http://www.nep.searo.who.int/LinkFiles/Health_Information_HSC.pdf

My Major was in Health Services Administration. I am currently working for Blue Cross Blue Shield so have a pretty good perspective of the Health Care system in America from the Health Insurance point of view. I want to discuss with other Nepalese working in the Health care industry about the challenges and opportunities for the Health care system in Nepal and how we can use Health Information Technology in the way that many South Asian countries are doing .

I am looking forward to hearing your valuable perspectives and points of view. Thank you.

What are the main problems that you feel we suffer from?

I would like some help in doing a PEST analysis:
http://en.wikipedia.org/wiki/PEST_analysis

 First thing, doctors (not all but many) back home are using their occupation as means of earning money rather than serving people. There are doctors in well facilitated areas but if you go to villages it's hard to find one. It's not just the case of very remote districts, but even in districts close to Kathmandu and other major cities. Health posts don't even have a person trained to administer vaccines, let alone docs. People who take care of health posts (sweepers, peons) are giving vaccines. It's a mess.

Doctors need motivation to work in remote places. If you look at current MBBS students back home, they go to field trips and health camps in remote villages and they absolutely enjoy it. But when it comes to a long term commitment to those areas, they run away. When you become a doctor, you take an oath to serve people first, not yourself. And that's the point doctors and medical students are missing. Healthcare backhome is turning into a money making business, just like here in the States. And doctors are one reason behind that - they provide service if only you pay them good. And a good pay is in the cities that house good/big hospitals and clinics. 

There are tons of problems like this I can write about all day but i've gotta study for my finals. Will get back. Thanks for starting this thread!

df

 Jantarei, are you sure doctors have to take oath? As far as money is concerned, why would parents spend more than 1/2 crore on their children education if they won't see any return in investment. Respect alone does not pay rent.

 east, you can make a good money as a doctor regardless of where you work. well, you might make less when you work in a remote area than what you might make in a city, but if making money is the primary reason to become a doctor, then you chose a wrong career. you will be well off investing that half crore in some business than in being or making your offspring a doctor. if a medical student dreams of making big money rather than serving patients, he/she will be similar, if not worse than some doctors back home who take out kidney of a patient who goes to hospital for a simple ENT check-up. and btw, yes there is an oath doctors take, it's called Hippocratic oath. But i'm not sure if they do any such thing in Nepal though.

Here is an interesting and inspiring story I found on ekantipur. This doc didn't have anything or anyone special in that remote village of Gorkha, yet he spent so many years serving people. Why can't NEPALI doctors do that? Doctors who run after physical affluence and money should be ashamed of themselves.

नेपाली डाक्टरको विशेषता- पैसा, पैसा, पैसा !

 

गोरखा (आमपीपल), पुस २ - युरोपेली सुविधा र रमझमबीच आफ्नो पेसा धानिरहेको एउटा जर्मन चिकित्सकका लागि कष्टसाध्य लाग्ने नेपाली गाउँठाउँमा आएर दिन-रात नभनी स्वास्थ्य सेवामा जुट्नुको स्वाद के हुन सक्ला ?

'जे गर्दा तपाईंको मन खुसी हुन्छ, जीवन धान्ने सजिलो उपाय पनि त्यही हो,' बितेको आठ वर्षयता गोरखाको आमपीपल अस्पतालमा सेवारत जर्मन चिकित्सक  डा.उल्फार्ड स्टार्क भन्दै थिए, 'मसँग यो ठाउँमा टेलिभिजन छैन, रेडियो छैन । राम्रो रेस्टुराँ र बजार छैन । तर त्योभन्दा आनन्द आउने मान्छे छन् जोसँग कुरा गर्दा समय बितेको थाहै हुन्न ।' यी ६८ वर्षे डाक्टर पहिलोपटक सन् १९९० मा नेपाल आएका रहेछन्, हिमाली पदयात्रु बनेर । त्यसपछि थुप्रैपटक धनकुटा, खुम्बु क्षेत्र, डोल्पा, मुस्ताङ, सिमिकोटतिर ट्रेकिङमा पुगेका रहेछन् । जर्मनीको उरारबर्गस्थित अस्पतालमा हाडजोर्नी विशेषज्ञका रूपमा २१ वर्षसम्म कार्यरत रहेपछि युरोपमा देखिएको 'व्यापारिक शैली र दबाबमा काम गर्नुपर्ने स्थिति' का कारण विरक्तिएर उनले स्वैच्छिक अवकाश लिए ।

नेपालमा आएर पहिलोपटक काठमाडौं मोडेल अस्पतालमा छ महिनासम्म काम गरेका उनी ओठतालु चिरिएकाबारेको शिविर चलाउन चिकित्सक श्याम राईसँगै आमपीपल आइपुगे । 'यहाँको अस्पतालमा डाक्टरको अभाव हुने गरेका कारण सामान्य नेपालीले खेपिरहेको स्वास्थ्य समस्यालाई चाहेर पनि भुल्न सकिने स्थिति थिएन,' युरोपमै घरपरिवार छाडेर आएका स्वयंसेवी डा. स्टार्क मिसमास नेपालीमा भनिरहेका थिए, 'त्यही भएर म यतै बस्न थालें ।' जर्मनीको भाल्भोक सहरमा श्रीमती, छोरा, तीन छोरी र ५ नातिनातिनाको उनको परिवार बस्दै आएको छ ।

अस्पतालका प्रशासकीय अधिकृत बाबुराम गिरीका अनुसार गोरखाबाहेक धादिङ, लमजुङ र चितवन जिल्लाबाट पनि आमपीपल अस्पतालमा उपचार गर्न आउने थुप्रै सेवाग्राही छन् । सरकारी कोटामा दुइ चिकित्सक रहनुपर्ने अस्पतालमा एउटै दरबन्दी पूर्ति हुन नसकेको पनि वषौं भयो । डा.स्टार्कले बिहान आठ बजेदेखि बेलुका बिरामीको चाप होइन्जेल औसतमा ८० जना बिरामीको दिनहुँ परीक्षण/उपचार गर्ने गरेका छन् । आफ्नो बुढ्यौलीसँगै घरपरिवारलाई पनि समय दिनुपर्ने भएकाले डाक्टर स्टार्क केही महिनाभित्रमा ढुक्कै आफ्नो देश र्फकने भएका रहेछन् । 'अहिलेदेखि नै हामीमा चिन्ता सुरु भइसकेको छ, यति सहृदयी र सहयोगी अर्को डाक्टर अब भेट्न मुस्किल छ,' गिरीले भने ।

डाक्टर स्टार्कको बुझाइमा बितेको एक दशकमा नेपाली समाज र परिदृष्यमा धेरै परिवर्तन आएको भए पनि परिवर्तनको प्रभाव गाउँघरसम्म भने पुग्न पाएको छैन । सहर फेरिएका छन्, ती सुविधायुक्त बनेका छन् । तर अधिकांश गाउँघरमा त्यत्ति धेरै परिवर्तन देख्न सकिन्न । 'यो दुर्ग्ाममा आएर बस्न, काम गर्न कसैले पनि चाहँदैन,' उनी भन्दै थिए, 'अझ अधिकांश नेपाली डाक्टरहरू त केवल तीन कुराका पछि लागेका छन्,   पैसा, पैसा र पैसा ।' नेपालको स्वास्थ्य क्षेत्रको ठूलो समस्याका रूपमा उनले 'डाक्टर' लाई नै देखेका छन् । सधैं पैसाका पछि लाग्ने र राम्रोसँग सेवासमेत नदिने स्वभाव धेरैसँग छ । 'अर्को कुरा उत्तिकै खतरनाक छ, मेडिकल पसलमा बस्नेहरूले नचाहिँदो औषधि बेच्ने गरेका छन्, गलत औषधि बेच्ने गरेका छन् । यो बिरामीका लागि अत्यन्तै खतरनाक हुनसक्छ,' उनी भन्दै थिए । 

यसैगरी, गाउँघरमा सुधारिएको चुल्हो नहुँदा धूवाँका कारण दम र फोक्सोको समस्याबाट पीडित बन्नेहरू पनि उत्तिकै रहने गरेको उनको बुझाइ छ । बच्चामा हुने निमोनिया, महिलामा पाठेघर झर्ने समस्या र मुटुरोगलाई पनि डाक्टर स्टार्कले नेपालीमाझ रहेको प्रमुख स्वास्थ्य समस्याका रूपमा लिएका रहेछन् । उनको बुझाइमा एमबीबीएस वा एमडी गरेपछि पनि दुई वर्षसम्म सम्बन्धित अस्पताल वा सेवा केन्द्रमा काममा नपठाई कसैलाई पनि पढाइको डिग्री वा

सर्टिफिकेट दिनुहुन्न । अर्कातिर अनुभवहीन डाक्टरलाई दुर्गममा सीधै पठाउनु नहुने सुझावसमेत उनी दिन्छन् ।

डा. स्टार्कले हालै एउटा अंग्रेजी पत्रिकामा सरकारका स्वास्थ्यमन्त्री वीर अस्पताल भ्रमणमा गएको समाचार पढेका रहेछन् । तर एक घन्टासम्म अस्पतालमा पर्खंदा पनि कुनै डाक्टर नआएको स्थिति पनि समाचारमा रहेछ । 'यस्तो कसरी हुन्छ ? मेरो देशमा यस्तो स्थिति आयो भने कुनै छलफल र कुराकानी नगरी तुरुन्त त्यस्तो डाक्टरलाई निष्कासन गरिने नियम छ । फेरि सरकारी तहमा काम गर्ने डाक्टरले बाहिर निजी क्लिनिक पनि राख्न पाउँदैन,' उनी भन्दै थिए, 'यस्ता अभ्यास नेपालमा सुरु हुन जरुरी छ ।'

डा. स्टार्क दिनभरको अस्पताल-कर्मपछि साँझमा आमपीपल बजारका सानातिना पसलमा भेटिन्छन् । अनि थोरै कोदाको रक्सी पिउँछन् ।

मलाई मीठो लाग्छ, यस्तो नरम रक्सी मेरो देशमा पाइँदैन,' उनी रसिक बनेर भन्दै थिए । तर यत्तिका वर्ष नेपालका गाउँठाउँमा बिताएर अब घर फिरेपछि दिन कसरी बित्ने हो, उनी सबै कार्ययोजना सहजै भन्न सकिरहेका थिएनन् । 'सायद जर्मनी गएर म जर्मन-नेपाली शब्दकोश बनाउने र आमपीपल बसाइको मेरो समयको किताब लेख्ने काम गर्छुं होला,' बौद्धमार्गी डा. स्टार्कले भने, 'अनि मेरो धर्मअनुसार ध्यान र साधनामा अरू समय बिताउनेछु होला ।'

   Jantarei, it is very easy to blame someone else. Here is the question for you. Do you have anyone in your immediate family who wants to or is serving in the remote villages of Nepal as a doctor? Why did you not choose to become a doctor? It's not impossible. Being a doctor is a profession, however noble it may be so how can you isolate the monetary factor out of it. People just do not become a doctor just to serve people. They have families. Their families have wishes just like any others and money plays a huge role in fulfilling those wishes. My suggestion is: Don't expect too much from anybody.
   Are you sure all the doctors make the same kind of money everywhere in Nepal? Having a clinic in dense population centers would bring in more patients hence more money. More popularity as well. Hence the fascination of doctors to stick to cities. Furthermore, you can not rule that no nepali doctors serve in remote villages. There are a few doctors who have been serving in remote areas for a while and they love it.
   If this analogy helps - here in the US, doctors serve people, soldiers serve the country. But in the society, the respect for doctors far more outweighs that for soldiers. It is because doctors make whole lotta money but soldiers don't make shit in comparison. They say they support the troops. But the support doesn't have any legs because there aint no money.

 I don't have anyone in my family working as a physician, yet. But, one of my siblings is making arrangements to go back home and settle in far western region after his PhD. Not that he won't get a good paying job here in the sates, but he wants to go home and do whatever he can there. 
As for me, I don't have any intentions to stay in the states either. I want to go home after I complete my MD or PhD (trying to get into MD programs but it's hard since international students are not trusted with $200k+ of loans, if that doesn't work out, PhD is there for me) and work back home. Hope that answers your questions. 

You are focussing too much on the money, seems like you are one of those docs who runs clinic to clinic on a bike, or has someone in your family who does that or something similar. However, I agree that you can't isolate money from a medical profession, but when you become a doctor, that's not the only priority. Having a clinic in dense population centers would bring in more patients hence more money. If you think of it the other way, there are people in villages who are literally waiting for doctors to come and treat them. Why not earn money in remote places where nobody bothers to go? They are all your customers!

Talking about families, a person loses his 3 kids because they don't get timely treatment for pneumonia. Women die during labor because there are no doctors or nurses to deliver babies in remote health posts and hospitals. Are you and your capitalist thinking going to take care of their families? You see a doctors kid crying for a tricycle but you don't see a kid dying of diarrhea in Humla and Jumla, do you? 

Thank goodness there are still a handful of people like this German doc. 

   I wish I were a doctor. Let's not get personal because I am not blaming you. I was not blaming nepali doctors either. But I thought you were. So I just wanted to ask you some questions. We dont have to be aggravated to discuss this kind of situation. We can be civil and still make our point. Moreover, its highly commendable that you wish to return home and serve the country. There is no greater honor than serving your own people. Would it be possible for you to send me an email when you are serving in the remote villages of our country? And again, I am not questioning your credibility here. Just a request. 
  My understanding of your comment was - money should not be a priority for doctors. And my question was - Why not? They are humans too. Plus it is customary you have to go big if you wish to make it big. Since you responded with - Money should not be the only priority - then I got my answer. It is still one of the priorites. It should not be the only priority. Of course not. Not with any profession. More so in a profession as such.  Well there are Nepalese doctors like Stark as well. I know one myself. You may be one of them later. So let's not denigrate all Nepali doctors. 
  On a second note, if we are to offer healthcare coverage in Nepal through providers. We should have a system where we pay cash/credit at the hospital and get reimbursed by the provider/insurer. That way, I opine healthcare cost wouldn't be inflated like it is done here.

There is no greater honor than serving your own people. Would it be possible for you to send me an email when you are serving in the remote villages of our country? And again, I am not questioning your credibility here. Just a request. 
- Your own people? well, i see where you come from. Let's not talk about that, i'm not looking for a fight here. And i understand why you are asking for an email, simply because you think I'm just making up a story. You don't have to say no. I know it's hard to believe that a person would go back to Nepal while he can earn $100k+ a year with an ease. Btw, you shouldn't be asking for an email if you didn't question my credibility.

Plus it is customary you have to go big if you wish to make it big.
- why become a doctor then? you can earn bigger by doing other stuffs like running a pharmaceutical company. I'm talking about doctors using medical proffession for the  sake of money and nothing more than that. and that's what needs to be changed.

Well there are Nepalese doctors like Stark as well. I know one myself. You may be one of them later. So let's not denigrate all Nepali doctors. 
- Thank goodness there are still a handful of people like this German doc. 

 Jantarei, would it be a problem for you to hit me an email? If you don't I will assume that you were just too busy. No biggie. I doubt any chump running a pharmaceutical company in Nepal is more famous than Upendra Devkota. And surely, he is not in Jajarkot. And I did not understand why you highlighted 'your own people'  as if it was derogatory.

EastSidaz and Jantarei,

You both bring very important points of view to the table. Thank you.

I agree with both of you that we need to provide enough incentive to these doctors so that they feel inspired to go to these rural places.

I think you both agree that Nepal's health care could use improvement. You both agree that the rural sector is neglected in terms of health care.

I think where you both disagree is how best to inspire doctors to volunteer their services in rural areas.

We have different options to inspire doctors to go to rural areas:
1) Praise them
2) Pay them
3) Shame them
4)  Respect them
5) Appeal to their sense of humanity
6) Appeal to their conscience

Which of the above options or combinations of options do you feel we could use? How could we do all the above? What are the methods we could use?

Maybe we should study case studies of the doctors who have gone to rural areas and interview them and see what it is that inspired them to go to these areas?

I agree with both of you that we need to provide enough incentive to these doctors so that they feel inspired to go to these places.

Any suggestions of all the different ways we could inspire the next generation of doctors, health specialists, nurses, etc to go to rural areas?

 east: i highlighted those words because the way you wrote them, it sounded like you don't give a damn about Nepal and people back home or never gave a damn in your life. that's all.

budmash: one way is to increase pay of doctors working in rural areas. just give them a bit better pay than those in the cities get. that's one thing to lure docs to the villages because i don't think anyone (sparing the few who do) would go to villages since they don't get amenities of the cities. next thing is there should be a rule that will make a medical student serve at least a year or two in a remote area as a part of their residency. that will not only provide training to the medical student, but also provide service to people. for people who get degrees from countries besides nepal, government should make a rule that they will get licence to practice private medicine in Nepal only after serving a year or two in remote areas.
but the problem is nobody wants to do it besides the few who choose to do so. and there is chance that rules like such will discourage medical students and they'll move abroad. doctor is no longer a lifesaver, he/she is a businessman. as long as docs don't see the how much their 1 or 2 years of sacrifice (can hardly call it a sacrifice since they are getting paid) benefits rural people, healthcare is going to remain $hitty, just like politics.

Jantarei,

I hear your frustration. Your ideas are good ones. Don't give up. Nepal needs the passion of people like you. It is through feeling the frustration and outrage of youth like you that America created an organization like the one you are suggesting called Americorps:
http://en.wikipedia.org/wiki/AmeriCorps

Jantarie, I agree with you about creating rules based on National emergency. Healthcare in Nepal is a national emergency and shame on all of us Nepalese for not seeing it as such. I feel that you see Nepal's healthcare problem quite clearly.

No one asks for a national emergency. But when there is one, it should be a crime for people to ignore it. Certainly, the nation of Israel was faced by a national emergency because of the threat that it faces from the Arab nations that surround it. They needed to take concrete action against this.
So what did the Israeli government do? They took positive steps to ensure that Israel would always have a strong military by making a rule that all Jews in Israel need to serve in the army. They made it  Mandatory for everyone over the age of 18 to serve in the Israeli army.

Nepal's healthcare system is in such a poor state that we have a national emergency. Who can deny this? It is mandatory for all Nepalese to address healthcare reform in Nepal.

Here is how everyone in Israel is forced to accept the nation's security problem as their personal problem:
http://en.wikipedia.org/wiki/Conscription_in_Israel

I really like your idea: We need to force everyone in Nepal to accept Nepal's health problems as their personal problem.

How do we do this?

Stories like this are making it more and more clear to me of where the root of Nepal's problem's lie.
http://sajha.com/sajha/html/index.cfm?threadid=94984

Look at how the ANA governs itself:
http://sajha.com/sajha/html/index.cfm?threadid=94986#846928

We need to talk about where the solution of improving the Healthcare System for Nepal needs to begin.

There was a time when in the early 1990's that I was convinced without doubt that the solution to Nepal's problems would come from Kathmandu. I think much of Nepal believed this. But the Maoist insurgency, as much as it was a flop, showed the nation that not all solutions to Nepal need to come, or will come, from Kathmandu. If the Maoists, despite their faults, proved one point, it is this: that the solution to Nepal's problem can come from anywhere: villagers, peasant women and children. Despite all the hurt, disillusionment and carnage left behind by the Maoists, this lesson is clear: that any one person can bring change within Nepal. Any one can bring together resources to bring about change.
As time has gone on, the more and more we are seeing that Kathmandu is not the solution to Nepal's problem. In fact, we might need to accept that Kathmandu's culture might be the root of Nepal's problem.

From time to time we've been tempted to believe that society has become too complex to be managed by self-rule, that government by an elite group is superior to government for, by, and of the people. Well, if no one among us is capable of governing himself, then who among us has the capacity to govern someone else? All of us together, in and out of government, must bear the burden.

I feel that it is from here that the solution of improving the Healthcare System of Nepal can begin.

 I agree that people acting violently towards doctors when a patient dies is wrong. But, is it ethical for doctors to shut down the whole hospital? The news below says that this time doctors beatt/cut the patient's relatives. Does anyone know if there's a law that says that doctors will not be held responsible in case a patient dies during treatment?

 

 

पोखरा, पुस ११ - अस्पतालमा असुरक्षा भएको भन्दै विरोधमा उत्रिएका चिकित्सकले सोमबार पनि मणिपाल शिक्षण अस्पतालका सवै सेवा ठप्प पारेका छन् ।

शनिवार बिरामीको मृत्युपछि कुरुवामाथि कुटपीटमा उत्रिएका चिकित्सकहरुले आफूहरु असुरक्षित भएको भन्दै आइतबारदेखि सवै सेवा ठप्प पारेका हुन ।

बिभिन्न अस्पतालवाट रिफर विरामी आउने अस्पतालमा दुई दिनदेखि सवै सेवा ठप्प हुँदा विरामीहरु मर्कामा परेका छन् । चिकित्सक र स्वास्थ्यकर्मीहरु सुरक्षाको ग्यारेण्टी हुनुपर्ने, अस्पतालमा चिकित्सक र सुरक्षाकर्मी जनशक्ति वढाईनुपर्ने लगायतका माग राखेर काम नगरी वसेका छन । चिकित्सकहरुले आफ्ना माग पुरा नभएसमम काममा नर्फकने अडान लिएका छन् । अस्पतालमा विहान आठ वजेदेखि नै ओपिडका विरामीको लागि टिकट बिक्री वितरण गरिने भएपनि सोमबार विहानदेखि गरिएको छैन ।

अस्पतालका डाईरेक्टर पिके चक्रवर्तीले चिकित्सकहरुले सुरक्षासहित विभिन्न माग राखेर विरोधमा उत्रिएका कारण सेवा बन्द भएको बताए । 'अहिलेसम्म अस्पताल बन्द छ' उनले भने 'वार्तावाट समस्या समाधान गर्ने पहल गरिरहेका छौं ।' उनले चिकित्सकका सवै माग अस्पताल प्रशासनले तत्काल पुरा गर्न नसक्ने जानकारी दिए ।

विरोधमा उत्रिएका चिकित्सकहरुले अस्पतालको ईमजेन्सीमा थप जनशक्ति वढाउनुपर्ने, भौत्तिक पूर्वाधार र सामाग्री थप गर्नुपर्ने, सुरक्षाका लागि सुरक्षाकर्मी खटाउनुपर्ने लगायतका माग राखेका छन ।

कास्की पुम्दिभूम्दि ४ का ४८ बर्षीय रुद्रनाथ वरालको शनिवार विहान उपचारको क्रममा मृत्युभएपछि उत्पन्न विवादमा चिकित्सकहरुले समूहले मृतकका छोरा अर्जुनसंगै प्रसन्न पौडेल, विजय पौडेल, राजेन्द्र अधिकारीलाई धारिलो हतियार प्रयोग गरी हातपात गर्नुका साथै कुटपीट गरेका थिए । मृतकका आफन्तलाई सुरक्षा दिन लाग्दा चिकित्सकहरु आक्रामक शैलीमा नारावाजी गर्दै प्रहरीमाथि खनिएका थिए ।

अस्पतालको ईमजेन्सीमा दैनिक करिव ५० र वहिरंग विभागमा ३ सय जति विरामी परीक्षणका लागि आउने अस्पतालले जनाएको छ । 

Jantare, you are right.

Because the state of healthcare system in both countries is in such a different condition, what Nepalese need to be healthy and what Americans need to be healthy are almost opposite things.

In talking about healthcare, we sometimes forget that America is a very rich nation in comparison to Nepal. So in that way, America has many different kinds of problems from Nepal. America's health care problem is that their children are too fat from eating too much. Obesity is such a big problem in America that they talk about it in terms of an epidemic.
http://www.obesityinamerica.org/

Nepal has the opposite problem. Our problem is a lack of nutrition. Lack of nutrition and clean water is a problem of epidemic proportions.

So while talking about health, America and Nepal have opposite problems. In many ways, we talk about "health care" like there is a generic solution for both countries. But it is not.

So we almost need to redefine the health problem in terms of both countries. We cannot just look for one generic solution that would fit both countries.

For Americans to be healthy means to eat less fatty, unhealthy food. It means for them to exercise more.

For Nepalese to be healthy means having strong shelters, nutrious food, clean environment, strong relationships, positive work environment, supportive communities.

Do you agree?

I agree. Nepal needs to take a broad approach to health:
http://en.wikipedia.org/wiki/Medical_anthropology

I found a paper specifically related to this subject in relation to Nepal's healthcare system:
http://www.dspace.cam.ac.uk/retrieve/533457/OPSA_07_01.pdf

Hi
I'm not a doctor either, but I want to support those doctors who are out in the remote districts. I just came back from Pyuthan and saw the good work that the doctors at the district hospital there are trying to do. Unfortunately there are not enough doctors like them, who are willing even if not for ever, to work with commitment in the ryural areas. And of course, there are also some very dedicated people who are devotong their lives to working in these places. 

I think Budmash makes some very interesting points.

Irun Rural Assistance Nepal (RAN),(www.rannepal.org) a UK registered charity that employs some teachers and midwives and brings medical and teaching volunteers to help in the remote areas. I'm working with Dr Mrigendra Pandey and other doctors to set up a network for doctors in remote areas. It's stillin early stages, but any doctorsworking out in the regions who might be interested, please feel feel to contact me (my contact details are on the charity's website).