I come from a rural background in hilly district of western part of Nepal.
I received primary & secondary level education in my village, where I have
seen both happiness and suffering. I have seen my uncle die young on the way to
hospital 3 days away from our village. I have also seen neighbors die untimely
just because he could not receive timely quality care. It was common to see
people suffering from ailments due to worm infestations, protein energy
malnutrition, diarrhea & vomiting, which were thought to be bad omen as a
result of angry spirits / local deity. So, it was a common practice to rely on
faith healers rather than health professionals. This scenario was of 1980s
& 90s that I remember vividly just like yesterday. During those period, I
was not aware of what all these mean in a rationale mind. I was only a child
with playful innocence as any child, only to be perplexed at a time by
suffering or death of near and dear ones. One moment I still remember, our
grandmother crying when we had to lose our uncle at a tender age. This had a
deep impact on me with some kind of uneasy feeling. Now, I realize what all this
means to lose your near and dear ones including good neighbors and villagers to
preventable & treatable ailments and what possibly went wrong so we had to
lose them. Passing by all this moments in rural environment, I grew up with
various impressions on my subconscious mind. After I completed my high school,
I entered university to pursue intermediate science (I.Sc.) in Kathmandu. I studied
science as a major that included biology, chemistry and physics.
After the completion of I.Sc. I got an opportunity to pursue Bachelor in
Medicine and Surgery (M.B.B.S.) in BPK Institute of Health Sciences (BPKIHS, a centre
for excellence, located in eastern part of Nepal. After completion of MBBS, I
worked for around 2 years in Accident / Emergency and General Outpatient Department
(A/E & GOPD) in the same institute. During this period, I had a privilege
to partly understand diseases that are rampant in low income countries. Here, I
utilized skills to assess and manage variety of medical
including paediatrics problems common in developing countries. Managed
infectious diseases like Malaria, Visceral leishmaniasis, Acute gastroenteritis
including Cholera, Enteric fever, Japanese encephalitis, Dengue fever / Dengue
Hemorrhagic fever, Worm infestation, Protein Energy Malnutrition, Acute / Chronic
viral hepatitis, Measles / Rubella, Vitamin deficiency, Micro- nutrient deficiencies
as well as growing Non –Communicable Diseases (NCD) that require ongoing care
like diabetes, hypertension, chronic lung and renal diseases. This was also a turning point for me. I began to realize
the importance of preventive care at primordial, primary and secondary level. I
felt, we were treating only the negative outcome of poor sanitation and hygiene
rather than the cause of all these ailments. So, I headed to take up a job as a
surveillance medical officer (SMO) working with World Health Organization (WHO)
– Nepal. Our primary task was surveillance of vaccine preventable diseases like
paralytic poliomyelitis, neonatal tetanus, measles / rubella and Japanese
encephalitis. All of these diseases are / were major cause of child hood
morbidity & mortality, while viral encephalitis, which is a major cause of
death and neuro – motor handicap, was creating havoc in Terai belt of Nepal. I
found this period a real time experience, which enabled me to comprehend wider
public health landscape in Nepal.
