Kalikot as seen by Dr Amogh Basnyat

These are some of the lines from an article published by dr basnyat in J Family Med Prim Care. 2013 Jul-Sep; 2(3): 218–221 about his experience while working in kalikot district hospital. The impression I got from reading his writing is that time has changed in nepal but not for the doctors. His impression and his writings are more emotional than scientific. His outburst regarding the mismanaged hospital management, pain of being in remote places and lack of support in a lonely environment is clearly evident from his words. Here are some of his words....... "Kalikot is a district located in the mid-western development region of Nepal and is one of the districts of the Karnali zone which is touted as the most backward and underdeveloped region of the whole country. Kalikot was placed in the 72nd position among the 75 districts in terms of its district health office performance in a report issued by the Ministry of Health this year. No doubt, the general health scenario and related public awareness in the area are abysmal." "As in any other district hospital, lack of awareness as to its assets of all kinds and consequently the lack of their maintenance are rampant in this hospital too. Hence, the prevalence of “disuse atrophy” rather than wear and tear due to use is more visible regarding almost each and every biomedical equipment and other devices. It's indeed very disheartening to see the same tendency in terms of the government-supplied drugs as well." "The state of the cleanliness, orderliness, and the measures for the infection prevention are nominal even when described in the most optimistic term. No need to mention that like any other district hospital it's understaffed, underresourced, and too often overexerted. The fact that it's linked to the rest of the country by a highway track that is meagrely a fair weather road and remains clogged throughout the rainy season only makes the matters worse for it. In the majority of these procedures, I have myself provided the SAB. In a few of these, another doctor has done the job. But mostly, I prefer the junior doctor to be assisting me in the surgery rather than looking after the anesthetic part. Usually, a nurse stands by for the anesthetic monitoring. Sometimes, I would have to be operating entirely with the nursing personnel because the other doctor would be out of station. Not forgettable at this point is the fact that operating without suction machine and cautery has become a norm here because neither the landline of electricity nor the generator (which is mostly out of order) is able to handle the extra load. Mostly, I do not even have the “luxury” (?) of having an oxygen concentrator by my patient's side. During bad days, I operate under quarter power solar lamps that look and work more like dinner lights in restaurants rather than properly focussed and powered operating theatre light. Most important of all is the fact that one is able to play the role of a real, complete doctor for an entire community; this is one of the last remaining opportunities left out to be exercised by a quickly vanishing breed of health care providers in the present global scenario. One must feel blessed to be able to exercise all these privileges. Hence, despite whatever dismal conditions I am working under I also have my own reasons for solace." This is how a doctor who is working in such conditions describes his plight and the policy makers just repeat the same dialogues again and again in the comfort of capital of this country that it's doctors who is to blame for not being able to work in remote areas. I believe no single doctor can work in such conditions for a long time. His capacity need to be upgraded, he need to have better facilities and he should be supported with other manpower preferably by another mdgp. Dr basnyat should take the initiative not only to point out the problem but also to formulate the solutions.