Of sound heartbeats and clear vision

KATHMANDU, Aug 18 : In the fields of eye and heart care, the services provided by governmental institutions in Nepal in the past 10 years have developed tremendously, and the number of patients going abroad for medical care has been minimised considerably.

"In the past several years, many patients who could afford to travel to India or Bangkok for their operations have been keen to have themselves treated here in the governmental hospitals," said Dr Damodar Pokharel, Chief Cardiac Surgeon at Bir Hospital.

The Cardiac, Thoracic and Vascular Surgery Division at Bir Hospital is just one of those sectors where many Nepalese now find the services competent with international standards. "This is because the government institutions are providing quality service to the people," added Dr Pokharel. Only recently, 45-year-old Pampha Subba of Jhapa had the tumour in her lungs removed at Bir Hospital. Subba, who went for a check-up in Silguri, India, was not cured.

"They just gave me medicines," she said. After coming back from Silguri, she continued to grow thin and weak. "Then, from recommendations of friends, I went to Dharan where I was referred to Bir Hospital." According to Dr Pokharel, a 10 percent of the total patients visiting Bir Hospital have some kind of heart problems, and around 25 percent Indians in the category use its cardiac facilities each year.

Similarly, the Shahid Gangalal Heart Centre, the only one of its kind in Nepal, established only two years ago, is being known widely as an address for quality and affordable services ranging from major heart surgeries to outpatient care and consultation. In the past year, it conducted over 400 surgeries.

More importantly, both the above healthcare institutions are run and managed by the government. "The cost of heart care in Nepal is much cheaper than, say, in India," said Dr Deepak Koushal, chief cardiologist at the private sector B&B Hospital.

"There are two notable surgeons in Nepal, namely Dr Bhagwan Koirala of Gangalal and Dr Damodar Pokharel who are doing excellent works for the Nepali people." Dr Koushal added that it was necessary to encourage these surgeons in continuously providing quality services to the people.

According to Dr Koushal, a heart bypass costs around 250,000 Indian rupees in an Indian private hospital whereas it costs around 250,000 Nepali rupees in a Nepali private hospital and only 110,000 in a government hospital.

Similarly, in the field of eye care, the Tilganga Eye Centre takes the lead. Not only does the centre provide quality eye care services, but it also manufactures intra-ocular lenses - used in cataract surgery - for use in Nepal as well as for export.

In the last year alone, of the 5,000 cataract surgical operations carried out at Tilganga in Kathmandu, only 1,600 were Nepali patients and the rest were Indians. "More Indians than Nepalese benefit from our services in the Nepal-India border areas," said Dr Sandruk Ruit, Medical Director, Tilganga. In the past 15 years, Tilganga and other eye hospitals in Nepal have been able to discourage patients from going abroad because of the same facilities available here, and at much cheaper rates and devoid of hassles involved in going to foreign countries.

"I first had my eyes checked in Delhi where I was given drops," Mohammand Sherajul, from Motihari, India said. At a time when his eyes were failing to improve, he happened to hear about Tilganga from a friend. Recently, he underwent a cataract surgery and is satisfied with the treatment he received at Tilganga.

"We promote the use of intra-ocular lenses manufactured in Nepal as they are of high quality and relatively cheaper," said Dr Rajesh Kishore Shrestha, an eye surgeon at Om Hospital and Research Centre.

But there is still a long way to go. "Until we can attract all the paying patients in the captive market, we’ll not be able to provide quality services to the poor," says Dr Ruit.

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Safe sex awareness in urban sex markets

KATHMANDU, Aug 11 : Studies amongst female sex workers (FSWs) – nationally identified as a vulnerable group susceptible to HIV/AIDS – show that 39.5 percent of them use condoms consistently. The research conducted by New Era, an organisation which has been studying FSWs in Nepal for the past several years, concludes that while knowledge of HIV/AIDS is high, consistent condom use with clients and other partners is comparatively low.

Thus, there is still a long way to go. However, while it is easy for organisations working in promoting safe sex amongst FSWs and teach them about condom use, it is yet another story when it comes to the implementation part. "It is hard to convince men to use condoms," said Sheetal Uprety who works in Kathmandu. "Although they know how to use them, they find it more ‘enjoyable’ to have sex without protection."

She adds that sometimes it is the older men who tend to increase the paying rates for having sex without protection. "Men who are already married and often those who know about condom use are the very ones who do not like to use them and instead pay higher prices, often twice as much," she said.

But in the case of unmarried youth in the age group of 16-26 years, most do not carry condoms but tend to practise safe sex. "Teenagers don’t have condoms with them as they find it odd to buy them in the local stores," said Roshni Tuladhar, a sex worker in Kathmandu. She adds that more than 80 percent of the time clients come without condoms. "We need to provide them ourselves."

But what FSWs say is that when it comes to safety, it is the women who should be able to stand up for their rights. "I think it is necessary for women to be assertive and think about their health when it comes to practising safe sex," she explains. "If we are strict about our health, then only will we be able to survive."

"At first, most men do not want to use condom and look at it as a nuisance," added Uprety. "But, you need to coax them by saying it is for their own safety and for the wellbeing of their family. Eventually, they will use it."

Another technique that a lot of women say comes in handy is the fear factor. "Sometimes you have to scare them by telling them that they will get AIDS and die if they do not use condoms," says Geeta Paudyal who practices her profession in Kathmandu.

"I have even sometimes told them that I have STD and if they don’t want to catch it, they should wear a condom," she added. "It is actually not hard to convince men. You just need to know how to do it."

Just practising safe sex will go a long way in the prevention of HIV/AIDS amongst both FSWs and the population. Using condoms is not only the best prophylactic prevention against HIV/AIDs or other diseases, but is an effective contraceptive as well.

"Women are becoming more empowered than a few years ago and now stand up for their rights more assertively when it comes to the protection of their own health," said Bharat Raut of GWP, an organisation working with female sex workers for the past 10 years. "But one can only do so much," he adds. "It is up to the women to think about their personal health."

(The names of the sex workers have been changed for obvious reasons)

Morality clashes with safety: Should a woman carry condoms?

KATHMANDU, August 1 : Unlike even a decade ago, Nepal’s youth are no longer shy when it comes to pre-marital sex. A 1999 survey by Valley Research Group showed that one in every four adolescent admitted to having their first sexual experience at age 16.

While education and growing encroachment of pop culture riding on the back of satellite television and films have contributed to changing sexual mores, teens and the young are also becoming more aware of sexually transmitted diseases. This awareness is slowly being translated into safer sex practices, such as using condoms.

A result of this awareness is that, more and more young people are now carrying condoms in their pockets or purses. Among them are a growing number of young women who often carry condoms in case their partner forgets.

An example is Sushma Chhettri. The 22 year old who is in a stable relationship often tucks away a few condoms in her purse, just in case. "I find it more convenient than relying on my partner. Sometimes he forgets, so it’s better if I have a spare."

Chhettri adds that most of her friends carry their own prophylactics too. "With the threat of diseases like HIV/AIDS, couples are thinking ‘safe sex’ and the condom is considered as one of the best prevention of this disease."

The uninitiated may call the likes of Chhettri and her friends as women with loose morals, but experts say it is indeed an encouraging trend that many young women are choosing to take control of their own lives, especially their sexual rights. And in the process, they are protecting not just their lives but also of their partners. But such women are still tiny in numbers, thanks to a rigid and heavily patriarchal society.

Sociologists who are only now beginning to notice the trend say, a deeply conservative society such as Nepal’s will not support such behaviour without some radical change in social mores.
"It is a positive sign," concedes sociologist Dr Krishna Bhattachan of Tribhuvan University, referring to women carrying condoms. "But until there is a behavioural change, the society will not support this…In Nepal, when a girl is found to carry a condom, her parents, relatives or friends can place pressure on her and inflict mental torture."

Dr Bhattachan added that it was necessary for campaigns to address these issues. "Just promotion of condoms will not solve the problem. Other aspects need to follow side by side." He argues for education of women, more career opportunities and ensuring a secure environment.

Just how difficult it is for women is illustrated by this true account: A few weeks ago, Sita Adhikary (name changed on request) was travelling on a bus to Jawalakhel. When she opened her purse to get some money to pay the conductor, a few packets of condoms fell out from her bag. Two people sitting behind her began harassing her. "They asked me why I was carrying so many condoms," says Adhikary. "I told them it was for myself."

Incidentally, one person was a policeman. "He spoke to me in harsh tones and embarrassed me in front of everyone," she adds. "Even a lady sitting nearby joined in by calling me a bhalu (prostitute)."Incidences such as this show just how difficult it is for young women to carry condoms. "Why can’t they think that it is actually a good thing that women carry condoms instead of looking at it in a bad sense," questions Adhikary. "After all we are conscious of safe sex and we want our families to be healthy as well."

What often happens is that, when women carry condoms they are thought to be in the sex trade, and treated accordingly. The harassment towards women has made the jobs of organisations working for safe sex through condom promotion hard.

"Some women do not want to use condoms for fear of harassment from the police and other people," says Bharat Raut of General Welfare Pratishthan, an NGO working in the field of HIV/AIDS prevention. However, Kuber Rana, Superintendent of Police based at Hanuman Dhoka denied any incidences of harassment. "Maybe during checking at night the police do harass the women but there have been no reports," he said.