Can Nepal not make its own vaccine?

 Can Nepal not make its own vaccine?

At that time, the demand for the vaccine against Covid was very high, while India did not have enough vaccine for its own citizens.

It is said that although there was a need for vaccine production in Nepal, policymakers ignored it and a vaccine production company should be established.

The context is during the Covid-19 pandemic. Nepal was importing 2 million Covid-19 vaccines from India. After sending the first batch of 1 million, the second 1 million vials could not arrive. The import of the vaccine to Nepal was stopped due to a court order there.

The main reason for this is that there was not enough vaccine for their country. After this, Delta, which is considered the most deadly of the Covid variants, badly affected Nepal after India. If the second 1 million vaccines had arrived at that time, perhaps many deaths could have been saved.

Similarly, the recent resurgence of Japanese encephalitis has seen an increase in the number of infected deaths in the last few years. Nepal must rely on imports for this vaccine as well. Apart from these, vaccines are considered the surest way to prevent the outbreak of many other infectious diseases.

Past and present experiences of these studies also show that as we enter the 21st century, vaccines are the only solution for new (like Covid) and previously controlled and resurgent diseases (like Japanese encephalitis).

Although some medicines are currently being produced domestically, there is no vaccine production. It seems that policymakers have almost ignored the need for vaccine production.

Is it that Nepal itself cannot produce a vaccine for use in humans? Or has the health sector not yet realized the need for it, been unable to do it, or is not interested?

There are not enough health centers or hospitals in Nepal. Moreover, health centers equipped with the necessary physical infrastructure and resources are even more limited. In such a situation, if any infection spreads or takes the form of an epidemic, there will be a shortage of hospital beds, resources, and health workers.

This increases the risk of patient death. When I was working at Teku Hospital two and a half decades ago, dozens of patients with diarrhea and cholera were admitted every hour during the rainy season.

Similarly, Japanese encephalitis has a high mortality rate, so dozens of people were admitted every week during the mosquito season. Most of those admitted had to die because they arrived at the hospital late.

Generally, the impact of Japanese encephalitis is greater in the Terai. Due to the lack of sufficient hospital beds and manpower there, they were forced to come to Kathmandu.

But later, after the vaccine against Japanese encephalitis was used in Nepal, the mortality rate decreased sharply. At that time, support for the vaccine came from neighboring China. The support itself is not bad, but the question is for how long?

Nepal had expected foreign support for the vaccine during the Covid epidemic. At Nepal's request, India agreed to provide the Indian-made vaccine called Covoshield. However, when the second batch was to be sent, the vaccine could not reach Nepal because the court there had ordered to give priority to its citizens first and not to export it.

This decision is not surprising. Because at that time, the demand for the vaccine against Covid was very high, while India did not have enough vaccine for its own citizens. At that time, 'vaccine diplomacy' was also very popular.

There was a competition among developed countries to develop the vaccine against Covid the fastest. At that time, Covid was present as a great enemy against humanity, and the world was working day and night to develop a vaccine to protect itself from it.

After the Covid vaccine was stopped from India, another neighboring country, China, received the Covid vaccine as assistance. This also shows how important vaccines are during major epidemics.

The role played by the Serum Institute of India during the Covid pandemic is also an example of how much relief can be provided in an epidemic when a vaccine manufacturing company is available.

Although Covid itself is a new disease, scientists were able to develop a vaccine faster than expected due to their hard work day and night. Naturally, the possibility of developing a new vaccine is also greater in developed countries due to the presence of high-quality research laboratories and excellent scientists.

During an epidemic of a highly infectious and deadly disease that terrifies the world, only a limited number of vaccines are produced by limited production organizations in limited countries. In this case, the possibility of sending it to other countries or the rest of the world is also reduced.

But if the vaccine formula or the 'components' used in the vaccine can be obtained and a vaccine manufacturing company is available, India can be taken as an example that vaccine production can be continued. If there was a vaccine manufacturing company in Nepal during the Covid pandemic, human losses could have been prevented to a large extent. It was a situation where we had to sit and stare at foreigners.

It has only been a few years since the Covid pandemic ended. Those moments are still very tragic, especially for those who have lost their relatives to Covid or who have managed to survive severe Covid.

But it has also taught us some lessons. 

Use of AI in healthcare: How useful, how dangerous?

 Use of AI in healthcare: How useful, how dangerous?

Doctors use AI in conjunction with their knowledge, experience, and patient conditions, and the risk increases when patients base their decisions on that.

Use of AI in healthcare: How useful, how dangerous?

AI is not a replacement for doctors, but a tool to expand their capabilities, and its responsible use in the healthcare sector is necessary.

Some time ago, during the confusing time when the Medical Education Commission announced the PG results, I created a ‘seat predictor’ tool using available data and AI.

Recently, when the actual results of the government seat came out, this tool of mine seemed to be ‘conservatively’ very safe. The tool had ‘underestimated’ the actual rank somewhat, so that doctors did not have false expectations and could make safe decisions.

I have also included its detailed description and how to use it in the description of the MD/MS video of my Bimarsha Acharya YouTube channel. This small experiment made me realize one big thing, that AI is not an ‘enemy’ for the Nepali healthcare sector, but rather a powerful ‘co-pilot’ for those who know how to use it correctly.

In this context, I have been conducting clinical research training sessions, in which I have also been regularly covering the use of AI, its ethical aspects and its responsible integration into daily medical practice.

In the process, I have trained more than 700 doctors and medical students in Nepal. This experience has further highlighted the need to use AI not just as a tool, but also in a safe and responsible way with proper guidance.

AI has become like a companion to me while seeing patients daily in the hospital. I use it regularly to remember medication doses or precautions, compare different treatment methods, align my decisions with international guidelines and understand the results of the latest research and trials. In complex cases, comparing your initial clinical thinking with evidence-based information makes decisions clearer and more confident. In this way, AI is a powerful tool to augment the capabilities of doctors, not replace them.

AI for doctors: Which is more useful?

The various AI tools in use today, such as Grok, Gemnai, ChatGPT, Perplexity, and OpenEvidence, have their own roles. However, their use varies depending on the context. ChatGPT, Gemnai, or Grok can be useful for understanding general information, clarifying concepts, and facilitating quick clarification. Perplexity presents information with sources, making it easier to search and compare. However, evidence-based, contextual, and up-to-date information is extremely important for clinical decisions.

OpenEvidence is considered particularly useful in this regard. This platform focuses on providing evidence-based information based on international journals, clinical trials, and established guidelines. It shows doctors not just the answer, but also the scientific basis for it, which makes clinical decisions safe, reliable, and accountable.

Therefore, while various AI tools can be used for general understanding, OpenEvidence is considered one of the most suitable options in the current situation as an evidence-based platform for clinical practice and decision-making.

The danger of relying on AI's advice

Nowadays, many patients have started using AI like doctors. There is an increasing trend of seeking medical advice directly after experiencing common symptoms, which can be a serious danger.

For example, if someone has a stomach ache, AI can recommend a medicine to relieve common pain. But a serious problem like appendicitis may be hidden within that symptom. Even if the medicine provides relief for some time, the disease may become more complicated.

This is where the difference between AI used by doctors and patients becomes clear. Doctors use AI by combining their knowledge, experience, and patient's condition, while patients directly base their decisions on it, which increases the risk. Self-medication can sometimes even put lives at risk.

AI in Nepal's health sector

In a country with geographical challenges like Nepal, AI can bring about a major change in healthcare. In remote areas where there is a lack of specialist doctors, AI can help in decision-making at the primary level. Its use in X-rays, cardiac tests or emergency assessment can guide timely treatment.

Combining AI with telemedicine can reduce the distance between villages and cities. Patients can get specialist services nearby, while doctors can also provide better service with limited resources.

AI can also play a big role in the research sector. It can help increase participation in complex studies, data analysis and international publications. This has the potential to make Nepal’s health system knowledge-based and technology-friendly.

Our responsibility now

The future competition will not be between doctors and AI, but between doctors who know how to use AI and those who do not. A system that cannot adapt with time will fall behind.

Therefore, it is necessary for both the government and the private sector to work together to formulate a clear policy to integrate AI into the health system. It is imperative to provide training, resources and incentives to doctors.

If we fail to embrace this technology today, we will be unable to compete globally tomorrow. But if we move in the right direction, Nepali health care The sector can establish its identity on an international level.

The question now is clear: will we lead the change or lag behind it?

Food with ‘trans fat’ in abundance in the market, heart and brain are paying the penalty

 Food with ‘trans fat’ in abundance in the market, heart and brain are paying the penalty

Doctors say that the trans fat (very bad fat) hidden in bakery products, noodles, puffs and French fries, which are abundant in the market, is causing serious damage to the heart and nervous system at a young age.

Food with ‘trans fat’ in abundance in the market, heart and brain are paying the penalty

February 15, Kathmandu. ‘What is the worst fat found in?’ This is a question that senior cardiologist Dr. Ommurthy Anil often asks his patients who come to him for check-ups.

Most of those who come to check answer, ‘Red meat, ghee, milk, butter.’

Some add, ‘The fat in oil can be bad.’

He explains, ‘The worst fat in the world is found in foods containing trans fats.’

According to Dr. Anil, eating foods containing trans fats for a long time is fatal to the heart, blood vessels, kidneys, and brain. But we do not find it unusual to eat biscuits with tea in the morning, puffed noodles in the afternoon, and french fries with friends in the evening.

But hidden within this easy and tasty option is ‘trans fat’, i.e. very bad fat (unhealthy fat).

According to the doctor, foods containing trans fats are causing chronic diseases in the body. This is not a ‘normal fat’, but a silent poison that opens the door to chronic diseases.

A monitoring conducted by the Department of Food Technology and Quality Control last November showed this alarming situation. During the monitoring, the ‘croissant’ of Nanglo Bakery and the puff produced by Khajuri Nepal Pvt. Ltd. were found to be harmful to health. After ‘trans fat’ was found to be more than the limit set by the government, the Food Department completely banned the sale and distribution and destroyed them.

Trans fat is considered one of the most harmful fats from a health perspective. According to experts, the reason for the increase in trans fat is unhealthy diet and urban lifestyle. Due to trans fat, heart attacks are increasing at a young age.

‘The trend of heart attacks that we are seeing in patients is directly related to diet,’ says senior cardiologist Dr. Prakash Raj Regmi, ‘Trans fat is an important reason for that.’

What is trans fat?

Trans fat is found from two sources, natural and artificial. It is found in the fat in red meat of animals such as cows, buffaloes, goats, and in dishes made from milk and yogurt. According to doctors, trans fats obtained from natural sources when consumed in small amounts do not have much negative impact on health. However, consuming excessive amounts can have negative impacts.

Industrial trans fats produced in the food industry are extremely harmful to health. They are obtained from artificial sources.

Industrial trans fats are mainly produced by converting vegetable oils into ghee through hydrogenation. In this process, it is produced by heating vegetable oils at high temperatures and adding hydrogen molecules. In this process, the liquid oil is converted into a solid state, i.e. vegetable ghee.

The vegetable ghee produced from this process is used to make various processed foods including bakery products, biscuits, cookies, ready-made noodles, bhujiya, dal moth, potato chips, etc.

Trans fats, which are produced by heating cheap oils in the industry and adding hydrogen, increase the amount of fat. In addition, foods cooked in such very bad fats become tasty and can be stored for many days.

Foods cooked in such oil are mostly used for packaged foods. Foods that look attractive from the outside are very harmful to health. Even if vegetable oil is heated many times, the amount of trans fat increases. Pakodas, samosas, potatoes, and chicken cooked in such oil are delicious to eat.

Another senior cardiologist, Dr. Premraj Vaidya, says, “It is considered good to eat one teaspoon of ghee a day. However, trans fat-rich foods are very dangerous.”

Senior cardiologist, Dr. Ommurthy Anil, says that heart attacks are increasing in people in their 30s and 40s. The main reason for this is a bad lifestyle and eating trans fat-rich foods. He says, “Trans fat-rich foods cause blockage in the blood vessels of a healthy person and lead to heart attacks. It affects everyone from children to senior citizens, pregnant women.

Transfats that poison the blood vessels

Ultra-bad fats (transfats) increase the amount of bad cholesterol in the blood and reduce the amount of good cholesterol. Similarly, they negatively affect the inner part of the arteries and increase the narrowing of the arteries.

'Not only does it narrow the blood vessels, it also causes inflammation (a condition like a swollen wound) in the inner part,' says Dr. Regmi, 'When cholesterol accumulates, blood blockage occurs. Which can lead to a heart attack or stroke.' Not only this, transfats increase the risk of type-2 diabetes.

Due to processed foods prepared for commercial purposes, fat accumulation around the stomach, weight gain and metabolic syndrome are increasing. There is an increasing addiction to junk food among children these days. Obesity, high blood pressure and pre-diabetes are starting to appear at school age, says Dr. Vaidya.

Experts say that excessive trans fat intake by pregnant women can affect fetal development. “There is a possibility that the effects of trans fat can reach the newborn through breastfeeding,” says Dr. Vaidya, “and the risk can last for a generation.” It is not limited. It has a bad effect on the health of the unborn child.

The fried and packaged foods in the market are rich in trans fats. Doctors say that excessive consumption of which leads to fatal diseases at an early age and many people die.

Dr. Regmi claimed that a young woman died after eating Bhujia after watching an advertisement. Recalling an incident a few years ago, he said, "Amitabh Bachchan had promoted Bikaji Bhujia in a very attractive way on Sony TV. A young woman is an Amitabh fan. After consuming Bhujia for a long time, she had reached a state of heart failure."

According to Dr. Regmi, continuous consumption of Bhujia weakened the heart muscle, increased blood pressure and cholesterol. Due to which the heart could not pump properly.

Heart disease is becoming the leading cause of death in the world. The main risk factors are unhealthy diet, physical inactivity, tobacco and alcohol consumption. A study by the World Health Organization has shown that high intake of trans fats increases the risk of death by 34 percent.

Effects of diet on the brain

Experts say that brain diseases have started increasing among Nepali youth due to changing diets along with modern lifestyle. According to neurologist Dr. Sushil Mohan Bhattarai, serious neurological diseases including stroke, Alzheimer's, Parkinson's and other diseases have started appearing even in young people in their 30s due to trans fat-rich foods and unhealthy lifestyle.

Dr. Bhattarai, who works at a civil hospital, says, 'Earlier, paralysis and brain stroke were considered diseases that occurred after reaching the age of 70. But now it is seen in young people in their 30s.'

According to Dr. Bhattarai, after trans fats enter the body, they go directly to the cell membrane. Cell membranes are very important for maintaining the structure of the body and for communicating from one cell to another.

In order for the brain to implement what the hand thinks, there must be continuous communication between the nerves. But when trans fats start to mix with cell membranes, communication is disrupted and brain functions gradually deteriorate.

According to Dr. Bhattarai, trans fats reduce the amount of serotonin, the ‘happy chemical’ produced in the brain. Due to this, people in the modern era have started to tend to be more sad, negative and depressed. Not only that, but the ability to learn new things and memory decline.

‘Many college-going students come to the clinic with problems with concentration,’ says Dr. Bhattarai.

Similarly, according to Dr. Rajiv Jha, senior neurosurgeon at Bir Hospital, when the amount of fat in the body increases, the blood vessels that carry blood begin to clot. When fat accumulates in the veins, the blood flow is blocked, due to which the amount of oxygen that should reach the brain decreases.

According to Dr. Jha, if blood circulation is blocked in any part of the brain, the risk of stroke is high. ‘When too much fat accumulates, the vessels become narrow or stiff. That leads to brain hemorrhage or stroke,’ says Dr. Jha says.

According to Dr. Bhattarai, smoking is the number one risk factor for stroke in young people. In second place is unhealthy diet and foods high in trans fats.

‘Brain-related diseases are more common in urban youth and they smoke and eat foods high in trans fats from a young age,’ said Dr. Bhattarai.

Regarding the direct link between trans fat intake and stroke, Dr. Jha says, ‘Obesity and high blood pressure are the main problems in many patients who come to the hospital. Patients who have strokes at a young age often have an unhealthy lifestyle, excessive consumption of junk food, and lack of physical activity.’

Trans fat-rich foods in abundance in the market

Data from the Food Department shows that some of the foods produced in the market are very harmful to health. The department had monitored 67 prepared food items and the raw materials used in them in the last one year.

Of these, 16 percent, or 11, were found to contain trans fats exceeding the standard. In which the total fat content of the food item was more than two percent.

Manita Vaidya, Director General of the department, says, ‘During the monitoring, up to 15.5 percent trans fat was found. Which is very harmful to health.’

Eight puffs were tested during the monitoring. Four puffs had trans fat levels exceeding the standard. Four of the six vegetable ghees tested had high trans fat levels. Vaidya claimed that the products found to have trans fat levels exceeding the standard were returned to the market.

Dr. Anil says, ‘Finding 15.5 percent trans fat in food in the market is a poison for health. Eating such foods directly blocks the blood vessels of the heart and causes heart attacks.’

In the race to increase profits, hotels, restaurants and roadside shops are repeatedly using oil to make fast food such as pakodas, samosas, puris, chicken fries, sausages, etc., which produces trans fat. Deep frying destroys all the nutrients in the food and adds harmful fats to it.

“Most of the sweet shops in the market are using vegetable ghee and oil containing trans fats to make sweets. These dishes, which look smooth, shiny and durable, are actually poisonous to the heart and blood vessels,” said Dr. Vaidya.

Dr. Regmi adds, “Repeatedly heating oil is harmful. It is used Not only is it linked to disease, but it is also linked to the risk of cancer. It is advisable to avoid using vegetable ghee as much as possible.

Main causes of death Heart and stroke

The mortality rate from non-communicable diseases is increasing in Nepal. According to statistics, a large part of the total deaths are due to respiratory diseases, heart diseases, and strokes.

According to experts, unhealthy diet and increased consumption of processed foods are one of the main reasons for this.

According to the 2023 data of 'Nepal Burden of Disease', respiratory diseases are the number one cause of death in Nepal, heart disease is the second, and stroke is the third.

Our diet, behavior, and lifestyle have emerged as the main root causes of the spread of non-communicable diseases. Experts say that non-communicable diseases are increasing as a 'dormant' epidemic in developing countries in recent times. The mortality rate is also increasing in proportion to that. According to the latest statistics, 71 percent of deaths in Nepal are due to non-communicable diseases.

Public health expert Dr. Rita Thapa says that the increase in the incidence of non-communicable diseases has become a matter of concern in recent years. According to Thapa, non-communicable diseases are increasing due to luxurious lifestyle and carelessness in eating, high blood pressure, and diabetes.

According to Dr. Thapa, the reasons are in our hands. There are things related to our lifestyle. Our behavior, junk food, lifestyle, use of tobacco products at a young age, and lack of exercise are the result.

‘Children at a young age consume tobacco products, junk food, and alcohol. Parents also give junk food to young children for lunch,’ Dr. Thapa clarified, saying, ‘The burden of non-communicable diseases is increasing due to lack of physical exertion and excessive stress.’

Is it right to call food ‘junk’? – Online Khabar

State silence, consumer health at risk

With the beginning of the 2000s, health agencies in various countries of the world began to implement regulations to control trans fats used in food. Denmark introduced stricter standards in 2003, while Switzerland banned trans fats in 2008.

Within the United States, New York banned trans fats in 2006 and California in 2008. Canada followed suit in 2008. These decisions led to very low trans fat levels in many foods and complete bans on many products.

Then, it was announced that heart attacks, high blood pressure, obesity, and diabetes in young people had decreased. Denmark announced that it had reduced the incidence of diseases in young people by 50 percent. But at the time, many countries found it difficult to believe what Denmark had announced.

The World Health Organization investigated the issue and declared Denmark a “trans fat-free” country.

In the United States and Canada, the amount of trans fat must be stated on the label of packaged foods sold.

The World Health Organization had launched a campaign with the goal of eliminating industrial trans fats from all countries of the world by 2023.

On 24 Magh 2078, the government passed the Multi-Sectoral Action Plan (2021-2025) for the Prevention and Control of Non-Communicable Diseases. Under this plan, there is a policy to keep trans fats below 2 percent of the total fat content of food.

The Department of Food Technology and Quality Control has implemented the standards since 25 Shrawan 2081 after the standards were approved by the Food Standards Committee. However, it has not been adequately monitored.

Consumer rights activists say that the state machinery is still not serious about trans fat-containing foods being sold openly in the market. Consumer rights activist Madhav Timalsina says that the problem will worsen unless the state comes up with a clear and strict policy. According to him, the problem extends from production to regulation.

‘First of all, there should be stricter restrictions on the import of raw materials. Trans fat testing should be made mandatory at customs and quarantine checkpoints. But it does not seem to be happening effectively,' said Timalsina.

Stating that merely setting standards is not enough, he says that strictness is needed in implementation.

'The policy is limited to paper. There is no will to implement it. The terror of trans fats in the market will not stop until a comprehensive awareness campaign is launched among the government, industrialists, importers and consumers,' said Timalsina.

Department spokesperson Bal Kumari Sharma claims that food products have been monitored regularly lately.

'Last November, we recalled the puff produced by Khajuri from the market after it was found to be substandard,' says Sharma. 'We found that it was safe to eat in subsequent monitoring.'

Lax regulation

The Food Hygiene and Quality Act, 2081, clearly provides for mandatory labeling of food and beverages. It is the responsibility of producers and sellers to provide consumers with accurate and clear information about the nature, quality, quantity, expiration date and potential risks of the product.

Similarly, the Consumer Protection Act, 2075 BS, has ensured the right of consumers to be informed about price, quality, results and purity, and has provided a legal basis to protect them from the sale and distribution of products that are harmful to human health.

But the law seems to be limited to paper. Unlabeled food products are found being sold openly in the market. Some products do not even mention the details of ingredients, production and expiry date. Due to this, consumers are directly at risk due to weak state monitoring.

The Advertisement (Regulation) Act, 2076 BS and the Consumer Protection Act, 2075 BS clearly prohibit misleading and false advertisements related to health and nutrition. Who is it? These legal provisions could have been enough to stop the aggressive marketing of unhealthy foods, sugary drinks, and industrial trans-fat products targeting children. But implementation is weak. The Food Technology and Quality Control Department and provincial-level laboratories have cited a lack of manpower as the reason for their inability to conduct effective monitoring.

The argument of limited technical capacity and weak laboratory infrastructure at the food department, provincial laboratories, and local levels has been repeated. The growing market for highly processed foods, the tendency to not follow labeling, and a weak monitoring system have made the situation more complicated. The regulatory mechanism is in disarray, increasing the health risks to consumers.

Health experts say that mandatory mention of trans-fat content on food labels, clear visual warnings, and targeted implementation strategies are necessary to control industrial trans-fat. They suggest that inspection and laboratory capacity should be strengthened by implementing tax policies and strict labeling at the provincial level.

Consumer rights activists in Timalsina say that there should be no delay in making market monitoring effective and banning the sale and promotion of high-trans-fat products in schools and communities.

Preparations to bring a multi-sectoral action plan

The government has said that preparations are underway to bring a new multi-sectoral action plan for the prevention and control of non-communicable diseases. According to Health Secretary at the Ministry of Health, Dr. Bikas Devkota, the action plan implemented from 2021 to 2025 has expired. Now, the process of formulating a new strategy for 2026 to 2030 has been initiated.

Stating that the main causes of non-communicable diseases lie outside the health sector, Dr. Devkota says that multi-sectoral cooperation is indispensable.

‘About 80 percent of the causes of non-communicable diseases are related to factors outside the health sector,’ says Dr. Devkota. ‘They are linked to other ministries and agencies on issues such as environmental pollution, chemical substances, waste management, and pesticides.’

According to him, although the previous action plan tried to include a multi-sectoral concept, sufficient success was not achieved in practical implementation.

‘The health sector alone cannot be held responsible; other sectors should also reduce the causes that negatively affect health through their policies, investments, and practices,’ he emphasized. He also said that a strategy will be prepared so that various ministries and stakeholders can clearly contribute through policies, resources and programs.

‘A plan is being prepared to incorporate the lessons learned from the previous period into a new strategy and address the weaknesses and challenges seen in implementation,’ says Dr. Devkota, adding, ‘A more effective and clear multi-sectoral approach is now needed to control non-communicable diseases.’

‘A person smiling on the outside may be in pain on the inside’

 ‘A person smiling on the outside may be in pain on the inside’

A hectic lifestyle, economic insecurity, rising unemployment, social expectations and fear of the future, as well as the influence of excessive social media, are further increasing mental pressure.

‘A person smiling on the outside may be in pain on the inside’

The \'Let's talk about our hearts\' campaign launched by the Nepal government is a national initiative to make mental health a social priority and break the silence.

The campaign aims to encourage adolescents, youth and the general public to seek awareness, empathy and support about mental health.

We live in a society bound by collective thinking and culture. It is our habit to talk to each other, gather, and exchange experiences. Whether at home, in a tea shop, in the office or on social media - there is no shortage of words. But one important thing is often lost in all this dialogue - the heart.

From the outside, many people look normal and happy. They have a smile on their face, and their behavior is easy. But that smile is not always genuine. Some people put on a show of their pain so that no one can see it. On the inside, they may be tired, scared, confused, and depressed. These mental struggles that are not visible on the outside are not easily understood, and are often ignored.

The Importance of the ‘Let’s Talk About It’ Campaign

The ‘Let’s Talk About It’ campaign launched by the Government of Nepal is not just an information program, it is a national initiative to make mental health a social priority, break the silence, give courage to speak up, and encourage people to seek help.

The campaign focuses on promoting awareness, empathy, compassion, and dialogue about mental health, especially among adolescents, youth, and the general public. It aims to remove discrimination and misconceptions, develop stress management and various skills, and encourage people to seek professional help when needed. In addition, the campaign also covers social safety and support services such as digital wellness, family and community support, and the 1166 helpline.

The Pain Behind the Smile

In daily life, many people are fulfilling their responsibilities with a smile, but on the inside, they are suffering. They want to express their feelings, but they are afraid - 'If I tell my pain, will society think I am weak, will they criticize me, will they blame me?' Worries like these prevent them from speaking up.

Because of these thoughts and fears, the pain of the mind remains hidden inside. Over time, these problems become deeper and begin to affect the person's performance, relationships, and enthusiasm for life. Eventually, it may become difficult to even do normal tasks.

How do mental problems look?

Many in our society still associate mental problems with 'madness'. Most people easily assume that 'he is depressed' or 'he is crazy' when they see symptoms such as sadness, anxiety, fatigue, or inability to concentrate. But the reality is different from such simple perceptions.

Mental problems come in many forms and can manifest differently in each person. While some may suffer from constant sadness, lack of confidence, or insomnia, others may experience excessive anger, anxiety, social distancing, or changes in behavior.

Some people may experience difficulty expressing their feelings, losing focus at work or school, or having difficulty fulfilling daily responsibilities. Similarly, there may be a more severe mental health problem that can have a long-term impact.

Importantly, not all mental health problems are always obvious from the outside. Some people hide their suffering and act as if they are normal, which can mislead society. Therefore, a sensitive approach is needed to understand each person’s experiences, circumstances, and inner feelings, rather than judging mental health problems solely based on external behavior.

Why is a mental health campaign necessary now?

Mental health problems are not new in Nepal. But the environment for talking about them openly was not created for a long time. Many still associate mental health with ‘weakness’ or ‘madness’. These are challenging times – a hectic lifestyle, economic insecurity, rising unemployment, social expectations and fear of the future, as well as the influence of excessive social media, are increasing mental pressure.

These are the reasons why people are stressed inside. In such situations, the ‘Speak Your Mind’ campaign works to break the silence, encourage people to speak up, and create an environment that inspires them to seek help.

Listening: Our Shared Responsibility

Many people ask – what can we do if we are not the treating doctors?’ The answer is simple – we can listen. This means listening attentively, not interrupting, and not imposing immediate solutions. Without denying feelings, sometimes a simple statement like ‘I understand you’ can be a great support.

When is it necessary to seek help from a specialist?

Not all problems can be solved by yourself or with the help of a friend. If the problem persists for a long time, begins to affect work, studies, or relationships, persistent negative thinking increases, or thoughts of self-harm/suicide begin to arise, it is essential to seek help immediately.

In this case, consulting a doctor, psychologist, psychiatrist, or other mental health professional can be a life-saving step. Seeking help in a timely manner can help Health problems are easier to manage and have a positive impact on a person's life, performance and overall health.

Only when we speak our minds, understand others and show empathy, can we build a healthy, cooperative society. The 'Speak Your Mind' campaign gives us this message - speaking up is not weakness, it is courage. Sometimes, a little listening and a little support can save a life.

Lungs: What they are, how they work?

 Lungs: What they are, how they work?

Damage to the lungs from minor infections or injuries can heal on their own, but damage from smoking, pollution, or chronic diseases can be permanent.

The lungs are the main part of our respiratory system and work to deliver oxygen to the body and remove carbon dioxide.

How many times do you breathe in a minute? In seconds? Have you ever counted? How long can you live without taking a breath? Have you ever wondered about this?

Because breathing in and out is an automatic process, for which you do not have to make any extra effort. But, what happens if that breath suddenly stops? You certainly have the answer.

Not only is it essential for life, but the lungs play a major role in taking in and releasing oxygen, which is needed every moment.

The lungs, which are soft, sponge-like structures inside the chest, supply the body with oxygen and energy and remove toxic carbon dioxide.

What role do the lungs play in the continuous process from taking in oxygen to taking out carbon dioxide? Why are two lungs necessary? How much damage does smoking cause?

What is the function of the lungs and what is their structure?

The lungs are the main organs of our respiratory system. They are made of soft, flexible tissue like a sponge and are located inside the chest around the heart. The lungs have a thin membrane on the outside that protects them. They are divided into two parts: the right lung has three parts: ‘upper, middle and lower’. The left lung has two parts: ‘upper and lower’. The left lung is slightly smaller because the heart occupies more space on the left.

The respiratory system begins with the nose or mouth. Air enters the trachea through the throat. It is then divided into two parts. The air we inhale enters the right and left lungs separately. After reaching the lungs, the bronchi divide 23 times like the branches of a tree, reaching the smallest tubes and ending at the ‘alveoli’ (air sacs).

The alveoli are thin membranous tissues like grape clusters, around which the blood vessels coming from the heart are spread like a spider web. An adult has 300 million to 600 million alveoli.

If the lungs are fully expanded, their surface area is 70-100 square meters, the size of a tennis court. The lung weighs 1 to 1.2 kilograms. The right one is slightly larger and heavier. The lung is the only organ in the body that can float in water, because it is always full of air. Even after breathing out completely, about 1 liter of air remains in it.

What is its main function?

The main function of the lungs is to supply oxygen to the body and remove carbon dioxide, which is called gas exchange. This is possible due to the thin membrane between the alveoli and the blood vessels.

Oxygen is absorbed from the air coming from outside and enters the circulatory system and reaches various cells of the body to provide energy. Similarly, carbon dioxide, a toxic gas produced by the body's organs, enters the alveoli through the blood vessels and is released when we exhale. This process continues continuously. The lungs also filter the air, which protects the body from infection.

It produces phlegm, which traps dust, germs, and pollutants and expels them when we cough them up. We breathe 8,000 to 9,000 liters of air every day, but the body uses only 5 percent of the oxygen from this air. The lungs are closely connected to the heart, so heart problems can also affect the lungs.

Why do humans have two lungs? What happens if one lung fails?

The main reason for having two lungs is for the body’s balance and safety. Both lungs work separately but support each other. If one lung develops a problem, such as cancer or infection, the other one takes over, which can help save lives. This makes it easier for the heart and other organs to function together.

Even if one lung is completely removed, a person can still survive, but not at full capacity. The failed lung can cause problems such as infection, blistering, or bleeding, and the infection can spread to the other lung because there is no barrier between the two.

Pollution or other external factors affect both equally, but some diseases can affect only one side. If a failed lung causes a lot of problems, it may need to be surgically removed.

How do the lungs take in and expel air?

The process of taking in air is called respiration, which consists of two stages – ‘inhalation’, which is the process of drawing air in, and ‘exhalation’, which is the process of expelling air out. This process is controlled by the brain and occurs 12-20 times per minute.

During inhalation, air from the nose or mouth passes through the throat, trachea, bronchi, and small tubes in the lungs, and then reaches the alveoli. The diaphragm muscle moves down, increasing the space in the chest, which draws air in. About half a liter of air is taken in with each breath.

During exhalation, the diaphragm moves up, the chest narrows, and air is expelled from the lungs. This process is also called ventilation. It is affected in chronic lung diseases, which are called respiratory failure. Sudden problems such as food getting stuck in the airway or tumors can also affect it.

Is there a chance of recovery if the lungs are damaged? How does smoking affect this?

The likelihood of lung damage depends on the type and extent of damage. The lungs have some ability to regenerate. They can heal themselves from minor infections or injuries, such as damage from the flu or pneumonia, which can be treated and cured with time and rest. However, serious damage caused by smoking, pollution, or chronic diseases such as COPD, fibrosis, or cancer can be permanent and may not fully recover. In such cases, medical treatment, medication, or surgery may be necessary.

Smoking is harmful to the lungs. It damages the fine hairs and membranes of the airways, which makes it easier for dust, smoke, or viruses to enter the lungs. This increases the risk of pneumonia or other infections. Smokers' lungs become black/brown, inflamed, and damaged. However, quitting smoking has a positive effect on the lungs. The lungs have various defense mechanisms, such as nasal hairs, which are damaged by smoking but largely repaired after quitting.

Although not completely restored, the risk of infection is reduced and health improves. Quitting smoking is beneficial at any age, even up to 90 years. A healthy lifestyle, exercise, and avoiding pollution increase the chances of recovery, but this depends on individual health. If there is a problem, it is best to consult a doctor.

What are the main problems that occur in the lungs? And how to maintain lung health?

Immediate problems in the lungs such as colds, coughs, nasal congestion, sore throat, fever, chest pain, and problems with the airways that cause coughing or wheezing. In the long term, pneumonia, lung infections, asthma, pulmonary fibrosis, and lung cancer are the main ones. Lung infections, asthma, and cancer are more common in Nepal. As diseases like asthma increase, lung capacity decreases, which affects daily life.

Lung health depends on daily air quality, diet and lifestyle. Healthy lungs are pink in color. To keep them healthy, you should quit smoking completely, exercise regularly, which increases lung capacity.

Wear a mask to avoid pollution, breathe clean air, eat a balanced diet and drink enough water. If you have difficulty breathing, cough or chest pain, you should immediately get checked by a doctor. Since the lungs are connected to the heart and other organs, it is necessary to pay attention to overall health.

Prashant Tamang's death due to 'cardiac arrest', what is this problem?

Prashant Tamang's death due to 'cardiac arrest', what is this problem?

In our society, cardiac arrest and heart attack are considered as one problem. But from a medical point of view, these two are completely different problems.

Singer and actor Prashant Tamang passed away at the age of 42 due to cardiac arrest at his residence in Delhi.

Cardiac arrest is a sudden cardiac arrest that can lead to death within 3 to 5 minutes.

The number of cardiac arrests among young people in Nepal is increasing and modern lifestyle, stress, and lack of sleep are the main reasons. 

Kathmandu. There was once a very popular name in the music world - Prashant Tamang.

Tamang, a Nepalese resident of Darjeeling, is the winner of Indian Idol Season 3. In 2007, his voice and personality won the hearts of Nepali and Indian audiences.

In recent years, he seemed to be more busy with films than singing. And recently he made his debut in Bollywood. Along with singing and acting, his simple lifestyle made him an inspiration to many youngsters. But that inspiring character suddenly left this world at the age of 42. The reason was, 'cardiac arrest'.

In the last few years, not only in Nepal, but all over the world, news such as 'He fell and died while walking', 'He died while sleeping', 'Young people who were going to the gym suddenly fainted and could not survive' are increasing rapidly.

In the last few years, not only in Nepal, but all over the world, there are many news such as 'he died while walking', 'he died while sleeping', 'the young man who was exercising suddenly fainted, he could not escape', he fell while talking'.

Sudden death like this is often thought of as a heart attack, but medical science has shown that the reality is different. Doctors say that the real reason for most of these incidents is 'cardiac arrest' i.e. sudden heart failure.

What is cardiac arrest?

Cardiac arrest is when the heart suddenly stops working. Senior Consultant Cardiologist Dr. According to Ranjit Kumar Sharma, the word cardiac refers to the heart and arrest means stopping or stopping. When the electrical system of the heart breaks down, the heart beats irregularly and the heart cannot pump blood, the condition is called cardiac arrest. Dr. Sharma is currently the head of cardiology department at Medicity Hospital.

How can it lead to death? In response, Dr. Sharma says, 'Heart is the most important pump of our body. It continuously carries blood with oxygen to all parts of the body. When a cardiac arrest occurs, the heart suddenly stops working. Its effects start to appear in the brain within a few seconds. The person suddenly faints, breathing stops and the supply of oxygen to the body stops. If the heart does not restart within 3 to 5 minutes, the brain is permanently damaged and death occurs.

Why does cardiac arrest happen?

Dr. According to Sharma, in most cases, heart attacks occur first. A heart attack damages the heart muscle, due to which the electrical system of the heart breaks down, leading to cardiac arrest. During a heart attack, a sudden blockage (clot) forms in the artery that supplies blood to the heart (coronary artery) or the artery is completely closed. This causes the electrical system (rhythm) of the heart to deteriorate due to insufficient blood and oxygen supply to the heart muscle.

After the rhythm is disturbed, the normal movement of the heart is disturbed, leading to dangerous conditions such as ventricular fibrillation or ventricular tachycardia. In this condition, the heart cannot pump blood effectively, the heart only 'vibrates', not pumping. Cardiac arrest in this way Dr. Sharma says.

Also read this

Singer Prashant Tamang passed away

Therefore, if a heart attack is left untreated, it can turn into a cardiac arrest and cause death, he says.

He says that heart rhythm disturbance is another reason for cardiac arrest. "A heart attack, electrolyte imbalance, stress, medication, or congenital causes can cause the heart to beat very fast or irregularly," Dr. Sharma says, 'When the lower part of the heart starts beating very fast or irregularly, the heart cannot pump blood. It can knock down a person in a few seconds.

Cardiomyopathy (thickening of the heart muscle)

Virat Medical College Senior Cardiologist Dr. According to Madhav Bista, cardiomyopathy is the thickening of the heart wall. It makes the heart hard and does not allow blood to fill. This problem is mostly congenital and many are not aware of it. He says that the first symptom is sudden death.

"The most dangerous aspect is that congenital heart disease may be hidden in many young people," says Dr. Bisht. Even if a person with these diseases looks healthy on the outside, the risk of cardiac arrest increases due to sudden excessive stress, alcohol consumption, or physical fatigue.

Therefore, he suggests that young people should also get their heart health checked from time to time. Dr. Bisht says that it is wise not to do too much physical exercise at once and not to insist on alcohol.

Why is cardiac arrest increasing in young people?

In the last 10-15 years, the incidence of sudden cardiac arrest among young people is increasing rapidly all over the world. Nepal is also not exempt from this. The problem of cardiac arrest in Nepal is increasing alarmingly. Sharma says. First cardiac arrest It was considered to be a disease that occurs in 60-70 years, says Dr. Sharma, but now, even in the age group of 25 to 45 years, its number is increasing alarmingly.

According to him, the biggest reason for this is the modern lifestyle. The habit of sitting in front of mobile phones, laptops and screens for a long time has made the body inactive. When physical activity decreases, weight increases, cholesterol increases, blood pressure increases and the arteries of the heart narrow. He says that this situation will later cause heart attack and cardiac arrest.

He was very kind to his three-year-old daughter, he didn't even mention his career for her

Cardiologist Dr. Stress and lack of sleep in today's youth is another main factor leading to cardiac arrest. Bisht says. Dr. Bisht says, "The habit of using mobile phones till 2-3 o'clock in the night, sleeping irregularly, and taking pressure from work makes the electrical system of the heart unbalanced. It causes cardiac arrest, heart attack."

Smoking, alcohol, energy drinks, junk food and processed food have become part of the daily life of the youth. Dr. They cause swelling of body parts, increase blood pressure and damage of arteries. Bista says.

Studies have confirmed that such incidents can happen even after drinking too much alcohol. According to a study published in the National Library of Medicine, excessive alcohol can cause heart rhythm disturbances, which can make the heart beat irregularly. Alcohol lowers blood pressure and causes electrolyte imbalance, which destabilizes the heart. Sleeping drunk also increases the risk of vomiting or respiratory arrest. Those with chronic heart disease or other health problems are at greater risk.

What is the difference between heart attack and cardiac arrest?

In our society, cardiac arrest and heart attack are considered as one problem. But from a medical point of view, these two problems are completely different. Sharma says.

A heart attack is a blockage of the coronary artery leading to the heart and the oxygen supply to the heart muscle is stopped. It damages a part of the heart. But a person who has a heart attack can speak, walk, reach the hospital,'' he says, 'but cardiac arrest is the stopping of the heart. In this condition, the heart cannot pump blood at all. The person immediately collapses, passes out and can die within a few minutes.

According to him, cardiac arrest is a more dangerous condition than heart attack because it has the danger of dying quickly. If CPR and defibrillator are not used immediately, chances of survival are very low. For this reason, defibrillators are placed in sports fields, gyms, airports, large department stores, malls, railway stations, offices, etc. around the world, says Sharma.

Prashant Tamang: 'Poster Boy' of Nepali-speaking unity

"This device is easy to use and gives instructions by speaking," says Sharma, "If someone has a sudden cardiac arrest, anyone can use it to save their life."

What are the symptoms of cardiac arrest?

Cardiac arrest often comes without warning, but before that, the body has already started giving small signals. The problem is, many young people ignore those signs as fatigue or gastric. According to Dr. Sharma, chest pain, sudden increase in heart rate, difficulty in breathing, dizziness are some of its symptoms. Sometimes chest heaviness, burning sensation, pain in the back, neck or left arm can also be signs of a heart attack. Cardiac arrest can occur after a heart attack.

If a young person is experiencing the problem of frequent fainting, shortness of breath while running or climbing stairs, waking up at night while sleeping, then it should not be taken as normal, said Dr. Madhav Bista says. "That's not normal, it could be a sign of hidden heart disease," he says.

Sudden collapse, unresponsiveness, stopping breathing is a condition of cardiac arrest. At that time even a few seconds can be important. Bisht says.

Is it possible to treat patients with cardiac arrest?

Treatment of cardiac arrest is possible, but only within the first few minutes of hospital delivery. Dr. According to Ranjit Sharma, if a cardiac arrest occurs, the first treatment is cardiopulmonary resuscitation (CPR), not medicine. If the person can be rescued by giving CPR and being taken to the nearest hospital, the person can return to normal life. That is why it is called 'Basic Life Supporter'.

Dr. According to Ranjit Sharma, if a cardiac arrest occurs, the first treatment is cardiopulmonary resuscitation (CPR), not medicine. If the person can be rescued by giving CPR and being taken to the nearest hospital, the person can return to normal life. That is why it is called 'Basic Life Supporter'.

If a person suddenly collapses, CPR should be started immediately by chest compressions. He says that if the heart is not started within 3-5 minutes, the brain will be permanently destroyed and the person will die.

According to Dr. Bisht, people who survive cardiac arrest can be treated long-term with pacemaker, medicine or surgery after finding out the cause of the heart problem. He says that after such treatment, he will return to normal life if he pays attention to his lifestyle.

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."