One of my favorite faculty, prof Katrina was left us last year. She
returned back to UK, her home country. Before she left, on behalf of the
symphony, our collage magazine, I along with two junior friends of mine; Shweta and Saugat, took an interview with her. This is the original
draft of the interview. Edited short version was published in the magazine
Our very near
and dear faculty, Prof. Dr. Katrina Butterworth from UK, is known for her hard
work, her commitment to the academy and students, her compassion and empathy
for patients and her simplicity and softness. Her dedication, hard work,
simplicity and always smiling face is like inspiration and motivation to all
PAHS students. She has always been there for us with all her love and support
when we needed, when we needed a teacher or a complain box or needed favor to
take our words to the management. She is one of the strongest pillar of PAHS as
a doctor, as a founding faculty, as Student’s Affairs Committee (SAC)
Coordinator, and as a medical educationist in many places in the Academy.
Unfortunately, she is leaving PAHS and is leaving this country soon. Undoubtedly,
she is always going to be missed and will always be remembered fondly. We are
going to utter, we wish Katrina maam was here. Before she leaves, we took an
opportunity to talk to her and know her life and perspectives closely.
ST: Namaste maam.
KB: Oh Namaste, welcome. You are exactly
on time.
ST: Thank you maam. So finally after
5 years, the time has come when we will take your examination. (Everyone laughs)
I guess it’s ok if we record the conversation.
KB: Ya sure. so, 2 recorders, for in
case one doesn’t work.
ST: Yes, maam. If both doesn’t work.
You will have to give re-examinations. (Laughter again)
ST: Ok, the first question that carries
five marks is…. (Laughter again)
KB: It’s not written down. I’m not
answering. (Laughter again)
ST: Now on serious note, first of all, if we request you to introduce yourself. How would you?
KB: umm, I’m Katrina Butterworth. I’m
a General Practitioner from UK and I have been working in Nepal for last 18 years.
ST: Going way back, how were you as a kid maam?
KB: So my father was in royal air force,
which is a bit like army but it’s not. My young childhood passed travelling around
different countries where my dad was working. But we lived in England since I was five.
In school, I was always involved in multiple different things, I had lots of interest.
I was very involved and did all kind of things related to church I enjoyed singing, music, all kinds of sports
especially gymnastics and judo, and I’m brown belt in judo.
ST: Oh, we should
be afraid.
KB: Laughs, yaa, be very afraid. (Everyone
laughs)
ST: And your family maam?
KB: I have one brother. My father died when I was in my early twenties. My mother is fine. She lived
and worked in Nepal for eight years as a primary school teacher. She taught missionary children in different hospitals of Nepal and then she retired. But she still travels a lot to Nepal.
My husband- Martin is from Yorkshire, which is a north part of England. We are married
for about 25 years. He is basically trained as an engineer but working for UMN for
monitoring and evaluation.
ST: I am sure, you would like to share how you met him.
KB: When I was at university, we met through caving. I joined a caving. We were exploring caves and the mountain. My husband is quite older than me and there he was looking after the students making sure that we didn't kill ourselves going down these caves.
Thus we met through caving. (Laughter)
ST: Who proposed
maam?
KB: umm, he did but I forced him to.
(Laughter again)
ST: umm, how?
KB: I had ultimatum. I had to move after
graduation for job. I said, “I am not moving unless we get married.” And he said,
“OK.” (Everyone chuckles)
ST: Maam, what were your happiest and saddest moment of life? Other
than getting married to Martin. (chuckles)
KB: Well, it’s kind of related to that (laughs). The birth of both daughters of mine, the
elder daughter was born in Patan Hospital and my younger daughter was born in
Tansen. So their birth was Happiest among every good things.
And the Saddest, there is a lot. Every one especially who works as doctor at
Nepal has many sad experience. It’s really hard to see people suffering and I
cannot do anything about it. Because many suffering is not due to physical
thing, but due to social, psychological thing, and a doctor can’t actually
help. I find that very hard.
ST: Where did you do your schooling and jobs?
KB: I went to Northallerton Grammar School
at Yorkshire for schooling. Yorkshire is north of England. Then, I went to New Castle
University for graduation. After graduation, I got married and moved to Bradford.
I worked there for 4 years, then came to Nepal. At Nepal first I took language training
for six months, my first language teacher is now hospital director of Aampipal Hospital,
Gorkha. Then I worked for 5 years in Butwal and then came to Kathmandu.
ST: And Palpa maam? You have written a lot about Palpa in your
books and articles.
KB: Not really, when I lived in Butwal,
I visited Palpa a lot of times to visit my friends there and I did some clinics
as well at Palpa. My second child was born in Palpa.
ST: Why did you wanted to become a doctor?
KB: People suggested me to become a doctor because I was good at studies but I didn't want to. Because I thought it was big responsibility to become
a doctor. Because
people rely on you, they trust on you and I wasn't sure I could do that. But when I was thirteen years old, I became a Christian. I made my own commitment to Jesus, at the same time I very clearly felt God telling me that he wanted me to be a doctor and that he wanted me to work overseas. So it's very much related to my faith.
ST: At 13 you
became Christian, and before that?
KB: So I was brought up in a Christian family. But there is a difference
between being brought up what your family believes and then making a decision
for yourself. So I made
a decision for myself when
I was thirteen.
ST: Will you please summarize
us about the challenges you faced in your journey to Nepal, from a student in U.K. to a professor here.
KB: There had been many challenges.
So one of the challenge is, I made a decision that I want to be a doctor at 13. I was 28 when I came Nepal. From the age of thirteen to age of twenty eight, whole time I knew this is what god wants me to do. And everything I was doing was preparing for coming to Nepal.
And then when I arrive Nepal- for me OK I'm here now and I am a doctor but what is the plan now? I didn't know what the plan was.
And the big challenge for me here was- I like to be very organized, and I would like to
plan exactly what’s happening. When I arrived Nepal, Nepal doesn’t plan in
advance. So having to wait and see what other people want to do and to listen to what God wanted to happen next and not me be in-charge. That was very difficult for me and I think in PAHS it's the same thing that I like to be very organized, I like to plan in advance
and people here doesn’t usually plan in advance. And that’s difficult
for me.
ST: I’m sure you had some
language barrier as well in your earlier years, may be 18 years back. Please share
if there is any interesting experience.
KB: My worst best memory
of language barrier is-
Patient laai pakhalaa lagyo, I asked,
“tapaiko pakhalaa kasto chha? Guliyo chha?”
I meant to say- gilo chha. There was stunned
silence and then whole room burst out laughing. I am little bit better now.
ST: Lot better
maam.
Maam we would like
to know about ragging in UK. PAHS updates its Anti-Ragging-Act every year. Is
it present in UK, and what is your view on it?
KB: NO, it doesn’t really
happen in UK. There isn’t any ragging thing. Ragging means the older students bullying younger students. I think it's really bad. I think it's very harmful. And it shows lack of respect for each other. Since we all have to work as colleagues later, so I think we should show mutual respect.
So, don’t do any ragging. (Smiles)
ST: We don’t maam. (Laughs). Now, what would you call your greatest achievement yet?
KB: The one to be mentioned is, joining PAHS and seeing my
students, 1st batch is just about to graduate. And for me, just to see the way that the students have grown as people and as doctors, watching the compassion that they show to the patients. And also seeing how my students like Dr Samita, Dr
Ashish, Dr Yagya, Dr Sumana etc. have become the faculties. I see them now as my colleague, my friend, that's my biggest achievement to see them independent and doing a really good job as a faculty and doctor
at PAHS.
ST: And, something that you want to achieve but couldn’t,
if there is any.
KB: There's a couple of things that I'm still working on that haven't happened yet.
First is, I do work with the government for Continuing
Professional Development, to put that into the system for all Nepali doctors. I work with Nepal Medical Council (NMC)
on that and that hasn’t happened yet. We want to make sure, every doctor have to do it to maintain their registration so that every doctor keeps up-to-date. Because I feel very strongly that you have to learn for your entire life as a doctor.
That’s one thing, and the another thing I'm working on and hasn’t happened yet is- to get General Practice taught in every medical school in Nepal. Because I think general practice is really important and many students don't know what GP is. And how can you choose the specialty that you don't know what it is?
So that's the two work-thing that’s not completed yet. And other than work thing, I really wanted to go to visit Tibet. But when my friends were going there last year my
Nepali visa had run out and I couldn’t leave the country.
ST: Now we would like to talk about GP. How did your interest in GP developed?
KB: So when I was in the medical school I wanted to be an internist. Because I knew I was going to work overseas, I asked people, what
the most useful thing to work overseas is? And everybody said
GP. Then when I did general practice as a medical student. I think General Practice and it was really exciting. In UK, as
a GP we go to people's homes and I really like that. Being able to know people in little bit more depth. I got trained in GP because
I wanted to work overseas. But what I found was the depth of relationship in GP so much more than I think most specialist get because you know people for many years. I really enjoy it.
ST: Now maam,
I suppose this should be your favorite question- we would like you to summarize
the role and need of GP doctors for Nepal.
KB: (Laughs,)
OK
Well. (Being our student) You know the answer. I feel very strongly about this.
Where Nepal needs doctors is in rural areas. And if you're in a rural area you need to have certain skills. You need to have surgical, orthopedic, community health skills, management skills and you need to have medical, gyane &
obs and pediatric skills. And the only doctor that does all of that is the GP. So
the GP doctor can provide essential health care to everybody. So they will make the biggest difference in health care in Nepal. Thus I am struggling with the government policy that they shouldn’t have one surgeon, one obstetrician, one pediatrician and so on because there's never going to be enough volume of patients for those doctors to be happy and to maintain their skills. Whereas the G.P. can do all different things and so they are never board. They often have too much to do. But they can save lives. It's not just about dramatic surgery but it's also looking at the long term, how to improve the health at a community level, at public health level as well. So the GP doctor is trained in all that. So it’s like, they don't work on their own, they work as a part of a team. But we call them ‘the Captain of the health care team in district’.
And I also think that GP has a very important role in city.
Particularly for first part of care and longitudinal care. I think all patients should see GP first. Patient
often doesn’t know which specialty care they need. Say a lady with abdominal
pain may be in the need of surgical care, or may be medical care or may be
gynecological care. So, if she goes to a GP, she will be managed there, or may
would be referred to correct specialist if needed, the way it happens at Patan hospital. And I think this
way gives a better care for the patients. I think it gives them a better working environment for the specialist as well. Because specialist see the patients that
need to see them, and they're not wasting their time with things that doesn’t need a care
from a specialist, but a generalist can see, or other specialist should
see. So GP has a major role, both in rural and in city.
ST: This would probably
be helpful in our exam too. (Laughs)
Now, for the undergraduate curriculum, we have different process of selecting students
compared to other medical schools. What are the core qualities that PAHS thinks
a medical student must have?
KB: That would depend on what you believe a doctor should be like in the end.
At PAHS we believe that doctors should be having the intention of service,
they should be technically competent, and they should be compassionate. So we chose our doctors in that way.
So if you are in a private medical school, it depends if your purpose is to have a very technically competent doctors who can go and work in America, then you're going to have a different set of criteria. Then if you want to hire competent compassionate doctors who are willing to serve in Nepal. And that's why we have such different entrance system.
ST: A lot of competent
Nepali doctors migrate to abroad every year. How do you think that such
scenario of brain drain can be reduced?
KB: 1st of all, the big
thing is there should be change in culture. It should be seen as a good thing
to stay in your own country to serve your own people. It should come from your
heart. A heart should change.
This is what we do at PAHS. We want to change heart of our graduates, we want
them to be willing to stay in own country and serve own people. It won’t be
ethical to force people to be here, I would like people to choose to be here.
If we see around the world to address brain drain, what they do in Thailand is,
they make a bond that you have to work first 5 years for own country only then
you are allowed to move for any foreign country. I think if someone is paid by
government for study, they should work for government for some years. Even if
someone has paid for their education, actually you learn from patient. The
Foley catheter you apply and the NG tube you inert is painful for the patient,
it won’t be painful if I or some other expert do it. So the common people, the
patient have invested to make you competent and thus you owe for the society.
So I hope they understand this and choose not to leave the country.
Even more, in our academy, the whole point of PAHS is to train doctor for
Nepal. We would be disappointed if our graduates choose to work overseas. We
hope our graduate will work here, that’s the whole aim of PAHS.
ST: Children of many renowned
people, doctors, and other professionals, they join medicine, if money is not the
problem, what do you feel about this?
KB: I think that’s fine, as long as children choose it for themselves.
I feel medicine is something that should be chosen that you need to feel passionately that this is what you
want to do. Because if you only want to make money, then there are many other jobs that pay much better with lot
less work. So don’t join medicine to make money. So like my own children do not want to be doctors, because they know how much work it is. And they're just not interested in medicine and that's fine. I think they need to make their own choices.
ST: If you had the option for your kids, what would you have wanted them to be?
KB: Frankly, I want my children to love the work that they do, what they find rewarding. And preferably there would
be some great benefits to the world. That would be my choice. (Smiles)
So my younger daughter wants to be an actress, so we will see on the
stage (smiles).
And my older daughter wants to do international politics. So we will see.
ST: We wish
both of them a good luck.
Will
you please summarize the difference between health system of UK and Nepal.
KB: The system in Nepal is,
if you can pay money for health care you need then you are ok but if you don’t have
money than you are not OK. And that’s a justice issue to me. And I strongly feel,
this is not fair and not ethical.
It’s quite a lot of different in UK, there is national health system in UK so nobody
pays for health services there. So weather you are rich or poor, you don’t pay at
all at hospitals. But according to how much you earn, a handsome percentage of your
salary goes on to the government, in return of which your health care need and educational
need is assured for whenever you need it, which I think is great. The problem with
it is, government needs to have enough number of people working and earning enough
to support the system. In UK now, we are struggling because cost of care has increased
a lot. The treatments available now cost so much money so there is some problem
in addressing this hike in costs. But the trouble in Nepal for health care need
is way lot more.
ST: Now lets come to Patan hospital. What exactly is Patan hospital
and PAHS for you?
KB: Everyone in PAHS/Patan Hospital who
feels passionate about PAHS goals, which mean the people in kitchen or laundry or
are any staff, faculty or student are core PAHS family. I’m impressed by all of
them. I feel pleasure and privileged working here, I really enjoyed working here.
The best thing to mention is the team spirit of faculty and students, I’m really
impressed to see all of them helping and supporting each other. It my kind of prayer
that you all continue to work as a team, together, be compassionate, love and serve
your patients, and when you disagree- do compromise and always remember the purpose
of PAHS.
Patan Hospital is kind of my work home. The whole aim of this hospital since it
was started is to serve poor and marginalized and demonstrate compassion. I like
to work in that type of environment. So it feels really good to be part of this
team.
ST: What is your dream for PAHS, where do you want to see PAHS
in some ten years of time?
KB: In ten years, I would like to see
that there are PAHS graduates and medical personnel working in all district hospitals
of Nepal. They are all engaged in service and are also teaching and training others,
and are finding their job personally fulfilling. They don’t feel- oh, I have to
this. But they feel- this is what I really want to do. Such whole culture develops
within the university and all PAHS family works to achieve the goal and overall
health care of Nepal improves.
We could have 2 GP in every district hospital, who are supervising junior doctors
as well. I hope some the GPs will be PAHS graduates and some of the junior doctors
will be PAHS graduates as well. May be there are students working alongside them.
So there can be continuous cycle of posting in district hospitals and people have
really good learning experience in those rural areas which will make the doctors
and students want to go back in such places and serve people there.
ST: Do you have any comment on politics inside PAHS, or possible
political works by PAHS students in future.
KB: No, No comments on it.
umm, politics was never my thing. I hate politics, so I will be very happy if there
is no political unions of students or faculties at PAHS. I know, it could happen,
unions affiliated to many political party may be started at PAHS too as in other
universities but it would be sad.
Actually the problem with politics is, it usually not there to make things run smoothly
but they are there to make good things difficult thus I would prefer if we could
manage to resolve our differences in pleasant way without any politics.
ST: What were your concerns and expectation and experience with
new concept of PBL and CP in medical curriculum in Nepali medical school?
KB: Well, the CP curriculum had never
been used in clinical teaching, was only used tin basic science teaching. Thus,
I was little anxious about it initially about how it will work out and how will
faculty deliver it but all faculties and students have coped brilliantly, and that’s
great, really great. Also, I feel students really enjoyed it. They became more confident
as people, learned to listen and support and work as team and they preferred learning
form PBL and CP rather than traditional system teaching by delivering lectures in
class rooms.
Some medical school are very competitive, my medical school too was very competitive
and everyone wanted to be best. And that’s ok, as long as it doesn’t mean that you
don’t help other students. In PBL, I have seen students supporting each other and
not feeling competitive but learning from each other and teaching each other and
thus being more competent every day in very healthy manner.
ST: Students and doctors from our part of world are accused of
not being well-involved in research activities. Do you think your students will
be different?
KB: Oh, I think so, because you have
already done quite lots of research as a medical student. Many of them were quality
research as well. I am pretty sure students are going to continue it in their professional
life and are going to enjoy researching and gathering evidences and finding new
things. I have seen PAHS students doing quality research thus I definitely hope
they will continue to do that in future.
ST: Medical collages generally teaches ethics by lectures but
at PAHS, it’s quite different. Students are exposed in real hospital situations,
analyses it according to ethical principles and the 4-Box-Method and finally come
to some type of meaningful conclusion. What were your experience with this ethical
teaching?
KB: Now, this was little bit scary. As a medical student, we were
never taught ethics in our medical schools. But as a doctor, if you are aware of
concepts, you deal with it every day. I know how difficult it is. I don’t know how
it is done in other places. But PAHS is pioneers in many ways. At PAHS, we not only
wanted our students to have head knowledge, but have a knowledge that you can use
and apply every day in clinical practice. That’s why we developed that system for
ethics teaching.
ST: Maam, professionally we know you as a doctor, an author, a
researcher, a medical educationist and a professor of GP and many other form. Will
you please tell us, being what do you enjoy most?
KB: I actually like to do everything. May be that’s why I love
GP so much. I won’t enjoy being and doing only one thing, I prefer being good and
quite some number of things. That’s same from my childhood, being involved in many
different things. For me, it’s all important and it all make some part of what is
me. So I can’t be just one of them, just a professor, or just a GP, just a novel
writer or just an educationist. I need all of those things to be me.
ST: “For the ordinary people of Nepal, who have suffered so much
for so long.” was the heading line of your Novel- ‘Red Dawn Rising’. When did you
first thought that you are going to write a novel in this manner about the real
Nepali people.
KB: I wrote it in some three month
time. In the middle of Maoist conflict when we left Butwal and came to Kathmandu,
I had about three month leisure and that was space for me. There were lots of political
changes going on and there were lots of violence and I met many patients who suffered
a great deal. And we had a prayer group and we were praying for patents with whom
really really horrible things were going on. So the writing of Novel was started
then with their stories. The idea of that Novel was to let other people know
what it is like in Nepal and how the life and struggle of many people in Nepal
is.
ST: I remember it was our second sports week. You were placed
in first position in five-km-marathon-race among females. I was wondering, what
keeps you this fit and this young?
KB: Two things I Love cheese and I love
chocolates. If you eat those things and you don’t exercise then you get very fat.
So I exercise so that I can eat what I like. I run four times a week for half an
hour in the morning. And I cycle in other days.
ST: You are soon leaving us, you are leaving PAHS and returning
back to UK. What are your plans after that?
KB: I will go into General Practice in
UK. I passed my exams. I have a job sorted out. I have six months of re-training
to do. And I have an offer of long term job after that at Bradford, UK. I am happy
about the place, it teaches medical students and post graduates. So I can still
teach after returning UK.
ST: Congratulations maam for completing your exams and for a job
you wanted to have. We are expecting a treat right after this session. (Everybody
chuckles)
And maam, what do you think you will miss the most after leaving Nepal?
KB: I will miss patients and my students
the most. Unfortunately there would be no formal relation of mine with PAHS. I just
hope I will be in touch.
ST: In the end, do you have any message for symphony team?
KB: I wish you good luck. I have experience
of being involved in journals, it’s kind of hard work. Just keep going and keep
an open mind at different people and enjoy it.
ST: umm, we shouldn’t ask. But if it’s ok, What’s your age?
KB: I am forty six.
ST: You look a lot younger maam. I guess
if we had met in Sajha-Bus, we would have addressed you didi or something like that.
KB: It’s flattering and I’m not that
young… (Everyone laughs)
ST: Thank you maam
