Bad prescription:Political appointees threaten medical schools with mission to train rural doctors



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The only medical school in Nepal designed specially to train doctors to serve in rural areas has been paralysed by the political appointment in August of a new chief. Angry staff at the Patan Academy of Health Sciences (PAHS) have partially shut down the hospital in protest for the third week running.

Nepal’s private and government medical schools produce over 1,500 doctors each year, but half of them migrate overseas and the ones that stay in Nepal choose to work in urban areas. PAHS was designed to train doctors to serve in district hospitals, and 60 per cent of its students are from underprivileged families whose scholarships require them to work for up to four years in rural areas after they graduate.

However, political appointment of new Vice Chancellors have this year plagued both PAHS and TU Teaching Hospital (TUTH) in Maharajganj, which were set up with similar philosophies of training rural doctors at a time when private medical schools are being commercialised and have political protection.

A fast-unto-death hunger strike in July by Govind KC, a TUTH doctor, forced the government to cancel the nomination of a political appointee there. In PAHS, there is deep concern among doctors and international partners that the appointment of the politically-connected new Vice-chancellor Sangita Bhandari to replace founder, Arjun Karki, will undermine the hospital’s mission.

“The new VC has not respected the abilities of the founding faculty members,” says Bharat Yadav, professor and chair of the Department of General Practice at PAHS. “She and other recruits do not understand our mission.”

Bhandari, who is related to powerful Madhesi politician and former minister Sarat Singh Bhandari, has told media that she faces opposition in PAHS because she tried to clean up the hospital of corruption. Her appointment of Soumya Bajracharya as Rector prompted PAHS staff to stage sit-ins and lock-outs of the hospital this month with police entering the hospital to forcibly break up the protests. Stakeholders convinced agitating staff on Sunday not to let their protests affect medical treatment and care of patients.

Kedar Baral, professor and chair of the Department of Community Health Sciences, says PAHS’ entrance criteria and curriculum are designed to mould motivated doctors. “The current VC wants to change the entrance criteria, recruit more commercial students,” says Baral, “this will turn PAHS into just another medical school, it will no longer be a school for rural physicians.”

Shrijana Shrestha, professor of paediatrics, says PAHS staff had initially given Vice-chancellor Bhandari the benefit of doubt, but the new chief showed scant regard for the hospital’s mission, and has been disrespectful of faculty. “The current dispute risks the mission of service of PAHS, and Bhandari is a bad role model,” Shrestha adds.

In interviews, PAHS students said the VC had threatened to cancel the scholarship of the first and second batch students and cancel admissions of third batch. “How will someone like that lead and motivate us to serve in rural areas?” asked one student, who did not want to be named.

PAHS has tried to change the trend of Nepali medical students migrating abroad or gravitating to private clinics in cities by taking the strategic and difficult approach different from traditional medical education in Nepal. It selects competent and compassionate students using IQ and personality characteristics testing, teaching an innovative curriculum that is strongly community orientated.

“PAHS actively recruits capable students from rural and remote Nepal with the view that these students with existing ties will more likely want to serve in those areas,” says Katrina Butterworth, Professor of General Practice at PAHS.

The International Advisory Board has involved over 200 educators, scientists, doctors and other health care providers from all over the world in the past decade. One such volunteer doctor is Darren Nichols from the University of Alberta in Canada, who says: “We are volunteers who share the vision of building peace in Nepal through health equity. PAHS has a brave and visionary mission of serving the neediest people of Nepal a mission that has attracted a global following.”

The dispute has threatened ten years of work by PAHS founder, Arjun Karki, and his team to develop the institute as a role model not just for Nepal but for all countries that struggle to recruit rural doctors. A private medical school in Nepal charges more than Rs 6 million for an MBBS education. PAHS costs less than half of that for private applicants, but 60 per cent of its students are on full or partial scholarships. More than 80 per cent of students enrolled this year are from outside Kathmandu. Over half the second batch students are women and many are from marginalised communities.

Assistant Professor Sabita Rana says the political appointment of an inappropriate Vice Chancellor threatens to unravel PAHS’ achievements.

She says: “We risk losing local faculty who have sacrificed better salaries to teach our more demanding course, we risk losing the trust of district hospitals, we risk losing our essential international partners, and most importantly, we risk disappointing students who have come to learn that medicine is a social service, not a way to get rich quick.”