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)

 

 

 

 

 

 

 

 

 

स्वास्थ्य र समाजवाद

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सन् २००१ सेप्टेम्बर ११ मा अमेरिकाको न्यूयोर्क शहरमा आतंककारी हमला भयो । ट्वीन टावर क्षणभरमै धराशायी भए र भग्नावशेषमा हजारौं मानिसहरु फसेका थिए । त्यही बेला अमेरिकी जनता स्वतस्फूर्तरुपमा अप्ठ्यारोमा परेकाहरुलाई सहयोग गर्न होमिए– त्यो संकटको धु‘वा धुलोको कत्ति पर्वाह नगरी । तर त्यही प्रदूषण र दुर्घटनाको चपेटाले कालान्तरमा धेरैलाई स्वास प्रश्वाससम्बन्धी समस्या एवं मानसिक तनाव (PTSD) ले प्रभावित ग¥यो । उनीहरु आफ्ना देशका अस्पतालमा गए, उपचारका लागि । तर आफूलाई जोखिमयुक्त वातावरणमा स्वेक्षाले राखेको भन्दै त्यहॉका इन्सुरेन्स कम्पनीले उनीहरुको उपचार खर्च गर्न मानेनन् । आफै पैसा तिरेर उपचार गर्न एउटा मध्यम वर्गीय नागरिकलाई अमेरिकामा असम्भव प्रायः हुन्छ । त्यहॉ स्वास्थ्य विमाको चलन छ ।
उनीहरु डुंगा चढेर समुद्रको बाटो हु‘दै क्यूवा झरे । त्यहॉका हेर्दा सामान्य झै लाग्ने क्लिनिकमा नाम र उमेर मात्र सोधेर निकै सस्तोमा उपचार गरियो र घर फर्किदा अलि दिन पुग्ने औषधिसमेत लिएर फर्किए ।

आजको युगमा दुई नितान्त अलग दर्शनहरु पू‘जीवाद र समाजवादको द्वन्द्व छ । अमेरिका पू‘जीवादको द्योतक हो भने क्यूवा आधुनिक समाजवादको सीमास्तम्भ हो । दुबैले आफ्नै किसिमले प्रगति गरेका छन्– आर्थिक, सामाजिक, सैन्य–विभिन्न पहलहरु होलान् तर त्यहॉका जनताले कति सुख
सुविधा पाएका छन् भन्ने कुराको एउटा कसी स्वास्थ्य सेवा हो र त्यसमा निःसन्देह क्यूवा अगाडि छ ।

हाम्रो देशमा प्रत्येक चुनावमा कम्युनिष्ट भोट बढी खस्छ । त्यो फरक कुरा हो कि उनीहरु कहिले माले एमाले बनेर हार्छन्, कहिले एमाले र माओवादी बनेर हार्छन् । फलस्वरुप आम नेपालीमा शायद जन्मसिद्धरुपले विकसित ‘समाजवादी’ भावनालाई कदर गर्न असमर्थ हुन्छन्- पानीले भरिएर पनि लोटा चुहिएर एउटा पियासु अतृप्त भएजस्तै । मैले ‘जन्मसिद्ध’ र ‘भावना’ भनें किनकि त्यो नेपालमा छरपस्ट भएका वामपन्थी दलहरुले शिक्षा र जागरणको अनवरत प्रयासले विकसित भएको चेतना होइन, बरु समानता र एकरुपताको प्रकृतिपरक स्वभावले प्रादुर्भाव भएको फगत एउटा सुषुप्त भावना हो । जुन भावनाले न माक्र्सवाद सुन्न पाएको छ, न पू‘जीवाद केलाउन पाएको छ । अल्छी कम्युनिष्टहरुको निस्क्रियता, भ्रष्ट बामहरुको दुराचार र उग्रवादीहरुको नरसंहारमा परेर त्यो भावना एकाकार भएर चेतनामा विकसित हुन पनि पाउ‘दैन । त्यो अमूर्त भावनाले न अन्याय र अव्यवस्थालाई पहिचान गर्न सक्छ, न त्यसको विरुद्ध
आवाज नै उठाउन सक्छ । त्यो त चूपचाप सहन्छ– १२ घण्टाको अन्धकार, पानीदेखि पेट्रोलसम्मको हाहाकार, आर्थिक मन्दी, शिक्षण संस्थाको तालाबन्दी, अड्डा अदालतमा निर्लज्ज भ्रष्टाचार, बेरोजगारी, महंगी र अपराध ।
त्यसैले त यहॉका कम्युनिष्ट भनाउ‘दा सत्तासीन पार्टीका केन्द्रीय नेता निजी मेडिकल कलेजका निम्ति खुलेआम लविङ् गर्छन् समाजवादको खोल ओढेको पू‘जीवादी ब्वॉसोले जस्तै । म निजी मेडिकल कलेज र निजी अस्पतालको खिलाफ होइन– उनीहरुले पनि आफ्नो किसिमले सेवा दिएकै छन्, तर एउटा कम्युनिष्ट कहलिएको व्यक्तिबाट स्वास्थ्य जस्तो आधारभूत कुरामा यति निजीकरण र नाफामुखी उद्देश्य निसंकोच व्यक्त हुनु दुःखलाग्दो कुरा हो । चिकित्सकजस्तो अहोरात्र खटिएर विरामीको सेवा गर्ने पेशा पैसा तिरेर पढ्ने कुरै होइन, त्यो पनि लाखौं । यसमा विद्यार्थीको क्रयशक्ति भन्दा पनि सेवाको भावना मुख्य हुनुपर्ने तर बिडम्बना नेपालमा सरकारी मेडिकल कलेज एउटा मात्रै छ । फलस्वरुप परोपकार र सेवाको भावना भएका जेहेनदार र काविल विद्यार्थीहरु पनि स्नातक तहमा लाखौं र स्नातकोत्तर तहमा करोडौंसम्मको मूल्य तिरेर पढ्न वाध्य छन् । यसरी स्वास्थ्य जस्तो संवेदनशील क्षेत्रमा उत्पादन हुने जनशक्ति क्षमताको आधारमा नभई खर्च गर्ने औकातका आधारमा तयार हुन्छ । स्नातक तहमा अपुग र स्नातकोत्तर तहमा शून्य प्रायः छात्रवृत्तिको व्यवस्थाले गर्दा अध्ययनमा शिक्षा र सीपभन्दा स्रोत मुख्य हुन पुगेको छ ।
जब पैसा, त्यो पनि धेरै, तिरेर अध्ययन गरिन्छ, सेवामा पनि व्यापारीकरण बढ्छ । एकातिर चलाख व्यापारीले खोलेका निजी क्लिनिक र नर्सिङ होम, अर्कातिर ठूलो लगानी गरेर बनेका चिकित्सक/स्वास्थ्यकर्मीहरु, अनि कसरी हुन्छ स्वास्थ्य सेवा सस्तो र सर्वसुलभ ? नेपालको समग्र स्वास्थ्य क्षेत्रको सबैभन्दा ठूलो कमजोरी भनेको सरकारले कहिलै नेतृत्वदायी भूमिका निर्वाह गर्न सकेन । उसले आफ्ना जिम्मेवारीहरु, विशेष गरी अध्ययन अध्यापन, निजी क्षेत्रको जिम्मामा छोडिदियो र लगानीकर्ताहरुलाई यो राम्रो अवसर भयो । संसारमै आज स्वास्थ्य सेवा ठूलो व्यवसाय बनेको छ– औषधि, औषधिजन्य उपकरणहरुको उत्पादनदेखि शिक्षण र सेवा प्रदानसम्म ।
जब निजी क्लिनिक र नर्सिङहोमहरु मौलाउ‘दै गए, सरकारलाई पनि सजिलो भयो– उसले ठान्यो आफूले गर्नुपर्ने काम अरुले नै गरिदियो । मारमा परे जनता, जुन चिज निकै सस्तोमा सजिलै उपलब्ध हुनुपर्ने थियो, त्यसलाई चर्को मूल्य तिरेर प्राप्त गर्नुपर्ने भयो । अपर्याप्त दरबन्दी भएका सरकारी संरचनाहरुलाई अपुग तलब
भत्ताले उदासीन र असन्तुष्ट स्वास्थ्यकर्मीहरुले धान्न सकेनन र यिनै भोका नाङ्गा श्रमजीवीहरुलाई थोरै बढी सेवा/ सुविधाको सम्मोहनले तानेर व्यापारीहरुले गुणस्तरीय सेवा भन्दै निजी व्यवसाय सञ्चालन गरे ।
स्वास्थ्य कदापि व्यापार व्यवसाय बन्नु हु‘दैन । यो जनताप्रति देशको दायित्व हो । अहिले सरकारको निस्क्रियता र निकम्मापनले गर्दा जुन अभाव छ , त्यसलाई निजी सेवा प्रदायकहरुले केही पूरा गरेका छन्, त्यो सह्रानीय छ तर प्रत्येक मान्छेको सुस्वास्थ्य, उत्तरदायी सरकारको जिम्मेवारी हो । जसरी आम मान्छेको सुरक्षाका लागि प्रहरी छन्, कतै आगो लागे दमकल आएर निभाउ‘छन्, कतै बाढी पहिरो आए सशस्त्रका उद्धार टोली खटिन्छन् र त्यसका लागि पैसा तिरेर सहयोग गर्ने निजी कम्पनी हु‘दैनन्, स्वास्थ्य पनि त्यस्तै हो । यो कुरा सुन्दा अचम्म लाग्ला, किनकि सबै कुरामा सहनशील हामी नेपाली जनतामा आफ्नो नैसर्गिक अधिकार बुझ्नसक्ने क्षमता पनि हराइसकेको छ । तर कालान्तरमा स्वास्थ्य धनी गरीब सबैका लागि समान, गुणस्तरीय र सर्वसुलभ हुनुपर्छ । यो आजको भोलि सम्भव नहोला तर त्यो दिशामा प्रयास आजैबाट शुरु गर्नुपर्छ ।

 

डा. चिरायु रेग्मी

श्रीगाउ‘ प्राथमिक स्वास्थ्य केन्द्र श्रीगाउ‘, दाङ

NO ELECTION IN NOVEMBER-2

-Chirayu Regmi

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Call me a skeptic, but I do not really see the point of upcoming constitutional assembly election. There are two, valid I think, reasons I dare say that.

Why did last constitutional assembly fail to deliver the much anticipated book of laws, even while its term was extended, four times? Well, they say it was about the ‘type’ of federalism, they could not agree upon- so after a series of disagreements, they finally gave up shamelessly, to appear again to forever forgetful forgiving people of Nepal, each one of them (major parties) hoping maybe, could salvage a majority this time, and make a constitution like they want.

And if we really believed in that, and if were clever enough to conspire to make one party win (but there are oh, so many parties), then this election might fulfill its aspirations. Otherwise, without the major parties (while a major chunk of a major belligerent party remains anti-election) agreeing on a common ground, or at least willing to, this whole election will be a mere fiasco. And what if the parties agree, negotiate and work towards the goal? Then, we simply don’t need the election! Revive the old committee, and publish what is almost drafted already.

When we were young, while playing cards, if none of us had a good set in hands, we used to unanimously agree to a rematch, and each one drawing cards again hoping to get something better this time.

Election costs lots of money- not just government’s. One candidate spends a minimum of 5 million, and one can easily guess what kind of money that is. Huge sums pledged by businessmen, and agents of various sorts, will be thankfully refunded, with hefty interest in terms of undue favors when the bloke makes it to power. It’s a vicious cycle of corruption and crime.

Second reason is more pertinent. We are heading to an election that would dictate ways of our life, without proper preparation. Without discussing the grave issues like Federalism, the prospects of sustainability, the economic viability, the risk of collapse and danger of disintegration, we are upto it, like it is some magic wand that will take all our woes away.  No, Federalism is just a fancy word here, to give people a false sense of achievement.

We have a communist party who looks to secure votes in name of ethnicity, a 180 degrees of deviance from what Marx said in ‘religion is opium of society’, rather juxtaposed to the British ‘divide and rule’. Parties’ manifestos are overburdened with bogus terms, and do not even bear a clear insight of the situation or society, let alone deal with the problems in a sensible manner. Corrupts and incompetents constitute the standing committees. Convicts, murderers and goons are contesting.  Do we really want these people sketch our dreams, design our destiny? We do not yet have the political maturity, in public or the leadership good enough for the purpose. That is why it aborts, maybe for right reasons.

Bangladesh burning

 

 _Chirayu Regmi

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Bangladesh has been making headlines for months now. Bloody headlines, for all the wrong reasons. Some months ago there was a fire at a garment factory that took lives of more than 100 workers, and an investigation later suggested it was sabotage. Owners of the factory, failing to deliver the consignments on time decided to burn down their own factory, to save some money. And there was much hyped war crime trials that triggered great riots all over the country, for the prosecution of the convicts and against it. And more recently a building collapsed killing 1100 people- most tragic of the kind.  As of yesterday, there was a more vandal demonstration by radical Islamists demanding Shariha type laws and death for blasphemy- and so far 26 are dead already in this spring of riots.

Bangladesh is a small country, much like our own- but it is the most densely populated country in the world, with the population of about 160 million.Most of the people are poor, with greater segregation between filthy rich elites, and the Rikshwa pullers and day labourers occupying the lowest strata. But middle class population serve a great buffer, and it is this population that has helped this country become a rampant economy in last decade.

To understand Bangladesh, one needs to look at its traffic. It must be the most awful driving culture in the world, they drive fast and rash, not leaving an inch of space between the vehicles. Every single, and I literally mean every single vehicle has been scratched here and banged there. That’s how life is like in Bangladesh. Its harsh- you have to keep moving, struggle to survive. If you stop for a moment- either you are run down or you fall far behind. So everyone is in hurry, everyone is making plans- not of great amusements, but merely of survival.

When Radcliffe decided to draw lines between India and Pakistan, he had merely religious considerations. And thus, culturally immiscible Pathans, Punjabis, Sindhis, Balochs and muslim Bengalis (situated 1000 miles away) were made a single country- Pakistan. The ruler class in West Pakistan always suffered from superiority complex, regarding Benagali muslims as lesser kinds and though majority of the population lived in East, and they produced maximum revenues through glorious jute exports, the Bengalis had very little representation in civil administration or military.   Thus when Mohammad Ali Jinnahdeclared only and only Urdu would be the state language for whole Pakistan, the language loving population of erstwhile east Pakistan retaliated. The bhasha andolan that started in early fifties, and culminated into climax- the liberation war of 1971. People were already angry over decades of economic injustice and racial discrimination, and in November of 1970, a cyclone hit badly in the east. Central government in the West responded poorly to aid the victims. In the election that followed Awami League led by Seikh Mujib emerged as the biggest party, but Pakistani elites were reluctant to recede. Despite winning a clear majority AL was not allowed to form the government, so Bengalis had no choice but seek independence.In one of the bloodiest military suppression in history of mankind, where 3 millions are said to have been killed and as many as 4 hundred thousand women violated.Eventually, on 16th December, 1971 a new nation was formed, called Bangladesh.

And there were some Bangladeshi nationals who were loyal to Pakistani government. They helped find the educated men and women, hindu people and kill them. These people are called razakars– the betrayers. But strangely enough, they managed to bounce back to mainstream politics, and they now make a third largest party- called jaama e islami, with a strong student wing, called shibir. Suddenly, the government has decided to deliver justice that was long due- that’s what the war crime trials is about. And many people are not happy about it.

For the atrocities Pakistanis inflicted upon their people, one might assume there must be a strong anti Pakistani sentiment. But that’s not the case- which is vivid during notorious indo-pak cricket matches. There are die hard fans of Pakistani cricket- and usually they support the BNP and those in favour of India are sympathizers of Awami league, lead by the prime minister Seikh hasina. It had a landslide victory in last election. And in election before that, BNP had a similar victory. Bangladeshi public thinks shift in power is essential to keep things in balance. So the timing of war crime trials is very important. This has brought people with modern secular views and radical ideas into conflict. While majority is undecided and bear no sympathies to war criminals, they might have been meaning to vote for BNP, out of habit. Now cards are on the table and one has to choose sides- BNP, is still loyal to its long time aide jamaat, but as the cracks go deeper it has a huge risk of losing its moderate base. Because smart people (yes they are) of Bangladesh have seen what radicalization has done to Pakistan- bomb blasts are so frequent that they don’t make headlines anymore, a girl is shot for advocating education, US drones can come down to their villages to destroy homes and kill, with no questions asked.No party has ever won an election in a row, and it is really hard to tell from attack in Buddhist villages in Ramu to burning of temples in Tangail, which is orchestrated, which is spontaneous.

Bangladesh is a small country with big resources and bigger problems. They have mines to dig out natural gas, coals, numerous suitably situated sea ports, great beaches for tourism, well established universities in every corner of the country and rather unfair, cheapest work force in the world. Corruption is so deep rooted that it has become a culture, people do not ask questions anymore. Power is in the hands of two political parties, and people have no say. And its such an established system of impunity, common people, civic leaders have no voice or representation. Political prosecution, punishment transfers keep them at the bay.

One can’t help but compare. Our country’s small, not so many resources and perhaps smaller problems. We live in a secular society, in harmony with different ethnic communities. We have small population to feed and foster, suburbs that could become great cities, countless possibilities and people who can contribute immensely for country’s good. We do not have hard-line radical values that stop us from trying a something new. But the biggest distinction is, a common man can still make a lots of difference by his saying and doing, as long as he gets out of comfort zone of his humdrum life and decides that only problem this country has is its corrupt incompetent politicians and it is time we seek representation of people who are better qualified for the job. There’s a thin line between criticizing the netas at every social gathering to becoming, finding and supporting someone that the country needs. Or we can tuck ourselves in the cocoon of our own saliva and vomits, bear the filth and the odour, and look while the most imbecile of our kind take turns to loot the country, slowly poison our ears to communal hatred, and rule over us from their concrete castle of oligarchy. Like we have adjusted ourselves to 14 hours of load shedding, we will surrender to insecurities to life, we will manage with no jobs, we will comply with frauds and injustices in everyday life, we will grow sicker for mean hospitals and become dumber for bad schools. But we will adjust. And when our kids from future generation ask us, why our country is in such a bad shape, we will shamelessly answer, k garne yestai ho!

Writer is a medical doctor by profession and founder at Bibeksheek Nepali 😉

Like something in my Diary

Except that, I don’t write a diary.

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I think keeping a diary is a way of conversing with oneself- much like soliloquy, but in a more elaborate fashion of course. Because, it is really difficult to find someone you could share everything with, who can understand you, and wouldn’t judge you for the absurd things in your head. Someone who could feel you. So people befriend themselves- they keep diary, and pour themselves totally onto it.

This life, I am 25 years old. I’ve lived one third of my life already. I’ve been a good son, good brother and a bad boyfriend so far. I’ve been a good student- now I’m a medical doctor, I earn good money, I enjoy my work, but I am not satisfied. My aspirations are different.  But I am so busy doing my job, I don’t have any time left for doing what I’ve always dreamed of doing. And this realisation that I am letting my dreams die out is making me depressed- its like a train honking out of the station- the train I should catch, but I am too frozen to move, maybe little scared to abandon my comfy little place- uncertain of where the train’d take me. Nevertheless, I know in my heart that’s my  train.

Nepal’s seriously wronged, by its corrupt incompetent leaders, and by its ignorant, reluctant citizens. I live in a country where there’s load shedding 12 hours a day, kids read in darkness- kids, that we call future of our nation. Well, since this is supposed to be a diary-like I’m not going to repeat everything that’s wrong with my country- can’t bore myself- but in the back of my head, I know, what my country is while what it could have been. I want to make things better. I know I can. And its something I always wanted to do.

Divine intervention- these two words I pick from Dan Brown’s novel. Though it turned out to be something else in the fiction, I like the idea- some out of the world power manifesting somehow to show us the right direction. Not in the magnitude of miracles, but I believe God(?) expresses himself in small things- subtle clues. There are things that have happened in my life that I happily remember as God listening to me- I decided that with a fine reasoning.

But then, it was not just God. It was me actually, that worked hard, that smiled, that persisted, that used brains, common sense, sweet talks- that solved the problems.. I tend to be careless when I depend on God, weak, dependent type. Its like not doing homework and going to school hoping, praying that the strict school teacher wouldn’t come. Sometimes, he didn’t- but most of the times he did. God won’t pick you up everytime you fall. What happens to you, is mostly the consequence of what you do.

 

So I decide, most of my disappointment is due to my inaction, my failure to do all the things I mean to do. I’ve been into difficult situations due to my doing something, but my regrets are more for those times when I didn’t do.

Carpe Diem!

नेपालीको रगतमा के छ?

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नेपालीको रगतमा के छ?

 

चिकित्सकको नाताले प्रत्येक दिन धेरै बिरामीहरुको रगतलाई नियालेर हेर्नु पर्छ- कति चिनी, कति चर्बी या कुनै जीवाणु, इत्यादी। मान्छे किन बिरामी पर्यो भनेर थाह पाउन प्राय हामी रगत जाँच  गर्न लगाउछौँ र रिपोर्टमा पाएको तथ्यलाई आधार मानेर उपचार गर्छौँ ।

राजनीतिक अस्थिरता, आर्थिक मन्दी, दण्डहीनता, असुरक्षा, ठप्प विकास निर्माण- यी सबै देशलाई सन्चो छैन भन्ने संकेतहरु हुन्। धेरै दिनदेखि थला परेको देश- हाम्रो नेपाल र हामी नेपालीको रगतमा के छ भनेर एकछिन गौंढ गरौ, किनभने राष्ट्रिय रोगको ठोस उपचार न अहिलेसम्मको कुनै ‘परम्परागत’ पद्दतिले गर्यो, न त ‘बन झाँक्री’ को ओखातिले नै बिसेक गर्यो । अब नाडी छामेर  उपचार खोज्नु पर्छ, आत्तिएर हुदैन, तातिएर हुदैन, पद र प्रभावले मात्तिएर त झन् हुदै हुदैन । नेपाली समाजको इतिहास, यसको बनावट र चरित्रलाई  नजिकबाट नियाल्ने हो भने धेरै कुराको जवाफ पाउन सकिन्छ।

सम्पूर्ण  भारत मुगल साम्राज्यद्वारा शासित थियो, तीन शताब्दी। बाबुरको सेनाले जित्नु भन्दा अघि पनि, भारतका हिन्दुहरुले लगातार अरबी, तुर्की र पर्सियन मुसलमान सेनाहरुको आक्रमण खप्नु परेको थियो। यो समयमा त्यहाँका ठुला मन्दिरहारु भत्काईए, माटोमा मिलाईए, धेरै हिन्दुहरु मरिए, आइमाईहरु लुटिए – र यो क्रम तबसम्म चलिरह्यो, जबसम्म उनीहरुले आफ्नो आस्था र सभ्यतालाई मुगल चरणमा अर्पण गरेनन । तक्श्यशिलाको आगोमा हिन्दुहरुको औतिज्य धेरै दिनसम्म जलीरह्यो । त्यसपछि आएका फिरंगीहरुले बरु यिनीहरुलाई राहत दिए- धार्मिक स्वतन्त्रता पाउने देखेर  भारतीय हिन्दुहरुले एककिसिमको ‘मुक्ति’ महसुस गरे, र धेरै ठाउँमा स्वागत पनि गरे । त्यसैले दुइ शताब्दीसम्म ‘ब्रिटिश राज’ मजैले चल्यो। तर धेरै समयसम्म औपनिवेशिकताको उकुसमुकुस र अमेरिका/अफ्रिका मा चलेको स्वतन्त्रताको हावा यता  पनि लाग्यो, र भेदभाव, असमानताले भुक्त  भारतीय उपमहदेशले स्वाधिनता खोज्यो, र पायो पनि । यसरि त्यो बेलाको भारतका जनताले  चरणबद्ध रुपमा धार्मिक, सांस्कृतिक, सामाजिक र आर्थिक शोषण भोग्नु पर्यो, जसले गर्दा त्यताका जनतामा राजनीतिक चेतना, परिपक्वता पैदा गरेको छ। जति अनपढ भए पनि, तिनीहरुलाई सहि र गलतको पहिचान छ, र अन्यायको बिरुद्धमा आवाज उठाउनु पर्छ, मौनता दासताको श्रोत हो भान्ने बुझेका छन्। ‘७१ को बंगलादेशको रक्तरान्जित इतिहास जसमा लाखौं मान्छे मारिए, र त्यस अघिको पाकिस्तानि आत्यचारले पनि त्यहाँका बीस करोड बंगालीलाई यहि पाठ सिकाएको छ। यो त्यहि चेतना हो जुन संसारभरि बर्गीय बितृष्णाले हेपिएर/खेदिएर यहुदीहरुले आफुमा बिकसित गरेका छन्- जसको रापमा सेकिएर उनीहरु आज धेरै सम्पन्न र शक्तिशाली भए।

नेपालीले यस्तो केहि भोग्नु परेन, त्यसैले त  नेपाल धनी बाबुको पुल्पुलिएको छोरो जस्तै  हो- नेपालीले सहि अर्थमा ‘दुख’ कहिलै गर्नु परेन। स्वाधीनता सुखी चिज हो, र संसारका प्रत्येक सुखले जस्तै, यसले नेपाली जनतालाई लाटो बनाएको छ, कमजोर बनाएको छ। यहाँका जनता चलाख  भएनन्, भविष्यलाई हेरेर हिसाब किताब गर्न, गलत कुरालाई गालत भन्न, बिरोध गर्न,  एकजुट हुन- यिनले जानेका छैनन् । नेपालीको मनमा भय र संकोच छ, किनभने उसलाई कतै बिरोध गरें भने आफूले पाइआएको सुख सुबिधा खोसिएला कि भन्ने डर छ। यो संकोचको श्रोत के हो भने, स्वाधीनता इत्यादी ऊसले आर्जेको होइन, उसले पाई आएको हो, जसमा बिजयको तिलक छैन, छ त केवल मेहेरवानीको मोहोर। त्यसैले ऊ सकभर चुप लगेर बस्न रुचाउछ।

दार्जेलीङलाई हेरौं, त्यहाँ बस्ने प्रबासी नेपालीहरुलाई। पारिजातदेखि वांग्देलसम्म, अरुणादेखि अनुराधासम्म, पत्रकार/ कलाकार, ककारभिट्टादेखि

काठमाडौँ हुदैँ कंचनपुरसम्मका बोर्डिंगका अब्बल मस्टरहरु- किन संख्यामा थोरै भएर पनि यी दार्जेलीङका हाम्रा गोत्यारहरुले यति धेरै विधाहरु ओगटेका छन/ चम्केका छन्  अनि आफु र नेपाललाई पनि समृद्ध बनाएका छन्? किनभने त्यहि  ‘नेपाली’ नेपालमा र सिमनापारिको त्यो जिल्लामा एकदम भिन्नै किसिमले हुर्क्यो बढ्यो- यता हुने खानेले दुख गर्दै गरेनन, बसीबसी बौद्धिक र दार्शनिक चिन्तनसम्म पनि गरेनन, र जो गरिब थिए, तिनले गरिबीलाई नै नियति ठानेर हुनेखानेको भरण पोषणमै जीवन यापन गरिदिए। यसरि ‘हुने’ र नहुने’हरु दुवै एक आपसमा सन्तुस्ट भएर बसे, निस्क्रिय। उता दार्जेलीङमा कामको चटारो हुँदो हो, यसै त परदेश, त्यसमाथि बंगाली र केहि बिहारीको प्रतिस्पर्धा, के काम गर्ने, कसरि कमाउने, कसरी आफुलाई काबिल बनाउने, सीप, ज्ञान,  कला, कौशल- कसरि यो बिदेशमा आफु नेपालीहरुको गरिमा र पहिचानलाई  उच्च राख्ने- यस्तै प्रश्नहरुको उत्तर खोज्दै गर्दा बनेका होलान ठूला ठूला कविहरु, कलाकार, समाजसेवी,रंगकर्मी। जब देश भित्रका नेपालीहरु अझै तँ  यो जात, म यो जात भन्दै राजनीति गरिरहेका छन्, उताका नेपाली दशैमा मस्त दौरा सुरवाल लगाउछन्, असारमा उत्साहका साथ भानु जयन्ति मनाउछन् । के नेवार, के लिम्बु, के क्षेत्री,के बाहुन, उता नेपाली हुन काफी छ ।

यो उदाहरण ‘नेपाली’ जाति फरक परिवेश र वातावरणमा कसरि एकदम वेग्लै किसिमले बिकसित हुन्छ भन्नलाई हो।

 

अब राम्रो कुरा पनि गरौँ । नेपालीको विशेषता के हो भने नेपाली बीर  थिए तर रक्तपिपासु थिएनन्, कहिले  भएनन्। नेपालीको मिजास ठण्डा छ, सरल छ जिन्दगि,मिलेर बस्न चाहन्छन्। उदाहरण- नेपालकै जस्तो जनसंख्या भएको देश, क्याम्बोडियामा दश वर्ष जनयुद्ध हुँदा २० लाख मान्छे मारिए । उस्तै जनसंख्या भएको अफ्रिकी मुलुक सुडानको द्वन्दमा त्यो भन्दा पनि बढिले ज्यान गुमाए।  नेपालमा पनि जनयुद्धको आगो पुरा एक दशकसम्म दन्कियो, सारा देश धेर थोर प्रभावित भयो, तर तथ्यांकलाई हेर्ने हो भने (केवल उदाहरणको खातिर, जनयुद्धमा मारिएका प्रत्येक मान्छेप्रति मेरो श्रद्धा छ, र मृत्युलाई अंकमा अनुवाद गर्न हुँदैन) नेपालमा १४ हजारले ज्यान गुमाए। भन्न खोजेको के भन्दा नेपालीले हिंसामा विश्वास गर्दैन- नेपाली सदभाव र शान्तिमा विश्वास गर्छ । नत्र संसारको कुनै कुनामा, टाउकोको मूल्य तोक्ने र तोकिएका टाउकाहरुले मिलेर शासनसत्ताको प्रजातान्त्रिक हनालुच गरेको उदहारण छ? गजब छ हाम्रो मानसिकता- अघि उल्लेख गरेको राजनीतिक अपरिपक्वताको शायद सुखद बाई -प्रडक्ट । हामी कट्टर छैनौ, अंग्रेजीमा भने जस्तै हामी ‘कुल’ छौ, बिन्दास छौ। त्यसैले त हामी माओबादीलाई, एमाले र कांग्रेस जस्तै ‘राजनीति’ गर्ने भए किन तेत्रो मान्छे मर्नु परेको भनेर पनि सोध्दैनौ, किनभने हामीलाई  लाग्छ त्यस्तो प्रश्नहरुले बखेडा झिक्न सक्छ। आखिर, सत्य भन्दा ‘शान्ति’ प्यारो हो, हामीलाई औलाको टुप्पोमा तराजु अड्याउने अभ्यास जो छ।

भरातले भर्खरै समलिंगीहरुबीच हुने सम्बन्धलाइ कानुनी रुपमा अवैध घोषित गर्यो । अमेरिका लगायत अरु पश्चिमी मुलुकहरु समेत यो सवालमा डरलाग्दोसँग विभाजित रहँदा, जुन देशले त्यो कुरालाई निर्बिरोध स्विकार्छ, त्यो देशलाई पक्कै उदार मान्न सकिन्छ। नेपालमा जातीयताको नाममा राजनीति गर्ने होड चलेको छ- त्यो गलत कुरा हो, त्यसको कुनै गतिलो आधार छैन । मैले नेपाली समाजमा केहि भेदभाव छैन भनेको होइन, तर जे जति छ, त्यसको स्थिति नाजुक छ र  धेरै दिनसम्म रहनेवाला छैन- त्यसलाई अतिरन्जित गर्नु हुँदैन, किनभने यथार्थ यो हो कि एउटा नेपालीले अर्को नेपालीलाई हेर्दा आफु सरह नै देख्छ। भर्खरै भएको चुनावको नतिजाले पनि यो तथ्यलाई प्रमाणित गर्छ।

समानुपातिकको उम्मेदवार नामावली पठाउन त एक हप्ताको समय ‘थप’ माग्ने राजनीतिक दलहरुले एक बर्समा संबिधान बनाउने छाठ देखिन्न । यो पटक पनि नेताहरु व्यक्तिगत र दलिय स्वार्थमै अल्झिनु भनेको जनमतको घोर अनादर हो। उनीहरु जनता अझै लाटा छन्, जे गरे पनि हुन्छ भन्ने सोचछन् र दिक्कलाग्दो हर्कतहरु गर्छन। तर जनतालाई यो अराजकता र कोलाहालकाबीच निस्पृह भएर मस्त निदाउने अवकाश छैन, किनकि उसलाई शहरको धुलाम्मे सडकमा, छिमेकीले कमाएको अवैध सम्पतिको तडकभडकमा, हलो नचलेर  बाझो भएको गाउको गैराखेतमा, ग्यास र पेट्रोलको आकासिदो रेटमा, जागिर खाने अफिसमा, छोराछोरीको बोर्डिंगको फिसमा, अस्पतालको शैयामा, सरकारी कारिन्दाको रवैयामा, सिन्डिकेटको कोचाकोच गाडीमा, अरबको पट्ट्यारलाग्दो  खाडीमा, अनि सांझ लोडशेडिङ्गको अध्यारोमा तरकारी पकाउदा- नुनको प्याकेटमा, र चाईनिज ज्याकेटमा समेत, राजनीतिको भुत आएर तर्साउछ। यो दुस्वप्नबाट अब जनतालाई जाग्नुछ  र आँखा मिच्दै ब्युझिएर ‘परम्परागत’ राजनीतिक दलहरुसंग, बितेका तीन दशकको हिसाब माग्नुछ। अब पनि गोटा चार एक ‘टाउके’ नेताहरुकै लोभ र लहडको भुमरीमा फसिरहादा देश, हामी चुपचाप मुकदर्शक मात्र बन्यौ  भने, हाम्रो रगतमा अलिअलि बाकी रहेको आत्मसम्मान र स्वाभिमानका श्वेत रक्तकोशीकाहरु ग्लानिले मर्नेछन् र देश गलत राजनीतिको दिर्घरोगले ग्रस्त हुनेछ।

 

डा.चिरायु रेग्मी

-चिरायु रेग्मी

काठमाडौँ र दशैं

Image

काठमाडौँ

उसको अबैध प्रेमिका जस्तै हो,

जसको अंगालोमा ऊ प्रत्येक रात सुत्छ,

जसको हरेक झिसमिसेमा ऊ जुर्मुरौदै उठ्छ,

जहाँ ऊ खान्छ,

हग्छ, मुत्छ,

थोरै मात्र दिएर,

सके जति सब लूटछ,

तर काठमाडौँ उसको ‘मिस्ट्रेस’  जस्तै,

किनकि यो सम्बन्ध,

त्यतिबेला सजिलै टुट्छ,

जब दशैंको लागि घर जान,

नयाँ बसपार्कबाट गाडी छुट्छ ।

 

 

‘मिस्ट्रेस’  जस्तै किनकि,

उसलाई इच्छा अनुसार

यहाँ आउने र जाने छुट छ।

 

 

ऊ यसकै आकाश मुन्तीर,

यसकै माटोमा पल्टेर,

थरि थरिका सपना देख्छ,

प्रत्येक सपना खोज्दै हिड्दा,

यसकै सडकमा पाइला टेक्छ,

ऊ गिद्धले सिनो खोजे जस्तै,

यसको भूगोललाई खुब नियालछ,

तर कानो,

न काठमाडौँको सौन्दर्य देख्छ,

न  माया गरेर मैले जस्तो,

कविता नै लेख्छ !

 

 

काठमाडौँलाई एउटै   मात्र खेद छ,

ऊ घर बन्न सकेन कसैको,

फगत होटेल जस्तो,

जसको भित्ताको र कोरेडोरको

कसैलाई पर्वाह हुँदैन,

पिलर मक्किएको / ढलान चर्कीएको,

कसैलाई थाह हुदैन ।

जहाँ बस्न हुन्छ,

तर आत्मा राख्न हुदैन,

जो सबैको साझा हुन्छ,

तर कसैको आफ्नो हुदैन ।

काठमाडौँलाई त्यति गुनासो छैन,

यस्तै हो,  भन्छ

बुझ्छ कुरा,

तर जब दशैमा घर जान,

नयाँ बसपार्कबाट गाडी छुट्छ,

हल्का चित्त दुख्छ,

अनि भीत्र भीत्रै भक्कानो फुट्छ।

_चिरायु रेग्मी