With almost nonexistent sewerage, messy solid waste management, and undependable water supply system, monsoon is boom time for gastroenterologists. For the medicine business in general, however, autumn is the harvest time. This is the period when general health practitioners, cardiologists, and all kinds of specialists observe a dramatic rise in number of patients.[break]
Public healthcare of Nepal is in shambles. Only two kinds of people go to government hospitals these days: The over-privileged who can pull strings to get the best possible attention, or the underprivileged who have to be content with whatever attention they can get. Everyone in the middle has to rely upon the healthcare providers of the profit sector.
The medical shopkeeper is often the only healthcare personnel that the urban poor can think of in any exigency. The diagnosis at such outlets begins with a straightforward question: How much money do you have to treat your offspring, parent, or spouse? The prescription would then be commensurate with the spending capacity of the customer and can vary from a few doses of over-the-counter medications to a mixture of antibiotics followed by colorful pills. Those are vitamins—placebos that do wonders to the profitability of friendly neighborhood druggists.
The lower middleclass maintains its faith in formality. The nursing home and research center in the vicinity may just be a signboard, but it at least gives the appearance of being an institution. The Senior Assistant Deputy Sales Supervisor of XYZ Savings, Credit and Finance Cooperative wouldn’t lose face even if the quality of the service provider behind the laminated counter were not much different from that of the adjacent medicine shop.
No visit to a nursing home is complete without some tests. The relief that comes from being told that one didn’t have the disease that one had never suspected but the paramedic saw it fit to test for anyway is precious. Professionals know their job. If they recommended an examination, there must have been some reason behind the apparent sneezing or runny nose. Who knows what the symptoms of common cold can hold?
The upper middleclass prefers private hospitals. The computerized front office, stainless steel recliners in the waiting hall, dim lighting in the lobby, White Coats pushing trolleys, the constant beep of the mobile intercom, urgent sounding announcements over the public address system, and the computerized billing of integrated services—ah, these guys pay VAT!—give the allusion of being in competent hands. Should an emergency arise—God forbid!—there is always the frightfully expensive ICU at hand.
Private hospitals thrive on what is known as ‘procedures’ in the business. Have a problem in the stomach? How about an eye check as you wait for the ECG or whatever fancy initials the consulting physician has scribbled before finally deciding that you should see a surgeon of the same establishment? Apparently, popping antacids can have dangerous consequences. A friend from Delhi once confided that a very senior surgeon was fired from a very famous hospital of the profit sector because he prescribed too few ‘procedures’ to his patients. Business cartels would make sure that such cases would never come to light in Kathmandu.
When someone of the upper class catches cold, she flies to New Delhi; and if something serious is suspected, local agents of Bangkok hospitals handle everything, including visas for caregivers, foreign currency and transfer arrangements from the Suvarnabhumi terminal. Their biggest worry is getting to the airport in time here in Kathmandu, what with impromptu bandas, frequent chakkajam and regular sawaris that may condescend to give way to an ambulance in an emergency but refuse to recognize that some patients may be traveling in private cars or public taxis.
It’s the middle-middle—above the Senior Assistant Deputy Sales Supervisor astride his motorbike but lower than the Program Officer of an INGO with her EMI-funded car—who doesn’t know what to do when a seasonal ailment strikes. Most of them can’t afford private hospitals but know too much to trust neighborhood nursing homes. They flock instead to private clinics where consulting physicians make a killing from the gullibility that comes from a weird combination of a fair idea of social realities but a complete ignorance of the ways pharmaceutical industry and medicine businesses operate.
Illustration: Sworup Nhasiju
The autumnal crowd at a successful general physician’s or a reputed respiratory disease specialist’s private clinics can run to several dozen in the evening. Most of them are attached to some formal institutions—proliferating medical colleges in need of marketable ‘names,’ private hospitals requiring social recognition, and nursing homes seeking fast-track respectability—during the day. Each patient gets, according to a very rough estimate observed during several visits, about seven minutes at private clinics. Prescriptions are often standard: A course of antibiotics, some anti-histamine, and the vitamin that sustains the local pharmaceutical industry—B-Complex. To the credit of these practitioners, they recommend more precautions than procedures. And if you happen to know the doctor, be prepared for a lecture on the sorry state of the state of Nepal in lieu of even a small discount in the consultation fee!
Epidemic Baburamitis
The festive season of dining room binges and drawing room vegetation is over. There is a nip in the air during the morning. The dust during the day in Kathmandu is so thick that it can sometimes be cut with the wave of a hand. Little wonder, the Valley is under the grips of what can perhaps be termed Autumnal Baburamitis (AB). More research is necessary—preferably by a multi-disciplinary team of doctors, public health experts, sociologists, economists, and psychologists, funded by a donor agency that doesn’t consider social inclusion to be an issue—to ascertain the exact nature of the AB eruption. However, from initial assessment of stray cases, it can be hypothesized that AB is an affliction that comes from a combination of respiratory conditions such as bronchitis, pharyngitis, laryngitis or tonsillitis and something analogous to the Holiday Syndrome.
Unable to identify the precise causes behind a sudden upsurge in hospitalisation, suicide and attempted suicide cases between Thanksgiving and the New Year’s Day, researchers in the USA attribute regular outbreaks of desperation during the period to anxiety, depression and repressed rage. This they call the Holiday Syndrome. Something similar happens in AB where patients tend to lose their voice before they turn their repressed rage upon themselves.
Physical triggers of AB are easy to observe, though impossible to overcome. The air quality in Kathmandu is bad most of the year except during the rainy months; it gets much worse during autumn when temperature inversion traps pollutants close to the ground that can’t be swept away even by strongest of winds due to the saucer shape of the Valley. Doctors also attribute the rise in respiratory incidences to increased ‘virus infection at this time of the year and increased pollen and mold spore counts,’ whatever the jargon means. And then there is the dust: powdered dust here, flying dirt over there, and suspended sand particles almost everywhere in the city.
Maoists insist that an egg must be broken so that an omelette can be made. The statement is a cliché by now, but its relevance endures in certain Federal Democratic Republic where all these qualifiers have meanings different from anywhere else in the world. Communists do not believe in eating boiled eggs, which is too plebeian for the refined taste of the revolutionary vanguard. However, making an omelette also involves enduring the heat in the kitchen, washing pots, pans and utensils, and watching to make sure that the concoction doesn’t get burnt on the stove. The demolition drive in Kathmandu, likewise, has begun to increasingly appear like a whimsical action rather than a well-conceived street decongestion plan.
At the center of all urban development plan in Kathmandu there has to be a pedestrian, not a motorist. It is not more than about two hours’ walk from any point inside the Ring Road to another, unless someone wants to amble along the 28km circumference. Kathmandu Valley was once a lake and its shape is ideal for walking—fishes swim, they don’t fly. With a million motorized vehicles—two- and four-wheelers jostling for space on all thoroughfares—the life of a pedestrian in the city has become a nightmare. The biggest anxiety of an urban dweller is then how to acquire a motorized vehicle. Motorcycles cost over one hundred thousand Rupees; the cheapest cars begin at around a million . It is not very difficult to sympathize with aspirational anxieties that aggravate respiratory complications to turn it into AB.
Promises of prosperity
At least three generations since the 1950s have grown up believing that Nepal is a resource-rich country. Once the fiction was that the forest cover was an encashable property: Hariyo ban, Nepalko dhan. Then the slogan changed to immense hydropower potential. The country was told that the Apaar Jal Sampada (immeasurable water property) was veritable White Gold; in fact, even better, as it was renewable. Meanwhile, the ruling elite made fortunes from where the real money lies in any consumption economy: Rental properties, usurious lending, manpower export, and import of goods.
About three decades ago, dreams of turning Nepal into Macao, if not outright Monte Carlo, of South Asia were revived. Increased tourism was dangled as a bet, and the possibility of turning the country into a center of money laundering were explored. The Lumbini delusions of Pushpa Kamal Dahal are perhaps based on the assumptions of some multinational investors that they can influence Beijing and New Delhi to let the place emerge as landlocked Singapore of South Asia.
Dreams are good if they lead to innovation, enterprise, and the daring to succeed against all odds. The ability to handle failure is what differentiates winners from whiners. However, desperation sets in when one finds that life is far more complex than had been depicted in Panchayat-era textbooks—extant with minor modifications—and what successive political, social and economic leaders have promised even afterwards.
Sure, science can do wonders, but destiny probably had different designs when it gave Nepal some of the most treacherous terrains, unstable slopes, unpredictable weathers and furious rivers in the world. Per capita resource base, which is very different from resource potential, in the country is so low that a lot of public energy has to be invested in keeping the entire population adequately fed, properly housed, rudimentarily educated, gainfully employed and satisfactorily cared for in the event of an emergency.
Visions of becoming Switzerland of Asia are all very well. “Oh, but man’s reach should exceed his grasp, or what’s heaven for?” But the nightmare of at least three destructive wars (the First and Second World Wars, and the long Cold War) within a century that made European elite hoard cash in a country guaranteed neutrality by the consent of all warring sides should not be wished upon some of the most populous and volatile countries of the world in Nepal’s immediate neighbourhood. Even if someone wished so, it would be fiercely resisted.
The quantum of ‘alleged’ corruption in China is mind-boggling. According to the New York Times, relatives of Chinese Premier Wen Jiabao’s have been rolling in money. The venerable paper found that “review of corporate and regulatory records indicates that the prime minister’s relatives—some of whom, including his wife, have a knack for aggressive deal making—have controlled assets worth at least $2.7 billion.” Neat figure: $2.7 billion related to one powerful person. However, not a paisa of this fortune probably managed to cross the Tibetan Plateau, let alone climb the Himalaya to reach Nepal.
Indian media is often imprecise. What can one make of a phrase like ‘Lakhs of Crores’ reportedly swindled in various scams since the liberalization, privatisation and globalization wave hit New Delhi except that there must be more zeroes in such a figure than the capacity of calculators in most cell phones? Why can’t Arvind Kejriwal quote Swiss Bank account details in Euro, US Dollars or even Swiss Francs? It would save quite a lot of zeroes. But Indians love to flaunt their zeroes. After all, they invented it.
Imagine a pittance of these huge heists from two of the biggest economies of the twenty first century finding its way to the land of everlasting peace and love? Nepal would be Switzerland of digital cuckoo clocks with movements brought from the markets of Khasa and cases bought in Loharpatti of Raxaul. The Chinese and Indians know this. They have learnt their lessons from French, Germans, Russians, British and the Americans. So they wouldn’t let Kathmandu emerge even as Singapore or Dubai, let alone Geneva.
There is yet another constraint. Land-linked is nice catchphrase; but for all practical purposes, Nepal is India-locked. Once the realization sets in that it is extremely difficult for commoners in the country to lead a level of life very much different from an average Bihari, frustrated Nepalis of all ages lose their voice. “The key lies elsewhere,” Premier Baburam Bhattarai was reported to have rued, thus disowning the entire legacy of “anti-imperialist and anti-expansionist” struggles of his past in a moment of unnerving revelation.
It is the stress of coping with the uncertainties created by helplessness and compounded with hopelessness that makes Autumnal Baburamitis (AB) such an unnerving affliction. The cure lies in absolute silence, which, Jean Jacques Rousseau (1712-1778) is reported to have said, leads to sadness, “the image of death.”
Lal contributes to The Week with his biweekly column Reflections. He is one of the widely read political analysts in Nepal.
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