Robbery in Medical Education in Nepal

On September 26, the Association of Private Medical and Dental Colleges of Nepal warned that colleges will not admit new students this year in the present scenario. The colleges demand more seats in MBBS and BDS and increment in fees, furthermore (quite funnily) claiming that they are going bankrupt.

Why is medical education costly in Nepal?

Medical education is not supposed to be as costly as it is now. The government of Nepal in October last year (2018) set tuition fees for MBBS course at NRs. 38 lakh for private colleges in Kathmandu Valley and NRs. 42.4 lakh for those outside the Valley. The fee is NRs. 19 lakh for the BDS course. Even these amount of fees are not able to satisfy the owners of private medical institutions thus all of them have been breaching the government ceiling.

Being a doctor is associated with unique social prestige in the country (may be all around the globe or at least in Indian subcontinent.) Thus, middle class parents want their children to grow to be doctors to have proper pride in them. In a country where the government salary of a doctor is just around NRs. 35,000 per month, fees for the courses ranging from NRs. 19 lakh to NRs. 42.4 lakh is just outrageous.

Even if a student spends NRs. 42.4 lakh only for fees of MBBS excluding the illegal extortion by the college and other personal and living expenses, it would take almost 10 years to earn just as much serving as a government doctor. (By the way, who can save all her salary?) If a student spends NRs. 4 – 5 lakh for B. Ed. then in a similar manner, it would take about a year to earn the expenses in her education serving as a government teacher.

Additionally the doctors will be beaten (sometimes even to death), threatened and sacrifice family time. Despite of a dark future (as per current government rules, regulations and system), surprisingly parents want to make doctors out of their children for pride! And the students passionately study to crack the entrance exams and enter the world of medicine and dentistry. The vastness of the curriculum of the courses are entirely a different matter.

So, it can be safely assumed that it is only the associated prestige (which is also questionable in present circumstances of manhandling of doctors) for which Nepalese students enter this field. And, only this factor is creating a great demand for private medical colleges. Greater the demand, greater is its value. The Association of Private Medical and Dental Colleges of Nepal understand this clearly.

In past when there were no rules to regulate the fees of colleges or the entry of students according to merit, everyone was happy. Even a student with poor merit if payed thick wads of cash to a medical college, he used to get admitted.

Is medical education supposed to be this costly?

The Association of Private Medical and Dental Colleges of Nepal claims that the current scheme of fees is unscientific. Well, that is entirely untrue.

The BDS and MBBS courses are of almost equal length of time. In the first two years of both the courses, the students are taught almost same subjects (with differences being Community Medicine in MBBS and Dental Material Sciences and Orofacial Anatomy in BDS) with slight variations in depths.

The differences arise from the third year through fourth till fifth year. But the number of subjects are roughly same, the number of teachers are roughly same, the number of practical hours are roughly same. And even the salaries of the teachers do not have much differences. Then why is there such a large difference in the tuition fees?

In 2011-12 session, the Nepalese students studying BDS in Universal College of Medical Sciences had to pay record low fees varying from around NRs. 5 lakh to NRs. 12 lakh (surprisingly less attraction towards BDS that year), while their Nepalese batch-mates studying MBBS had to pay NRs. 35 lakh and higher in the same college. This example clearly reflects that a college, if the students are not attracted can teach BDS to their students even at NRs. 5 lakh. At the same time, a student studying MBBS teaching whom the college has to bear almost same expenses as that of a BDS student has to pay NRs. 35 lakh.

Yes, private medical colleges should earn profit because they are established by businessmen who did so in desire of profit. But robbing common people in the name of profit in business should be ruled punishable immediately.

It is obviously a lie that medical education is supposed to be this costly. It is only the advantage of the common mindset that the colleges are taking to set such a costly fee structure. It is plainly outrageous to demand even more. This high cost of medical education is not only turning medical education into an elitist affair but also bitterly undermining the healthcare system.

How is costly medical education undermining healthcare system?

The government should either reduce the fees of MBBS and BDS courses to around NRs. 4 – 5 lakh or should increase the salary to at least NRs. 4,00,000 per month. Or if the government sets the fees to NRs. 18 – 22 lakh, then salary to NRs. 2,00,000 or if the fees to NRs. 9 – 11 lakh, then salary to NRs. 1,00,000. It is simple math which the government forgets to do (frequently).

Now in present scenario, from a student who has to spend around NRs. 50 – 60 lakh to become an MBBS doctor (post-graduation is still there!) who is paid around NRs. 35,000 by the government, what do you expect except financial frustration? Poor student did not know six years earlier that his future was going to be dark and dreary. Yes, dreary because the mobs are ready to beat him any time in the emergency room!

And what do you expect from a financially frustrated and frightened doctor? Social service? Lok Sewa?

Not only the government hospitals, majority of private hospitals are exploiting doctors equally. The dream of being a doctor for a decent life and social service is realized by working in an insecure and financially frustrating exploitative environment. And, if the state is unable to give a doctor secure environment and a handsome salary then it is the failure of the state. It is also the failure of the state to set such a costly range of fees for medical education in the first place without assuring a decent future to the student.

These unpleasant situations are compelling the doctors to practice as much as possible, as long as possible to earn at least the expenses in their education so that they could show their doctorly faces to their parents who paid for their education. Apart from these some of the doctors are engaged in malpractice for financial gains! It would not be too much to say that the government itself is responsible for this and for the undermining of healthcare system.

The government also needs to see how the private medical colleges are paying their medical and dental officers (of course, ridiculously). Neither the government nor the private medical colleges seem to be paying any heed to the uplifting of the healthcare. The government seems to be busy appeasing the annoyed medical businesspersons and medical businesspersons seem to be focused only on extorting more and more of money. Humanitarian aspects seem to be ousted from the rules and regulations where in fact these should be the primary aspect in healthcare.

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