1. Public concern, their scrutiny, transparency and accountability of health and medical professionals
Today, we together with other peoples of Nepal have fought and realized Loktantra. We envision Loktantra as the highest form of republican democracy of the people and by the people. As the word implicates Loktantra can have none above or bellow Lok or peoples and peoples’ world. A monarchy in any form or any other creed-based superstructure is out of question in Loktantra. We, the people of Nepal, are not praja of prajatantra but fully sovereign, responsible citizen of Nepal. The established norm of Lok accepts no exclusion or deprivation of citizens by gender, geographical region, ethnicity, religion, political or social orientation, physical or socioeconomic state or condition.
Along with Loktantra there is a tremendous rise in expectations of peoples. The rise can even be called exponential. This is natural after centuries of feudal oppressions, and political corruptions and mismanagements pinnacled by royal takeover to steal away our democracy and remaining rights and security of peoples. Such upsurge of expectations can even be called explosions of public energies and potentials. If managed wisely and appropriately these would help to institutionalize democracy firmly and accelerate the pace of development of our country, cultures and societies.
Along with the raised expectations there is however a corresponding growth in tendencies of dissatisfaction from our services among the people. This has put a lot of stress on us, our profession and health institutions. We have got to be sensitive to the upsurge in public concern and scrutiny on how we behave, respond or serve to meet health and medical needs of patients, individual users and communities. We are doubly vulnerable because we are forced to respond to these expectations with limited resources, facilities and technical know-how or options for informed decisions and actions – because of non-availability of updated epidemiological information of the locality or the country –, and outmoded health systems and constraints with which we have to serve. We can safeguard us and institutions we work with out of the crisis only if we make us and our institutions transparent and accountable. We have to respect their rights to know and of informed choices related to the state of their health needs, problems, and the cheapest and best ways and means to come to appropriate diagnosis and management in any given condition. We have to have professional interactions including involvement of patients and people in the development of our decisions and plan of actions. We need to share with them the information related to available options with weighted benefits and risks of each, most feasible and appropriate decision, expected roadmaps of events and outcomes including possible complications, precautions to avert or minimize these and expected quality of life after that. We also have to motivate them to the needed exercises, change in lifestyle, diets, emotional and psychological conditionings and adaptations, and follow-up intervals and procedures. If we stimulate informed dialogue among ourselves, between us and societies, be transparent in our working style and serve the patients and people with informed consent and atmosphere of trust we will ever remain safe. This automatically obligates us to be professionally and morally accountable to what and how we do.
There will be more and more legislative and systems components coming to become integral parts of our professional services and prescriptions. Traditional trusts on us and our professions will now become more or less a ‘sense of false security’. All these will oblige us to comprehend ground realities, philosophy and objectives of health and medical services, and our own social and professional responsibility.
Rudolf Virchow, one of the most distinguished forerunner of medical profession and an activist in the German Revolution of 1848, after intensive research in Upper Silesia of Germany devastated by an epidemic of “famine fever” (Typhus or relapsing fever) in 1847 stated that ‘Medicine is a social science, and politics is nothing more than medicine on a large scale.’ In order to carry out our professional responsibilities fully and democratically we have to learn to love politics and stop hating politics as we are constantly taught and instigated by some dishonest leaders of political parties and systems world over. Many politicians in our country practice polemics and trickeries in stead of politics. This way they might even have forgotten what politics actually is. Politics is the domain of peoples and most precious wealth of all. This is a part of common human goods; knowledge, collective wisdom, sciences and heritages and products of human civilization being other parts of the latter. Politics is certainly not the one to be monopolized, even by political leaders and parties, especially by political jamindars (Feudal lords) or dictators. There is a strong positive correlation between the quality of public participation in country’s politics in one hand and public consciousness, real human development status including education, health, eco-harmonious lifestyle and other qualities of life on the other.
2. Our professional and social responsibility
We have to make our profession and services not only people-oriented but also result-oriented as felt and expressed by the people. We are a part of people educated and trained to serve the people. We may thus develop human resources within ourselves optimally in following five interrelated responsibilities:
a. We need to take health as integral component of country’s development and social justice. We have to respect the fundamental rights of all to health and development. Our participation in health development should enrich families, communities, societies and the country. For that reason we need to participate actively in politics of health and health policy decisions to protect the rights of people.
b. Our main professional responsibility is to serve the people, especially the poor, deprived, marginalized and disabled, with the best of our knowledge, skills, and ways and means available with us. This is according to the principle of distributive justice which obligates a human to serve by degrees of needs. Those who need most care and could have best outcome of the available interventions should be prioritized first. We need to refuse, consciously and by deeds, to become co-opted to the process of making health better for the rich at the expense of the poor and voiceless. We have to serve as friends and facilitators – learning from people and sharing our experiences with the people.
c. In order to fulfill our responsibilities better we constantly have to update ourselves and refine our experiences up to current national and international standards and trends. For the same we also have to improve human resources in us, individually and collectively, with continuing, progressive, interactive and integrated education for advanced quality learning, skills and services.
d. We ourselves should develop spirit and environment of trust and confidence on ourselves by actively participating in research and development to create new knowledge, techniques and technology, and systems including new and better ways of thinking and behaving. Research and development is an integral part of services as well as professional responsibilities. R&D should not however be taken as cosmetic or purely academic exercise. Every human has rights to contribute his creativity to human societies. As informed professionals we are better positioned as creative thinkers and doers.
e. Finally, we must be committed to make a difference with our services. The evidence of the differences should be supported statistically as well as by felt expressions of the people of perceived benefits or positive results. Statistical data without opportunity for the people to taste the benefits are mere ‘human tears in figures’.
3. Holistic approach in health and medical services
Habitual addiction to patch works – so common in Nepal – should now be replaced by sensible development of holistic programs after careful planning with informed decisions to meet optimally the needs of peoples and to solve all possible problems, their determinants and complications generated by time and components of programs, and carefully supervised and monitored implementation. Prescriptive top-bottom planning should be replaced by evidence based and bottoms-up planning with the participation of peoples or concerned health services users. We need to cease to be swayed by attractive slogans and hypes. Let us take an old adage as example. “Prevention is better than cure” is mind-catching and attractive slogan. But if one carefully examines critically the adage tends to separate health into two distinctive compartments. Secondly, most of the preventive diseases can’t be checked without reducing human and other reservoirs. Thirdly, if the pains of the affected person is not appropriately addressed no amount of convictions or prophecies would work to motivate people to preventive mode. Finally, we have to be conscious of relationships between health and ecosystems including health of the planet Earth.
This is an inaugural speech on the occasion of the Fifth National Conference of the Society of Dermatologists, Venereologists and Leprologists of Nepal, held in Kathmandu, November 25, 2006
Yen, Nepal Sambat: Saturday 5, Thinlla Thwao 1127