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NepalHealth-Care Facilities
The health-care delivery network in Nepal was poorly
developed.
Health-care practices in the country could be classified
into three
major categories: popular folk medical care, which relied
on a
jhankri (medicine man or shaman); Ayurvedic
treatment; and
allopathic (modern) medicine. These practices were not
necessarily
exclusive; most people used all three, depending on the
type of
illness and the availability of services, sometimes even
simultaneously.
Popular folk medicine derived from a large body of
commonly
held assumptions about magical and supernatural causes of
illness.
Sickness and death often were attributed to ghosts,
demons, and
evil spirits, or they were thought to result from the evil
eye,
planetary influences, or the displeasures of ancestors.
Many
precautions against these dangers were taken, including
the wearing
of charms or certain ornaments, the avoidance of certain
foods and
sights, and the propitiation of ghosts and gods with
sacrificial
gifts. When illness struck or an epidemic threatened,
people went
to see a jhankri for treatment. Such pseudomedical
practices
were ubiquitous; in many parts of Nepal, a jhankri
was the
only source of medical care available. Nepalese also
regularly saw
jotishi (Brahman astrologers) for counseling
because they
believed in planetary influence on their lives, resulting
from
disalignments of certain planetary signs. Jotishi
were
commonly relied on even in urban areas, and even by those
who were
well educated and frequently used modern medicine. And,
virtually
no arranged marital union was proposed and concluded
without first
consulting a jotishi.
The Ayurvedic system of medicine was believed to have
evolved
among the Hindus about 2,000 years ago. It originally was
based on
the Ayur-Veda (the Veda of Long Life), but a vast
literature
since has accumulated around this original text. According
to the
Ayurvedic theory, the body, like the universe, consists of
three
forces--phlegm, bile, and wind--and physical and spiritual
wellbeing rests on maintaining the proper balance among these
three
internal forces. A harmonious existence between body and
mind
results. Ayurvedic pharmacopoeia--based on medicinal
plants, plant
roots, and herbs--remained a major source of medical
treatment in
Nepal. This school of medical practice also applies the
hot-and-
cold concept of foods and diets. In the late 1980s, there
were
nearly 280 practicing Ayurvedic physicians, popularly
known as
vaidhya, 145 Ayurvedic dispensaries, and a national
college
of Ayurvedic medicine in Kathmandu.
In 1991 the most commonly used form of medical
treatment,
especially for major health problems, was modern medicine
whenever
and wherever accessible. Within the domain of modern
medicine,
providing public health-care facilities was largely the
responsibility of the government. Private facilities also
existed
in various regions. Modern medical service generally was
provided
by trained doctors, paramedics, nurses, and other
community health
workers. The government-operated health-care delivery
system
consisted of hospitals and health centers, including
health posts
in rural areas.
Hospitals were located mostly in urban areas and
provided a
much wider range of medical services than health centers.
They were
attended by doctors, as well as by nurses, and equipped
with basic
laboratory facilities. Small health centers and posts in
rural
areas--most of them staffed by paramedical personnel,
health aides,
and other minimally trained community health
workers--served the
needs of the scattered population. Even though these rural
facilities were more accessible than urban hospitals, they
generally failed to provide necessary services on a
regular and
consistent basis. The majority of them were barely
functional
because of such problems as inadequate funding; lack of
trained
staff; absenteeism; and chronic shortages of equipment,
medicines,
and vaccines.
Nepal had a total of 123 hospitals, eighteen health
centers,
and 816 health posts in 1990. There was one hospital bed
for every
4,283 persons, an improvement since 1977, when there was
one
hospital bed for every 6,489 persons. The number of
doctors totaled
879 in 1988, or one physician available for about 20,000
people.
For the same period, other medical personnel included 601
nurses,
2,062 assistant nurses and midwives, 2,790 senior and
assistant
auxiliary health workers and health assistants, and 6,808
villagebased health workers.
There was no doubt in the late 1980s that considerable
progress
had been made in health care, but the available facilities
were
still inadequate to meet the growing medical needs of the
population. The majority of people lacked easy access to
modern
medical centers, partly because of the absence of such
facilities
in nearby locations and partly because of the physical
barrier
posed by the country's rugged terrain. Because there were
very few
modern means of transportation in rural areas,
particularly in the
hills and mountains, people had to walk on average about
half a day
to get to health posts. Such a long walk was not only
difficult
(especially when the patient needed medical attention),
but also
meant economic hardship for the majority who rarely could
afford to
be absent for the whole day from their daily work. As a
result,
many minor illnesses went untreated, and some of them
later
developed into major illnesses.
In the early 1990s, Nepal's geographical limitations
continued
to play a large part in the country's social and economic
problems.
Moreover, despite twenty-five years of family planning
programs,
the population growth rate continued to outpace
agricultural
production and parts of the country continued to be food
deficit
areas. The educational base was also limited; only
one-third of the
population was literate. The generally poor health of the
population and a lack of adequate health-care facilities
also
hindered social and economic improvements.
* * *
A good source of information on cultural and physical
geography, although outdated, is Pradyumna P. Karan's
Nepal: A
Cultural and Physical Geography. Barry C. Bishop's
Karnali
under Stress not only provides a good geographic and
climatic
description of Nepal, but also covers ethnic history and
analyzes
the economic strategies practiced by the mountain and hill
peoples.
Although Bishop's surveys were conducted in the Karnali
region,
they apply to the entire upland region--hills and
mountains--of
Nepal. Jack D. Ives's and Bruno Messerli's The
Himalayan
Dilemma is another good source of physical geographic
information on Nepal; sections concerning environmental
degradation
are particularly useful.
The Population Monograph of Nepal, prepared by
the
National Planning Commission, is a good source of
statistics on
demographic, social, and economic issues. Another
publication by
the commission, The Statistical Year Book of Nepal,
1989,
supplies fairly extensive and up-to-date data on various
social and
economic variables and indicators. Pitamber Sharma's
Urbanization in Nepal uses census data from 1952 to
1981 to
examine the various aspects of urbanization.
Badri Prasad Shrestha's An Introduction to Nepalese
Economy is somewhat outdated, but has good background
material
on the contemporary economic situation. Mahesh Chandra
Regmi's
An Economic History of Nepal, 1846-1901 is an
excellent
historical treatment of the economy, and his
Landownership in
Nepal is a classic study of land tenure. Nanda R.
Shrestha's
Landlessness and Migration in Nepal and Vidya Bir
Singh
Kansakar's Effectiveness of Planned Resettlement
Programme in
Nepal supply detailed analyses of internal migration
and land
resettlement in the Tarai. (For further information and
complete
citations,
see
Bibliography.)
Data as of September 1991
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