An Rx for heath care in Nepal

Imagine dying from simple surgery for haemorrhoids, an annoying but non-lethal condition. That happened in one of Nepal's most prestigious private hospitals recently, and this sad case is an important reminder that medical care can as easily harm as help. Studies in developed countries show that what makes people healthy is not medical care. Indeed, there are indications that in developed countries medical care may contribute to as much as one death in 10. And yet the predominant wisdom in developing societies is that the path to better health is more medical care; specifically, more specialised medical care. Thus, much public expenditure is incurred for the diseases of the few, and health facilities reflect rather than address an extremely hierarchical society.

The common perception in Nepal is that medical care must be the reason for the remarkable health advances in the country over the last 50 years. Everyone is aware that deaths among young children are not so frequent as they were even 10 or 20 years ago. The Nepali middle class is pleased with the plethora of health services available in the larger cities and towns today. There is an enormous number of nursing homes, hospitals, and an increasing number of medical schools to train the next generation of doctors. CT scans, ultrasounds and other sophisticated tests are routinely available in Kathmandu now, and this is put down with certitude as progress. And even while these advances are not unremarkable, people now routinely die of heart attacks, strokes and cancer, which was rare 30 years ago when I first worked in Nepal. Certainly back then, these were causes of deaths in Kathmandu, but they were relatively uncommon in the hills, where people were more likely to succumb to dehydration or tuberculosis (TB).