On August 23, Dr Arjun Karki, 56, Vice-Chancellor of the Patan Academy of Health Sciences (PAHS), was replaced by Dr Sangita Bhandari, 43, former head of the Department of Ear, Nose and Throat (ENT) at the Dharan-based BP Koirala Institute of Health Sciences (BPKIHS). Doctors at the PAHS now fear that with Dr Bhandari’s appointment, many programmes that Dr Karki introduced might come to a grinding halt. In 2007, the Cabinet endorsed a bill establishing Patan Hospital as a teaching institute and Dr Karki, who joined the institution in 2003, was subsequently made the vice-chancellor.

Under Dr Karki, the academy instituted a four-year MBBS programme, which has a strong ‘rural’ component, where students visit rural areas for over three weeks. Moreover, the 15 percent of medical graduates, who are granted full scholarships by the PAHS, are required to spend their first four years after completing their MBBS degree at a rural health centre. Similarly, the 40 percent of students, who are granted partial scholarships (50 percent), are required to do so for two years.Dr Karki and his team strongly believed that this ‘rustication’ would help students gain a practical understanding of rural health and develop empathy for the under-privileged. Karki, who served as Health Assistant in 1978 at government-run health institutions in Nuwakot and Dolakha, is no stranger to the many malfunctions that mar rural health

institutions in the country. That practical knowledge helped Dr Karki and his

team set up an educational mould that pays as much attention to medical practice in rural areas as it does to urban ones, said insiders.

A ‘collaborative scholarship’ scheme that the PAHS introduced during Dr Karki’s tenure has also made arrangements for students from select rural regions to study in the academy. Costs are borne jointly by the PAHS and local authorities (a sponsorship or a District Development Committee), under the condition that the chosen students will serve the first four years of their career in the home district as a doctor. This year’s batch of students studying under the collaborative scholarship will be from districts of Ilam, Dailekh, Achham, Dolpa, Baitadi, Jajarkot and Makawanpur. “There are few people in Nepal who pay heed to the social accountability of medical schools,” said medical educationist Dr JP Agrawal. “Dr Karki is someone who has not only realised this but also translated it into concrete action through the PAHS.”

Another of Dr Karki’s initiatives was the mandatory ‘set list’ introduced after medical practitioners were found to have been lured into lucrative deals by pharmaceutical companies to prescribe their medicines, often times more expensive than similar medicines produced by other companies.

“I have no personal grudge against the appointment [of Dr Bhandari]. However, because the PAHS is an autonomous body and our dream project, we expected to be consulted before such an important decision was taken,” Dr Karki told the Post. “It is as if the ministry has forgotten our autonomy and has treated us like a government department where they can unilaterally pick the chief.” The PAHS Act 2008 says that the VC can only be appointed upon the recommendation of a three-member committee consisting of the health minister as chairperson and two other members from the academy’s senate, by the prime minister, who also acts as the chancellor of the academy. The senate is the academy’s highest authority with 30 members from various fields.

This time around, Health Minister Rajendra Mahato, along with Secretary at the Ministry of Health and Population Dr Praveen Mishra and VC of the BP Koirala Institute of Health Sciences Dr Balbhadra Prasad Das, recommended three names—Dr Bhandari, Dr Sangita Shrestha and Dr Smriti Karki—for the VC’s post to PM Baburam Bhattarai. It is learnt that Mahato was in favour of Dr Bhandari, who was eventually picked by Bhattarai.

Many faculty members at Patan Hospital said they were expecting an extension of Dr Karki’s term as the ministry was formally informed of his upcoming retirement three weeks in advance. As the 2008 Act does not specify issues of term extension, the government, through the recommendation committee, could easily have extended Dr Karki’s term, said one faculty member.  Mahato, the chairman of the Sadhbhawana Party, is said to have good relations with Dr Bhandari’s first cousin, Sarat Singh Bhandari, the chairman of the Rastriya Madhes Samajbadi Party and a former minister. Dr Bhandari is also an advisor to the UCPN (Maoist)-affiliated health professionals’ association. “I got the position not through my family connections but through my capabilities,” Dr Bhandari, a qualified professional who had been heading the ENT Department at the BPKIHS for eight years, however, said. “I approach my work with a lot of aggression too. If a man does something similar, he becomes a hero. When a woman does it, she becomes infamous.”

Although a few members of the medical fraternity welcomed the government’s appointment of the first-ever female VC, there are many who remain sceptical. While not overtly characterised as a political appointment, there are suspicions that Dr Bhandari’s appointment could have been influenced by her family and political connections. If so, Dr Govinda KC, a Tribhuvan University Teaching Hospital (TUTH) doctor who recently held a five-day hunger strike against political appointments to public institutions and won, might have suffered in vain. There are those who feel that Dr Karki, “a successful leader,” perhaps deserved a second term. Former VC of the Tribhuvan University Kedar Bhakta Mathema said there were others currently serving more than one term in other university positions and it would have been better had the government extended Dr Karki’s term.

“Now, since the new VC has already assumed office, she should go along with the spirit of the Patan Academy and work closely with Dr Karki and his team members,” Mathema said.

source: The Kathmandu Post,4 Sept 2012