How does an air purifier clean polluted air?

 How does an air purifier clean polluted air?

An air purifier only cleans the air in its coverage area. It gives good results only if you have a separate purifier for each room.

An air purifier works by continuously drawing in, cleaning and releasing air back into the room.

The CRDR shows how quickly the air is cleaned, with a higher CRDR being required for larger rooms.

When we enter a house, we think that no matter how much dust or smoke there is outside, the air in the house is clean. But the truth is that these days the air inside the house is as polluted as the air outside. Especially in big cities, where the air quality index is consistently bad.

In such a situation, most people want to buy an air purifier, but they are worried about how to identify a good quality air purifier. If you do not buy a good quality air purifier, the air will be polluted. Therefore, before buying an air purifier, it is important to fully understand its actual workings, essential features and common misconceptions.

What does an air purifier do?

Many people think that an air purifier only freshens the room. But an air purifier works in a continuous process of pulling air, cleaning it and releasing it back into the room. The fan inside the machine pulls in dirty air, dust, PM 2.5, pollen, pet dander, smoke, etc. from the room. Then various filters do their job.

The HEPA filter captures very fine particles. The activated carbon filter absorbs household odors, cooking odors and gases. The pre-filter extends the life of the HEPA by blocking large particles. Some machines also have an ionizer or hybrid system, which makes the air even better.

6 things to pay special attention to before buying an air purifier

1. The higher the CRDR, the better

CRDR 'clean air delivery rate' shows how quickly the machine cleans the air. A high CRDR is needed for a large room and a medium CRDR for a small room. If you choose the wrong CRDR, the air will never feel clean.

2. Understand the life of the filter and the cost of replacement

Many people only pay attention when buying a machine, but replacing the filter later costs a lot. An air purifier is not a one-time item, but an item that requires regular maintenance. Therefore, you should buy it only after understanding the life of the filter and the cost of replacement.

3. How much noise does it make?

Especially in winter, when the fan or AC is not running in the room, even the light sound of the purifier can be heard all night. Therefore, if the noise of the air purifier is too loud, sleep will be disturbed and the benefits will be reduced. Therefore, you should choose one with low noise.

4. Power consumption should be low

Air purifiers should be used for many hours a day. Therefore, it is beneficial to choose a machine that consumes less power.

5. Smart features are necessary

If you are tech-savvy, features like Wi-Fi, mobile apps, real-time AEQI monitoring are very convenient. They can also control the machine remotely.

6. Remove these myths from your mind right now

Myth 1: One purifier is enough for the entire house

This is completely wrong. An air purifier only cleans the air in its coverage area. Only having a separate purifier for each room gives good results.

Myth 2: HEPA filters also remove odors

HEPA only captures particles. Only activated carbon filters have the ability to clean odors and gases.

Myth 3: Purifiers are only needed in winter

The air is not only polluted in the winter, it can also be polluted in the summer. In big cities, the AQI is often bad in every month, so an air purifier is useful all year round.

Choosing an air purifier with these things in mind will provide you with truly clean and healthy air.

Children may be deficient in vitamin D in winter, what to do?

 Children may be deficient in vitamin D in winter, what to do?

Sunlight is the best natural source to compensate for the problem of vitamin D deficiency.

Children may be deficient in vitamin D in winter, what to do?

Vitamin D helps strengthen children's bones and teeth, helps in height growth, and increases their ability to fight disease.

Children are deficient in vitamin D due to less exposure to sunlight in winter, wearing thick clothes, and not taking them outside much.

Vitamin D is an essential nutrient for the healthy development of children. Vitamin D strengthens children's bones and teeth, helps in height growth, increases their ability to fight disease, and helps in muscle development.

According to the American Academy of Pediatrics, vitamin D deficiency can cause problems such as 'rickets', a softening of bones in children, which weakens bones. But vitamin D deficiency in children is seen due to less exposure to sunlight in winter, not taking children outside for a long time, and wearing thick clothes.

Parents need to know why children develop vitamin D deficiency during the winter, how to recognize it, and how to prevent and treat it.

Causes of vitamin D deficiency in newborns:

Vitamin D deficiency in newborns is often associated with pregnancy. The baby gets vitamin D from the mother while she is in the womb. If the mother does not spend enough time in the sun during pregnancy or is deficient in vitamin D, the baby can also be born with a deficiency. According to the Mayo Clinic, vitamin D deficiency in pregnant women increases the risk of rickets in the baby.

Although breast milk is the best food, it contains low levels of vitamin D. Therefore, exclusively breastfed babies may need vitamin D supplements.

In winter, if the baby is not exposed to the sun due to fear of cold, the skin cannot produce vitamin D. The body produces vitamin D from UVB rays, which are less in winter.

Babies born prematurely have low vitamin D stores in the body, which increases the risk of deficiency by 2-4 times.

Children with dark skin produce less vitamin D from the sun, and this problem is also more common in polluted areas.

Why is vitamin D deficiency more common in winter?

The main reasons for vitamin D deficiency in winter are:

- The sun's rays are shorter in winter.

- Morning and evening sunlight are not effective, because the 'UVB' rays are weaker.

- The child's body is covered with thick clothes, which blocks the skin from the sun.

- Especially in cold weather, children play less outside.

- Fog and pollution block the sun, which reduces UVB rays.

For all these reasons, the child's skin cannot produce enough vitamin D. Vitamin D deficiency weakens the immune system, which leads to frequent infections.

Symptoms of vitamin D deficiency

The symptoms of vitamin D deficiency vary according to age.

In newborns and young infants: from birth to 12 months

- Excessive crying, irritability.

-Low milk intake or loss of appetite.

-Slowness in lying down, sitting up or crawling - 'delayed motor development'.

-Soft skull bones.

-Excessive sweating, especially on the head, even at a young age.

-Vitamin D deficiency causes fatigue and weak bones.

In older children: above 1 year

-Leg pain or fatigue.

-Fatigue or muscle weakness when walking.

-Bold legs.

-Frequent illness, such as respiratory infections.

-Height and weight not growing as expected.

Treatment and prevention of vitamin D deficiency

The sun is the best natural source to replenish vitamin D deficiency. Therefore, you should expose your hands, feet or face to the sun for at least 3-4 days a week, for 15-30 minutes.

Newborns can be given vitamin D drops as recommended by a doctor. Do not increase the amount yourself, as excessive amounts can cause problems.

Foods rich in vitamin D can be given after 6 months.

-Egg yolk

-Milk yogurt, ghee in small quantities

-Sun-dried mushrooms

Vitamin D deficiency can be prevented with these foods. Salmon and eggs are also suitable for pregnant women.

Tips for parents:

-Mothers should take vitamin D daily during pregnancy. For that, they should pay attention to sunlight and nutrition.

-The baby should be safely exposed to sunlight regularly, but sunburn should be avoided.

-Vitamin D drops can be given to babies who are exclusively breastfed on the advice of a doctor.

-The child's development should be monitored regularly, such as height, weight and motor skills.

-If there is any doubt, a health worker should be consulted.

By adopting these measures, children's vitamin D levels can be maintained even in winter, which improves their 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."

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.