How One Doctor Has Transformed Medicine in Nepal

Dr Govinda K.C. has worked relentlessly to develop better medical care for ordinary Nepalis and has rallied against the commercialisation of medicine.

Doctor KC on fast. Credit: Ajay Rana Bhat/Twitter

Dr Govinda KC on fast. Credit: Ajay Rana Bhat/Twitter

There is no one quite like Dr. Govinda K.C. It would not be an exaggeration to say that the sexagenarian orthopaedic surgeon from Nepal spends every minute of his wakeful existence in the service of mankind. Over the past five years K.C. has staged eight different fast-unto-deaths to put pressure on the government to stop the rampant commercialisation of medical education, and to make cheap and quality healthcare available to the people of the country. Every time he starts one of his famous fasts, the national discourse centres on the fasting doctor, the larger political and constitutional issues are put on the backburner.

In these divisive times in Nepal, when the very meaning of what it means to be a Nepali is being questioned, K.C. has become a common national hero of Nepalis, transcending all caste and class barriers. He enjoys such mass support because of the nobility of his missions.

Most good hospitals and healthcare centres in Nepal are concentrated in its three or four urban hubs, chiefly in the Kathmandu Valley. But new medical colleges still continue to sprout in these over-saturated healthcare markets. These colleges are established with one purpose: to make money. Medical education is a lucrative business in Nepal. An MBBS seat at a private medical college can fetch anywhere between 4 million to 10 million Nepali rupees (or up to INR 6 million). This is why new medical colleges that cater to the upper middle class and upper class clientele have been mushrooming, for those who can afford to fork out big sums so their children can study medicine.

K.C. questions this rampant commercialisation of medical education in Nepal. How can a student who spends up to 10 million Nepali rupees – which is more than most Nepalis earn in a lifetime – be a good doctor, he asks? The focus of such students once they graduate, will be on how to recover their ‘investment’ and not to serve the poor and needy,  K.C. argues.

He believes that if these new medical colleges really want to serve the people and produce capable doctors, as they claim, they should focus on rural areas where there is a dearth of good healthcare facilities and where they are most needed. Such rural hubs will also provide these new hospitals with enough patients with which to train their students. The situation in Kathmandu is so bad that most private medical colleges don’t even get half the number of patients required by the law.

Doctors for all

This is why, the recent agreement between  K.C. and the government of Nepal, arrived upon only after his eighth round of fasting, is meaningful. The two sides have agreed to open at least one medical college in each of the (future) federal provinces. The new agreement also places a 10 year moratorium on construction of new medical colleges inside the Kathmandu Valley.

Moreover, the agreement provides for at least 50% of MBBS seats at government-run medical colleges to be free and filled strictly on merit basis. A parliamentary committee has also been formed, as per Dr. KC’s demand, to investigate the likely complicity of the head of the country’s chief anti-graft body in the arbitrary allocation of MBBS seats.

Taken together, these reforms represent a sea change in how medicine is practiced in Nepal. Without Dr. KC’s intervention, they may never have happened. After the restoration of democracy in 1990, Nepal embarked on the path of near total liberalisation of its economy. Without adequate safeguards for the poor and the marginalised, such commercialisation has only served to accentuate the gulf between the (few) rich and the (many) poor. Dr. KC believes the government should, in a poor country like Nepal, continue to have a major stake in vital sectors like health and education. Such government involvement, in his reckoning, is vital in levelling the economic playing field. Even the constitution guarantees the right to cheap and reliable healthcare to each and every Nepali.

Even though he was asking for sensible reforms, the odds were heavily stacked against Dr. KC. Most private medical colleges in Nepal have investments from high-ranking politicians, MPs and rich business people, all capable of deploying money and muscle power to protect their interests. This is why every time Dr. KC fasts, the government promises to fulfill most of his demands, but soon backs down, partly due to the pressure of vested interests.

Otherwise, he would not have had to repeatedly put his life on the line. This time, too, the government has made big promises. But it won’t be as easy for it to break promises this time as the Gandhian satyagraha of Dr. KC now has the backing of people from all walks of life, including, for a change, many parliamentarians. There will thus be immense public pressure on the new government under Maoist chairman Pushpa Kamal Dahal Prachanda to honour all the recent promises made to Dr. KC.

Noble soul

Dr. KC is a lifelong bachelor and devotes all his time to his students and patients. Every year, he gets two weeks off from his duty at the Tribhuvan University Teaching Hospital in Kathmandu. He spends these two weeks visiting the remotest parts of the country, spending whatever saving he has to treat and buy medicines for the poor and the needy. But his humanitarian works are not limited to Nepal.

For instance he spent three weeks tending to those injured in the 2001 earthquake in Bhuj, Gujarat. He has been to places as diverse as Pakistan, Myanmar, Haiti and the Philippines to offer his services as a medical doctor following various natural calamities in these countries. For this selfless service to humanity, there is now a growing consensus in Nepal that Dr. KC deserves nothing less than the Nobel Peace Prize.

It will be rightly earned. He has become a role model for millions of young Nepalis who otherwise see no hope in Nepal. The dream of most Nepali youngsters these days is to leave the country at the first available opportunity. They have little to cheer for. The country continues to witness up to 14 hours of daily power-cuts. Drinking water supply is patchy. Cartels and syndicates control virtually all sectors, artificially inflating prices of daily commodities and transport services. Hundreds of thousands of earthquake victims continue to live in rickety tents that provide little protection against heavy rains and the bitter winter cold. The never-ending political transition following the 2006 democratic changes, meanwhile, drags on and on.

But when these youngsters see how a single man has succeeded in transforming the lives of millions of Nepalis for the better, with nothing more than his unshakable moral clout, they see some hope. The success of K.C.’s non-violent struggle is meaningful also because this is a country that recently witnessed a bloody civil war in which nearly 16,000 people were killed. Many believe that the decade-long Maoist insurgency legitimised the use of violence in Nepali society. K.C. has now proven that it is possible to bring about meaningful social change, even through non-violent means.

A common refrain one gets to hear on Kathmandu’s streets nowadays is how our forever feuding political parties will do well to take a leaf out of  K.C.’s book: a book that offers a lesson on how best to win people’s hearts and minds.

Biswas Baral is a Kathmandu-based journalist who writes on Nepal’s foreign policy. He tweets at @biswasktm.