PHCC posting…

Our medical school has opted CBLE (Community Based Learning and Education) as a strategic approach to make its medical graduates ‘community oriented and advocates of disadvantaged’. (Why so? I will talk about that in my next blog). Recently we 4^th year students were posted in different PHCC (Primary Health Care Centre) of Makwanpur and Lalitpur district for our 6^th CBLE. I am sharing few of interesting experiences during my posting at Chhatiwan PHCC, Makwanpur.

First of all, villagers had wrongly received message that some senior doctors from Patan Hospital are visiting them. Thus we put on our card indicating “MEDICAL STUDENTS” and we introduced our self as same wherever required.

Government of Nepal doesn’t have adequate human resources. This was true in our PHCC too. A medical doctor with MBBS degree was supposed to be there but not even an HA(Health Assistant) was present. The PHCC was run by a team of motivated staffs leaded by a senior AHW (CMA).

There were some admirable tasks done by community. HFOMC (Health Facility Operation Management Committee) had established a laboratory where some basic investigations could be done. This helps up to some extent for right diagnosis and management. DPHO(District Public Health Office) had managed an extra ANM (Auxillary Nursing Midwife) as well. The 3 ANM is still not enough for PHCC services and 24 hour maternity service. Yet they are doing it. I highly admire their job.

Our PHCC was doing somehow fine(?) job for Family planning, Safe motherhood, Immunization, Reproductive health, Curative services etc. But a health facility with limited medications, inadequate lab, no basic facilities like ECG, X-Ray, USG (Video X-Ray) could hardy give proper care to its patients. There were many things unacceptable for me.

I found that patient safety was not cared at all. In the dressing room, the used instruments should be well sterilized. Do you know how is that done there? The instruments were washed with soap and tooth-brush, and rubbed with spirit before use. Amazing!! Isn’t it? An autoclave is not that expensive machine and is easy to use too. Unless it is managed, the instrumented can be boiled in water. But who cares?

Let me tell you, any patient visiting the facility with fever due to systemic illness were given treatment of malaria and typhoid both. Though it was an endemic reasion of these diseases, one of the diagnoses was compulsorily wrong and both might be wrong for some patients. They are receiving over treatment. People are receiving antibiotics not needed to them. Such practice will make organisms resistant to antibiotics we have, and we won’t be able to manage those disease because of unavailability of new antibiotics in future. I was not satisfied, but nothing could be done. This is how these health facilities run. And I was just a trainee there to understand how things are.

I also noticed that such centers are acting like non referral center. They refer very very few patients. Even patients with significant problem requiring visit to higher center were managed haphazardly. I feel that there is serious need to train these health professionals to identify RED FLAG SIGNS and get patients with those signs referred to higher centers.

I remember a patient of mine. An 18 year old unmarried lady visited me with some problem. Her problems were suggestive of Sexually Transmitted Infection (STI). But she denied having a boyfriend or any unsafe sexual activity. Urinary Tract Infection (UTI) was another differential diagnosis, but it was less possible and urine microscopy as well was not suggestive of it. Other investigations were not available. I got confused and consulted my supervisor, the AHW of PHCC. Do you know what he did? He gave medications for both the disease. This lady too got overtreatment.

You have to make a record of every patient, diagnosis and treatment in specified registers of HMIS (Health Management Information System). In the chart provided, COPD (Chronic Obstructive Pulmonary Disease), a respiratory problem, was kept under cardio vascular disease. I wonder how did the experts in ministry made such blunder and distributed all over the country.

During my posting at ANC (Anti Natal Checkup i.e. Medical and nursing care of women during pregnancy) I found that most of the women being pregnant for 1^st time were 15-17 years of age. It clearly shows early marriage in our communities. I asked the age of marriage to those mothers. Most of them answered 14 or 15. Along with smoking, alcohol and drug abuse, we are also worried about problems of premature sex in big cities of our country. But this is socially rampant in rural too. This is definitely going to adversely affect the heath of these mothers and their children too. I asked to all the mothers visiting me in ANC care room about their contraceptive use as well. Almost half of them replied that they didn’t use any, other half said that they didn’t need it because their husbands were in foreign. These examples clarify why our CPR (Contraceptive Prevalence Rate) is stagnant in below 50 % (Source: DHS 2011).

A really nice calendar like pamphlet is designed for pregnant mothers. Danger signs during pregnancy, delivery, peurperium, infancy and Maternal and new born care is well explained there. See  photo below. Since most of the patients are illiterate, PHCC staffs suggest those mothers ask someone to read it for them in home. I don’t think this is going to help. I suggest: the health facility staff should themselves read and explain it to the mothers.

Army officers, coming there for the security of different programs related to upcoming election were staying in new maternity building of the PHCC (not used yet). I remember our last evening there. We went to canteen for our dinner. Different varieties of alcohol are available even in canteen of the PHCC. Some army officers were drinking there and the whole canteen smelled really very bad. We waited outside for long, until they left. Smoking, drinking etc. is banned by Government of Nepal in public places like hospital. As always we have made admirable rules and regulations but failed implement it. I was many times disturbed by bad smell of cigarette as well, by local people (mostly female) even inside emergency of PHC.

Chhatiwan is large VDC. Providing health service to entire VDC is not possible by single health facility. Thus the PHCC runs other SHP in parallel. This is good step for public welfare. The government doesn’t has the provision of keeping two health facility in one VDC. Thus they have divided the human resource in PHCC for two facilities. Single health facility is enough in VDCs of hill with population of less than 5000 population or so. The VDCs in terai are comparatively larger with more than 10,000 population each. I think, running parallel institution, as done by Chhatiwan PHCC could be an option to solve such problem in large VDCs with comparatively more number of population. 

Thank You

The silent husband

Being a medical student in a public hospital is a huge luxury. Luxury in a sense that you can closely visualize your society with wide open eyes. You have the exposure to the real society better than anybody else. People from different community, different social backgrounds come with some interesting stories which can dig your brain, crush your emotions.

I remember a lady whom I met in night call during my obstetrics and gynecology posting. She was not so different case. She had classical symptoms of fibroid uterus which is benign tumor of uterus. Let me tell you, medical students are provided with a long list of question to ask with their patients. The question is about the symptom/problem, about medications, about problems in other uninvolved systems of body which patient don’t have any problem with but something missing can be found some times. And also some social, personal issues are asked along with ideas, concerns (worries) and expectations of patient.

While I reached to the social history, she told me about some of her family problems. She was married for 35 years. She has two sons of 29 and 24 years respectively. How it feels when someone special goes leaving you in trouble, in difficulty, in agony.  Leaving you alone to face it? I guess nobody knows the answer better than this lady. She doesn’t live with her husband now. Her husband lives with other wife (कान्छी श्रीमती). The torturing thing was- her house and the new house of the husband shared common veranda. That is both houses were side by side. And they don’t talk to each other at all. Imagine a lady, who sees her husband daily. The man she was married with, the man whom she gave 25 years of life (from the age of 14 to 39), the man with whom she shared some of the best time of her life, the man who assisted her during delivery of her two babies, the man whom she once thought would give all possible happiness to her. The same man lives in front of her with other woman and even talks to neither her nor the children. Imagine being hurt by someone who once promised to take care. Imagine the tear being brought by someone who promised to bring joy. Imagine the pain given by someone who promised to love… I wonder how she faces all this. And what had been the psychological effect of it in the children?? I, being a poor creature, can do nothing at all other than thinking, imagining, being touched, being hurt…. I think about days before separation. How those might have been? He must not have been able to ask for divorce at once. He must have opted to quarrel and fight in small issues, torture her mentally and physically, abuse by one way or other etc. in the topic of cookery, room, cleanliness, dresses and what not, hoping that she would herself get frustrated and ask for divorce. How patient would she have been in those days of distress? Let’s imagine that, one day she went too frustrated that she replied with anger, ”If you are this unsatisfied with me, or I am this unfit for you, why don’t you leave me?” Obviously, if anything like this was told, he would have happily accepted since he was waiting for it. And even more, how did he purposed or managed another girl to marry him? Did he say that ,"I have a loving wife, two dear children and I am not satisfied and happy with them for such and such reason, so marry me.” Funny, isn’t it? And how did she accept? How did she agree to stay in a home sharing common Veranda with home of previous wife and their children? I don’t know how things happened then. Things are simply unimaginable for me.

She is having a significant medical problem. She is going to have surgery (operation) within few days to remove her uterus, both the ovaries and fallopian tubes. And she is in huge economic problem but he doesn’t care. He is financially stable being in a good position in Nepal Rastriya Bank (NRB). But he doesn’t find it necessary to help his previous wife and his children by any means. How can a man be like this? Not only wife, he also ignored his own children who are growing up in front of him and he hasn’t talked to them since 10 years, just imagine the cruelty. Is the new wife happy with this?? I doubt. I have definitely talked to only one side. The husband also must have his own version of story. But I don’t think any justification would be enough. His wife is living separate alone and taking care of the children and himself living with other women. Isn’t he embarrassed anyway? He had a good job, a wife, 2 children and a home. This is more than required for a common man. What made him destroy his family??
He was not happy with his wife?? Ok that’s fine, but was those two children not a responsibility of him???

This story made me remember an incident in community posting during my 1^st year of medical school. In the last day of our community posting at Markhu VDC of Makwanpur, the rector of our academy, Prof. Dr. Neelam Adhiakri was there with us too see our last day presentation. I talked to her about a poor lady in village who had uterine prolapse (आङ खस्ने समस्या). I also talked how she is abused by her husband, how her husband hits her almost daily. Rector ma’am managed free treatment (operation) of her in our Hospital and also managed lodging and food facility for a caretaker (कुरुवा) whoever comes with her. Talking about the abuse, she said, “All the problems in society are created by males.” I was not satisfied to her. I knew she is talking in a feminist view. Yet I didn’t say anything, probably because she was a senior faculty of us, and even more because she managed the treatment for free to that lady. And I was very happy for that.

Today, after hearing the story of this lady who has such a cruel husband. My brain is again thinking, was rector ma’am right that day? Are male really cruel creature?? Is it us alone who create suffering for others??? Are we a creature with no heart and only selfishness (स्वार्थ)???? Are we, males the reason behind all the problems in society????? Probably not, but unfortunately our society has plenty of such people…. For which I personally can do nothing other than being unsatisfied with….

He might suicide tonight

     कुरै नबुझ्ने साथी-सङी र परिवार लाई छोडेर जादै छु ।
        बाँचनै नदिने यो स्वार्थी संसार लाई छोडेर जादै छु ।। 
   मुख मा राम-राम अनी बगलीमा छुरा हुदो रहेछ ।
           आदर्श छाट्ने यि ढोंगी अनुहार लाई छोडेर जादै छु ।।   

Photo: Google

This is starting lines of a suicide note of a character in one of my story (unpublished yet). Today I am talking about suicide. Specially about identifying the person planning to suicide, and what can we do for them? According to CDC (Center for Disease Control), suicide is the 10th leading cause of death. 1 million people attempts suicide every year worldwide and around 50,000 of them succeed/die. Remember, suicidal attempts are more in nights than in day. Suicidal attempts are about three times more in female than male. But successful suicide (not just attempt) is more in male by five times compared to females. Together we can spread awareness. Stand up and do take action. Start now. Things will slowly improve and finally will get fine.

Can we identify someone who is planning to cause his own death?
Yes, most often. First of all, we have to understand that every suicidal person is a human like you and me. He/She has the same feeling of sadness and happiness like we do. Currently they have something to worry, something to express, but there is no one to listen to them, help them, and stand with them. They are not able to ask for help though they want it, they need it. He do want not to die. He wants the pain to be vanished. He wants the suffering to come to an end. Yes, most of the people who commit suicide don’t actually want to die. They just want to stop being hurt. They must be suffering from something unbearable. They do want to get rid of it but they can’t see any alternative. They are in disgust, are hopeless, are in isolation, are in deep pain and they can’t see any escape other than death. And they mislead themselves thinking ‘suicide’ to be a permanent solution of temporary problems. Thus they choose to kill themselves. What can we do then? How can we identify them? Understand that, a suicidal person needn’t be crazy. Someone in extreme distress and emotional pain can anytime plan suicide. A suicidal person needn’t have any mental problem. Any person planned to suicide can be stopped. People planning suicide mostly give some clue. If you are able to understand the clue and take few steps, you might save a life. They may comment for being hopeless, helpless or worthless. They show anger at self, may have increased irritability, moodiness and aggressiveness. Mostly suicidal person have sudden and unexpected switch from being very sad to being very calm or appearing to be happy. If anyone uses sentences like “you will miss me”, "it would be better if I wasn't here" or “I have no way left” etc., we shouldn’t ignore such clues at all. Someone talking about suicide might not be just trying to seek attention. Take it seriously. A Facebook status indicating final ‘BYE’ doesn’t need your likes and comments. You need to meet them instead. Even if your interpretation were wrong, there is nothing to lose. So do stand up and take action.

How would we know if someone is planning suicide?
There might be some clear reason for pain or sadness. Some failure in exam, unemployment, economic problem and loans to pay, recent breakups or divorce, bad family relationships, family violence etc. can be the cause of suicide. Remember recent suicide by Bollywood star Jiya Khan, who explained break up to be the reason of her suicide, in her six page long suicide note. Similarly, patients of psychiatric problem like depression or schizophrenia, victims of physical and sexual abuse, an alcoholic or drug abuser etc. attempt suicide more than others. Thus these are alarming factors. If someone has attempted suicide earlier, be careful, he can again attempt and may succeed to kill himself this time. Recent suicide by a family member is also a risk factor. Suicidal usually lose interest in day to day activities. Do try to pick up such clues. Many suicidal talk about killing or harming themselves. They may write about death, sometimes even in social networking sites or so. They may bid a good bye through facebook statuses or telephones. They might be collecting things like rope, suicidal drugs, poisons, guns etc. to use for suicide. Talk to them about their problems. Deep sadness, Loss of intrest (दिक्क लाग्ने), trouble sleeping, eating getting worse etc. for more than two weeks are common problems in suicidal. If you find any of such clues, you need to be alarmed.

American Association of Suicidology developed a mnemonic "IS PATH WARM?" to help identify key warning signs for suicide-

• Ideation — Talking about or threatening to kill or hurt oneself; looking for ways to kill oneself, talking or writing about death, dying or suicide
•  Substance abuse — Increased substance use 
• Purposelessness (व्यर्थता)
  
• Anxiety — Anxiety, agitation, or changes in sleep pattern
• Trapped — Feeling like there is no way out 
• Hopelessness 
• Withdrawal — Withdrawing from friends, family, and society 
• Anger 
• Recklessness (लापरबाही/खतरा प्रती ध्यान नदिने) 
• Mood changes

If you see any of above risk factors in any one, get alarmed, they are most likely planning suicide. They need help. You need to take action.

How to help?
Talk to them. If you have seen any of clues as mentioned earlier, you can directly talk about their suicidal thoughts or plans. “With all the depression you've been dealing with, have you ever had the thought that you'd be better off dead?” or any question like this could be asked. Show that you care. Don’t worry, there is no harmful outcome. You can't make a person suicidal by showing that you care.
You came to know about his intentions by phone or facebook? Go to meet him immediately. Talk to him. “I was being worried for you.”, “The way you bade me good bye today was not usual.”, “Your facebook status shows that you are in some trouble.” Etc. can be some sentences to start with.
If he comes up with any tendency like suicide, Ask “when did he begun to feel so?”, “what the real problem was?”, “how can he be helped?” etc. Do show support. Say- I am here for you. Once, I too was in similar situation. Things will be fine. Suicidal feelings are temporary etc. such sentences will help to build up his confidence. He would probably let his feelings come out in front of you and make himself calm. Giving a suicidal person the opportunity to express his or her feelings can provide relief from loneliness, and thus it may prevent a suicide attempt.
Listen to whatever he says calmly being non-judgmental. Let his feeling and sadness come out. And be careful- you should never argue with his thought. Don’t give a lecture on value of life. He doesn’t want to hear it now and it doesn’t help as well.
We should neither over act. He is in distress, he isn’t crazy. You shouldn’t say artificial things. Words are not that important. If you are concerned, your voice, manners and non-verbal communication will show it. Just be yourself.  Ask when has he planned to suicide (time set). If time for suicidal is set, then it’s more severe problem. Inform people nearby to take care of him and do involve doctors/psychiatrists. They can help better. If you think, things are not enough to prevent the suicide than you can inform the police as well.

Let’s unite against this cowardly act. Together we can spread awareness. Let’s stand up for humanity. Let’s attempt to decrease suicide attempts.

Remembering the “Protest at PAHS (Patan Hospital)”

Adjacent photograph is of Basic-Science Library of PAHS- School Of Medicine. I think, this is the liveliest place of our medical college. I don’t consider this place good to read, Few students do. I would rather borrow books and bring to my hostel. There are few students reading in library. Many are chatting in small groups. Some (including me) almost always visit this place to have a look at newspapers. Photocopying, Printing etc. are other important task to be done here. The didis (staffs) here are cool and very close to almost all of us. They are like a friend of us. Many of us visit the library once to just bid them a good morning. During vacations, one who can’t go home spends his/her most of time in this library. I remember a time, when this exciting and interesting place was completely silent. The tables and chairs, journals and book stacks, the environment was all same there. But there was no life, no liveliness. Everything was standstill. The didis of library were idle and alone for almost whole working hours. I am explaining, How did it happen…

It is easy to destroy good things but mostly very very difficult to make it, create it. There is a lot of admirable things in our hospital. Like- any patient coming to this hospital gets emergency treatment even if they can’t pay. This is only hospital where doctors prescribe only generic names of drugs and thus the pharmacy department supply drugs with best quality and lowest price. No Medical Representatives (MR) are allowed in this hospital. The medical school is dedicated to produce socially responsible physicians who would serve the poor in rural. etc. etc. Along with this, it is one of the 3 medical academies of the country. It is a tertiary health center with country’s 2^nd highest number of patient flow. The yearly budget is around 200 million and the social service (for poor patients who can’t pay) alone is of more than 20 million per year. From a business eye, this academy is like a cash cow. What will happen if this cow in own/leaded by someone who is interested in milking the cow rather than feeding it??? The protest in PAHS last year was a huge struggle of people against someone dedicated in milking this cow as much as she could and finally destroying it. Fortunately the protest had a happy ending. I am documenting what I saw and experienced as one of the more or less actively involved protestant during that chaos.

The VC (Vice Chancellor) is head of the university whose creativity, far sightedness and selflessness matters a lot to the path and vision of the university. The tenure of previous founding VC of PAHS had ended and people were eagerly waiting to welcome the new VC. One day news came that someone from another similar university/Institute at Dharan (BPKISH) was appointed our new VC. We were proud to know that we will have the first female VC of Nepal. Sadly news also reported that she is several times accused of corruption. Our friends studying at BPKIHS added even more about her bad nature. They also informed that, the news that she was leaving BPKIHS had made people there so happy that they threw a huge party.  There was a huge rumor that she got this post because of being close relative of a renowned politician Sarad Singh Bhandary. And the rumor was most likely true. Slowly, her actions at PAHS made it certain to everyone that she didn’t get the post because of her capability and neither was she a deserving candidate for it. The political power had overruled the concept of merit and seniority. This was the 1^st step of political cancer in PAHS and that cancer was sure to metastasize and kill PAHS one day. Exactly the way it killed Janakpur Cigarette Factory, Himal Cement etc. Fortunately we were able to prevent it.

We, first batch students were on preparation leave for our final exam of Basic Science. Basic Science is initial two year long course in medical school. Failing this final exam would drop the student to junior batch which would completely destroy his/her one year. Thus the exam was crucial and those preparation leave were of huge importance for us. One day I and a friend of mine met a professor of ‘Community Health Science’ department. We talked about exam etc. In the end I asked about the appointment of new VC. He said that they had just got the letter about the appointment and haven’t met or talked with her yet. We further told about the news being published regarding her bad and controversial background during her work at BPKIHS and during her study at IOM, Maharajgunj. Since she is already appointed by the Prime Minister, we had no options other than physical interruption like not letting her enter the academy and come in protest against the appointment. He said that we need not worry. She is here just for four years and the faculties and staffs are for long time. So she alone can’t change our mission, vision and goal. PAHS staffs have a high moral and huge dedication for disadvantaged and underprivileged people of Nepal. PAHS students are being made socially responsible and would serve those needy. Working with such people can change her and make her a good person by four years. We were amazed to see how optimistic he was. Let me tell you, few months later he was one among the leaders of the protest against the same VC.

We were preparing for exam and things were going all bad in hospital. Faculties wrote comminique (बिग्यप्ती) against her bad deeds in PAHS. After few days they protested by working with black band (कालो पट्टी) in hand. Still student had no information about things going on. Once I met our dean sir and talked. In PAHS, there is not much hierarchy and even senior officials are close and accessible to everyone. He asked me about preparation for exam. In the end of conversation, I asked about the protest in hospital and students not being informed about anything. He suggested not to think about it unless exam finishes. Involving students would hamper academic calendar so they want student to finish the exam first. After exam, we were supposed to use our conscience whether to take part or not to take part in the ongoing protest.

Though no one was telling us anything, frequent news about the doctor’s protest in our hospital made us understand things. The news were regarding the huge amount of two crore (20 million) rupees she gave to PM’s wife to be the VC of PAHS, her corrupt acts at BPKIHS, and physical assault (beating)by her  to an operator in IOM. Her disrespectful behavior to seniors and everyone, trying to bring procurement committee (खरिद समिती) of PAHS under her personal control, trying to change the dean of School of Medicine, appointing a friend of hers as rector of PAHS, her activities towards interference to the hospital cafeteria, hospital parking, and bank in hospital premises etc. All the things were related to money by one way or other. A health magazine reported that she was asking people to help her earn money she invested to be the VC. Kantipur daily wrote editorial for two times against her deeds. All of us were mentally prepared for our active participation after exam in the favor of faculties to protect our hospital. The next day of completion of exam, we had a student meeting in school and decided to actively take part in protest. We were huge mass of 175 young students. After we joined, the protest took pace.

We printed our communique in the name of students in the favor of protest. I and a friend of mine went to VC’s office to stick it in notice board there and also to hand over a copy of it to communication officer.  While we were talking to the communication officer the VC herself came in the door and started shouting very horrifyingly. A lady with that harsh voice made us really fearful. The friend of mine beside me tightly grasped my arms in fear. I was thinking, if this lady starts beating us here the way she did with someone in IOM, what can we do? The communication officer’s room is so congested and small that there is not even enough room to run away. Fortunately she didn’t. Some of sentences that I still I remember were- she asked to collect the names of student involved in protest. She would rusticate those students from the academy. Admission of all the students in 1^st year will be cancelled and new list of selected students will be published etc. etc.

These become hot topic of discussion among students. Unlike private medical collages, all the students at PAHS, even of full paying category, are selected on merit. So, does a VC have an authority to cancel the admission? Is she threatening us? etc. etc. This again sensitized the people and made us determined not to stop unless her appointment is cancelled. We talked to faculties and seized the keys of vehicles of PAHS that the VC and rector were using. In fact the driver dais were very close to us and they easily themselves handed over the keys to us. They even took out all the extra keys available and gave us. The faculties might have instructed them to do as we say. We still went to faculty’s room upstairs and informed them. Off course, they were happy with our deed. We hardly deed anything without permission of faculties during the protest.

In the meeting, we suggested to halt all the service except emergency. Our professors didn’t want to do that. The concern was public support could be lost if we halt the service or close the hospital. So we had to do things in creative way by neither losing the moral support of public nor hampering the goodwill of the hospital. Plenty of ideas came. Some of them were- running the emergency department in the open field of hospital. This was not accepted because of difficulty in management of infection control, oxygen and suction pipes etc. A professor of pediatric department suggested running the pediatric clinic in corridor of administration. The crying babies would irritate the VC and rector. But taking the sick kids in fourth floor was not easy. Other very strong idea was, mass resignation (सामुहिक रजिनामा) of all the doctors and faculties working in hospital. The protest committee decided to lock the VCs room from the next day. And keep the idea of mass resignation as next step. Since students stay in hostel and can come early, we were given the responsibility of coming hospital at 6am early morning and take care of lock in the VCs offices. Thus when VC and rector come at 8 am (normal time), they can’t go inside. Even if the VC comes earlier than us, we will ask her to come out and lock it. If she denies coming out, we will lock her inside. The doctors will return to see the patient in ward and OPD at 9 am and we will take care of lock. They will join us turn by turn during lunch and break time. Meeting was over with this decision.

We all students had a meeting in hostel that night, and we decided to go to hospital at 5 am, 1 hour earlier than scheduled time. Next morning we woke up early morning, went to all the rooms in hostel, wake up every one and reached hospital. When we reached there, scenario was completely different. There were some trucks and vans of cops in hospital. Cops were there all around. We came to know that the plan of padlock was known by the VC and she used her political and economic power to stop us. Thus the cops were guarding her office since previous night. They didn’t allow us to enter inside the hospital building. We didn’t know what to do. We phoned to some of our senior faculties and informed about the situation. They asked us to stay in canteen and not to do anything. By 7 am all the faculties arrived. Few vans of cops were added. Doctors decided to take the pamphlets, banners and go to VCs room to lock it. Few cops tried to stop us in ground floor. Dozens of faculties and more than 50 students were too much for them. We pushed them step by step to 4^th floor. All the cops gathered there. Though we were huge in number, we couldn’t put the trained cops aside. The situation became chaotic. Plenty of patient party accumulated. I remember dean sir telling, “I am dean, the dean’s office is beside VC’s office. How can u stop me from going to my own office?” all of us burst into laughter.

The push and pull went on for more than an hour. Some news reporter arrived and started to shoot. Some faculties made contact with the Chief District Officer (CDO). Students not staying in hostel slowly arrived and joined us. Staffs as well started to come and many of them joined us. The staffs working in canteen brought water for us. Things were getting more and more unjust. They said that they are ordered not to allow us to padlock the VC’s office in any cost. A doctor replied that in that case, we won’t work and get out of hospital. And let them take care of VC office as well as patients of hospital. Obviously there was no reply. In every interval of 5-15 minutes, students would accumulate energy and push all the cops aside. And again they would push us back. It was really funny for time being. I remember dean sir threatening the in-charge of the cops that if anything bad happens to his students he won’t spare them. The police were getting harsher. Now it was felt that they would use stick to beat. Students got even angrier and were almost ready to fight back. At the meantime, doctors stopped us and stepped ahead.  I remember a professor of surgery whispered in my ears, “babu, they might start लाठी चार्ज now, so you guys get back and let us go front." We did same but started नाराबाजी against VC, government, cops and corruption. The cops went out of control. And a sort of fight started. A junior student was hit. Stethoscope of a doctor was thrown by the cops. My own apron (white coat) was tore. Cops were still silent compared to how they generally are in such chaos, probably because they were in hospital premises. Finally the team who went to talk to CDO came to negotiation that they would allow us to lock the office and then we should leave letting them break the lock. Both the party agreed and same happened. What a drama!!

I remember a scene in Janakpur that I saw during Madhes Aandolan. I was in the roof of my rented house. The protesters came in huge mass from one side. Plenty of police came from the other side. There was attack. Everybody ran away helter-skelter. And there were many low quality, cheap slippers in the road. There were no costly or good slippers. It reflects what type of people was there in the protest. This is normal scenario in protest where poor people are in road fighting with the police and so called leaders are enjoying in air conditioned rooms. Would any leader ask the protester in danger to come back and let him face it, the way that surgeon and other doctors did with us??

 

The scene of this protest in our hospital was broadcasted in television. My parents saw me in the front row in television. They phoned me and advised to do as the faculties say. That was a huge inspiration for me. Probably it happened same with many other friends too. From next day cops didn’t come. VC herself never again came to Patan Hospital. She instead booked a costly room in ‘Greenwich Hotel’ and started doing PAHS activities from there. We heard that she spent 2 million rupees in few junior staffs of hospital to help to stop the protest. There were plenty of criminal like muscular men inside the hospital rented by her (भाडा का गुण्डा) to mess with us, faculties, doctors, staffs etc. If any bad incident had happened then in hospital, they might have attacked us badly. Faculties started lobbing from different aspect to kick the VC out of PAHS. Some even were lobbying to manage some better post like ambassador (राजदूत) for her so that she would herself leave PAHS. Some were repeatedly visiting the Prime Minister (PM) and Health Minister to suspend her. Even PM was very positive towards PAHS. He was well known to the goodwill of PAHS and Patan hospital. He informed that after she was recommended for VC, he waited for more than two weeks to sign it. But nobody from PAHS approached by any means so he declared the appointment. I remembered, few months back, when VC was to be selected for BPKIHS Dharan, they published ad in national newspaper that they won’t accept if someone out of BPKIHS is appointed as VC. I wonder, if any such thing was done by PAHS, this trouble would have never come. We student as well went to different student union office. All of them sent us letter in written that they would help us the way we ask. Faculties didn’t allow us to call those union people in hospital because the union might ask us make student-union in PAHS. They were worried that student politics would enter inside PAHS and would harm the teaching-learning activities the way it is happening in other universities. Written letter of support (ऐकेबध्यता) was received from different medical collages, student council, doctors and professors council etc. Dr Govinda KC who did hunger strike in IOM during similar problem of political appointment, himself came to encourage us during the protest.

We student separately made a struggle committee with about 50 active members. We selected one of the most active students during the protest as a president of committee. We also raised fund from ourselves for the protest. During meeting, we made a list of our demand with the government. One of the most important was, invalidate the rule of appointing VC of university by the PM or government. The issue was really genuine but who was going to listen to us? Obviously no one.

There was almost no gain for weeks. Things were all freezed. There was a pause everywhere. The whole academy looked standstill. Things were uncertain. How long would it take for the outcome? Nobody knew. VC didn’t dare to come again. But our classes were halt and hospital was running. Doctors were busy. It was almost for sure that the VC will be kicked out by one way or other, but when? Many students even started talking about resuming classes since there is no need of us. Others claimed that resuming classes will make us busy and protest will get weak. Some other student including me were advocating for active protest and fast result. In a meeting, when faculties were again talking about same old things. I came up with loud voice that VC’s office is locked which nobody sees, hospital is running well, doctors are working well, everything is going normal, then where the protest is? Why are our classes being halted? Why are we students alone being hampered? Either we should go to next step of mass resignation or hunger-strike otherwise classes should be resumed. A professor from department of obstetrics and gynecology added that students are telling right and they should start collecting signatures for mass resignation. I still regret for my harsh voice that day. There were complex and personal reason for me to get hyperactive, but I was not supposed to be so. They all were our teachers. They have got the responsibility to train us. All of them must have forgotten that small mistake by now. Still it was a breach of discipline by me and I am supposed not to forget the lesson from that error.

Whatever anybody interprets, faculties leading the protest had known that VC can’t be kicked out by this means and she is not going to resign by herself at any cost. She would rather work as VC in Greenwich hotel for four years and never coming to PAHS. So they had decided to go legally. Legal process was, 25% of senate member should register complain of impeachment (महाअभियोग को प्रस्ताब). Then ministry would form an investigation committee. If investigation committee found her guilty then voting will held among senate members. If 51% or more voted against her, then she is legally kicked out. There are many other lifetime effects of being kicked out by this manner, so faculties tried their best to make her resign herself. So that she can at least fight for other better post in life. But we couldn’t succeed to make her resign.

When the process of collecting senate members started, Kumvakarna (कुम्भकर्ण ~ Sleeping) VC suddenly woke up. She understood that her power, politics, money and rented criminals couldn’t do anything more for her. It was too late by then and she didn’t have anything remaining to do. The biggest group taking part in protest was the students. Probably she made some plans with the rector. Then they came to our student hostel in a late evening. The student hostel has five buildings and canteen in the center. They came to canteen and asked hostel staffs to call all the students in canteen. The news spread within seconds among the student that VC and rector were there in hostel. Nobody knew what to do. Being the senior most students, we had to decide what to do. Before coming to decision, we phoned some senior faculties. Some suggested to meet them other suggested not meeting them.  With no confusion, we instantly decided not meeting them. When no student was in her support, she lied to media that plenty of students are in her favor. Now if we meet her, no matter what happens she will interpret it as her victory so we concluded that no one will go to canteen even for dinner till late night. At least 1 student in each floors of 5 buildings were phoned about the plan. Student out of hostel were phoned not to come hostel for time being. The rector called someone in ground floor and politely said, “Won’t you even meet us?” he replied that everyone is busy studying and don’t have any time to meet them. Moreover they need not expect anyone to help. After some time, they left. We again informed our faculties about the incident and again, definitely the admired our deeds.

Out of 24 senate members, 7 (>25%) registered complain of impeachment and investigation committee was formed by ministry. She was now legally suspended. She filed a case in court against everyone in PAHS. The hospital lawyers were seeing it. Our class resumed. We started clinical year with 1^st week of nursing week where student work with nurses. Everything came to normal. After few days, we went to hospital at 7am (normal time for nursing week) for class/duty. Much to our shock and surprise, there were again plenty of cops in hospital. It took no time for us to assume that VC has again used power. Cops have already broken the lock in office and she is coming today in PAHS as VC. Faculties were already informed. Media personals were called. There held emergency meeting of doctors. We all the students and plenty of staff again went to administration to lock it. Again same chaos, same fight. All these were live telecasted by television. Thus VC didn’t dare to come. This was the last day we acted for protest. From next day cops didn’t come, those rented criminals (भाडा का गुण्डा) were not seen any more in hospital. The investigation committee started its work and found enough written evidences against her. She was proved guilty. Senate voting was held. 100% of present members (14 nos i.e. 59%) voted against her. After around a month, a professor from department of surgery was appointed as our VC by the PM, a professor from Department of Community Health Science was appointed as rector and everything went fine.

After a fight, no matter what result is, the related people always loose something. Both the ex VC and Rector resigned from BPKIHS as well and are fighting in Supreme Court against PAHS. The staffs loosed harmony among themselves. It took a good time to all of them come together. Especially those junior staffs who were thought to be taking VC’s side because of money she spent in them. These guys had some conflicts with PAHS administration for salary and other facilities from long back. These are political labor unions who always try to do something to show their presence (hardly anything creative). They do stood against us, but not openly. Gradually they understood that the protest was in the favor of the hospital, to save the sanctity and uniqueness of this institute, to save this academy from being like other medical collage working to make money alone. Finally everything is good now (except few for our junior batches, regarding their student’s feedbacks and community postings, which I will talk later). We students as well loosed all our vacations because of time elapsed in protest. Our one week long sports week was also cancelled and sports were held in Saturdays. We will not get any leave in big festivity of Tihar this year. About a year has passed but students from out of Kathmandu haven’t ever got any time to visit their homes yet. If we question on it, there is straight reply that nobody called us in protest. We went by ourselves being self-motivated. So we ourselves have to pay for it. Another more important thing is, if we ask for those vacations and sports, our 6 year long course will get even longer, are we ready for it? Off course not. Let me repeat “After a fight, no matter what the result is, the related people always loose something.” We too did. These will pass, what we learned from protest was amazing and a life time experience…….

Vacation at home

Our brand new medical school, with no passed out students yet, doesn’t believe that student need time to relax and vacation is important part of student life. We have no New year or Independence day or Krishna janmastami or summer/winter vacations or anything else. After more than a year, we got a leave for about one and a half week for the biggest festival- Dashin. We were provided with tasks to accomplish in vacation, but who cares? we kept it for last day of vacation. I left for home. I was being at my home in Dashin after three years.

At Lahan

The road in front of my house joins different villages including my ancestral home. The road is not black topped and always muddy. The bus is always overcrowded. Election camping have already started entering inside these villages through this road. Let me tell you, the vehicles used by the political parties are mostly Indian. See the number plates in photos below. They are using vehicles which probably pay the road tax and other payables to Indian government. If not to the Indian government then to no one (for stolen vehicles). Neither way, they are paying the taxes to Nepal. Can any morality let me (or anyone) vote them???
I remember, even cops used vehicles with indian number plates last year. Mostly by APF (Armed Police Force). Later on they were stopped to use such vehicles.

While talking about politics in my home town, I can’t overlook the president of UCPN-Maoist, comrade Prachanda who is a candidate in the election from same district, siraha EC No. 5. Talks are being heard how he made Dr. Birendra Mahato to take his name off. Dr Bidendra was candidate of MJF and has goodwill in that area and would easily win. Prachanda used all sham, daam, danda and bhed (convincing, buying, beating and exploiting/confusing) for it. It’s claimed that Prachanda threatened his businessman brother Dr Upendra Mahato that he would damage his business if Dr Birendra didn’t take his candidacy back. Candidate of Nepali Congress is also already made to step back.

***

These seven years in Kathmandu have slowly made me friendly to Kathmandu and an outsider to this place, my place. I remember one evening at hatiya (vegetable market), the shopkeeper didi gave an amazing look towards me. I thought for a while why this happened? This had actually happened because I addressed her “madam” while paying, saying “madam linus”. It’s not that common there.

***

In Nepal, wherever you go you will definitely find corruption. The next day of tika in the morning, there were few cops in the road in front of my home. They were checking all the bikes coming. A rider didn’t have license. The punishment given to him was a small treat (breakfast) in nearby hotel. I was seeing all these live. Other than the payment of hotel, they also might have taken some bribe (black money) from him. The rate at Kathmandu valley for not having a Driving License or other small errors is NRS 100 to 200. I think the rate is similar throughout the country including my hometown. Interestingly traffic police and cops don’t accept bribe for Ma. Pa. Se. i.e. driving while drunk.

***

My elder brother recently completed his study and is posted as dental surgeon at Sagarmatha zonal hospital. He leaves home at 9 am and returns back at around 1 pm. He has plenty of leisure time now. The private dental clinics there are all run by quacks (duplicate/untrained doctors). The quacks threaten and don’t let registered dental surgeons stay there. A doctor from BPKIHS Dharan had recently come there and was made to leave. This is Nepal. These all happens. Being a local resident we are not in danger but we don’t want any dispute as well. After enough brain storming, he decided to start his own clinic. He asked me to suggest a quote for his dental clinic. Few I suggested were-

• Put on your best smile every day.
• A smile is the prettiest thing you can wear.
• You are never fully dressed without a smile.

Best one is still to be selected. I would be more than happy if you suggest/select the best one. 

***

Before leaving Kathmandu, I went to bookstall to get few novels for myself in vacation. I bought ‘Malaya express’, Damini bheer and Santa chaudhari’s “Kamlari dekhi sabhasad samma (कम्लरीदेखी सभासदसम्म). I dropped the plan of buying Ghamkiri and Jiban Kaada ki phool because of condensed size of my pocket. I have kept these two for next vacation. Malaya Express was bought unplanned. I didn’t know about this book. The name is not so interesting thus I must have missed to see the reviews in daily newspapers. In bookstall, the authors name-  Akhanda Bhandari draw my attention. This author’s column “Voice of the voiceless” in The Kantipur Daily is my favorite. His tactful way of presenting things has always impressed me. Thus I bought Malaya Express and read it first. This book as well was nice enough. Few paragraphs were identical to the one printed in “Voice of the voiceless”. Yet it was interesting and I completed the whole novel in 10 hours or so.

The next was damini bheer. That is a name of a hill (भीर) named on a (so called) lower cast’s female (दमिनी). This is pretty famous one. It was awarded by reputed Madan Puraskaar this year. I remember an article in Nagarik dialy. The author could not believe his novel won Madan puraskaar because this news was given to him by a person who had updated his status in facebook advising not to read the novel Damini bheer. The person’s reason was, every so called lower cast author write swearword and abuse upper caste people and there can’t be anything else in this novel as well. So better not read it. I struggled a lot in the beginning of this book. It went interesting after I completed half of it. The endings are good and interesting.

For me both of these novels are not a must read one. I would rate three out of five (3/5) to both of them. I am yet to read the third novel Kamlari dekhi sabhasad samma.

***

As always, vacation time passes faster than anything else. In no time the vacation ended and I am back to Kathmandu. Back to the same life with some hope, some frustrations and a lot of fun...