August 9 – Powerful Deterrents

So today, we went back to Patan Hospital to sign Dr. Bishnu’s training agreement. I also found out that Director Shrestha, while the Patan Birthing Center undergoes renovation, is working as coordinator of the night shift nurses. Unfortunately, that means that I have to show up either really late at night or really early in the morning. (I’ll be going at night, since there’s no way I’m waking up at 5AM).

To finally put some closure to the MDGP scholarships, I also went to NSI (The Nick Simons Institute) to sign our agreement with Dr. Zimmerman (and pick his brain about some clinic legal issues). One of the issues we discussed was medicolegal aspects of the clinic: how to deal with malpractice suits. Personally, I was curious about this as well, since I knew that Nepal was not a sue-happy place like America. Dr. Z enlightened me about the way things are done here: no doctors have malpractice insurance. The Nepalese don’t really sue in this department, and the law is somewhat loose as well. Apparently, until 15 years ago, medical malpractice had to be tried under assault and battery statutes. Even now, cases are seen more in the sense of consumer protection laws.

On the other hand, the Nepalese are more willing to take matters into their own hands. Should an egregious case of malpractice occur, threats, vigilante action, and out-of-court monetary demands are common. A more powerful deterrent is the press: families with connections can publish articles defaming physicians for their negligence. On top of being completely in the hands of the writers, such measures ensure humiliation and the fact that the doctor will probably be unable to practice in that city again.

That’s some scary stuff.

July 26 – This is for you, Nick Simons

Working in a developing country is interesting since you routinely encounter folks involved in a variety of development NGOs. We met today with Dr. Zimmerman (a *gasp* American) with the Nick Simons Institute. NSI is offering MD-GP (Medical Doctor-General Practitioner) scholarships for eligible MBBS doctors (Medical Bachelor/ Bachelor in Surgery). Though our current medical director is not interested, we hope this will be a sufficient incentive to attract future doctors to the Nyaya Health clinic. The problem with the program is that in the current Nepali system, a bachelor in medicine is usually sufficient to allow a doctor to enter the field. An MD-GP is nice, but unnecessary. In fact, most MD-GPs work in rural areas (with charitable intentions), since their additional training enables them to become proficient family doctors.

Anyways, you may ask “why a funny name like Nick Simons?”

The story gets interesting: According to Chris, Nick Simons was a wealthy young man who lacked a goal in life but enjoyed traveling to exotic places. During one such visit, he was trekking through rural Nepal. Somehow, something he saw here touched him so much that he decided to become a doctor and devote his life to serving the people of Nepal. Unfortunately, on the trip home, he stopped by in Indonesia, where he drowned while swimming in an atoll.

His parents, in his memory, decided to continue his work and have thus created the huge institute in Nepal to improve health in rural areas via MD-GP scholarships, nurse/midwife training, and improved clinical research methods.

With this in mind, Chris, Bibhav, and I went to the NSI offices—and were amazed. Though tucked away in a residential area, the NSI building is immaculate, A/Ced in every room, computer-enabled in every office (with wireless internet too!), and full of massive furniture. We actually joked with Dr. Z that we may consider working for him on account of the impressive setup. That aside, negotiations went well with NSI, and we’re well on track for signing a number of scholarships each year with the organization.

Upon leaving the building, Bibhav let us know that he had done his research. Apparently, Mr. Simons (father of the late Nick) is among the 60 wealthiest people in the world. NSI is actually just one part of the great charitable projects they’ve financed in this country. Patan Hospital’s birthing center (the model for all Nepali birthing centers and a fully-independent [no doctors] program that has seen only 2 technical complications out of the last 600 births) was built (and now being renovated) by a million-dollar gift from the Simonses. Sadly, the family has not been similarly blessed. Nick, the eldest, met his untimely end in Indonesia. The second son was killed in a car accident while riding his bike outside his home. The third son is apparently autistic. Though I haven’t had time to confirm these facts, they’re a grim, but encouraging reminder that philanthropy is an important and powerful factor in global development.

On a lighter note, Bibhav and I had pizza today. Chris is from Connecticut, so he remained a skeptical of Nepalese pizza-making, but I thought it was okay. Definitely no Peppe’s or even Papa John’s, but it was recognizable as pizza.