To Future Me

Well, as a medical officer I have realised quite a few things- that could be changed to better health services in Nepal. No one else is going to do anything about it. And I can’t do anything now- because I’m not yet in the position to.

Pachi, when I am a top doc- maile pani birshinchu hola yei kura haru- But I want to make a difference, so just for ‘Future’ Me’ to remember these things-

1. Medicolegal issues- Every MO (medical officer) should be properly trained in this matter before they are asked to do a postmorterm or ghau check-jaanch. There should be a judicial body with a medical background- doctors who studied law- to analyse M/L cases and give judgments on Medical negligence cases. Daktarko laparbahi- this verdict shouldn’t come from attendants and jurnos- like nowadays. And if it does, they should be held accountable prosecuted for defamation. LAW about all these. Keeps moral high, of medicos- when there’s a sense of security in their professional environment.

2. MO can work very hard at OPD, ER in peripheries with a guaranteed provision of PG after 3 years of hard work, and this transition should be systematic- orientation on treatment protocols and procedures, M/L system, work assisting Senior MOs- OPD-ER-Academics. A rough design on this system can be found on my other article ‘On Revolutionary Medicine’   http://whyouth.wordpress.com/2014/07/15/on-revolutionary-medicine/

3. As a part of smooth and systemic transition- doctors above 60 years of age will be streamed into teaching and a very responsible governing body of medical fraternity- NMC, NMA.

4. Essential drugs should be available all the time at ER and concerned wards- so no time is wasted in procuring them. Accessibility to labs, and other units should be easy- architecture, so no time is wasted in reaching there. No COPD patient should lose their breath ‘to go to toilet’

5. Roads should have a separate line for emergency vehicles like ambulance, police vans and first responders.

6. Little doctors- for awareness and activity among  (school) children in the community

7. Strong volunteerism (undergraduates), an extension of #6- to help out, and (themselves) have a basic know how- at hospitals.

8. Government owned drug companies- providing high quality drugs- for free.

9. Technologies- microbio./biotechno.- so we can have our own ground breaking research and invention of drugs, don’t have to rely on big drug companies for life saving drugs. No worries about patents and taxes. Home-grown-industries. Essential, because at this time, whole of west Africa suffers  from Ebola because they can’t simply make a vaccine out of thousands of people who have recovered. And there’s a hell lot of ‘money laundering’, yes I call it that for it is as evil, if not more- in the name of preventive measures, awareness, food, social behavior changes etc. to feed unto health bureaucracy. Like wars around the globe is necessary for world’s big economies to benefit- diseases seem to help health agencies thrive. On other hand, people of Africa- all they need is a vaccine. Small pox would be still around  if not for Edward Jenner’s discovery- despite all the ‘awareness, isolation and rehabilitation’. So we will need our own share of high end labs, for our people.

10. Clean food, clean water, clean hands to cook- even while eating out- this is going to be relevant forever. LAW about that.

All these I have on my mind now. But it will be quite sometime before I can really make a difference- maybe a decade. But I will remember!

Murders in my Mind  

moths-flying-around-a-streetlight-530x353

Thousand murders in my head

Every single detail, methods meticulate

Samsheer of razor blades and

Hesitation cuts

Anxiety in ashtray-

A thousand cigarette butts.


In the Temple of sweat

Like an angel of Death I pray

In throbbing of the vessels, I sail

To an abstract everyday

I walk through the reverie-

I can see arts in the wall

And feel carpet in the floor

Touching the wood I,

Slowly push the door,

Creaking like an aazaan -

inspires me a thrill,

Would I, spare you a final appeal?


Not an act of a madman

Not out of rage,

In a cold blood I see you,

Like a climax of the chase.


Thee might be sleeping

Or in awe,

(You) saw it coming,

But not right now.

Fast like a thunder,

Down like a rain

Slices through the throats and

Peripheral vein

When a bleed to death-

There ain’t much pain-

Thus,

Would I want to try again?


To hear the shrieks and

Watch ‘em cry

Would you give me another try?

Even before smears in the wall

Get a chance to dry.


Murder after murder

To feed the soul

‘Know Thyself’

Says Aristotle,

Do you understand a part (of you)

Or even see it whole?


You can kill all you want

As long as its just in your head,

And consequently-

No one, turns up dead.

Bad Habit

-Chirayu Regmi

qwe

You are my choco-pie

Not so sweet

You are my bye bye-

Couldn’t quite do it

You make the background of all I do,

You are the constant music in my head,

You got me hanging by my neck, baby

Till I drop down dead.


Element of my own desire,

you are my funeral pyre,

Smoking my shoulder blade.


You numb my senses,

And kill my wit,

Baby, you are a bad habit,

I really need to quit.

Okay, now

images (1)

Relaxed, maybe good for blood pressure. But how about life?

How about in your prime, when you are young and strong? You are relaxed with your situation- very much comfortable with it. 8 hours of loadshedding a day, noise, pollution, crappy leadership in the country, mis-judged policies. Hooliganism and anarchy. Injustice. If you are relaxed and do nothing about it. Then your situation is not going to change, you have to speak when you need to, fight when you need to stand up against something. (my)Old saying- it is more difficult to be on the wrong side- they might look intimidating- but they can’t fight. Because righteousness is always a bigger sword.

So don’t shy from confrontations- for there will always be. Problems don’t solve by itself, they need to be nailed down. And you can’t depend on anyone else to solve your problems. You got to do it on your own.

No that takes time too. And effort. I am at a situation where I need all my efforts to be best placed to my studies, so I can specialize early enough, make good money by 40s and then do what I want to do for the rest of my life. Most of the people would end their life at what I want to achieve at forty. But I want more- much more. My dreams don’t end with good house, cars and family. I want to get into politics, I want to write, I want to make the difference that I believe in. For that I need a base- to know that I have done for my family- made enough money to live by comfortably. Because getting into politics is a slow process. It will undermine my existence at first, they will all downplay my capabilities. I might even implode. So it’s a survival strategy- that I earn first. Become filthy rich. I am not going to ignore my family’s needs and put the country first. Yes, I do have big plans for the country. But I don’t believe in sacrifices. I don’t agree with bigger the sacrifice, bigger the difference. I will (okay, say selfishly) do with my personal priorities first. I am not a selfless hero.

Thus, I have to stop procrastinating now. I have been in an intellectual coma for a very long time. I have to come out of it. Be alive. For the time, is passing by. And if I don’t build a foundation for my future now my dreams would never realize. If not for dreams, what is there to keep living?

About love, I have loved. Truly, most wonderfully and most sickeningly. It would not be something entirely missing in my life. Though I miss being in love, I can’t afford time to cajole one. So, I will put that in my ‘in a while list’.

I have a long way to go. And fast. So I need to work hard.

Robert Forst said,

Woods are lovely, dark and deep

But I got promises to keep

Miles to go before I sleep.

Miles to go before I sleep.

I missed You

I missed you for so long,

and so bad 

but I realized 

It was not you that I missed.

Or the lover You were

But I missed the Love 

I was in,

and that Love was,

entirely mine-

You were but, a mirror-

where I could see

reflection of my own affection.

 

Where you existed in me,

is a vacant space now-

but that doesn’t make you irreplaceable-

For in winters,

a hand needs a glove

and a dove needs a dove.

My old love,

Goodbye.

 

Random things on my mind

 

 

The blog is infact, named that. But I have not been quite so random. Let me be.

’14 has been a bad year for aviation industry. Malaysian A380 still missing, another one shot down in Ukraine with all the travelers dead, and as of yesterday- a Taiwanese domestic carrier went down trying to make an emergency landing.

Its been a bad year so far- bad for humanity. And shameful too, for us who are merely spectators of the extreme form of injustice around the world- and can do nothing about it. Not just a common folk like you and me, but the very UN, who is entrusted with such a job.

1. Fall of Muslim brotherhood in Egypt, a military coup- who is passing indiscriminate sentences, prosecuting opponents, free thinkers, including journalists. Devolution of Egypt from the great nation it once was.

2. Hundreds of girls abducted by boko haram in Nigeria, to be raped and enslaved- and we could do nothing about it.

3. ISIL, a sunni militant group, who were once aided arms and otherwise by US, NATO(in Syria, to fight proxy war against Russia/Assad)- surge most of Iraq- with Iraqi government now weak and helpless- as foreign forces that invaded the country to find ‘weapons of mass destruction’ turned it upside down, only not to find it and left- can’t defend its ethnically diverse population- shias, kurds, christians etc. Its terrible to see them lined up and shot in the back. And we can do nothing about it.

4. People of Ukraine kill each other, in ethnic lines- but the conflict is, a mere tug of war between Russia and rest of Europe. Why pay so heavy.

5. Tragic of all is killing of people of Palestine by Israel, most of them commoners- unarmed men, women and children. I can’t even comprehend how such a thing can happen in this ‘modern’ age. But, Israeli airport had to be closed for a couple of hours due to air raids from gaza, makes a bigger news than thousands being killed on the other side.

I abhor international community, the UN, leaders of today for not doing what they can do to save innocent lives around the globe.

Someday, I will make a difference.

p.s- I started meaning to write all the random things I had in mind, but the tone of this post has turned so grave, other petty thoughts don’t even compare. But they are there too, I will post separately.

On Revolutionary Medicine

Socialized_medicine

 

The life of a single human being is worth a million times more than all the property of the richest man on earth.’ Che Guevara, 1960.

Upon being hit by jet liners in the terrorist attack of 9/11 the Twin Towers of New York City collapsed and turned into rumbles within minutes. Thousands of people were buried inside. Brave American men, fire fighters, first responders along with many civilians volunteered to help, amid lots of smoke, dust and pain.  As a consequence of unprotected exposure to pollutants and trauma, many of those who volunteered developed a variety of respiratory illnesses ranging from pulmonary fibrosis to cancer. Many had psychological terrors like PTSD. When they sought for healthcare in American hospitals, they were denied such, as their insurance did not cover the deliberate exposure of oneself to hazardous conditions. Paying on your own is way too expensive.

As depicted on a documentary called Sicko by Michael Moore, some of these patients sail on speedboats to reach Havana, Cuba, where they receive free checkups, treatment and plenty of medicines to take back home.

Even if we doubt the facts laid by Moore, there is one thing we can all agree upon- though highly sophisticated, the capitalist-styled profitable healthcare system of USA is non universal and thus, a non-existence to many of its own citizens.

Cold war is over. Capitalists have emerged victorious in all but one front- provision of free and high quality essential services to all, like police service for security, emergency responders for fires or any other calamities, health and education. Yes, I deliberately put doctors, teachers, firemen and policemen in the same context, because as much as it is the responsibility of the government for the peace and security of its citizens, it is, for universal health and public education. There can be another discourse on education. This time we talk about health.

Driving around Kathmandu, I see many hoarding boards of private clinics and hospitals. They advertise of services and make promises- like a fairness cream would promise a glow. Such an utter commercialization of health care- it breaks my heart. If you delve in deeper, you can realize the ugliness behind posh medical facade. There are many private hospitals in the city with ‘marketing officers’, whose sole duty is to call ambulance drivers to negotiate commissions for bringing a critically ill patient to them, which is often as high as 4000 rupees. Imagine the size of the bill on discharge.

Poor patients are often denied proper medical care. Every other day some newspaper runs an impromptu piece on how a patient died due to a doctor’s negligence and hospital got vandalized. How government hospitals are understaffed and unclean. And about corruption in purchase of life saving drugs like misoprostol.

But all these examples represent merely the tip of an iceberg. Everything that is wrong with existing health care system is due to chronic lack of vision and planning in making of health care workers, doctors and dispatching them for duty.

 

Making of a doctor

Despite being a profession underpaid and overworked, exploited and allegedly, mundane- our society fancies in their sons and daughters becoming doctors. With dull economy, a medical job might look more secure than other things, so there are many who want to become doctors- which is not bad at all- so many people signing up for a service oriented profession like this. But there’s a catch- we don’t have proper medical education system in our country. We have just one government medical college providing about 40 undergraduate scholarship seats, and rest of the private or semi private institutions serve the desires of aspiring doctors, but in a very high price. It costs at least 4 million to become a MBBS doctor. The prospect is as grim for post graduation studies. Scholarship seats are so few, an aspiring doctor has to either provide his service elsewhere like USA or Australia or pay as high as 10 million or even more to specialize.

Medical education should be free, and to the deserving students. Because the profession is such- where you work really hard through med school and the whole life; where study and work are lifelong priorities; subduing personal comforts or family life; where you skip meals or sleeps for strangers called patients.

The irony is, society expects doctors to invest like a businessmen and serve like a clergyman. It simply cannot happen.

Prof. Dr. Govinda K.C led a fast unto death against such a system, a part of it. Motive behind was to make post graduation scholarships available and of high standards. But despite medical doctors all over the country striking for several days, it could not bring anything tangible. It is because neither our brotherly organization NMA nor governing body NMC has realized impending failure of the system. Or even if they do, they are too happy to complain with the commissions provided by private colleges. But I am not. I worry for the moment when someone in my family gets ill and needs a sophisticated medical care. USA or Singapore or Delhi is beyond everyone’s reach. We have to improve our system and survive here.

 

Where does all the health budget go?

Yes, we do get an ample amount of budget for health care. This covers the salaries of government medical staffs, which they receive for attendance at their institution, and their bhattas which they receive for doing everything else. That is okay, in light of meager salary they obtain for such a hard work (which indeed is, if they work as per norms and needs). But a big chunk of it is wasted through a syndicate of NGO/INGOs with collaboration of health bureaucrats especially during June/July, at the closure of fiscal year- in programs and projects hurriedly planned and carelessly executed. Global Fund provides huge financial support to the government to be spent through partner organizations, and they work- mostly on paper and reports. With most of the aid bearing managerial cost of the projects, they fail to bring any tangible change. To improve overall health of the people, to reach the goal of ‘Health for all’ as we signed in Alma Ata in 1978, all this money should instead be used in establishing a proper health education system in the country, so we can have skilled and willing-to-serve human resource. After all, we cannot depend on foreign aids for the health of our people.

 

How to solve?

A scientific and sufficient health service delivery system, reaching people.

A medical education system to teach, train and produce doctors, nurses and other paramedical staffs.

We have 3600 VDCs in the country. Each VDC has a Health Post, the basic unit of our health organogram. It should have a Health Assistant incharge, with 2 AHWs. Co-existing birthing center should have a staff nurse with 2 ANMs. At next level is a Primary Health Center covering an electoral constituency, which we have 240. Since it provides OPD services to a larger number of and referred cases from Health Posts, in-patient along with 24 hours emergency services, it should have 3 medical officers (doctors) with 2 HA and 5 AHW. Birthing center at this level should have a nurse with Bachelor’s degree, with 2 staff nurses and 5 ANM. PHC will also be overseeing all the community level preventive health programs like immunization, infant care, hygiene etc, rendering NGO led activities redundant. It will be a cost cutting measure in long run.

Each district hospital should be able to treat 80 percent of the cases. After all, it is a health center for the whole district. It should have a double team of consultants (there should be at least two of medicine specialists, gynecologists, surgeons etc) so that one of them can be available all the time; nobody can work 24 hours a day and 365 days a year, thus. It should have a team of 6 medical officers and other paramedical staffs in proportional ratio.

Zonal hospitals should become tertiary centers; teaching hospitals. With ICU, CCU and higher specialists, it should be able to solve 90 percent of the cases. It will have highest flow of the patients, highest concentration of doctors, labs and everything. Since lack of free medical education is a core issue, each of these 14 zonal hospitals will have excellent medical schools, providing 50 scholarship seats for undergraduate studies every year (a total of 700!), to deserving candidates- irrespective of caste, sex, or hometown- but based purely on merit- for we want the best to become doctors and deal with our life and sickness, not the lesser competent.

Such academic centers will not only produce free education to aspiring doctors and nurses but also vacancies for professors- who will now be available at zonal levels. They will mentor post graduate students. With two PG seats in each faculty (including both clinical subjects like medicine, surgery and basic sciences like anatomy, pathology etc)- we will be producing about 30 specialist doctors from every zonal center.  Multiply that with 14 teaching hospitals- we will be providing higher medical education to more than 400 doctors every year, which is a great leap from existing 40. With residents to work round the clock in such hospitals providing meticulous care to patients, service quality will greatly improve and upon graduation they will serve at district hospitals, replacing the consultants who will now become a faculty at zonal teaching hospital. Not only will there be a constant production of medical graduates and specialists, there will be a system of service at all levels, as a clinician and as a teacher- and a timely retirement.

 

With highly sophisticated zonal centers, we would not need the namesake sub regional hospitals. Regional centers will take care of all unsolved cases. Here, professorships will be awarded to consultants, and higher specialization courses will be offered. It will also be the center for skill based trainings and research- where we will invent and devise ideas to revolutionize medical science, provide something to humanity. There will be government pharmaceuticals producing high quality drugs and these medicines will be provided for free- just like medical care would be.

Further, some highly populated districts can have two or three district-level hospitals of equal stratum and formation, each one of them responsible to zonal centers. Big cities can have a couple more; in addition to specialized centers for trauma, heart, kidney etc. But this new plan will discourage people to cluster around cities, since (availability of) health facility is one of the reasons why people migrate.

One might ask, what will be the role of private hospitals and medical colleges, then? They should be graciously thanked for the service they provided when there was none, and asked to seek business elsewhere, for healthcare is not a business and it should be free, for all.

The system as it is, is already a mess and on the verge of a breakdown. If we really want the state of affairs to improve, we- the people, the doctors, the clients, the stake holders should do more than just lament or charity. We need to work on similar plans and preserve to the realisation.

This whole idea might appear audacious to many. I would like to quote Che again, ‘At the risk of seeming ridiculous, let me say that the true revolutionary is guided by a great feelings of love.’

 

Dr. Chirayu Regmi

(who is doing his part at a primary health center in Shrigaun, Dang)