"The poor must not be ignored"

Dr. Dinesh Nath Gongal, MS, FRCS, FACS, a senior consultant surgeon has devoted 44 years of his life to the medical service in Nepal. He worked in the Bir Hospital as a medical graduate in 1956 and as a surgeon from 1961 until 1997. In between he spent two and half years in Koshi Zonal Hospital as the chief. He ran the department of surgery in Bir Hospital as the head of the department and was also the chairman of Bir Hospital Development Board for 3 years. He is currently working as a local convenor for the FRCS exams of The Royal College of Surgeons of Edinburgh. His biggest achievement was the establishment of surgery in Nepal and in particularly neurosurgery. He has also contributed a lot in training the much required surgical manpower in the country .He was recently awarded for his achievements by the prestigious award, the Jyotirmaya Subikhyat Trisatthipatta by His Majesty King Birendra. He was also awarded the College Medal by the Royal College of Surgeons of Edinburgh for his contribution to the College and surgery in general. He talked about his experiences recently with Sushma Amatya of The Independent. The excerpts:

Q: What gives you greatest pleasure in your profession?
A: To see my patient get well after surgery especially when all odds are stacked against him. I am sure this is true for other doctors too.

Q: What is your opinion on the medical practice in our country?
A: Medical practice has undergone tremendous development and we are trying to keep pace with it. Sub-specialities are developing. We have highly qualified young colleagues. The facilities and quality of service have improved. The only sad note is that there seems to be increasing commercialisation of the profession.

Q: Kathmandu has more doctors than it really needs while other parts of Nepal suffer from a paucity of doctors. What do you have to say about this sorry state of affairs?
A: Not only Kathmandu but other cities like Pokhara, Birgunj, Biratnagar too have more doctors than needed. The situation is going to remain as such until other areas of our country prosper and job opportunities become available. Certainly, Kathmandu is super saturated with doctors.

Q: With many students aspiring to become doctors, don’t you foresee a shortage of other medical hands?
A: Yes, there are many students wanting to become doctors. At the same time, there are increasing numbers of medical related subjects e.g. nursing and paramedics. I agree that they play an important role in the management of health service. But with the rising number of paramedical institutions, there is a danger of compromise in quality.

Q: What is your opinion on accountability of doctors?
A: This is one profession where accountability has always played an important role since ages gone by. Moral accountability is important for building of trust between the doctor and the patient. However, there seems to be a decline in accountability of late in medical practice, perhaps due to commercialisation.

I do agree that patients must start asking questions and they must also try and educate themselves regarding the body and the diseases that they are suffering from. I believe that the issue of accountability must also be considered by doctor community and bodies like NMC. They should probe into unethical or unscientific practices and negligence should not be tolerated.

Q: How was your experience in Bir Hospital like?
A: Working in Bir Hospital was an excellent experience. It was a great challenge, working with limited facilities and having to provide high quality care and training. I thoroughly enjoyed it. I must have spent 60-70% of my waking hours during that time in the hospital and I would not have had it any differently. The highlight of my career was when I could establish the neurosurgery ward.

Q: What was the saddest period that you recall?
A: When I lost my first heart operation patient (mitral valvotomy) on a young girl, Goma. That tragic incident was followed by a similar but successful operation on Ganesh Bahadur after 2 weeks.

Q: Getting a medical education is an expensive affair that only the well to do can acquire. How can it be made mass friendly?
A: No doubt that medical education is expensive in Nepal. It is even more expensive abroad and even in India except in government run institutes. Health and education have become purchasable commodities and this is a sad fact. No matter how poor the parents are, they would always want to give their children the best education and forego many things themselves in the process. This is another reason that is probably promoting corruption. This undeniable fact needs to be taken seriously by the people who govern the country. Reasonable budget needs to be allocated to health and education. The private medical colleges were meant of NRIs who can afford their rates. However, we can always look at the colleges positively for the services they provide to the local people, hopefully at reasonable rates.

Q: FRCS exams are being held here. Could we not have facilities whereby our medical students could complete their higher studies in Nepal?
A: We are holding full FRCS exams here and also hold the Diploma ceremony. Advanced degrees are important and I am convinced that we should have our own Royal College in affiliation with international colleges so that we can train our manpower locally .

Q: How have the years of work and all the experiences changed you as a person?
A: I have learned to accept challenges in my profession and in life. I think I have also become more patient and tolerant.

Q: How do you occupy yourself these days?
A: I am working in the HM Hospital. When I have time, I go to my ancestral farm in the Terai. I am kept busy during the winters by organising Fellowship exams.

Q: What advice would you give to young doctors?
A: My message especially to young doctors is to treat their patients with respect and patience. Patients should be treated like gods, no matter who they are, how poor or rich they may be. Doctors should develop good rapport with the patients and build confidence of the patients.

Q: How can an important issue like health be given its due respect and the related problems solved in our country?
A: To make life more comfortable for all of us, it is important to break away from the set norms and stop making health and education a purchasable commodity. I agree that development of private sector in health has helped to take the patient load but this is only available for those who can afford it . The government cannot forget the unfortunate poors who not only have the burden of poverty but also have to bear the misery of suffering from diseases. Government hospitals must be better funded. The poor must not be ignored.

Q: You earned a reputation of being very curt and impatient. What do you have to say about that now? Of course’, that in no way detracted from your reputation as a very diligent and competent doctor.
A: Yes, many times, I have been very rude to people due to lack of patience, a quality that I realise is so important now; and all the more reason I advice the young doctors to develop this important quality. In the process of practicing selflessly I often overlooked this important humane quality.