Ethics…

Imagine a young guy of around twenty years old. He has some pus under his skin in legs in the form of abscess. He goes to the oldest and most renowned hospital of Nepal, The Bir Hospital. Let me tell you, Bir hospital is good and well facilitated hospital with plenty of doctors of different level. They can manage almost all health problems which is manageable in Nepal. And that young boy with abscess in leg, need a minor surgery called Incision and Drainage (I&D). I&D is a very common and simple surgery that can be easily done even in resources poor setting. He went to Bir Hospital, a well facilitated hospital. So we can assume that he got a good care and was treated there easily.

Unfortunately, story didn't go like this in reality. I have heard that many of the patients reaching Bir hospital are not treated. By a means or other, they are force to go to nearby private hospitals. Most of those private hospitals are owned by doctors of Bir hospital, and are opened to make plenty of money. Similar to many other patients, this young boy too was also (forcefully) referred to one of the nearby orthopedic and maternity hospital. The orthopedic department, who manage disorder of bone and joint, admitted this boy who is a case of general surgery department. I don’t know was this right to do, but since I&D is very simple operation, they have an expertise to do it.

What I want to talk about is a different matter. A hospital staff asked the orthopedic doctor,” How much should the boy pay?” 

The doctor answered, “Take around 15000 or 16000 ( पन्द्र-सोर्ह हजार लिनुस् न).”

He made a bill of sixteen thousand and handed it over to the boy. He was a student and this was big amount for him. He phoned someone of his family in village and said in a very sad manner, “I am very sick, I am planned for operation in hospital. It cost sixteen thousand, I don’t have more than four thousand rupees. Please send me money as soon as possible.”

The poor family somehow managed the money for their very sick (they think) child who need operation. And I&D was done the next day after he deposited the money.

Now let me tell u. In a public hospital, the charge of I&D is around one thousand. I’m sure it’s even more cost effective in Bir hospital. And this guy was not economically sound to pay this huge amount. But who cares. I don’t think if these doctors ever knew what ethics is, what professionalism is. Let me add, the charge of normal delivery in that private hospital was about seven times more than our public hospital. Cesarian-Section (The delivery of a fetus by surgical incision through the abdominal wall and uterus) cost about 10 times more.

I came to know about this story because a close relative of mine used to work in that hospital in very very low wages (say volunteer). I’m sure he must be unsatisfied for his job that helped those sinners who suck the poor.

This hospital is just an example. I have heard from different means that, there are plenty of such hospitals around Kantipath and Putalisadak that runs as unethically as possible. And patient for them is managed/sent by the Bir Hospital. Many of the patients are over treated. All of them are over charged. Many of them are made to stay in ICU which is not required (no medical indication). An ICU bed costs about five thousand per day, which is a huge amount. Moreover, these hospitals are under facilitated and resource poor. Even ICU, which should be run by an intensivist, are run by nurses. I am not blaming everyone. There are many hospitals running ethically and professionally. But malpractice exists, and has crossed its limits. I hope government, system, medical council would woke up soon and take action. Few years back, the Tribhuwan University Teaching Hospital (TUTH) also called IOM, at Maharajgunj was also similar to Bir hospital. There always used to be few ambulances of private medical collages and private hospitals in the parking of TUTH to take patients of TUTH to the private hospitals. The Emergency doctors of TUTH would lie saying ward is full and refer the patients to Private ones in the greed of commission. Thanks to Dr. Bhagwan Koirala who stopped this after being hospital director of TUTH. Many senior doctors tried their best to kick Dr Koiralaa out of that post. Fortunately they didn’t succeed and TUTH is fine now.

Talking about this made me remember about recently published news on corruption. Transparency International, a NGO that lead global movement against corruption, recently reported Nepal to be 36^th most corrupt country of world. Political parties being most involved in corruption, followed by bureaucracy, parliament, judiciary and army in the fifth. 

I was wondering, in the hierarchy of corrupts, where do doctors and medicine stand??

May be its not there because doctor’s profession is still not that bad and corrupt. There are plenty of doctors and medical personals who practice justifying the trust of common people on them. Who show respect for human life and whose practice meets the expected standards in all domain.

Another more Probable reason is, may be malpractice in medicine is not commonly seen or understood by common people, so it remains unreported. 

I hope the former one is correct…..

I hope these malpractices would be controlled soon. There must be some problems of doctors as well. The medical school charges being too high, salary of them being too low, higher study being too expensive and unaffordable, etc. I hope even those will be addressed.