VOL. 04, NO. 17, Feb 25 2011 (Falgun 23, 2067)

The coalition government in the UK is introducing major reforms to the state-owned health services in the country, but will it work?

By BHAGIRATH YOGI in London

In October 2007, Balram Pyasi, a freelance Nepali journalist, was staying with his friends in North London, when he suddenly felt burning and pain in his chest. As his pain intensified, his friends dialled the emergency number 999. Within five minutes, an ambulance arrived with three health personnel and emergency health equipment.

The ambulance reached the Royal Brompton and Harefield hospital, some 40 kilometres away from his residence, in about 15 minutes. He was rushed to the Operation Theatre where senior doctors were waiting for an emergency cardiac operation on him.

After the operation, a senior doctor at the hospital told him, “The capillary through which blood circulates in your heart was blocked; now it has opened up after the surgery.’

Two days after he was discharged from the hospital, Pyasi received a bill from the hospital amounting to £6,593 (around Rs 850,000). “As you are not a permanent resident of United Kingdom but a tourist, the National Insurance regulation does not apply to you, therefore you will have to pay for your treatment, according to your capacity on instalment basis,” the letter said.

“The NHS saved my life. If I had had stroke in Kathmandu, I am not sure if I could ever make it to the hospital,” said Pyasi, who returned to Kathmandu later that year. After a few days, he visited the Gangalal Heart Care hospital at Bansbari with his medical records. A doctor on duty gave a cursory look at his prescriptions, asked him to continue his medicines and called another patient in barely two minutes. “I felt very bad. There was no way I could compare the quality of care and services which I received in the UK (with that in my own country),” he added.

‘Jewel in the Crown’

Not only foreigners like Pyasi, an overwhelming number of British people see their state-run health provider not only as a service but also as a symbol. Obviously, reforming NHS was a major plank in the parliamentary elections in UK last year. While proposing to cut millions of pounds from different departments, Prime Minister David Cameron said that he would ring-fence the budget of the NHS. “When Tony Blair was elected in 1997, he said his top three priorities would be Education, Education and Education. My top priority can be described in three letters, N-H-S,” declared Cameron.

Introduced more than six decades ago, NHS is the publicly-funded health care system in England, which provides healthcare to anyone normally resident in England or any other part of the United Kingdom with most services free at the point of use for the patient. However, patients have to pay separately to procure services like eye tests, dental care, prescriptions, and many aspects of personal care.

During the 13 years of Labour government (1997-2010), deaths from cancer, strokes and heart attacks fell substantially. Mental health, access to drugs, infant mortality, life expectancy and access to General Practitioners (GPs) also improved. The NHS budget tripled to 105 billion pounds during the period.

The NHS has, however, seen its ups and downs. “In 1997, the National Health Service was in a state of disrepair. Hospitals were falling apart, more than a million patients were on waiting lists, there were too few staff and care varied widely in quality,” said The King’s Fund—a London-based think tank—in its report published last year.

Managing the NHS—the third largest employer in the world with 1.7 million employees ( first being the People’s Liberation Army of China and second the Indian Railways), has never been an easy task. “While the NHS budget has ballooned, productivity has somehow fallen and too little has been done to force through changes to how and where healthcare is delivered,” The King’s Fund said.

The new Conservative-Liberal Democrats coalition – that was voted to office last May-- has made sweeping proposals to restructure the NHS. They include dissolving both the Primary Care Trusts and Strategic Health Authorities—agencies responsible for delivering health services through local surgeries and hospitals. Instead, General Practitioners or GPs (also known as Family Doctors) will now have a major say in spending the massive NHS budget.

So, will the new proposals drastically improve the quality of service being delivered by the NHS?

Dr Raghav Dhital, who has been working as a GP since 1984, has witnessed big changes in 1990 and again in 2004 in the way NHS was run in the UK. “The current change proposed by the coalition government is by far the biggest in the NHS since its creation,” said Dr Dhital, adding, “The speed and scale of change has not been universally accepted by the profession. It is a challenge and opportunity for the GPs and will require sincerity and hard work from all concerned to make it a success.”

When the war-trodden Britain launched the NHS in the early 1940s, British economy was in the doldrums and the provision of social welfare in the tatters. More than six decades down the line, NHS is considered one of the best health service systems in the world-- ‘jewel in the British crown.’

“Nepal could learn many things and emulate from Britain to improve her health services in order to make our country a much better place to live. All we need is a political commitment and a strong will,” said Dr Dhital.

Journalist Pyasi, who told us he was enjoying his ‘second life’ in Nepal-- thanks to the NHS, agreed fully.

Diarrhea: a security risk?

Did you know that you could be perceived as a security risk if you have severe diarrhoea and you are trying to enter the USA? Returning from Kathmandu many tourists go home with a“valley” belly, a gentle ( and sometimes not so gentle) reminder to the tourist of the hygienic state of Kathmandu. People say that when tourists return home from Nepal, their family and friends ask them two standard, predictable questions, the answers to both of which are “yes” : Did you have a good time? Did you get sick? And sick generally means diarrhoea. But imagine your state of mind if the US government thinks you are terrorist because of severe diarrhea. (The state of your bowel takes a back seat at this juncture!) What follows is a true story.

Two days had passed since the attempted bombing of Northwest Airlines Flight 253 at Detroit airport, USA on Christmas Day 2009.The airline authorities were understandably tense. Unfortunately for the Nigerian man who flew into the same airport at that time with bouts of frequent diarrhoea, this tense airport situation did not bode well. When his plane taxied down Detroit airport, because he had spent so much time in the toilet during the flight, the plane was not allowed to the gate and panic ensued amongst the travellers. You can almost picture the American marines being alerted to storm in to tackle this potentially serious situation. However after detailed questioning and examination, it was determined that the gentleman from Nigeria was suffering from a genuine case of severe gastroenteritis. Everyone felt, well, relieved!

Obviously in these days of aeroplane terrorism, even simple acts like going to the bathroom become potentially highly suspect, especially if you have to run to the toilet many times in the plane or that your diarrhea is so severe as in this case of the Nigerian man that you cannot rise from the toilet seat. It is hard to blame anyone as you certainly want the planes to fly safely without dangerous individuals running around with their own agenda in the aeroplane.

What can be done for people to avoid having to frequently go to the bathroom in a plane? In a Nepali bus, the matter may be more serious as there are no bathrooms and the driver may not co operate with you to stop frequently. Following all the standard rules ( drinking boiled water, washing your hands with soap and water etc) of proper hygiene is of course important. But for travellers in a plane and bus in order to deal with the practical problem, there is a simple drug called loperamide ( Imodium) which works rapidly by slowing the transit time in the gut. 2 tablets of imodium for adults to start with is very effective and may help avoid security concerns as in the story of the Nigerian man . But above all, it is important to see a health care practitioner after deplaning.

Gender Identity: Women, Men and Transgender

Gender related trainings at local, national, international level rarely introduced the term of Third Gender Third Sex or Transgender or LGBTI where as gender has been getting space significantly since Beijing Conference 1995 in government, non-government organizations at large. Ridiculously, even in the educated society, academic intuitions, gender applies ONLYwomen and men.

As we socialized through cinemas, circus and other sources, society takes third gender as a fun, to some extent inferiority, powerless at private as well as public arena. The family and members/relatives also have taken third gender as a matter of stigma, humiliation, shameful and guilt because they thought that third gender is an outcome of sin in earlier life or ancestors. Thus, neither family discloses the concerns nor the individual expose themselves about their gender identity and sexual orientation.

Indeed, gender implies to women, men and transgender (TG). Even TG has various names or definition as their local context or country to country. However, TG refers to female to men, men to female and Hijara. At the mean time, in Nepal the representative society called BDS (Blue Diamond Society) called LGBTI largely. It covers lesbian, gay, bisexual, transsexual and inter-sex persons, neither of whom falls under the categories of male and female.

Actually, TGs are deprived from exercising their rights from legal frameworks/policies. Thus, they have been discriminating at multiple forms and ways at their daily life at individual, family and public life. Primarily, they have excluded at their home, mostly their needs, aspirations and interest ignored and taken as a psychosocial problems. Most of TG brings to the psychiatrics or seeking medical treatment. Likewise, they oppressed at school, community or their work setting. Once they disclosed, they have to illegible to continue their tasks or taken out as a punishment e.g. lesbian woman terminated in Nepal army in 2007. Similarly, they do not have category in official and formal institutions regards to their gender. There are only mentioned men and women.

Therefore, TG are not only marginalized or in minority but also pushed towards ranges of social, economical and emotional problems. It includes anxiety, depression, suicide, and unemployment. Initially, they are also natural persons, human beings but the society treat and make them different. Consequently, conflict, violence gradually induced in the society. They do not have choice and options as their interest and capacity. Finally, they are being further pushed in to criminal activities and harmful/risky behaviors including sex work.

According to the human rights 1948, none of the person deprive from their rights. However, countries don't have proper policies, provisions and frameworks (citizenship, marriage relationship and sex reassignment surgeries) for TGs. In Nepal, the representative of TG, nominated for member of Constitutional Assembly which is most appreciative as well as crucial due to transitional economic and political state and time for drafting new constitution and state restructuring. Likewise, the Supreme Court made decision for recognizing the TG as third gender as well as ensured their all citizenry and human rights for sexual minority in December 21, 2007. In top of that, Nepal government, include TG National census by mentioning other under the gender. In case of India, Arvanis, Tamilnadu is declared the first state to recognize TG and Karnatak (women and child department) passed a government order in India (September 20, 2010). In Pakisthan and Bangladeshi TGs also have suffering from similar forms of discrimination and struggling for same.

It is concluded that TGs are human beings and granted for equal human rights. It might see to everywhere and everyone regardless their caste, class, occupation, disabilities, religion, region. Thus, the government has to ensure legal frameworks for their identity, social and economical security including special provision for job opportunities, sex reassignment surgery (SRS). Meanwhile, the advocacy and awareness raising activities, enforcement of policies, are also equally crucial for peace, prosperous and just society.