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



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)










ब्रिहत बाम एकता


रोवटले आफ्नो महाधिवेशन उद्घाटन गरेको एमालेले पार्शब पोष्टरबाट माक्र्स र लेनिनलाई हटायो । अहिले नीतिबाट साम्यवाद हटाउने कुरा गर्दैछ ।

दोस्रो विश्वयुद्धताकाका प्रभावशाली बेलायती प्रधानमन्त्री विन्सटन चर्चिलले भनेका थिए– तिमी बीस वर्षको हु‘दा तिमी यदि कम्युनिष्ट छैनौ भने तिम्रो मुटु छैन र तिमी चालीस पुग्दा पनि तिमी अझै कम्युनिष्ट छौ भने तिम्रो बुद्धि छैन । अर्थात् साम्यवादी सोच र चेतना भावनाको कुरा हो । मान्छे–मान्छेबीचको असमानतालाई देखेर समताको खोजीमा तल्लीन र बिह्वल हुने भावना । भावना मान्छेमा हुन्छ, मान्छे भित्रको स्पन्दनमा । आधुनिकताको आवरणमा रोवटले महाधिवेशनको उद्घाटन गरेर एमालेले भावनात्मक शून्यताको सांकेतिक सम्पे्रेषण पनि गरिसक्यो । तर यो सैद्धान्तिक विचलन मात्र होइन, राजनीतिक मुर्खता पनि हो ।

कार्ल माक्र्सले कुनै पनि समाजको विकासक्रमलाई पॉच कालखण्डमा बॉडेका छन् –(१) घुमन्ते फिरन्ते गुफामा बस्ने, शिकार गर्ने र बॉच्नका लागि मात्र बॉच्ने पशुवत तर स्वतन्त्र आदिम युग, (२) राजा रजौटालाई गरिवपरवर भन्दै आफ्नो दासत्वलाई निर्बिरोध स्वीकारेको दास युग (३) सामन्तवाद (४) प‘ूजीवाद र (५) समाजवाद । हामी अझै बाउबाजेका टुक्रा टुक्रा खेत बिर्तामा पाउ‘छौ र त्यसैलाई अधियामा लगाउ‘छौं । हामी साना–साना तर अझ सामन्तवादी छौं, जहॉ कामको मूल्य छैन या निकै कम छ । अझै पुख्र्यौली सम्पत्ति या धन जो पहिल्यैदेखि छ, त्यसकै महत्व छ र हामी त्यसैमा आश्रित छौं । हाम्रो लागि काम गरिदिने अरु कोही छ या अरबमा कमाएको पैसाले हाम्रो खेत कसैले किनिदिन्छ र त्यही पैसाले हामीलाई पुग्छ । पढ्नुपरेको छैन, खासै काम गर्नुपरेको छैन । हाम्रो देशमा सर्वहारा (नभएकाहरु) र बुर्जुवा (भएकाहरु) उस्तै उस्तै छन् । नभएकाहरु केही गरेर खान्छन्, भएकाहरु केही नगरी खान्छन् । तर त्यही खान्छन् । खान्छन्, अर्थात देशमा उपलब्ध शिक्षा, स्वास्थ्य, सुरक्षा, आवासलगायतका सुविधाहरुको उपयोग गर्छन् । तर देशमा अर्थतन्त्रको कुनै भरपर्दो आधार छैन ।

पु‘जीवादको पूर्वसर्त के हो भने यस संरचनामा कुनै उद्योग व्यवसाय हुनुपर्छ । समग्र देशको अर्थतन्त्रलाई प्रभावित गर्ने बृहत्तर व्यवसाय हुनुपर्छ । त्यसमा ‘भएका’हरुले पू‘जीको लगानी गर्छन् । वस्तुको उत्पादन गर्छन र त्यसलाई बजारमा लगेर बेच्छन् । उनीहरु काम गर्ने श्रमिकहरुलाई तलब सुविधा पनि दिन्छन्, तर त्यो पारिश्रमिक बजारको मूल्यको सानो अंश मात्र हुन्छ । आफैले उत्पादन गरेको वस्तुको केवल ज्याला मात्र प्रप्त गरेर मजदुर, त्यही र त्यस्तै किसिमका सामानहरु चर्को मूल्यमा किन्न बाध्य हुन्छ । अर्कातिर लगानीकर्ता, त्यही लगानीकै बलमा राम्रो नाफा कमाउ‘छ, धेरै क्रियाशीलता या मेहनतबीना । यो नाफा लगानीकर्ताले गरेको व्यवस्थापकीय सेवाबापत पाउने ज्याला नभई प्रारम्भिक पु‘जीको प्रतिफल हो । मजदुरको मिहेनत, किसानको बरकतले भन्दा पु‘जीपतिको पेवाले बढी प्राथमिकता र पुरस्कार पाउ‘छ,  तब धनी झन्झन् धनी बन्दै जान्छन् र गरिब झन्झन् गरिब । काम र कमाइको कुनै तालमेल रह‘दैन । तब संघर्ष हुन्छ, घर्षण हुन्छ यी दुई वर्गको । र अन्त्यमा निर्माण हुन्छ वर्गरहित समाजको । त्यसैको परिकल्पनालाई र योजनालाई भन्दछन्, साम्यवाद ।


एउटा परिवारमा श्रीमानले कमाउ‘छ, श्रीमतीले पनि सकेको काम गर्छिन्, कमाउछिन् र खानाको पनि व्यवस्था गर्छिन् । त्यो परिवारमा साना केटोकेटी र बुढा आमा बाबुले कमाउन नसक्लान् । तर जसले कमाउ‘छ उसले आफूले सकेको जति काम गर्छ र आफ्नो परिवारमा आश्रित सदस्यहरुको सबै आवश्यकताहरु पूरा गर्छ । समाजवादले त्यही समुदायको परिकल्पना गर्छ जहॉ एउटा ठूलो सुखी परिवारमा जस्तै सबैले सकेको जति काम गर्छन् र सबैले आफ्नो आवश्यकताअनुसारको स्रोत र सुविधाको उपयोग पनि गर्छन् । यहॉ लोभ हु‘दैन, धन थुपार्ने लालसा हु‘दैन, अभाव हु‘दैन, अन्याय हु‘दैन र कुनै किसिमको विभेद हु‘दैन ।


नेकपा माओवादीको रक्तरञ्जित जनयुद्धको उद्देश्य सामन्तवादको यथास्थितिबाट छलाङ्ग मारेर सोझै समाजवादमा प्रवेश गर्ने थियो । तर बामे नसरी दौड्न खोजेको शिशु जसरी पछारिन्छ, असमयमा गरिएको अपरिपक्व आन्दोलन स्खलित भयो र उसले पनि आज कांग्रेस, एमालेले जस्तै सत्ताको राजनीति गर्दैछ । दलीय राजनीतिलाई माक्र्सले निषेध गरेका छैनन् । हामी त्यही प्रश्नहरुको मात्र जवाफ दिन सक्छौ, जो इतिहासले हामीलाई सोधेको छ – तीन शताब्दी अघिको उनको दास क्यापिटलले अहिलेको परिवर्तित विश्व सन्दर्भको प्रत्येक प्रश्नहरुको जवाफ दिन नसक्ला । त्यसैले समयानुकूल दलीय राजनीति गर्नु, प्रतिस्पर्धा गर्नु ग्राह्य मात्र होइन सही पनि हो । तर धर्मलाई समाजको अफिम हो, यसले मान्छेमा विखण्डन र वितृष्णा निम्त्याउ‘छ भनेर नास्तिक बन्ने कम्युनिष्टहरुले सस्तो लोकप्रियताका खातिर जातजातिका नाममा, सम्प्रदायको आधारमा संघीयस्वरुपको परिकल्पना गर्नु पनि कम्युनिष्ट दर्शनप्रतिको घोर अनादर हो । अहिले राष्ट्रियस्तरमै निस्वार्थ र सक्षम नेताहरुको अभाव छ । यो अवस्थामा यदि संघीयता आयो भने पनि राज्यहरुको ठेक्का, बगरका ढुंगा ठेक्कामा लिने ठेकेदारहरुले लिने छन् र राजनीतिक कुशलता एवं आर्थिक संयन्त्रको अनुपस्थितिमा ती साना–साना संघीय राज्यहरु असफल हुनेछन् । दक्षिणतिरका राज्यहरुले बिद्रोह गर्नेछन्, स्वाधिनताको जिकिर गर्ने छन् र युक्रेनबाट क्रिमिया छुट्टिएजस्तै छुट्टिनेछन् । कर्मशील, शिक्षित नेपालीहरु कि चुपचाप जागिर खान्छन् कि विदेश जान्छन् । देश जसको जिम्मामा छ, तिनमा देश बनाउने न त खुबी छ न इच्छाशक्ति ।


समाजवादको सबैभन्दा ठूलो दुश्मन पू‘जीवाद होइन, न त विस्तारवाद । यसको ठूलो अपराधी भनेको समाजवादको नाममा राजनीति गर्ने तर आफ्नो निहीत स्वार्थमा मस्त हुने कम्युनिष्ट भनाउ‘दा नेताहरु हुन् । परोक्ष र प्रत्यक्षरुपमा सधै सत्ताका नजिक भएर पनि एमाले, माओवादीलगायतका शीर्ष दलहरुले हाम्रो जीवनस्तरमा खासै परिवर्तन ल्याउन सकेनन् । सबैका लागि शिक्षा र स्वास्थ्यको नीति छ तर सरकारी विद्यालय र अस्पतालहरु संरक्षण र सुपरिवेक्षणको  अभवमा असफल छन् र निजीले प्रश्रय पाएका छन् । भूमिसुधार भएकै छैन, खेतवारीहरु बॉझो र अनुत्पादक छन् । कामको मूल्यलाई उच्च कदर गर्ने भने पनि निकै संस्तोमा हाम्रा जनता विदेशमा श्रम गर्न जान्छन् । देशमा न उद्योगधन्दा छ न अन्य कुनै आर्थिक क्रियाशीलता । न आर्थिक विकासलाई टेवा दिने गरेर पूर्वाधारहरु–बिजुली, सडक, रेल, सामुदायिक कृषि या सीप विकास नै भएको छ । बरु बिर्सिदै जाने र एकीकृत हुनुपर्ने जातजातिजस्ता बिखण्डनका पर्यायहरुलाई दातृ संस्थाहरुको सहयोगमा ब्यु‘ताइदैछ र त्यसैमा गरिदै छ, राजनीति ।


यथास्थितिस‘ग निराश र असन्तुष्ट वर्गले विद्रोह गर्छ र प्राकृतिक प्रवाहमा त्यो विद्रोह समाजवादको दिशातिर उन्मुख हुन्छ । यसर्थमा ०७ सालमा विपिले नेतृत्व गरेको राणाशाहीबिरुद्धको विप्लप, ०४६ सालको तानाशाही खिलापको जनआन्दोलन र ०६३ को राजाबिरुद्धको आन्दोलन सबैले समानताको शिखा समातेका थिए । पटकपटकका यस्ता विद्रोह र माओवादी जनयुद्धको प्रभावले पनि शायद विश्वका प्रजातान्त्रिक मुलुकहरुमध्ये सबैभन्दा बढी नेपाली जनतामा कम्युनिष्ट चेतना र सहानुभूति छ । त्यसैले प्रत्येक चुनावमा कम्युनिष्ट भोट बढी खस्छ, तर कम्युनिष्टहरु कहिले एमाले र माले बनेर हार्छन्, कहिले एमाले र माओवादी बनेर हार्छन् । समान विचारधारा बोकेका यी दुई दल एक अर्कालाई भन्दा दक्षिणपन्थी दललाई नजिक ठान्छन् र कार्यगत एकता गर्छन् । आफ्नै नेतृत्वपंक्तिमा झगडा गर्छन् । फुटछन् र हार्छन् । अनि सर्वाधिकार अरुलाई सुम्पिन्छन् । दोष नेताहरुको हो– जसले जनता र सिद्धान्तका पछि लागेका कार्यकर्ताको भावनाप्रति न्याय गर्न सकेका छैनन् ।तर यो वाम  उर्जा र उद्वेगलाई एकाकार गरेर नेपाली कम्युनिष्ट आन्दोलनको नेतृत्व यदि कसैले गर्छ भने पथभ्रष्ट, विमुख र विचलित भएका साना ठूला सबै दलहरु त्यही प्रवाहमा समाहित हुनेछन् र माक्र्सको आधारशीलामा एउटा विकसित र समुन्नत सुखी समाजको निर्माण हुनेछ ।