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.

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.

"They gave me food, what's wrong with you?"

Oh, he is happy! What is he missing? We are seeing so many beautiful photos on Facebook.

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