient to take it and it’s the end of the session……. this whole way of practice leaves me wandering what just happened and certainly the patient confused and clueless.

The patient whoever he/she might be, in what ever capacities has the right(1) and simply the necessity to know what is happening to him/her and the obligation of a doctor to clarify to the patient about each and every step of the process since it’s the patient’s health and at times lives, what they are dealing with at the first place.

Don’t take me wrong, I do know that it is impossible and simply not feasible for a doctor especially in these situations to give attention to each and every detail to each and every patient. But at least the attempt must be there, its simply our duty and responsibility and we have taken it on ourselves, when taking the oath and while choosing this line of work…..the line to serve.

I am not trying to talk about idealism completely ignoring the harsh realities and the constraints of the whole system…….. but may be I am just preparing myself for the inevitable. Because a day will come when the unawareness and ignorance will be gone and the see-saw will turn the other way. We have certainly seen some signs of it….with the new consumer protection acts coming up, the acts of vandalism going all around(2,3) and trend of suing starting to happen. Someday, the situation will be like in the “STATES”, where the consumer guides the relationship and have the upper hand rather than the other way round, where even many doctors who did nothing wrong are held liable(4).

However, as a medical professional myself, I do expect some degree of respect and appreciation but bearing in mind the respect and the sense of responsibility the patients do deserve. And yes after all being said………… I do believe the relationship can sustain successfully in harmony.

Rabin Nepali, MBBS 4th Year Student, Maharajgunj Campus, Institute of Medicine.

References:
1.World Medical Association Declaration on the Rights of the Patient. Adopted by
the 34th World Medical Assembly, Lisbon, Portugal, September/October 1981,
and amended by the 47th WMA General Assembly, Bali, Indonesia, September
1995, and editorially revised at the 171st Council Session, Santiago, Chile,
October 2005.
www.wma.net/e/policy/l4.htm (Accessed 18 Nov 2006)
2.Berserk mob vandalizes hospital. The Kathmandu Post May 24 2006.
3.Protestors vandalize Everest Nursing Home. Nepalnews.com May24 2006.
www.nepalnews.com/archive/2006/may/may24/news06.php (Accessed 18 Nov
2006)
4. Howard P.K. Is the Medical Justice System Broken? Obstet Gynecol 2003;
102:446–9.