NATIONAL 5 (Spotlight Weekly)]

‘Family Planning Should Be Focused More On Rural Areas’

— K.B. GHARTI

K.B. Gharti is a gynecologist and regional field officer for the United Nations Population Fund (UNFPA) in Pokhara. Gharti, who has worked in the most remote parts of the country in several family planning programs, spoke to SPOTLIGHT on some of his experiences.

On how attitudes toward family planning have changed: In 1989, I was working in Jumla at His Majesty’s Government’s Family Planning Association. A woman came up to me and asked me to perform a vasectomy on her husband. I asked the husband to come to me the next day. I remember he was a very tall, healthy person. I told him that he wife could not bear the burden of another child, as she already had too many. He told me he would rather leave the country than undergo the operation. Now such attitudes have disappeared. Everybody seems to be aware about family planning. But the government should focus more on rural areas.

On how the work environment has changed: Before 1991, there were many doctors in every district as they were assigned as hospital in-charge. Later the government changed the organizational structure of health system and assigned doctors as district in-charge. They were given the job that used to be handled by the district health officer. Doctors now have to look after public health programs. The result is that there are many districts were there are no health officers. When the doctor is assigned as the district in-charge, public health officers come under him. Before, these officers were autonomous. The new mechanism has created a lot of misunderstanding.

The officers say, "Why should we function under the doctors?"When we visit some districts, we find simple problems created by such misunderstanding. If a doctor is assigned to a district, his whole day is spent on signing documents. This leaves the doctor with no time for preventive and curative health care.

On misuse of resources: Earlier, doctors had no control over the money allocated for the district. But there are cases today where money meant for the district public health system winds up in their pockets. Donor agencies like the UNFPA have provided vehicles that are supposed to be used for supervision and monitoring. But they are being used for private purposes.

On his early days in the profession: My career started in 1986. In those days, doctors went wherever the government assigned them. Now things have changed. Everybody seems to have a hook in place and they use all means to avoid going to rural areas where doctors are required the most. Each district has a Central District Officer, police officials, and army personnel. If doctors refuse to go to the remote districts, how can we expect to provide proper health services to the people? My first government job was in Jhapa. My family was opposed to that. They felt bad that after my studies, I was being sent to a desolate place like Jhapa. But I thought of the challenges and went on to stay there for 26 months. My now dearest friends are in Jhapa.

On how training has changed: There is a vast difference in training. The director of the Family Planning Association then was Dr Tika Man Baidya. He told me to perform a vasectomy. Seniors in Jhapa taught me and I did one vasectomy in front of him. I was certified. Today training is more focused on competency, proficiency and skill. But have those training skills been utilized in Nepal? As I see it, people who have acquired such training have not been able to perform to the desired extent.

On why some doctors avoid going to rural areas: After 1991, we have seen so many great changes in civil aviation and telecommunications. Health facilities have also mushroomed. There are so many polyclinics in the capital today. A fresh graduate doctor in Kathmandu now can easily earn about 25,000 rupees a month and is considered eligible for further studies.On the other hand, if one is to spoil a doctor’s career, all that is needed is to send him to rural areas for four or five years. He will be used to being the senior district in-charge. Moreover, he will constantly feel that he cannot compete with doctors in the capital.

On his first camp: It was in Dhading. Although I did not know what a camp really meant, I still feel that it was very organized. At that time, the government regarded population control as a vertical program. Since they were more focused on family planning, it was a very tightly organized camp. I worked in Prasuti Griha, Kathmandu, for another year. I worked in Bir Hospital and at the family-planning program in Bharatpur after that. I left for further studies in obstetric and gynecology.

On his experience with UNFPA: I started working for UNFPA in 1995. I did not know that UNFPA was involved in this kind of work. I was to provide technical support for UNFPA’s programs in Nepalgunj. One of the main components of the UNFPA was field planning. I have visited 48 districts, including very remote ones, in the course of conducting family planning camps.

On risks in the profession: I remember an incident in Nepalgunj when someone telephoned me saying he wanted to meet me. I told him I was available for an hour and he came. He was a simple-looking bearded-man with a bag. I closed the door and asked him what he wanted to take about. He said, "Don’t ask what my name is or where I came from. We have been observing you so losely. You do not hesitate to go to Rolpa, Rukum, Pyuthan, Salyan, Jajarkot and Pyuthan." He asked me whether I was afraid of visiting places affected by Maoists. I told him that I did not go there to suppress the Maoists. I went to provide health services for anybody in need, including Maoists. I told him if I could provide a little more happiness to some people, why should I fear the Maoists? He asked me what plans were required for those areas, saying he would brief someone above him. I do not know who that person was. I told him that Dr Babu Ram Bhattarai and I studied together at Amrit Science College. He felt uneasy after that and said he would call me later.

On an incident that shocked him: In Salyan, I created an operation theatre. When I asked who would assist me in the operation, they showed me a nurse. She asked me if we were to make to incisions for a mini-lab that was to be done. I was shocked. Because mini-lab is done through only one incision. I told that I would give a class on mini-lab the next day and that year the number of cases in Salyan increased.

On the challenges ahead: Family planning awareness exists among the people but there are no doctors in rural areas. I do not know where the fault lies — with the government or the doctors. Doctors are not available at the right time in rural areas. The budget allocated for the districts takes a while to get there. People need service but we have not been able to provide that. The problem in rural areas is that people die in front of your eyes and you, being a doctor, cannot do anything because you lack very basic equipment.