Doctor exodus increasing, shortage of specialists

 Doctor exodus increasing, shortage of specialists

The state's investment is being wasted as skilled doctors, including those who studied on government scholarships, go abroad. The risk of quality decline and having to provide treatment by weak doctors in the future is increasing.

The number of doctors registered with the Nepal Medical Council is 38,499. Of these, 11,000 are specialists. Some of them are foreign doctors.

There is no exact figure for how many doctors registered with the Medical Council are currently in Nepal.

In a study conducted by the Nepal Medical Association in 2072 BS, about 36 percent of doctors were outside the country. At that time, only about 11,000 of the 17,000 doctors registered with the council were in the country.

Recently, doctors are being attracted abroad because they do not have guaranteed security at the workplace, are not paid according to their education and time investment, and do not see a career in Nepal. A clear indication of this is seen in the 'Good Standing Certificate' data provided by the Medical Council.

Doctors registered in Nepal must obtain a 'Good Standing Certificate' from the Nepal Medical Council to study or work abroad.

Not all people who have obtained a good standing certificate, which is required for registration with a foreign regulatory body, go abroad.

According to council officials, it is estimated that more than 70 percent of those who have obtained a ‘good standing certificate’ have gone abroad.

Out of 38,499 doctors registered with the Nepal Medical Council, 11,000 are specialists. However, in recent years, the trend of going abroad with a ‘good standing certificate’ has increased dramatically.

In 081/082 BS, the number of doctors who obtained a character certificate for study or work abroad was 2,681. In 2023, 2,318 people obtained a good standing certificate, while 2,692 doctors obtained registration.

Similarly, in 2022, 2,692 doctors registered, while 1,954 had good standing certificates.

In 2022, 1,954 people, in 2021, 1,327 and in 2020, 869 people obtained this certificate.

In 2021, 1,327 people obtained a certificate of good character. According to the Medical Council, 1,716 doctors were registered this year.

In 2020, 2,131 doctors were registered. In the same year, 759 people obtained a certificate of good standing.

Medical Council officials say that the number of people going abroad may be even higher as no one keeps integrated data on those going through processes such as study, fellowship, worker visa and dependent.

There is a continuous exodus of qualified manpower from the medical sector in Nepal. According to data from the Nepal Medical Council, the number of doctors going abroad is increasing every year.

In the last five years, 9,000 doctors have obtained a ‘certificate of good standing’ from the Medical Council. Among those who obtain such certificates, the highest number are doctors who are in the process of going abroad to the United States.

In the last five years, 2,466 people have obtained certificates to go to the US. Of which 276 in 2020, 273 in 2021, 496 in 2022, 843 in 2023 and 2,466 in 081/082 BS.

The number of doctors undergoing the process of going to the UK is also alarming.

In the last five years, 9,000 doctors have obtained 'Good Standing Certificates', with the largest number going to countries including the US, UK, Maldives, Australia, UAE.

In the last five years, 2,128 people have obtained certificates to go to the UK. According to the council, 162 people in 2020, 319 in 2021, 592 in 2022, 505 in 2023 and 550 in 2024 have obtained certificates to go to the UK.

Similarly, 216 people have obtained certificates to go to the Maldives in 2020, 403 in 2021, 453 in 2022, 395 in 2023 and 384 in 2024. The data also shows that the number of doctors going to Australia, UAE, Canada and Qatar is also increasing.

According to the Council's Registrar Dr. Satish Kumar Dev, the trend of doctors going abroad has increased significantly in recent years.

According to Dr. Dev, doctors who go abroad for study, training, fellowship or employment request a good standing certificate.

"Doctors have a high affinity for countries like the UK, America, Maldives, Australia and UAE," he said.

Most doctors going to the US want to participate in residency programs. The main purpose of doctors going to the Maldives and the UAE is employment. In Australia, the number of people who want to go for both study and employment is significant.

Dr. Dev warned that the exodus of doctors will lead to a shortage of skilled manpower in Nepal in the future. According to him, the minimum salary in the Maldives is 6-7 times that of Nepal, 8-10 times that of Qatar, and even more than that of the United States.

“It will be difficult to stop skilled doctors unless the state provides attractive opportunities and living standards,” he said.

Treatment is being escaped

The rapid exodus of doctors abroad in recent times has led to a shortage of doctors specializing in certain specialized and complex diseases.

For the past few years, there have been no admissions for doctors studying heart surgery, kidney and liver specialist studies in the DM and MCH (Super Specialist Research Degree) entrance exams.

According to experts, there have been zero or very few doctors studying super specialists in heart surgery and kidney and liver in the specialist field for the past few years.

Which, on the one hand, with the increase in diseases such as heart, kidney, liver and on the other hand, doctors are not interested in studying, such diseases will be prevalent in the country in the next few years It is clear that there will be a shortage of doctors in the field.

There are some reasons for the lack of interest in studying specialties such as heart, neurosurgery, kidney, liver, etc.

Complex and long studies, excessive hard work, low salary and allowances according to the effort and assignment, risky work, not being able to get a job in a private hospital after retiring from a government hospital or not being sure of a job even in a government hospital are the main reasons.

The outbreak of non-communicable diseases is increasing in recent days. According to doctors involved in the treatment, heart problems are becoming a factor in non-communicable diseases. Similarly, the burden of cancer, kidney, and tuberculosis is also increasing. Even now, the reason why such patients are forced to wait for a long time for surgery is the lack of enough specialist doctors.

Nepal Medical Association President Dr. Anil Karki says, “If the government does not create an environment for doctors to live within the country, there may be a situation where doctors from abroad will have to be brought in for treatment in 10 years.”

The Nepal Health Account 2017 published by the Ministry of Health and Population states that due to the state’s lack of investment in specialized services, more than 200 billion people go abroad for health care annually, and about 17 percent of citizens have become poor due to receiving health services.

Experts say that due to the government’s weak human resource planning and management policy, doctors in various fields have not been produced and ordinary people are dying due to lack of timely specialist services.

Why are doctors leaving the country?

The reasons for doctors leaving Nepal are not uniform. Some have chosen to go abroad because they did not get secure employment opportunities at home, some because they did not get a favorable working environment, and some have had to endure exploitation by private hospitals.

Many who studied at private expense argue that Nepal’s earnings do not cover the investment in education. The common attraction of all of these is the relatively high income they earn abroad. Although the reasons are different, the rapid pace of foreign migration has increased the risk that it will be difficult to find specialist doctors in various fields in Nepal in the future.

The government has not added new posts, and it has been 8 years since the Public Service Commission advertised for filling existing posts. 100% of specialist posts in central hospitals are vacant. Examples of which are Dadeldhura and Gajendra Narayan Hospitals.

The last time 100 doctors were appointed to government hospitals was in 2074 BS. As the health system is stuck in the old post structure of 25 years ago, the path to entry for new doctors is almost closed. Therefore, the only option left for many is abroad.

A survey conducted by a government study team coordinated by the then chief specialist of the Ministry of Health and Population, Dr. Tanka Prasad Barakoti, has shown that a large proportion of doctors are willing to go abroad.

The exodus of doctors has reduced the number of people studying super-specialists in complex diseases such as heart, kidney, and liver to zero or very low. This has increased the risk of drought in the future.

Of the 43 students who passed MBBS in 2022 from Tribhuvan University Teaching Hospital Maharajgunj Medical Campus, 100 percent are planning to go abroad.

According to the report, 41 of them (about 95 percent) had already registered for the foreign exam. Five of the 41 have passed the exam and entered the matching process, while 31 are taking the exam. Most of them plan to take the US medical license exam.

Also read: Government is ruining the health service by stalling the recruitment proposal

According to Dr. Barakoti, lack of safety in the workplace, not getting a salary commensurate with the investment of education and time, and no future for a career in Nepal are the main reasons why doctors are attracted to abroad.

The report also points to low salary and benefits, lack of meaningful and respected work, lack of opportunities for study, research and professional development, increasing violence in health institutions, and lack of sophisticated infrastructure as the main factors behind the exodus of doctors.

The tendency to stay there while studying

To become a doctor in Nepal, one must study for five years and six months at the undergraduate level. Then, one must study for three years for the postgraduate level and three years for the DM/MCh level. Due to the work experience required to study beyond the undergraduate level, many doctors are already 40 years old by the time they complete their studies. More than half of a Nepali doctor's life is spent studying.

However, doctors who have studied for 12/15 years and spent crores of rupees do not have good job opportunities and the service and facilities are very poor, so their attraction is to go abroad.

The economic, political and social environment in the country is chaotic. This situation has arisen especially because of the despair among doctors.

Former Dean of the Institute of Medicine (IOM) of Tribhuvan University Dr. Jagadish Prasad Agrawal says that the exodus of skilled doctors abroad in Nepal will seriously affect the quality of health services in the coming days.

According to him, most of the highly qualified doctors who pass the licensing examination of the Nepal Medical Council are preparing to go abroad.

‘The most competent person goes. There is a tendency to stay there while studying,’ says Dr. Agrawal.

Low salary and benefits, lack of respectable jobs, lack of research, increasing insecurity in health institutions and lack of infrastructure are the main reasons for migration.

Even those who studied on government scholarships go abroad The state's investment in crores has been wasted.

He opined that the practice of providing medical education to students with weak educational background in the medical education system should be stopped.

'If the trend of going abroad continues like this, the standard of healthcare providers in Nepal will decline,' says Dr. Agrawal, 'tomorrow, a person who has failed the council exam 32 times may have to be treated.'

According to Dr. Shree Krishna Giri, former vice-chairman of the Medical Education Commission, there are few job opportunities in Nepal.

'There are no opportunities in Nepal. And it was natural to look for them outside. The facilities available to doctors in Nepal are few and living conditions are difficult,' says Dr. Giri.

He mentioned the possibility of doctors who have studied abroad getting jobs there as another reason.

'If they go to study in the US, there is a greater chance of getting jobs there. That is why there is a trend of doctors who go to study and stay here,' says Dr. Giri.

'In 10 years, there will be a situation where doctors will have to be brought in from abroad.'

Dr. Anil Karki warned that the rate of emigration of health workers and doctors in Nepal is increasing rapidly and said that immediate policy reforms are needed to stop this trend.

According to him, the state's lack of adequate investment in the health sector, lack of proper management of human resources, low salaries and benefits, legal complications and workplace insecurity have created deep despair among doctors.

"If this situation does not improve, Nepal may have to bring doctors from abroad for treatment in 10 years," says Dr. Karki.

According to him, the high wages, living standards and safe working environment abroad have further intensified the trend of going abroad.

He pointed out the scholarship contract system, the mandatory one-year experience rule before master's studies, the lack of increase in permanent positions, lack of increase in salaries and benefits and excessive workload as the main reasons for emigration.

He said that the government should increase social, economic, political and security guarantees and services and facilities that are sufficient to survive so that skilled manpower can return from abroad and be retained.

Urging the government to increase investment in the health sector, improve facilities, remove policy barriers, and ensure safety in the workplace, Dr. Karki says, "We should make it a habit to find solutions, not just complain about going abroad."

The wrong policy that forced specialists to leave the country

 The wrong policy that forced specialists to leave the country

The Philippines has adopted a medical education and residency training system similar to the US. Nepal, on the other hand, has followed the Indian model, which is influenced by the British model.

In recent decades, there has been a steady exodus of specialists from Nepal to foreign countries. This issue is usually discussed in hushed tones. However, it is an issue that needs to be addressed immediately.

This exodus is not just about higher salaries or modern facilities. It has to do with the difficulties and structural obstacles that specialists face within Nepal’s institutional structure.

One of the biggest challenges in this regard is the issue of equivalence (certificate of equivalence). Tribhuvan University (TU) has the authority to recognize foreign medical degrees. Without this recognition, specialists returning from abroad cannot apply for government jobs or academic careers.

In this regard, TU does not recognize doctors who have completed residency training in the Philippines. Their residency program was not recognized as a real course, but as a general training without a thesis.

This decision is highly contradictory. Before going to the Philippines, each doctor had received an official letter from the relevant Nepali government agency. Due to the limited number of postgraduate seats in the country, many doctors were forced to go abroad for further studies in the last two decades.

Moreover, members of the Nepal Medical Council themselves used to go to the Philippines to understand and observe the medical education system there. This also indicated a tacit approval for Nepali doctors to study in that country. But the harsh and dismissive approach of TU has now sidelined hundreds of skilled specialists in their own country.

What is more painful is that until the beginning of 2073, TU was issuing equivalence certificates to doctors who had completed their residency in the Philippines. Many specialists had applied, submitted the necessary documents, and even paid the fees. Suddenly, TU changed its policy and stopped issuing certificates without any warning. The applications of many doctors were still in process.

If rules are to be made, they should always be for the future, not for the past. For example, Tribhuvan University could have said, ‘Starting this year, equality will not be given to those doing residency in the Philippines.’ But instead of doing so, the rule was implemented immediately. Which completely ruined the future of doctors who had completed their studies abroad and are studying.

Imagine, what must have happened to doctors who were in the middle of their residency in 2017? Long duty, sleepless nights, hungry stomachs, physical and mental fatigue. What must have happened to doctors who were struggling for a happy future despite facing all this with this sudden decision?

The arbitrary and discriminatory policy of the system has shattered the hopes of many doctors.

Some doctors have said that this sudden decision has even made them victims of depression.

No decision has been made yet about what will happen to those who had submitted all the necessary documents and the 5,000 rupee fee for the equivalence certificate in 2073 BS, shortly before the implementation of this rule. What kind of justice is this done to citizens?

The lack of recognition is not only undermining the hard work of these doctors, but also weakening Nepal’s health system. Nepal’s much-needed specialist surgeons, physicians, and pediatricians have returned with experience abroad. However, they are not allowed to teach in Nepal’s medical colleges or work as specialists in government hospitals. This is because TU refuses to issue the necessary certificates. Yet these same specialists are welcomed in other countries, their skills are respected, and they are employed.

In addition, there is widespread discrimination within the health system. Nepali doctors who return from high-level training abroad, especially those from the Philippines, are often the target of suspicion, professional jealousy, and administrative obstruction. They are treated like outsiders in their own homeland.

They are deprived of leadership roles, excluded from decision-making processes, and kept out of opportunities to make meaningful contributions to the nation’s health sector. They have now emerged as a group of highly skilled and talented doctors trained abroad. The message is clear—an attempt is being made to discredit expertise and create administrative obstacles in Nepal.

The Philippines has adopted a medical education and residency training system similar to the US. Nepal, on the other hand, has followed the Indian model, which is influenced by the British model.

The residency years in Nepal and the Philippines are similar, with some being longer in the Philippines.

For example:

-General Surgery – Nepal: 3 years, Philippines: 5 years

-Radiology – Nepal: 3 years, Philippines: 4 years

-Orthopedic – Nepal: 3 years, Philippines: 4 years

-Internal Medicine – Nepal: 3 years, Philippines: 3 years

-ENT – Nepal: 3 years, Philippines: 4 years

-Obstetrics and Gynecology – Nepal: 3 years, Philippines: 4 years

Based on this comparison, the claim that Philippine residency is ‘mere training’ is baseless. Rather, the programs are more structured and longer than those in Nepal, which raises serious questions about the biased policy of TU.

What is even more sad is that all responsible institutions are aware of this problem. Dean of the Institute of Medical Studies (IOM), Nepal May The Dical Council, the Nepal Medical Association, the Ministry of Health and Population, and the Ministry of Education are all aware of this problem.

But no one has taken responsibility for solving it. The main players are the current and former two deans and the officials of the Curriculum Development Board of Tribhuvan University.

Was this decision approved by the Ministry of Education or the Ministry of Health? The answer to this question has not come from anywhere. Under whose direction were these decisions made? Was there an influence of money or power? Why was a policy made to stop the specialists needed by the nation? Will these responsible people ever be investigated and held accountable?

Recently, about 200 specialist doctors have filed a petition in the court, where a permanent order has also been issued. However, no concrete solution has been reached yet.

Why is there so much silence about this policy that has become a factor in the exodus of specialist doctors?

Nepal is already suffering from a shortage of specialists in fields such as cancer, neurosurgery, cardiology, and pediatrics. But the doctors who can fill these vacancies are migrating abroad in large numbers. Most of the doctors who have gone abroad have left the country permanently.

They have gone to places where their training is recognized, respected and valued. Nepali patients are forced to travel abroad for expensive treatment or rely on substandard services.

If Nepal wants to save its medical talent, urgent reforms are needed. Tribhuvan University and the Nepal Medical Council must adopt a transparent and fair policy for recognizing foreign degrees.

Especially degrees from countries like the Philippines, where residency is internationally recognized. Instead of abolishing these programs, Nepal should focus on evaluation, breeding systems and collaborative partnerships. It is also essential to end discrimination and create a culture of respect for all specialists.

Does a dog bite transmit rabies? Let's know 9 myths and truths

 Does a dog bite transmit rabies? Let's know 9 myths and truths

The rabies virus is transmitted to humans through animal bites or their saliva, and it is fatal if not vaccinated on time.

Rabies can also be transmitted from not only dogs but also cats, monkeys, bats and foxes.

To prevent rabies, it is necessary to get vaccinated immediately after an animal bite.

Rabies is a disease caused by a virus. It is mainly a disease that occurs in animals, but it can also be transmitted from infected animals to humans. This virus remains in the saliva of infected animals. When an animal bites a person, the virus is transmitted to humans. Rabies is a serious and deadly disease, about which there are many myths and misconceptions in society.

Myth 1: Rabies is transmitted only through bites.

Truth: Rabies is usually transmitted through animal bites, but if the saliva of an infected animal enters the body in other ways, the disease can also be transmitted to humans. The disease can also be transmitted through cuts, abrasions, or contact with the mucous membranes of the eyes, nose, or mouth.

Myth 2: Rabies is only transmitted by dog ​​bites.

Truth: Many people have the misconception that rabies is transmitted only by dogs. However, this is not true. Rabies can also be transmitted by other animals such as cats, monkeys, bats, and foxes. Also, any rabies-infected animal can spread the disease.

Myth 3: Pets are protected from rabies.

Truth: Pets are not automatically protected from rabies. They need to be vaccinated on time. If they are not vaccinated, they can also be at risk of this disease. Therefore, it is important to regularly vaccinate your pet dog or cat against rabies. For this, you should consult a veterinarian.

Myth 4: Rabies vaccination is not necessary if you are bitten by a vaccinated dog.

Truth: If a pet dog or cat has been vaccinated and bites or scratches, you should seek medical advice immediately. Sometimes the vaccine can be missed or the immune system is not fully developed, so there is a risk of rabies. Therefore, post-bite vaccination should be done after consulting a doctor.

Myth 5: Rabies vaccine is given in the armpit.

Truth: Many still think that rabies vaccine is given in the armpit, but this is wrong. Modern medical science has made progress. Now rabies vaccine is not given in the armpit, but in the arm or sometimes under the skin. This modern vaccine is very effective and safe.

Myth 6: Applying turmeric, chili or oil to the bite site prevents rabies.

Truth: It is completely wrong to use home remedies like turmeric, chili on the bite site of a dog or cat. Such measures can cause more serious harm to the patient. The bite site should be washed immediately with clean water and soap and immediately go to the doctor and get rabies vaccine.

Myth 7: Rabies vaccine can be given at any time.

Truth: Many people think that rabies vaccine can be given at any time, but this idea is very dangerous. Rabies vaccine should be given immediately after a bite or scratch. Delaying treatment reduces the effectiveness of the vaccine. If symptoms appear, the disease cannot be treated. This disease is fatal.

Myth 8: Tetanus vaccine protects against rabies.

Truth: Many people seem to feel more confident after getting the tetanus vaccine, and some even avoid getting the rabies vaccine after getting the vaccine. As a result, we have experienced that people who have been bitten by a rabid animal have died due to rabies. Therefore, rabies vaccination is mandatory.

Myth 9: The vaccine should be given within 24 hours of a dog bite.

Truth: It is not necessary to get the vaccine within 24 hours of a dog bite. The sooner the vaccine is given after the dog or animal bites, the faster it works, so it is advisable to get it immediately. But even if it is delayed for some reason, it should be administered as soon as it is known or as soon as the vaccine is available.

Points to note

The only way to avoid rabies is prevention, which is possible through vaccination. If you have pets, they should be vaccinated on time. If you are bitten by an animal, you should immediately seek medical advice and do not use any home remedies on the wound. If symptoms of rabies appear, this disease can be fatal. Therefore, you should not believe any myths related to rabies and only follow the advice of a doctor.

Ways to keep Dashain meat healthy and safe for a long time

Ways to keep Dashain meat healthy and safe for a long time

During the festival season, many homes have an abundance of meat. If it is not properly preserved, it can spoil.

Clean equipment should be used while slaughtering and cleaning meat, and storage should be done at a temperature below 4 degrees Celsius.

The minimum internal temperature should be maintained at 62.8 degrees Celsius when cooking meat.

Now is the festive moment of Dashain. Those who are away from home for work and study have started returning home and gathering. How many people are traveling? How many are preparing for the trip? Meat is the most consumed food during Dashain family gatherings. Except for vegetarians, most people eat meat like every meal during Dashain.

Most families slaughter animals at home and store plenty of meat. At this time, every house has an abundance of meat. In this situation, if the meat is not stored properly, there is a risk of spoiling. And the meat can become poisonous. Consuming such meat can cause various health problems.

Improper slaughterhouse practices and methods, poor hygiene, and improper and inadequate meat preservation methods for large quantities of meat can create a breeding ground for harmful bacteria, which can cause unpleasant and sometimes serious illnesses.

To avoid such problems, special care must be taken from the time of slaughtering the animal to its other processes, storage, and even cooking.

Food poisoning from contaminated meat is mainly caused by microorganisms such as Salmonella, E. coli, and Campylobacter. It can have mild to severe symptoms.

Symptoms

- Nausea, vomiting

- Diarrhea

- Abdominal pain

- Fever

In vulnerable people, such as young children, the elderly, and those with weakened immune systems, food poisoning can have serious consequences.

How to slaughter safely?

For many, the Dashain tradition of slaughtering goats or other animals at home is a tradition. If this practice is not done hygienically, it can be a major source of infection in the meat.

-The designated place for slaughter should be clean and away from household waste and drains. There should be a place where the animal can be cleaned again after slaughtering.

-Make sure that the animal prepared for slaughter is healthy.

-Plenty of clean water should be provided for washing hands, tools and meat. Tools should be washed thoroughly with soap and hot water before and after using them.

-The person performing the slaughter should also pay attention to hygiene. Meat can be contaminated by a dirty person.

-People with contagious diseases (cold, fever, dysentery, etc.) should not participate in this activity.

-The intestines and internal organs should be removed carefully. When removing the internal organs, be very careful not to pierce the intestines, as this can spread feces and bacteria to the meat.

-After cooking, meat should be cooled to below 4°C as soon as possible to prevent bacterial growth. This can be done by using a refrigerator or clean ice.

Kitchen Safety

Once meat is brought into the kitchen, special care should be taken to prevent contamination. Maintaining good hygiene is important to prevent such problems.

Keeping raw meat and other vegetables separate

Use separate chopping boards, knives and utensils for raw meat and other foods, such as vegetables and salads. This will prevent harmful bacteria from being transferred from raw meat to ready-to-eat items.

-Always wash your hands thoroughly with soap and water before and after handling raw meat.

Cooking to the right temperature

Most harmful bacteria are killed when cooked thoroughly. When preparing dishes, meat should be cooked thoroughly, especially until the pink color is gone.

For large cuts of meat, the recommended minimum internal temperature is 62.8°C. The best way to measure the temperature is to use a food thermometer.

Storing for later: Modern and traditional preservation

When a large amount of meat is available, how to store it properly?

Meat storage methods

1. Freezing

Fresh meat can be stored in the refrigerator at a temperature of 4 degrees Celsius or lower and consumed within a few days. For long-term storage, the meat should be frozen. For this, it should be cut into the required pieces, filled with packaging plastic, sealed and placed in the freezer.

The refrigerator used for storing meat must be in good condition. Meat can be contaminated and spoiled in a dirty refrigerator. If the meat is kept in this way, it can be stored for a long time.

2. Preserving cooked meat in fat

This method is called confiting in English. In this method, the meat, especially goat, pig or duck meat, is well marinated and then immersed in its own fat. The fat acts as a protective seal. The meat can be taken out when needed and prepared in various dishes as desired. No refrigeration is required for this.

3. Salting

This method is used especially in Western countries. In this, raw meat is salted heavily and hung in a dry, cool place or stored in the refrigerator at a temperature of 4 degrees Celsius. Before using such meat, it should be washed thoroughly in water to remove the salt.

4. Making Sukuti

This is a traditional Nepali method of preserving meat for a long time. Many Nepalis used to make long pieces of Dashain meat and hang it over the fire. Even today, meat can be seen being stored in this way in rural areas.Once the meat is well dried, it will not spoil even if kept for a long time.

To make suketi, the meat should be cut into thin and long pieces. This will allow it to dry evenly. It is best to dry it in a well-ventilated place, covered with a net to protect it from flies. The meat should be completely dry and hard before storing. Meat dried in a slightly smoky place will last longer.

5. Making Pakku

Pakku is a traditional Nepali meat dish. It is mainly made from goat or cow meat. The method of making it is special. The pieces of meat are marinated in spices such as ginger, garlic, cumin, and coriander and placed in a pot. Then, without using water, the meat is cooked in its own fat and juices at a low temperature for a long time.

When cooked in this way, the meat melts completely, becomes very soft and tasty, and its color is dark brown or black. Since it is cooked in its own fat without adding water, it does not spoil for many days.

It can be made into a broth and gravy as per the requirement. It can also be eaten with rice and curries. The pakku prepared in this way can also be stored at normal room temperature. If kept in the refrigerator, it will not spoil for many more days.

Do not eat too much

Consuming too many fatty and spicy meat dishes can cause digestive problems. To facilitate the digestion process, plenty of fresh vegetables, salads, and fruits should be included in the diet.

Drink plenty of water

Drink plenty of clean water throughout the day.

How to mitigate the psychosocial impact of the current crisis?

 How to mitigate the psychosocial impact of the current crisis?

Nepal is currently in a period of political transition that has increased instability and uncertainty.

The deaths and injuries of adolescents and many others in the recent violent protests have raised deep concerns.

Immediate and long-term initiatives are needed, prioritizing mental health and psychosocial support.

Nepal is once again in a period of political transition. While change itself is an inevitable process, change accompanied by uncertainty creates more uncertainty than hope. At times, we are wondering whether Nepal is on the brink of instability.

The loss of lives of adolescents and young people in recent violent protests and movements, the injury of many people, is sending a message of sorts.

The massive damage to private and public property, from archaeological heritage to the prevailing sense of insecurity in the minds of ordinary citizens, have caused us deep pain. Not only the immediate damage, but also its long-term impact, its impact on mental health, is a matter of concern and discussion.

This crisis has affected all age groups in different ways. Children and adolescents have experienced fear, confusion, sleep problems, and difficulty concentrating in school. Youth and adults have experienced increased frustration, anger, anxiety about unemployment, and strained social relationships. The elderly are experiencing feelings of insecurity. People with disabilities and marginalized communities have their own unique concerns.

If these conditions are not addressed immediately, there is a risk of increased trauma, anxiety, depression, and suicidal tendencies. There is also a risk of social breakdown, deepening distrust, decreased productivity, and a decrease in human resource capacity.

Psychosocial support is urgently needed for children, adolescents, youth, women, the elderly, people with disabilities, and marginalized communities affected by violence, death, and insecurity. Many people are in a state of confusion right now. Most people seem to believe the information they receive on social media as official information. Many seem to be unable to distinguish between right and wrong.

This type of information seems to have made people very anxious due to the pressure of uncertainty about the future.

What to do in this situation?

Both immediate and long-term initiatives are needed to address such a situation. Primarily, psychological support, helpline services operated through telephone and social media, and community-based basic psychosocial support programs need to be started immediately.

Self-care and stress management skills should be provided to security personnel, health workers, media workers, and other service providers working in the field immediately. In the long term, mental health in schools, communities, and workplaces should be linked to education, protection, and health systems through policy management.

It is essential to develop a psychosocial support system with follow-up and conduct activities. Similarly, only by ensuring quality counseling services related to trauma and grief can victims have the basis to restore their lives to balance.

In this context, the first responsibility is to address the suffering of people who died, were injured, and were disabled in the movement. Immediate treatment, rehabilitation, compensation and ensuring justice should be the first step of the state. Trust in the people can be restored only by impartial investigation and accountability in cases of human rights violations.

Similarly, it is necessary to pay attention to the control of corruption and transparency in power raised by the protesters.

Special attention should be paid to returning people's lives to their previous state, restoring employment and creating new jobs. It is necessary to immediately facilitate and restart production and business that have been stalled due to various reasons. It is necessary to create an investment-friendly environment and create an encouraging environment.

Similarly, mental health and psychosocial well-being must be a national priority. The World Health Organization and the International Labor Organization have recommended linking mental health with development and employment. Therefore, Nepal needs to take the initiative in this regard in collaboration with development partners.

In the long term, it is essential to introduce psychosocial and mental health education in schools, communities and workplaces, a structure of community-based workers (CBTs) and psychologists, and policies and systems that link mental health to the primary health system.

Good governance and transparency are also indispensable. Rebuilding trust is not possible without participation in the decision-making process, accountability through e-governance, social justice and the implementation of concrete programs to end discrimination. Nepal stands at a crossroads of crisis and opportunity today.

Only if the state can put these five foundations into practice: justice and rehabilitation for the victims of the movement, eradication of corruption, job creation and economic expansion, ensuring mental health and social cohesion, and reconstruction with good governance and transparency, will Nepal's future not be just a story of struggle, but a common home for beautiful, peaceful, healthy and happy Nepalis.

Why is a postmortem necessary in unnatural deaths?

 Why is a postmortem necessary in unnatural deaths?

A postmortem is an examination of a body after death and is mandatory according to law in unnatural deaths.

A postmortem helps in finding the cause of death and helps in justice and helps in protecting the future from accidents and diseases.

A postmortem is an examination of a body after death. There are many misconceptions and misconceptions about postmortem in Nepali society. Due to such misconceptions and misconceptions in our society regarding postmortem, most of the relatives of the deceased do not want to perform a postmortem on the body of their loved one after death.

During a postmortem, the body has to be cut open and the internal organs examined. For this reason, people in Nepali society do not want to perform postmortems as much as possible due to religious and cultural issues.

However, if the death occurred in an unnatural manner, then a postmortem of such a body is necessary. For example: if someone finds a body in a murder, suicide, suspicious death, accidental death, sudden death, or a dead body, the police must be notified and a postmortem must be performed according to law. Since such deaths are suspicious, the cause of death must be found for the police investigation, for which a postmortem must be performed.

History of Postmortem

When digging into the history of postmortem, we have to go back to the beginning of the 14th century. In 1302, a postmortem of a body was performed for the purpose of investigating a death in Bologna, Italy. Similarly, since centuries ago, postmortems have also been performed in France, Egypt, and China to assist the law.

In the 18th and 19th centuries, postmortems gradually developed after the traditions of China and Babylon and the advanced use of European medical science. It was born separately in medicine, which was named ‘forensic medicine’. This field includes postmortems of bodies and medico-legal cases.

This branch of medicine is also known and understood as forensic pathology or legal medicine in some countries. In Nepal, the practice of performing postmortems in suspicious deaths seems to have started since 1960. The government doctor of Kathmandu's Prison Hospital officially started postmortems for the first time at Bir Hospital.

Why do postmortems?

Section 20 of the Criminal Procedure (Code) Act 2074 BS states that in the Nepali Constitution, in case of an accident, suicide or suspicious death within the territory of Nepal, the postmortem of the deceased must be paid by the government at all costs. Postmortems are performed at the request of the legal authorities responsible for investigating accidental and unnatural deaths, and the Nepal Police has the legal authority in Nepal.

A question that comes to the police every time after a death is why do we perform postmortems? What is the benefit of performing postmortems? The dead person is already dead, so why should we cause more suffering?

First of all, what should we understand is that we perform postmortems for the living rather than for the dying person. Postmortems provide a basis for finding out the facts and the cause of death, punishing the guilty and saving the innocent.

It helps in justice. In addition, performing a postmortem reveals many details about the death, which not only helps in investigating the death but also helps in making the living aware of diseases and causes of death.

In the event of a vehicle accident, the nature of the internal injuries can be examined and the safety systems of vehicles can be made aware. Previously, it was through such research that helmets were worn while riding a motorcycle, seat belts were made mandatory while driving, and airbags were made mandatory in vehicles, as well as head rests in the event of an accident.

Reasons for performing a postmortem

1. In fatal accidents

A postmortem is mandatory in fatal accidents because it can be found out which part of the human body is most affected in an accident and which part is most affected and leads to death. This helps in knowing about the measures to be taken to avoid the accident, the methods to be adopted in treatment, and awareness. This helps in reducing the number of deaths caused by fatal accidents.

2. In case of sudden death

In case of sudden death, postmortem can be done to find out the disease that most people die from. Postmortem can be done to find out which part of the body is affected by such diseases. By finding out the nature and condition of the disease, society can be helped to save it from diseases. Similarly, this can also help to find out about hereditary diseases and alert other family members in time to save it from premature death.

3. Help the law

The police must conduct a postmortem when investigating a death. The cause of death is mentioned on the basis of the postmortem report, based on which further legal investigation is carried out.

In case of suspicious death, the family, relatives and eyewitnesses of the deceased also make various statements according to their interests. Preparing a postmortem report based on statements affects the police investigation, therefore, postmortem is also mandatory from a legal point of view to help in finding out the exact cause of death and conducting a fair investigation.

3. For scientific research

The nature of the wounds on the body may vary between a vehicle accident, a fall, and a beating, which will allow proper scientific research to examine the nature of the injuries on disputed bodies in the future and determine whether the injuries were caused by a vehicle accident, a duty-related death (beating), or a fall. There may be grounds for distinguishing between the two.

How is a postmortem performed?

A postmortem is performed in all district hospitals or large government hospitals in Nepal. After a police report, it should be performed by a forensic expert or a doctor registered with the Nepal Medical Council. During a postmortem, the body is completely naked, the outer covering is noted, and the body is completely dissected and examined.

Sometimes, pieces of various parts of the body are removed to provide additional evidence for the police to investigate and the doctor performing the postmortem to determine the cause of death. And it is also sent to the police forensic laboratory for further examination. After the postmortem, a report with the doctor's signature is submitted to the police.

Postmortem related mistakes

1. The body is not dismembered during a postmortem

During a postmortem, the body is dissected as needed, and after examining the vital organs, the body is re-stitched and handed over to the relatives in its original state.

2. The organs of the body are not removed during the postmortem

The main purpose of performing a postmortem is to find out the cause of death. Therefore, the body is dissected and examined for important organs. Then the organs are placed inside the body and sewn up and sent. In any suspicious situation, small pieces of organs can be removed for testing for poisons and other chemicals as needed. Then the organs are sewn up in their entirety. After death, no organ works for another person.

3. A postmortem cannot be done without dissecting the body

In Nepal, a postmortem cannot be done without dissecting the body. However, sometimes, since hospital reports reveal the cause of death based on CT scans and X-rays, a postmortem can be done even with minimal incisions. Therefore, the hospital report is important after death.

4. Is it known whether a person is dead or not after an autopsy?

A postmortem is basically to find out the cause of death. After the cause of death is determined, the investigation into whether the death was accidental, accidental, or suicide remains. After the doctor determines the cause of death, the police investigate based on that. The doctor who performs the autopsy does not reveal the exact cause.

But sometimes, based on the nature of the injuries on the body, the doctor can give an opinion to the court about accidental, accidental, or suicide.

Postmortem Neglected

Postmortem plays an important role in determining the cause of death and minimizing deaths due to potential disasters.

Due to the state's lack of importance in this field, the new methods introduced by medical science in this field have not yet been introduced in Nepal, which is why even today the postmortem space in government hospitals in Nepal is limited to a dark room.

In developed countries, postmortem examination rooms are equipped with postmortem X-rays and CT scans, as well as labs for DNA, drug and poison testing, to minimize the amount of dissection required during postmortems. However, ironically, in Nepal, state agencies are less knowledgeable about what constitutes a dead body and have neglected this area in every way.

The wall didn't know, the mobile has ears!

 The wall didn't know, the mobile has ears!

We often listen, the wall also has ears. This saying is often used as a warning to be careful when having sensitive or confidential conversations. But in the current digital age, this has started to be experienced as a reality. It is not clear that the wall has ears, but many are now curious about whether the mobile is listening to us.

Many of us have experienced that after we talk to friends or family about a product or service, the related advertisement appears on the mobile. Therefore, many people now have the question, "Do our phones or apps really listen to our conversations?"

What is the fact that the mobile listens?

According to studies and experts, under normal circumstances, your phone does not listen to you constantly. However, some apps or voice assistants (such as Google Assistant, Siri) only activate and listen to audio after hearing a 'wake word' such as "Hey Siri" or "OK ​​Google".

Why do we see advertisements for the same product or service that we are talking about?

Rather than our phones constantly listening and showing us ads as we might expect, ads are targeted based on our internet usage, search history, location, and social media activity. That’s why sometimes ‘what we’re talking about’ and ‘ads in our feed’ coincidentally match.

How to check if your phone is listening to you

You can easily check if your phone is listening to you.

1. Think of a topic that you’re not normally interested in. No matter why you’re not interested, there’s no record of any previous searches, website visits, or conversations related to the topic.

2. After choosing a topic, sit close to your phone and talk about it. Use keywords related to the topic as much as possible. For example, if you think of the topic “boat engine,” say things like “where can I buy a boat engine?”, “which boat engine is reliable?”, “how much does a new boat engine cost?” Your words should clearly indicate a desire to buy an engine. Talk like this for a few days.

3. Then evaluate the ads that appear in your feed. This includes ads from platforms like YouTube videos, Google search, and social media feeds. If you start seeing ads related to boat engines or boats, your phone is listening to you.

What can we do?

Permission control: Go to your phone's settings and remove access from apps that don't require the microphone.

Turn off voice assistants: Disable services like Google Assistant or Siri when not in use.

Be aware: Don't install unnecessary apps, and read privacy policies when installing apps.

According to studies and experts, your phone or apps are not constantly listening to you. However, apps or voice assistants that have received microphone permission can listen to your commands. For this reason, we need to make it a habit to manage permissions consciously, turn off unnecessary services, and read privacy information.

What is Alpha School in America, where AI teaches instead of teachers!

 What is Alpha School in America, where AI teaches instead of teachers!

What comes to mind when you think of ‘school’? Surely, for many, classrooms from kindergarten to 12th grade, front-line teachers, and long lessons come to mind. This is how schools have been set up for centuries. But now, as AI is changing our lifestyle, the traditional way of learning and schooling has also started to take a new form.

Alpha School, located in Texas, USA, has become a global sensation due to its unique and modern way of teaching students. Instead of a teacher teaching 25-40 students at a time as per the traditional style, it is said that in this school, students are instructed individually by AI guides. It is said that the AI ​​system also analyzes their progress and provides immediate feedback, which helps them improve their weaknesses.

At Alpha School, students are said to have to study for only 2 hours a day. According to international media, after two hours of study, Alpha School students spend time on physical activity, problem-solving activities, leadership exercises, and life skills. These include activities ranging from long bike rides to creative projects and entrepreneurship training.

Another feature of Alpha School is its financial rewards system. Students are said to earn money for completing assignments, projects, or mastering skills, which they can spend on their own projects or interests, or even invest.

According to international media, Alpha School is not a school that appeared overnight or became famous. It has been operating on campuses in Texas, Florida, and California for more than a decade, and is now preparing to expand to New York City. It is said that a new Alpha campus is planned to open in Manhattan next September, with annual tuition fees ranging from $40,000 to $65,000, depending on the location.

This unique and technological teaching style demonstrated by Alpha School has shown the potential for education to take on a completely new form through innovation, not just limited to books and teachers.

Some of our habits, which can be improved to improve health

 Some of our habits, which can be improved to improve health

Eating late at night increases the risk of diabetes, so you should finish your meal by 8/9 pm and eat light meals.

Eating too fast can cause gastritis, so you should chew your food slowly and thoroughly.

Excessive salt intake increases high blood pressure, so it is recommended to not eat more than 6 grams of salt per day and eat less processed food.

A balanced and healthy lifestyle is essential to prevent and control any disease. Sometimes some habits cause disease. While some promote diseases. If we identify these habits and change them in time, positive improvements in health are possible.

There are some habits, which can be changed to avoid diseases.

1. Diabetes

Eating late at night can cause imbalanced blood sugar levels, which reduces the effect of insulin in the body. This makes it difficult to control sugar. It is better to finish eating by 8/9 pm. Dinner should be light. After eating, you should walk for a while.

2. Migraine

Skipping meals can increase migraine symptoms. Not getting enough nutrition on time can lower blood sugar levels and increase headaches. A regular and balanced diet helps in controlling migraines.

3. Heart disease

Physical inactivity is a major cause of the disease. Not exercising regularly can lead to obesity, high blood pressure, and cholesterol. You should do at least 30 minutes of light or moderate exercise daily. You can also walk.

4. Osteoporosis

Complete deprivation of sunlight weakens bones. Spend 15 minutes in the early morning sun and include calcium-rich foods in your diet.

5. Gastritis

Eating too quickly affects the protective layer of the stomach, which causes irritation and gas. You should chew your food slowly and thoroughly.

6. Acid reflux

If you sleep immediately after eating, stomach acid can flow back into the esophagus. You should stay active for at least 2 hours after eating. Eat light and less spicy food at night.

7. Stomach problems

Not drinking enough water can cause problems like constipation and acidity. You should drink at least 8-10 glasses of water throughout the day. So that the digestion process remains smooth and excretion is easy.

8. Liver disease

Excessive oil-spices and processed foods put an extra burden on the liver. Such foods should be avoided. Fresh fruits and vegetables should be prioritized in your daily diet.

9. Dementia

Mental inactivity and watching television for a long time negatively affect brain function. Therefore, you should learn something new every day and exercise your brain.

10. Insomnia

Excessive use of screens, especially before going to bed, affects sleep. You should stop using mobile and television at least 1 hour before going to bed. You should set a regular sleep time.

11. Anxiety

Spending time on social media can increase mental stress. Limit your use of social media. Include meditation, yoga, and relaxation techniques in your daily life.

12. High blood pressure

Excessive salt intake can increase blood pressure. Excess salt causes water retention in the body, which increases pressure on the heart. Therefore, you should avoid eating processed and fast foods that are high in salt and should not consume more than 6 grams of salt per day. You should also give up the habit of sprinkling salt on your food.

13. Anemia

Many people drink tea immediately after eating, but this hinders the absorption of iron in the body. Therefore, tea should be drunk at least 1 hour before or 1 hour after eating. Green vegetables, lentils, and iron-rich foods should be prioritized in the diet.

What are the procedures for postmortems and identification of those who died in the protests?

 What are the procedures for postmortems and identification of those who died in the protests?

Coordination between forensic science, police, and hospitals is necessary to identify and determine the cause of death of those who died during the protests.

An official letter of medico-legal examination from the police is required before the postmortem is conducted, which confirms the cause of death.

DNA analysis and other scientific methods are used to identify bodies that have been burned, but identifying completely burned bodies is challenging.

Violent incidents during protests cause great human loss. In such incidents, a complex and sensitive procedure is adopted to identify and determine the cause of death of those who die due to gunshots, fire, or other injuries.

Coordination between forensic science, as well as the police, and hospitals is very important to identify and determine the cause of death of the deceased. This process is sensitive from both a scientific and legal perspective.

Incident and initial procedures

People who die during the protests are often taken to the hospital immediately by eyewitnesses or friends. The name of the deceased is registered in the hospital and treatment is attempted. If the person is confirmed not to be alive, the body is sent for postmortem. Tribhuvan University Teaching Hospital, Kathmandu is a well-equipped centre for mortuary storage and postmortem. The body is preserved in a freezer facility. The teaching hospital has the necessary equipment for proper management of the body and postmortem, which makes the process systematic.

Identification process of the deceased

Initial identification

The identity cards, jewellery or other personal belongings of the deceased form the initial basis for identification. The name and address of the deceased can be ascertained from such items. If such items are not available, the relatives come to the hospital and identify the body.

Personal belongings are of great help in the identification process, but sometimes other scientific methods have to be used in cases where these items are destroyed.

Notification to relatives

Once the details of the deceased are registered in the hospital, the relatives are informed. The hospital maintains a list of the names of the deceased, which the relatives look at to identify the body. Once the identity is confirmed, the postmortem process proceeds.

Postmortem and medico-legal process

A medical-legal examination is required from the police before a postmortem can be conducted. In cases where police stations are affected, such a letter is issued by the Kathmandu Police Complex. A postmortem determines the cause of death, such as gunshot wounds, injuries or fire. This process is important for the relatives of the deceased and the community to uncover the truth.

The main causes of death during the protests currently include gunshot wounds, internal injuries, head injuries or fire. In cases of gunshot deaths, doctors analyze the nature of the bullet and the damage to the body.

Identification of people who died in a fire

The identification of bodies that died in a fire is complicated. For example, in the case of seven people who died in a fire in Bhatbhateni, identification is challenging. Methods such as presumptive identification and DNA analysis are used to identify burned bodies. If jewelry, clothes or other personal belongings are left, they can be used to identify them.

DNA Analysis

When a body is not completely burned and some tissue remains, DNA is extracted and analyzed. This process is carried out at the Central Forensic Science Laboratory of the Nepal Police. DNA analysis can confirm the identity of the deceased, but this process is time-consuming and resource-intensive.

DNA Analysis Process

DNA Extraction

DNA is extracted from white blood cells, because red blood cells do not have a nucleus. DNA can be extracted from bones or teeth in burned bodies, if they are not destroyed.

Polymerase Chain Reaction (PCR-M)

If the amount of DNA is low, the amount of DNA is increased by the PCR-M process. This makes it easier to analyze the DNA sequence adenine, guanine, thymine, cytosine.

Profile Matching

The DNA profile of the deceased is compared with the DNA of his father or mother. A 50 percent match between the father or mother's DNA confirms the identity.

Challenges in completely burnt bodies

If the body is completely burnt and the tissues are destroyed, DNA analysis is not possible. In such a case, identification becomes impossible. Also, if the relatives of the deceased do not contact them in time, the process becomes more complicated. The possibility of identifying completely burnt bodies is limited, but we must make the most of the resources and technology available.

This process is not only to identify the deceased and determine the cause of death, but it is also a means of ensuring truth and justice in society. Such sensitive processes provide comfort to the victim’s family and provide truthful information to society.

Back Pain: An Accounts Officer in the Circle of Wrong Treatment

 Back Pain: An Accounts Officer in the Circle of Wrong Treatment

Accounts Officer Tilak Shrestha started treatment for back pain at the Physiotherapy Unit of Bir Hospital in 2082 Jestha.

Tilak spent more than two hundred thousand rupees on various clinics and treatments for 6 months, but it did not get better.

Physiotherapy at Bir Hospital reduced Tilak's pain by teaching him evidence-based treatment and exercises, and he returned to work.

Tilak Shrestha (name changed) by profession, an accounts officer by profession, arrived at the Physiotherapy Unit of Bir Hospital in 2082 Jestha.

His problem was back pain.

He came here after wandering around many places for treatment but the problem was not resolved.

He recounted the list of frustrations he faced during treatment.

This experience is not unique to him, many people with back pain experience the same. Many people fall into the trap of wrong treatment by following unnecessary suggestions from various people.

Suffering from pain

Tilak had been suffering from back pain for 6 months. The pain was worse when he woke up in the morning. It was worse when he sat or stood for a long time. At first, he ignored it, considering it normal. The pain gradually spread to his legs and made it difficult to walk. He even changed his office chair twice, wondering if it was because he was uncomfortable sitting while working.

Unable to concentrate on work, unable to sit in the office for a long time, and daily life became difficult, he started looking for treatment.

Initial efforts

Initially, he went to an Ayurvedic treatment center in Basundhara as suggested by his uncle. There, he was told that his back hurt due to heavy lifting and sitting in the wrong posture. Tilak did not do heavy lifting. He concluded that his back hurt because he sat in the same position for a long time in the office.

He was given acupuncture services, hot water baths, and massage once a week. He was also told to take some medicines. Although these treatments reduced some of the pain, the problem did not completely resolve. He was charged Rs. 2200 each time for these treatments. The cost of the medicine was separate.

After the fourth massage during the treatment, he started having problems with tingling in his legs and increasing pain.

And at the clinic

When the problem did not work, he went to a clinic near his house to consult a doctor. On the doctor's advice, he got blood tests and X-rays done. These tests did not show any major problems. He was informed that there was a normal bone loss.

It was suggested that further tests be done for further investigation. Accordingly, tests were done for CBC, ESR, vitamin D, calcium, uric acid levels, etc. Additional blood tests were also done for other parameters.

After finding that all the parameters were normal, an MRI was asked to find out the cause of the back pain.

In the same clinic, ‘needle therapy’, ‘traction’, ‘tension’ were given as physiotherapy. However, Tilak did not feel any improvement. Instead, he felt more pain. He was advised to rest for some time and stay at home, not go to the office and not do daily household chores.

Second clinic and expensive expenses

Then he was advised to go to a clinic in Tripureshwor. After examining his problem, it was suggested that he should burst the lump in the back. For this, methods such as ‘needling’, ‘manual’, ‘chiropractic’ massage gun were used.

He underwent the treatment as prescribed there for 15 days at a rate of 1000 per day. But the pain did not reduce much.

More expenses at the third clinic

Then he went to another clinic near the Civil Hospital in Baneshwor. There he spent 500 per day and took hot steam for 9-10 days. He also took massage therapy for the same number of days. He spent 600 per day on that. Here, he spent about 10 thousand.

Although these simple massages and steam treatments provided immediate relief from the pain, they did not provide a long-term solution.

Towards natural treatment

Finally, Tilak went to a center in Baneshwor to seek natural treatment. Where he underwent treatment for 10 days continuously. There, treatments like ‘acupuncture’, ‘cupping’ were given. There, he was given 10 minutes of physiotherapy daily. In which the therapist would stretch his hands and teach him some exercises to do on his own.

These treatments also could not completely cure Tilak’s back pain.

Consultation with a doctor at the National Trauma Center

After many types of treatment did not help, he went to the National Trauma Center to consult an orthopedic doctor. There, the doctor said that the condition was very complicated and that an MRI should be done.

The doctor suggested taking medicine and doing physiotherapy for some time. If that did not help, he was told to get injections.

Tilak informed the doctor that he had not gotten better despite undergoing physiotherapy at various places. After hearing all that, the doctor suggested injections and surgery if necessary, and ordered an MRI.

At the Pain Care Center

Tilak was scared when they said injections and surgery would be necessary. When he consulted his friends and relatives, some gave examples of people who had undergone surgery and recovered, while others advised against surgery. This confusion left him in a dilemma.

After being diagnosed, he again started looking for non-surgical treatment. In the same vein, he reached the Pain Care Center. There, he was prescribed medicine for 20 days. After undergoing various therapies and treatments, he took the service for a few days at the rate of 700 rupees per day.

6 months of suffering and unnecessary expenses

Tilak went to various places for about 6 months for treatment of his back pain. During this, he had to endure physical pain, mental stress, work interruptions, and expenses of more than two hundred thousand rupees. He could not give time to his family. And his lifestyle was greatly affected.

He took 18 days off from work repeatedly during this time. Even after all this treatment, problems such as difficulty doing household chores, sitting in the office for long periods of time, and pain increasing when riding a scooter in potholes persisted.

What is his real problem?

The problem of back pain and the experience of suffering for treatment are common problems for many back pain patients in Nepal. In most cases, back pain is common and complications are rare. But if there is a health problem, it seems that the problem becomes more complicated when various people give various suggestions and the patient follows them.

The use of non-physiotherapy in the name of physiotherapy or the failure to use evidence-based physiotherapy treatment methods are also causing unnecessary suffering to the patient.

Time and money are being spent for free on treatments that do not yield results. There is a tendency to confuse patients by promoting new and unproven methods.

A misconception and practice that when there is a pain problem, an ‘MRI should be done’ at the first appointment has increased in Nepal. On the one hand, there is the problem of healthcare workers who insist on getting an MRI, and in some cases, patients themselves are dissatisfied with the healthcare workers not suggesting an MRI. There are also patients who think that the doctor did not ask for an MRI, perhaps ignoring my problem.

In fact, most back pain is not unnecessary to get an MRI. When an MRI is performed for normal pain, it may show normal ‘disk bulging’ or ‘degenerative changes’, which are also seen in many healthy people with age. When patients are told about these things seen on an MRI, patients are unnecessarily scared. They consider it a big problem and worry.

Similarly, the practice of injecting ‘steroids’ to relieve pain is also increasing in Nepal. Although steroids relieve pain immediately, their long-term effects and repeated use can have negative effects on the body.

What is even more worrying is the increasing trend of recommending surgery for simple back pain. While only 1-2 percent of back pain sufferers have a complex problem that requires surgery.

This is why patients are going through unnecessary suffering, expense, and mental stress. We need to understand that back pain is not a serious illness, it is a normal reaction of the body and can be managed with proper understanding.

The most important thing for back pain is reassurance, patience, and accurate information. About 95 percent of back pain is of a normal nature. It resolves on its own within 6 weeks to 3 months or is completely cured with good self-management.

Evidence-based ‘conservative’ treatment should be the first priority for the first 3 to 6 months. It is necessary to receive individualized physiotherapy services from a certified physiotherapist.

Exercises and hands-on therapies such as mobilization, manipulation, and stretching are provided according to the person’s condition, pain level, and functional capacity. The main goal of physiotherapy is to prepare the patient for self-management by teaching them about their body and pain. The physiotherapist assesses the patient’s functional capacity and suggests ways to increase their functional capacity.

This includes the following:

1. Self-management and patient education

The patient should be explained why back pain occurs, what its normal course is, and that in most cases it can resolve on its own. It is important to develop the idea that ‘back pain is not always serious’. Giving the patient accurate information about their pain reduces unnecessary fear and anxiety.

Fear and anxiety can cause and worsen pain. The patient should be reassured that back pain is normal and is not a long-term problem. Instead of bed rest, they should be encouraged to be active in their usual activities.

2. Pain management and exercise

Exercises that strengthen the back and abdominal muscles, increase flexibility, and improve posture (such as cobra pose, cat-camel stretch, pull exercises) should be taught according to the patient's condition.

Activities such as walking, cycling, and swimming increase blood circulation and help reduce pain. Hot or cold packs can be used to relieve short-term pain.

If the pain is unbearable, painkillers or muscle relaxants can be used on the advice of a doctor. However, relying on such medications for long-term pain relief can have negative effects.

3. Physical exertion and continuation of daily activities

You should be encouraged to continue your normal daily activities despite the pain. Prolonged inactivity can worsen the pain. Teach the correct way to sit, stand, and walk. Correct technique should be adopted when working on a computer or lifting heavy objects. Do not stay in any one posture or position for more than 30 minutes. Take ‘microbreaks’ every 20-30 minutes, such as getting up, walking, or stretching.

4. Psychological support

This is a treatment method provided by a physiotherapist in general and a clinical psychologist in complex cases when the patient shows yellow signs. For example: The role of mental health is important in chronic pain. It helps to change negative thoughts and behaviors towards pain. Meditation and mindfulness practices teach you to reduce the feeling of pain and accept it.

In what cases is complex treatment necessary?

If back pain lasts for 6 months If the pain persists for more than a month, does not improve with treatment, or if other serious symptoms occur along with the pain, other types of treatment are necessary.

For example, if there are problems such as weakness in the legs, problems with urine or stool control, persistent fever, or pain at night, additional tests such as MRI are necessary.

In this case, steroid injections or surgery should be considered. These treatment methods should be recommended only after a thorough evaluation by a specialist doctor.

The change in Tilak

What Tilak suffered in the name of treatment, he became a victim of malpractice. Which tortures the patient financially, physically, and mentally and reduces the importance of physiotherapy.

As advised by the physiotherapy unit of Bir Hospital, Tilak started taking regular physiotherapy sessions. He was given correct information about back pain. He was taught exercises to do daily. He improved his sitting style. He started walking regularly.

He realized that back pain is not always serious and staying active is the best treatment for it. Within a few weeks, his pain significantly decreased and he was able to return to his work fully. He was spared unnecessary expense and suffering.