Friday, December 21, 2007

Medical Education and KU

Apart from IOM, set up in 1972 and affiliated to Tribhuvan University, we did not have any medical institute in Nepal till 1992. After granting affiliation to Manipal College of Medical Sciences, Kathmandu University successfully started a venture to run health and medical institutes without government subsidy and financial back-up. Subsequent to Manipal college, Many other colleges have come up in Nepal and this process is still going on. BP Koirala Institute of Health and Sciences (BPKIHS)1993, College of Medical Sciences , Bharatpur, (1993), Nepal Gunj Medical College, Nepalgunj (1997), Nepal Medical College, Kathmandu (1997), Kathmandu Medical College, Kathmandu, (1997) , Universal College of Medical Sciences, Bhairahawa, 1998, Kathmandu University Medical School, Dhulikhel, 1998, and Janakpur Medical College, Janakpur,2004 is the latest in the least. Altogether, these medical colleges are likely to produce around 1000 Medical graduates from 2008. For 25 million population of Nepal, future of Nepalis health system looks promising. But, this is limited only in rhetoric. The statistics show that out of 35,000 medical practitioners, only 5000 are registered in Nepal medical Council. There are less than 200 doctors catering to Nepalis outside Kathmandu valley. Shortfall of doctors and health professionals have forced millions of Nepalis to perish even by less severe epidemics. Death of common Nepalis have so far not taken into account while talking about virtues of private sector in Nepal’s medical facilities. Policy makers, educationists and politicians all are busy counting up firstly the number of students who will graduate as doctors and secondly the money they have been able to bring in Nepal through foreign students.

Prof. Dr. Suresh Raj Sharma, a powerful Medical educationist in Nepal, has time and again gloated that his initiatives of involving private sector in Nepal’s medical education has helped Nepal a lot. He opines that by having these medical colleges on whatever rudimentary infrastructure, we are starting a new trend in Nepal. Quality wise, “has anybody bothered to look into the quality of medical education Nepalis students get in China and Bangladesh?” this has remained his counter question who ever asked him the quality of medical education in Nepal. Many, however, unlike him believe that without imparting quality and social responsibility, medical education is meaningless in Nepal. Moreover, people are really afraid of burgeoning medical costs in this scenario. The privatization in medical education in Nepal has not lessened the woes of people as it has helped to create a cartel, which can arm-twist even the government and Medical council of Nepal.

KU’s role
By granting affiliation to Manipal Medical College in 1992, KU set a precedent of academic dishonesty in Nepal. Under pressure by then Minister of Education, Mr. Govinda Raj Joshi, Prof. Dr. Suresh Raj Sharma gave that affiliation even though KU did not have any medical school as well as medical professors. With this affiliation, Suresh Raj tried to achieve two things; cement ties with politicians and establish himself as education mafia of Nepal. With active connivance, Suresh Raj went onto grant affiliations to many Medical colleges in Nepal. Manipal has, using its brand name, somehow succeeded in stabilizing negative media reportage. Barring the collapse of root-top from Pokhara hospital, when a number of patients was killed, Manipal College of Medical sciences in Pokhara has become 3rd favorite destination of meritorious students after Tribhuvan University Teaching Hospital and BPKIHS, Dharan. Initial hiccups were observed in functioning of KMC, NMN and Bharatpur Medical college. However, after active intervention by NMC, these colleges have somehow managed to taper off initial teething problems.

Most of the medical colleges, which received affiliations from KU, have by now developed standard academic practices. Barring receiving question papers from KU in lieu of annual affiliation fee, most of these medical colleges are cent percent autonomous. This could be attributed to doctors and officials in those medical colleges who managed to have good management practices in their respective institutes. As large sum of money is involved in Medical colleges, which unlike KU did not receive any land, and grants from the government, it was the least avoidable thing. But, the irony with KU’s medical education is its own inferiority. All the colleges which sought affiliation from it are now functioning well but KU’s own medical college is having a great deal of problems. As in other schools of KU, the problems in KUMS can also be related with nepotism and corruption of Suresh Raj.

Starting KUMS
KUMS has a unique distinction of initiating problem-based learning in South Asia. Professors from Harvard University came all the way down to KUMS to help Kathmandu University start its own medical school with a great fanfare. This was a remarkable feat for a besieged University, which was often criticized for degrading academic standards in the rush of garnering numbers. Prof. Arjun Karki and his team should be credited for this turn around of public opinion in favor of KUMS. With the team of Dr. Arjun Karki, KUMS started operating in Sheer Memorial Hospital Banepa. KUMS was on the path of charting out its own success story with able team members. However, certain developments unfolded so fast that a crisis was set in KUMS.

KUMS – first two years
After launching its own Medical School, Suresh Raj Sharma and Sitaram Adhikary were flabbergasted with the thick wad of money KUMS was brining in. Though many have claimed that KUMS happened to ward off constant criticisms, yet there are enough grounds to believe in some other reasons. Definitely not only Nepal Medical Council (NMC) but also the medical professionals all over the world got irritated when a university without Medical faculty started giving affiliations. In a number of occasions, Suresh Raj has pleaded helplessness for granting affiliations. He would invariably tell that political pressure has a hand in it. This was not true. As the political pressure put him in a hot spot, Suresh Raj knew very well that politicians of Nepal would not take action against him for implementing their ideas. So, the political pressure Suresh Raj had to face was a blessing in disguise for him. Now, after favouring the politicians, he is also in position to garner their favour. Moreover, he could socialize more confidently with politicians in addition to passing the buck entirely on them. This has helped Suresh Raj to exercise an unstinted control in KU.

In addition, hefty amount of affiliation fee for medical colleges forced Suresh Raj and Sitaram to do some more calculations. Till that time, Suresh Raj was focusing his attention on engineering only. The affiliation fees from 5 colleges far exceeded the total revenue generated by engineering program. This spurred Suresh Raj and Sitaram to sit up and take notice. Consequently, with rounds of meta-analysis and project documentation, Suresh Raj started his own medical school. With own medical school in KU, Suresh Raj reckoned that he would be real academic boss of Nepal. It would give him money, more connectivity, more inflow of requests by politicians, businessmen and other admission seeking guardians and the far greater realm to reap the benefits of KU. The recent report in Nepali language weekly “Dristhi” throws lights on how Suresh Raj has envisioned reaping the benefits. Providing contract worth 50 million to a relative is definitely a gutsy corruption move.

The best thing that had happened with KUMS was to have a sound medical professional Dr. Arjun Karki as a coordinator of the program. Dr. Arjun Karki and his team spent many sleepless nights to add another gem in the crown of KU. Lured by sweet talk of Suresh Raj, Dr. Arjun Karki and other meritorious members of his team felt great honors in improving KU’s medical school. Educated in western medical schools, Prof. Karki believed in autonomy. Till KUMS infrastructure was laid down, Suresh Raj provided whatever autonomy Dr. Karki and his team members demanded. Suresh Raj even lied in senate meetings while apportioning unbalanced salary structure for the medical staffs and professors. But once KUMS started flying on its own wings, Suresh Raj tried to control KUMS through his headquarter. Reigning in Dr. Arjun Karki had become a must for Suresh Raj after first two years of KUMS operation since 2001. Without controlling Dr. Arjun Karki, neither Mr. Mukunda Upadhyay, nor Dr. Sitaram could ever make any money. So, after the grand opening of KUMS, Dr. Suresh Raj, Dr. Sitaram and Mr. Mukunda sat together to clip the wings of Dr. Arjun karki.

KUMS- beginning of conflict
Prof. Dr. Sitaram Adhikary was all praise for Dr. Karki and many others till 2003. He was very happy to have visited Rochester in raising support, medical facilities and medical faculties from US. Prof. Dr. Sitaram Adhikary always appreciated Dr. Karki continuously for two years. In Nepal, appreciation must always be returned back in same coin. This has been practiced in Nepalis bureaucratic circle since ages. While appreciating Dr. Arjun Karki, Dr. Sitaram Adhikary was merely extending the same notion. He appreciated Dr. Karki so that Dr. Karki would, in return, be his good soldier and move on his instructions. But, that was not to happen with a US returned doctor who wanted to help Nepal improve her medical sector.

Apart from Dr. Sitaram, another person who constantly dealt with Dr. Karki for two years was Chief Administrative Officer of KU and brother of VC, Mr. Mukunda Prasad Upadhyay. Exactly as Dr. Sitaram Adhikary, he, too, tried to apply their magical wand on Dr. Karki. With Dr. Karki on their side, Prof. Suresh Raj Sharma, Prof. Sitaram Adhikary and Mukunda Upadhayay would have conveniently plundered KU in the name of developing KUMS facilities. Dr. Karki, unable to understand coded messages of Sitaram, Suresh Raj and Mukunda kept on working as honestly as possible while opposing undue demands of KU administrators. For Suresh Raj, Sitaram and Mr. Mukunda having an autonomous and independent official was a nightmare. Anybody citing rules and regulations has always created headaches for Suresh Raj and Sitaram. To continue in their own positions, Suresh Raj has to meet many undue demands of politicians, palace and other powerful personalities of Nepal. In one such occasion, Dr. Arjun Karki reportedly declined admission to one recomendee of Sitaram Adhikary. This deepened the distrust of Dr. Sitaram towards Dr. Arjun Karki.

On the other hand, another lobby was hyperactive in persuading Suresh Raj to leave Sheer Memorial Hospital in Banepa. The former mayor and former appointed member of King’s council Mr. Bel Prasad Shrestha wanted to have KUMS medical school in Dhulikhel for two reasons. By having KUMS in Dhulikhel, he could improve his image as real development oriented politician and at the same time he could impose his so called social worker brother Dr. Ram Kantha Shrestha in KU’s academia. For Suresh Raj, who has over the years developed a kind of filial and working relationship with Mr. Bel Prasad, it was very difficult to resist him. Moreover, in many previous projects, both of them have already accrued undue monetary benefits. And, Suresh Raj knew very well how to work with Mr. Bel Prasad.

In contrast to Mr. Bel Prasad, Dr. Arjun Karki never tried to seek any financial advantage. He himself neither saw any project as worthy of making a killing nor ever approved of the unnecessary projects pushed down from VC and registrar of KU. Consequently, differences appeared between Dr. Arjun Karki, and Dr. Sitaram Adhikary and Dr. Suresh Raj Sharma in KUMS meetings. Enraged by bold stances of Dr. Arjun Karki, Dr. Sitaram and Dr. Suresh Raj started working against him in KU.

KUMS-departure of Dr. Arjun Karki
The hush-hush affairs of KUMS problem would have never come to light but for over jealous machinations of Prof. Sitaram Adhikary. Because of some drug problems associated with KUMS students in Kathmandu University Boys Hostel, Dr. Arjun Karki advocated for separate hostel for KUMS student. As most of the wardens in KU boys’ hostel were quite immature, he was not sure of the strict monitoring in the hostel. Prof. Sitaram Adhikary in that case always consented with Dr. Karki. However, from behind he started chastising Prof. Dr. Pushpa Raj Adhikary. He incited Prof. Pushpa Raj by intentionally misinterpreting the version of Dr. Arjun Karki. He carried to Prof. Pushpa that for his deficiency as director of Students’ affairs, Dr. Karki has demanded a separate hostel. This led to verbal dual between Dr. Pushpa Raj and Dr. Arjun Karki also. In the meantime, Prof. Sitaram was busy telling everybody that Dr. Arjun Karki was not honest and had he been so, he would have never admitted his own daughter in KUMS by violating rules. Dr. Karki’s daughter got enrollment like all other students by appearing for KUMET. Yet, Sitaram thought that Dr. Karki did something like he has been doing for his apples of eye, Birjesh Adhikary and Sarad Adhikary. As a result, Prof. Dr. Arjun Karki’s good name was pulled through the muck. For resisting corrupt gestures of Suresh Raj and Sitaram, a systematic campaign is launched such that Dr. Karki appeared a crook. Subsequently, differences grew and an irrecoverable crack was wedged in. Subsequent meetings became witness of hot squabbles even for issues like transportation facilities. The issue reached the zenith when Dr. Karki came to know of hefty commission received by Prof. Suresh Raj Sharma and Prof. Dr. Sitaram Adhikary in purchase of an abandoned resort to develop it into Medical hostel. Further meetings revealed real faces of Suresh Raj and Sitaram. By now, Suresh Raj and Sitaram openly started favouring Dhulikhel hospital over Sheer Memorial Hospital in Banepa as an open indication of their mutual displeasure with Dr. Arjun Karki. And the decision to shift the medical school finally forced Prof. Dr. Arjun Karki to leave KUMS for ever.

Sheer Memorial and Dhulikhel Hospital: conflict for teaching hospital
Sheer Memorial and Dhulikhel Hospital imbroglio has been explained in many different ways. But, there is not an iota of doubt about the honest practices in Sheer Memorial Hospital, Banepa. Set up by Seventh Day Adventist Church, Sheer Memorial Hospital has been catering to the needs of large semi-urban, rural population outside the valley for around two decades. During April movement, Sheer Memorial treated many martyrs. Some of the facilities in Sheer memorial is really unique. Many patients have travelled all the way from Kathmandu to Banepa to remove their kidney stones. As its good Samaritan work itself is improving its social standing, it was not necessary for Sheer Memorial to bank on some one’s shoulder. As usual Sheer Memorial management tried to help the KU by providing its medical facilities as KU teaching hospital. The move of Sheer Management is definitely a magnanimous move.

But, Sheer’s association with KU was not liked by Mr. Bel Prasad. With KU siding with Sheer Memorial, relationship between Bel Prasad and Suresh Raj was somewhat strained. Bel Prasad’s greed and avarice was so profound that he applied tremendous pressure on another greedy. Suresh Raj buckled under this pressure. Making Bel Prasad unhappy was likely to be very costly for Suresh Raj. So, Suresh Raj tried to placate Bel Prasad family by opening Dhulikhel Medical Institute in Dhulikhel hospital.

Dhulikhel Hospital
Founded by Dr. Ram Kantha Makaju Shrestha, it grew tremendously under mayorship of Mr. Bel Prasad Shrestha. The initial days of Dhulikhel hospital was very troublesome. Dr. Ram Kantha and his wife both travelled to various European countires to gather funding, help, medicine, medical facilities and medical professionals for Dhulikhel hospital. Dr. Ram Kantha has worked like a mad man to build this hospital. With his vision and surgical skills, Dr. Ram Kantha Shrestha received much respect during those days. As he was considered a kind of social worker, people openly appreciated him. But, due to his unique personality, Mr. Ram Kantha could not maintain the respect. His growling and heckling staffs and subordinates showed his mean side of the personality. In other words, the success went to his head and Dr. Ram Kantha started behaving very arrogantly.

Dr. Ram Kantha’s arrogance would have been tolerated had he maintained his purity. He, in the garb of doing social service, started eyeing academic positions. A skillful surgeon desired to be another academic boss. What would one say if Mahabir Pun demands professorship of Computer Engineering tomorrow? What would one claim if Dr. Sanduk Ruit starts eyeing VCship of TU? It would be very good for our societal heroes if honours are bestowed on them. If honorable people start behaving in dishonourable way, then questions are likely to be raised. The problem with Dr. Ram Kantha is also something like that. It is debatable whether his ambitions are main product or by product of the political ambition of Mr. Bell Prasad. But, however, the brothers started working together to meet their respective goals.
With Dhulikhel hospital as a front, Dr. Ram Kantha and Mr. Bel Prasad are having something up their sleeves. Dr. Ram Kantha wants to be academic boss of KU which was erected on the land facilited by his mayor brother, and Mr. Bel Prasad wants to continually win elections using his development oriented image. Benefits are manifold for the dynamic duo when they were involved in KU. Mr. Bel Prasad’s other relatives could get contract for KU hospitality, they can open KU cafeteria and they can hire many of their relatives. With booming KU and the infrastructure, they sensed that it is the time to make the killing. The sustainable way of maintaining benefits would be there only if they can enter into KU’s academic circle.
With this vested interest, Mr. Bell Prasad and Mr. Ram Kantha have entered into KU. As Bell Prasad knew many of wrongdoings of Suresh Raj, he has been successful in getting most of his things done in KU. Providing scholarships to relatives of Bell Prasad, providing contracts with KU and even facilitating resort deal with KU, helped Bel Prasad family a lot. With more benefits, these people became more greedy. As a result, they applied extreme pressure on Suresh Raj to axe Dr. Arjun Karki and shift the KU Medical hospital to Dhulikhel.

Dr. Ram Kantha- a social worker or power hungry mandale?
As explained earlier, Dr. Ram Kantha is only a social worker. He is not a teacher or academician. He can do surgery very well but he lacks in many other aspects of society. He has very bad communication skills and he is very haughty. He insults even first time visitors without understanding the social stature of the people. So, for any academic position, where academicians need to talk diplomatically Mr. Ram Kantha is a total misfit. But in KU, the fittest one is who works well with Suresh Raj. Ram Kantha and Bel Prasad worked very well with Suresh Raj can be gauged by the fact that they are the ones who mobilized the goons against KUPA movement. The noted royalists/mandales were used by them to beat, thrash and physically abuse KU faculties. They consider themselves as the chief patron of Dhulikhel and as Suresh Raj is bringing in lots of benefits to their family, they have started to view the KU movement as the movement against themselves. This has unveiled the social worker mask of Dr. Ram Kantha and presently he is considered villain no. 1 against the academia of KU.

Another interesting issue that relates with Dr. Ram Kantha’s hunger is his acquiring of Associate deanship of KU School of Medical science. Once the Medical school was shifted to Dhulikhel, Dr. Ram Kantha has become the boss overnight. As in many other cases, to keep him and his brother Bel Prasad happy, Suresh Raj has even violated academic norms in making Dr. Ram Kantha a faculty member. Ram Kantha’s elevation as Medical faculty, in addition to his open mobilization of local goons, clearly indicates that this fellow is not as honest as he claims. Many voices are being heard in Dhulikhel that his misdeeds have remained covered because of his being a doctor. The days are not far away when people may hear his financial irregularities in Dhulikhel hospital.

However, the chief worry that pertains with Dr. Ram Kantha is his remaining in charge of the medical school. After Dr. Arjun Karki has left, many bright KU medical faculties have already left KUMS. Unlike affiliated colleges, KUMS is now falling into ignominy. Students are demoralized as there are not proper teachers. Senior professors find Dr. Ram Kantha’s behaviour objectionable. An equitable and open academia has remained amiss. Teaching and learning should be gregarious and full of mutuality. After departure of Dr. Arjun Karki, KUMS has not been able to practice both the PBL and CBL. This clearly shows that by having this kind of manipulations, Suresh Raj may have accrued lots of financial benefits. But, the new start up of Kathmandu University is going to perish even before it enters into adulthood. By imposing ruthless characters like Dr. Ram Kantha, Suresh Raj has rather accelerated this pace of deterioration.

Conclusion:
Kathmandu University is very good. It has good sets of teachers, meritorious students and competent staffs. But, it is plagued with incompetent, nepotistic and corrupt administrators. Most of the programs of KU are suffering now because of yes men gathered by Suresh Raj. A good medical institute is conceivable outside valley, but it is getting hampered by selfish people like Dr. Ram Kantha Shrestha. Parents and guardians desiring to enroll wards into KUMS need to think twice about the quality of education their wards are likely to get at the hands of people like Dr. Ram Kantha. A man who does not know academic freedom can never produce socially responsible doctors. For the time being, if things are not arrested, KUMS is likely to be doomed.

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