Journey from the history of maternity hospitals to modern services

 Journey from the history of maternity hospitals to modern services

Paropakar Maternity and Gynecology Hospital BS. 2016 is the only gynecological hospital in Nepal.

The hospital delivers 22,000 to 24,000 women annually.

Paropakar Maternity and Gynecology Hospital is the only gynecological hospital in Nepal. This hospital is known as the maternity hospital. Established as an important institution in the health sector of Nepal, Paropakar Maternity and Gynecology Hospital is making an invaluable contribution to the health and safety of women and mothers.

This hospital has played a historic role in Nepal's health service, focusing especially on obstetrics, gynecology and newborn health.

Establishment and early history

Paropakar Maternity and Gynecology Hospital was established in BS. 2016. This hospital was established in the name of Indrarajya Lakshmi Devi Shah, the wife of the then King Mahendra Shah. At the time of its establishment, the hospital was provided with the help of Paropakar Sanstha by Singh Shamsher.

Indrarajya Lakshmi Devi Shah died due to infertility. This is why history mentions that a hospital was established in her name with the aim of preventing others from dying from such problems.

Paropakar Maternity and Gynecological Hospital is a proud health institution of Nepal, which has provided maternity and gynecological services to lakhs of women in a period of 66 years.

Expansion and Development

The hospital has made remarkable progress in a period of 66 years. Initially started with 40 beds, this hospital is currently operating with a capacity of 515 beds, and a proposal to expand to 700 beds has been submitted to the government. Every year, 22,000 to 24,000 women deliver here.

Along with maternity services, the hospital has been providing various gynecological services, which include treatment of uterine prolapse, uterine tumors, cancer, hemorrhage, ovarian tumors and fertility problems.

Specialized Services

The hospital has expanded specialized services over time. Paropakar Maternity Home is the first government hospital in Nepal to start IVF service for infertility treatment. This service is being systematically run at the IVF center in Kupandol.

There are plans to make this center a center of excellence, and so far, 5 provincial doctors and nurses have been trained.

This service has been started through a tripartite agreement with the Government of Nepal, the Department of Health Services, and UNFPA for the treatment of urinary incontinence. This service is provided free of charge, especially for women affected by complicated deliveries and surgeries. There are plans to send two doctors to Pakistan for training for this service.

The maternity home has also started newborn screening. The ‘New Born Screening’ service was started last year to identify hereditary disabilities. Seven hereditary diseases including thyroid, phenylketonuria, and thalassemia can be identified.

Out of 2000 newborns, 20 have been diagnosed and treated. Which will help reduce the mortality rate of newborns.

Fetal and maternal echocardiography facilities are also available. From which 6,100 patients are availing the service in a year. This service has been run in collaboration with experts from Gangalal Hospital and Bir Hospital for the heart examination of pregnant women and newborns. This service has eliminated the obligation of patients to pay expensive fees in private hospitals. It has helped in timely identification and treatment of heart-related problems, especially in complex pregnancies.

The hospital also has a mental health OPD facility, through which 1,800 patients have already benefited. The mental health OPD service has been started for the treatment of postpartum mental health problems.

What did Dr. Shree Prasad Adhikari do after becoming the director?

The current director, Dr. Shree Prasad Adhikari, has made significant improvements in the hospital in the last two years. Since he took over, four new counters have been added, two OPDs, one billing, and one pharmacy. The online ticketing system has been made systematic and advanced, which has eliminated the obligation of patients to stand in line. Services have been expanded in Kupandol since Asad 15, 2081. IVF services, infertility treatment, safe abortion and a nursing college have been brought into operation.

Since the infertility treatment service began, 9,100 people have come for infertility treatment. Out of these, 300 have already taken IUI and 43 have taken IVF services, says Dr. Adhikari.

The hospital has brought a simulation lab into operation. According to the hospital director, Dr. Adhikari, it was established with the aim of producing skilled manpower for the treatment and care of mothers and newborns. He said that treatment practices will be conducted without affecting any patient.

Fistula surgery has also been started. This service is being run for the first time in a government hospital, which provides free treatment to women affected by complicated childbirth.

Former director Dr. Sheela Verma's statement

Former director Dr. Sheela Verma says that the maternity hospital feels like a family home to her. “I have always been impressed by the dedication and support of the staff and employees here,” she says. “I am proud to work here.”

Dr. Barma says that during her tenure, she implemented the Mater Suraksha program, which spread throughout Nepal. The program served many women, but there were also challenges due to lack of resources. The dedication of the team here and the excellent service the hospital provides She says that the desire to dance has brought this organization to this point.

She said that the Maternal Safety Program has contributed significantly to reducing maternal mortality in rural areas of Nepal. This is mentioned in the report of the Ministry of Health.

Challenges of the hospital

Although the hospital has made a lot of progress over time, some challenges remain. The hospital buildings are old, and there is a problem of water leakage during the rainy season. Director Dr. Adhikari says that a new building and cabins are needed.

The hospital is currently run by the committee's staff and contract employees. If the proposal for 700 beds is approved, staff and services can be added. The budget is also decreasing every year, which she complains is hindering the expansion of services. Patients are inconvenienced by the lack of parking and space.

A symbol of service and dedication

The maternity hospital, born from the tragic incident of the royal family, has today become a trusted friend of service recipients from all levels of Nepal. This hospital has been providing special services not only to women from low and middle income groups, but also to the upper middle class. The hospital currently provides OPD services to over 100,000 patients annually, which is significant compared to other government hospitals in Nepal.

Crisis of the Modern World-System

 Crisis of the Modern World-System

4. Crisis of the Modern World-System

Question: What are the key factors contributing to the crisis of the modern world-system, as described by Wallerstein? How do bifurcation, chaos, and choices shape the future of global capitalism?

Relevant Readings: Wallerstein, Chapter 5 of World-Systems Analysis; Frank Elwell, “Wallerstein’s Crisis of Capitalism”; Christopher Chase-Dunn, “Five Linked Crises in the Contemporary World System.”

Immanuel Wallerstein’s analysis of the modern world-system reveals a complex interplay of economic, social, and political factors that contribute to its ongoing crisis. In his work, particularly in Chapter 5 of *World-Systems Analysis*, Wallerstein identifies several key elements that characterize this crisis, including bifurcation, chaos, and the choices that societies face as they navigate these turbulent dynamics.

## Key Factors Contributing to the Crisis of the Modern World-System

### 1. **Structural Crisis**

Wallerstein posits that the modern world-system is experiencing a *structural crisis*, which he defines as a fundamental breakdown of the existing economic and political order. This crisis is not merely a cyclical downturn but a deep-seated transformation that challenges the very foundations of global capitalism. Key aspects include:

- **Economic Instability**: The capitalist economy has become increasingly unstable, marked by recurrent financial crises, rising inequality, and the inability to sustain growth. This instability is exacerbated by the interdependence of global markets, where economic shocks in one region can have widespread repercussions.

- **Environmental Challenges**: The capitalist system's relentless pursuit of growth has led to significant environmental degradation, contributing to climate change and resource depletion. These ecological crises pose existential threats to both human societies and the planet.

### 2. **Bifurcation**

Wallerstein introduces the concept of *bifurcation* to describe the critical junctures at which societies must make significant choices about their futures. This bifurcation is characterized by:

- **Diverging Paths**: As the world-system faces crises, countries and regions are confronted with divergent paths. Some may choose to reinforce existing power structures and inequalities, while others may seek transformative changes that promote social justice and sustainability.

- **Polarization of Responses**: The choices made in response to the crisis can lead to polarization, where societies either embrace regressive policies that deepen inequalities or pursue progressive reforms aimed at addressing systemic issues. This polarization can manifest in political movements, social unrest, and ideological conflicts.

### 3. **Chaos**

Wallerstein describes the current state of the world-system as one of *chaos*, characterized by rapid and unpredictable fluctuations in various parameters, including economic conditions, political stability, and social cohesion. Key points include:

- **Loss of Equilibrium**: The traditional pressures that maintained equilibrium within the world-system have weakened. In a chaotic environment, small social movements can have outsized impacts, leading to significant political and social shifts, often referred to as the "butterfly effect."

- **Increased Uncertainty**: The chaotic nature of the current world-system creates uncertainty for individuals, communities, and nations. This uncertainty can lead to fear and anxiety, prompting reactions that may further destabilize the system.

## Choices Shaping the Future of Global Capitalism

### 1. **Progressive vs. Regressive Forces**

Wallerstein emphasizes that the future of global capitalism hinges on the choices made by various actors within the system. These choices can be categorized into two broad camps:

- **Progressive Forces**: These include movements advocating for social justice, environmental sustainability, and egalitarianism. Such forces seek to reshape the world-system in ways that prioritize human needs over profit, emphasizing cooperation and solidarity.

- **Regressive Forces**: In contrast, regressive forces aim to maintain or restore existing hierarchies and inequalities. This includes authoritarian regimes, nationalist movements, and corporate interests that resist change and seek to preserve the status quo.

### 2. **Potential for Systemic Change**

Wallerstein argues that the current crisis presents both dangers and opportunities. The choices made in response to the crisis can lead to:

- **Transformation of the World-System**: If progressive forces gain traction, it may lead to a reconfiguration of the world-system that prioritizes equity, sustainability, and democratic governance. This transformation could involve new economic models that challenge the dominance of capitalism.

- **Continuation of Inequality**: Conversely, if regressive forces prevail, the world may witness a consolidation of power among elites, leading to increased oppression and inequality. This scenario could result in heightened conflicts and social unrest as marginalized groups resist exploitation.

## Conclusion

Wallerstein’s analysis of the crisis of the modern world-system highlights the intricate interplay of structural factors, bifurcation, and chaos. The choices made by societies in response to these challenges will significantly shape the future of global capitalism. As the world navigates this crisis, the potential for both progressive transformation and regressive entrenchment remains, underscoring the critical importance of collective action and informed decision-making in determining the trajectory of the world-system.

Citations:

[1] https://www.journals.uchicago.edu/doi/abs/10.1086/226431

[2] https://jwsr.pitt.edu/ojs/jwsr/article/view/494

[3] https://longnow.org/ideas/understanding-the-modern-world-system-over-the-longue-duree/

[4] https://study.com/learn/lesson/world-systems-theory-wallerstein.html

[5] https://www.ucpress.edu/books/the-modern-world-system-i/paper

[6] https://jacobin.com/2023/12/immanuel-wallerstein-world-systems-theory-development-cycles-capitalism-crisis-history

[7] https://en.wikipedia.org/wiki/Immanuel_Wallerstein

The modern world-system as a capitalist world economy

 The modern world-system as a capitalist world economy

II. Key themes 

A. ‘The modern world-system as a capitalist world economy: Production, surplus value and

polarization’

• IW: Chapter 2 of World-Systems Analysis: An Introduction (WSA). Pp. 22-41

B. ‘The rise of the states-system: Sovereign nation-states, colonies and the interstate system’

• IW: Chapter 3 of WSA: Pp. 42-59

C. ‘The modern world-system in crisis: Bifurcation, chaos and choices’

• IW: Chapter 5 of WSA: Pp. 77-90

• Frank Elwell: ‘Wallerstein’s crisis of capitalism.’ P. 5

• Christopher Chase-Dunn. ‘Five linked crises in the contemporary world system.’

Journal of World-Systems Research. Vol 19, No. 2, 175-80

The **key themes** from these readings focus on understanding the structure of the modern capitalist world-system, the role of nation-states and colonies in its development, and the current crises and challenges facing the system. Below is a detailed exploration of each of these themes:

### A. **The Modern World-System as a Capitalist World Economy: Production, Surplus Value, and Polarization**

- *Immanuel Wallerstein: Chapter 2 of World-Systems Analysis: An Introduction (Pp. 22-41)*

This chapter provides a detailed overview of the capitalist world-economy, focusing on how **production** and the extraction of **surplus value** are organized across the world-system. Wallerstein builds on **Marxist economics** to explain how capitalism operates globally, but he expands the analysis to incorporate the **international division of labor** between core, semi-peripheral, and peripheral regions.

#### Key Points:

- **Capitalist production** in the world-system is organized to maximize the extraction of **surplus value**—the value produced by labor beyond what is needed to sustain workers. This surplus is primarily accumulated in the core, where advanced industries and high-profit enterprises are concentrated.

  

- **Polarization** is a central concept, referring to the increasing gap between the wealthy core nations and the impoverished periphery. As capitalism expands, this inequality becomes more entrenched, with core regions benefiting from the exploitation of labor and resources in the periphery.

- **Unequal exchange** is a mechanism through which core nations extract surplus value from the periphery. Peripheral regions are often forced to export raw materials and labor-intensive goods at low prices while importing high-value products from the core, perpetuating their dependency and underdevelopment.

Wallerstein highlights that the **global hierarchy** of nations is not just a reflection of economic productivity but of historical processes that allowed certain regions (mostly Europe) to dominate global trade, finance, and politics.

### B. **The Rise of the States-System: Sovereign Nation-States, Colonies, and the Interstate System**

- *Immanuel Wallerstein: Chapter 3 of World-Systems Analysis: An Introduction (Pp. 42-59)*

This chapter focuses on the **political dimension** of the world-system, especially the rise of **sovereign nation-states** and the development of the **interstate system**. Wallerstein argues that the modern world-system cannot be understood purely as an economic entity—it is also a political one, structured by the interaction of states.

#### Key Points:

- The **sovereign nation-state** emerged alongside the capitalist world-economy in the 16th century. The state became the primary political unit through which capitalism was organized and regulated.

  

- The interstate system, or the network of relationships between sovereign states, played a critical role in maintaining global capitalism. **Colonialism** was one of the key features of this system, where core nations established colonies in peripheral regions to secure resources and labor.

- Wallerstein emphasizes that while nation-states may appear to be independent political entities, they are deeply embedded in the **world-system**. Their sovereignty is often limited by the pressures of the global market and the power dynamics of the interstate system.

- The **balance of power** between states, especially the core nations, ensures that no single state can dominate the system entirely, although certain nations have held hegemonic positions (e.g., the Netherlands in the 17th century, Britain in the 19th century, and the United States in the 20th century).

This chapter also highlights how the **state** serves as an agent of capitalism, facilitating the conditions for capital accumulation, such as protecting private property, enforcing contracts, and regulating labor.

### C. **The Modern World-System in Crisis: Bifurcation, Chaos, and Choices**

- *Immanuel Wallerstein: Chapter 5 of World-Systems Analysis: An Introduction (Pp. 77-90)*

- *Frank Elwell: "Wallerstein’s Crisis of Capitalism"*

- *Christopher Chase-Dunn: "Five Linked Crises in the Contemporary World System"*

This theme addresses the **current crisis** in the capitalist world-system and the potential for its transformation. Wallerstein, Elwell, and Chase-Dunn argue that the world-system is facing multiple crises that are fundamentally destabilizing its structures.

#### Key Points from Wallerstein:

- **Bifurcation and Chaos**: Wallerstein argues that the modern world-system is approaching a point of **bifurcation**—a major transition where the system may either evolve into something new or collapse into chaos. He describes this as a period of systemic crisis, where the internal contradictions of capitalism (such as inequality, environmental degradation, and overaccumulation of capital) can no longer be managed effectively.

- **Choices**: As the system approaches this chaotic state, Wallerstein suggests that we are faced with important **choices** about the future of the world-system. He implies that this period of crisis offers opportunities for fundamental change, potentially leading to the creation of a more just and equitable global order, though he also warns that the system could descend into greater inequality and oppression.

#### Key Points from Elwell:

- **Crisis of Capitalism**: Elwell builds on Wallerstein’s analysis to argue that capitalism is in crisis due to its inability to resolve its inherent contradictions. For example, the drive for profit leads to environmental destruction and social inequality, which undermine the long-term sustainability of the system.

- Elwell points to the increasing polarization between rich and poor countries, environmental degradation, and political instability as evidence that the **world-system** is reaching its limits.

#### Key Points from Chase-Dunn:

- **Five Linked Crises**: Chase-Dunn identifies five interrelated crises facing the world-system today: 

  1. **Economic stagnation**: Global growth has slowed, leading to economic uncertainty and unemployment.

  2. **Ecological crisis**: Environmental degradation, including climate change, threatens the survival of the system.

  3. **Social inequality**: The gap between rich and poor, both within and between nations, continues to widen, leading to social unrest.

  4. **Geopolitical instability**: Rising tensions between major powers, such as the United States and China, pose risks to global peace and stability.

  5. **Legitimacy crisis**: There is a growing distrust of political institutions, both national and international, as people lose faith in the ability of governments and global organizations to solve pressing problems.

Chase-Dunn argues that these crises are interconnected, and together they represent a **systemic challenge** to the existing global order. Like Wallerstein, he suggests that the world is at a crossroads, where the current system may be replaced by something new—either more democratic and equitable or more authoritarian and exploitative.

### Conclusion

The key themes explored in these readings reveal the **multi-dimensional nature** of the modern world-system as theorized by Wallerstein. His analysis provides a comprehensive framework for understanding global capitalism, its historical development, and its current challenges. By focusing on the **economic, political, and systemic crises** facing the world today, these readings also highlight the urgency of addressing the **structural contradictions** of capitalism, which are pushing the world-system toward a critical juncture.

These themes are essential for understanding the **historical trajectory of global capitalism**, the role of nation-states and colonialism, and the future challenges that the world faces as the capitalist system approaches a point of crisis. Understanding these dynamics can provide valuable insights for analyzing contemporary issues, including those specific to regions like Nepal.