Dr Bhola Rijal is a senior gynaecologist, obstetrician and Chairperson of Om Hospital. He is also the President of Nepal Private Medical Colleges Association. He spoke to The Himalayan Times on the report submitted by the high level task force formed to recommend national policy on Health Profession Education that was made public on Tuesday. Excerpts:

Private medical colleges have a difference of opinion on some points in the report? What is the main problem with it?

When Dr Govinda KC started his protest and hunger strike, it was for a very good cause and we supported it because we wanted institutions, universities and establishments to be free of politics and political parties.

He was somewhat successful in this movement but many other issues were not addressed. At that time, Tribhuvan University was for the UML, Pokhara for the Maoists and Purwanchal University for Nepali Congress.

In Kathmandu, we had rectors, vice-chancellors and registrars, who were divided. Later on, some other conditions were raised. These included autonomy for medical institutions, especially Tribhuvan University, and the type of examinations.

In the meantime, the question of Manmohan Medical College and Teaching Hospital arose, because Manmohan and a few others had already received the letter of intent and construction had begun. They were ready to start even though permission was not granted for affiliation to the university. So the entire question took a different shape.

Dr Govinda KC included these issues among his demands in his hunger strike and a committee was formed to give us a better perspective for the future of medical education.

The cost of medical education and number of seats was not included among the issues that the commission was to deal with in the beginning. These were included later. Secondly, this commission did not include stakeholders at all because the 18 private medical colleges did not know about formation of the commission. When we saw this in the news, we protested. We gave a letter to the prime minister saying that as stakeholders our representation should be there.

What is your disagreement regarding members of the commission?

Our logic was not accepted and the commission started working with six to seven persons. Except for one or two persons, we know their background and what they have done in their respective institutions and what is happening right now.

Two or three persons in this commission are from Tribhuvan University. They are among those who barred doctors at Teaching Hospital from private practice in 1986. At that time 23 senior consultants and the only DM in cardiology at that time, Dr BK Man Singh, were forced to leave Teaching Hospital.

Those doctors who worked as non-practising doctors got 200 to 250 per cent salary hike and some anaesthetists were paid 350 per cent extra as non-practising allowance. After we left, they gave those same non-practising salary to those who were still practising. Now all of them are practising while receiving non-practising salary. This is the ethics of people working there and billions of rupees have been wasted. And these very people comprise this committee.

Our doubt is, how can people who could not do the right thing in their own institutions now suggest what other people should do. I respect and appreciate Suresh Shrestha who has constituted and struggled himself to make his own university. But maybe he is the lone voice.

Then this report was handed over to the prime minister in the presence of Pushpa Kamal Dahal and other party leaders. Till today, I have never seen any report being handed over in the presence of different party leaders. So I’m surprised at this pre-planned handing over of the report.

Earlier, we read from the media about this report and asked the prime minister for a copy. We wanted a few points to be debated, as they were not suitable for the existing institutions and if these points were not considered no medical institute could survive. We will then have no other option but to hand over the keys to the government.

Which points in the report are unacceptable?

First, the report brings down the number of seats for students to 100. A few of our institutions are already running with more than 100 seats. Our infrastructure has been planned for 150 seats. If we are not allowed 150 seats it will not be possible to manage costs, students’ dignity, staff salaries and other things, along with the services we offer.

The second issue is cost. Five years ago the cost fixed by the Education Ministry was Rs 32 lakh, including inflation. By that understanding, the cost comes to almost 40 to 45 lakh rupees in the present day. But for no rhyme or reason and without any scientific basis, they have stated that the maximum cost should be Rs 35 lakh.

Third, there are only three medical colleges in Kathmandu. The others are in peripherial areas. If we have to hire faculty that gets paid Rs 1 lakh here, we have to pay Rs 2.5 lakh outside Kathmandu because no one wants to go to those areas.

The existing colleges are sustaining because of students from India, Sri Lanka and the Maldives. Now the report says colleges will not be allowed to take any foreign student without a central written exam. Nobody will come to Nepal to appear for an entrance examination. When I went to Dhaka for medical education, we did not have to sit for entrance examination. Even in India, whoever fulfils the criteria, can join and there is an exam and interview conducted internally by the institution.

The fourth issue has to do with university scores and cut off. It was 50 per cent, but now they have made it 60 per cent. We give the government almost 300 students free of cost through scholarships. In the last 20 years, the government produced around 300 graduates. We give education to the 300 free of cost and the government cannot even absorb all of them. Considering all these points we are asking why this attitude towards us.

The report claims that it seek to improve the standard of education while bringing down costs. Do you think this will happen?

I am all for supporting improvement in the standard of education and making it more affordable. When there was only one teaching hospital, I was there as assistant dean and director. We cannot compare the standard of education back then with today. But even then we produced excellent doctors despite lack of faculty and facilities.

Today’s education cannot be called low standard. I would like to ask what is the criteria by which you say the standard of private education is low? Doctors who have studied here and gone back to India have shown very good results.

If you take the case of Nepal Medical Council exams, those doctors passing from Nepal account for more than 80 per cent.

Those who studied outside Nepal have a pass percentage of 15 to 20 per cent only. If we talk about the American medical exam, most doctors from Nepal pass that.  Our doctors working in the field are considered the best  because even if they are only MBBS, they can perform well in any part of Nepal. So what is the criteria by which you say the standard is low?

Again, cost wise, government hospitals charge more than what we charge in medical colleges. Each of our medical college is taking care of all the areas in the country. We also send our specialists to district hospital,s but the government has to come forward with a clear plan. As far as cost is concerned, they say we have made it a money making business. Our question is whether or not the government is also charging.

They charge less because they use our tax money. They don’t have to buy land, pay interest, or pay the faculty, yet they don’t give free service to patients or free education to students. But they don’t want to improve their education, they cannot make it free either but they want us to make it free or susidise it. They want us to lower our standards. We smell something very foul.

What do you believe is the motive behind this?

If private institutions are closed or cannot run smoothly then a group of people who are very active in sending students abroad for nursing, MBBS and post-graduate studies to India, China and Philippines stand to gain. There is a commission for each student sent.

The commission for one MBBS student is Rs 3 lakh. Now you can calculate how much that is if even one medical college with 100 students is closed. There is a powerful lobby and if they can close down all private medical colleges in Nepal, which take care of 2,000 students each year, imagine how much can be earned in commissions.

I think the government has to prove that this is not the real reason behind the formation of this commission. I don’t see any other reason for such a report and suggestions.

The government is not helping us bring down the education cost either in terms of lower interest, or customs or service tax. Patients also have to pay five per cent service tax to the government. Nowhere in the world does such a system exist. It is the government that makes it expensive for us to provide education. Our concern is the hunger strike that has been proclaimed. This should not happen. It is against the medical fraternity.

But the medical fraternity seems divided on this report?

After the earthquake, doctors gave everything they could, even their blood. Who were there during that crisis? It was the media, the security forces and the medical professionals. We want everybody to be in harmony and in communication.

The medical profession is neglected. Why aren’t we fighting for that instead of being divided? I’m really hurt that till date no doctor or medical professional has been given a state funeral or recognition for services to the nation. Why?

The medical community is neglected and certain forces want us to keep fighting among ourselves. They don’t want to make this profession affordable or respectable. Today, anybody can come and damage your institution, manhandle doctors and do what they want while the government keeps quiet. This is happening today and I have grave concerns that there is an understanding among certain forces to spoil education as a whole, not just medical education, so that the bulk of students go abroad.

I think it is our duty to prevent this. As a pioneer I know the pains I have been through. If someone doubts this, come and discuss with us and understand our problems rather than take steps against us. We have conveyed our reservations on these points and sought discussions. If we are ignored and the report is implemented it will invite grave disaster. This is going to affect the entire medical community.