Janamaitri Hospital: A Model for Healthcare in a Future New Nepal

Intensive care in Janamaitri Hospital, photo credit: Eric Ribellarsi

From Winter Has Its End

The following is a report about the radical model hospital, Janamaitri. Janamaitri is a model of a new socialist healthcare system in Nepal, and what could become possible throughout the country if the old exploiters and oppressors are overthrown.

By Eric Ribellarsi

Janamaitri Hospital has a way of catching ones attention. It stands as a six-story tall glass building, one of the nicest looking buildings in all of Kathmandu. This is the second time I have visited this hospital.

When I stepped into a clean marble entry-way last year, and explained I was a journalist to the reception, I could tell the receptionist had mixed emotions. Clearly, there was excitement that journalists wanted to talk about this hospital, but there was also a fear. I would later learn that this sprang from a number of attacks by right-wing press on the hospital, claiming the role that the Maoists had in initiating the hospital was a reason to suppress its ability to get funding.

During my visits, I introduced to Dr. Rabindra Prasad Rajbhandari, the hospital’s Executive Officer, and the Managing Director, Krishna Sharma. Dr. Rajbhandari took a look at a rash I had free of charge. He and two other doctors laughed at me and gave me a hard time when they determined the diagnosis: lots of mosquito bites.

Dr. Rajbhandari shared a great deal of information about the hospital. Janamaitri Hospital is Kathmandu’s first “model hospital” that views itself as the beginning of a new kind of healthcare system in Nepal. It is not associated directly with the Maoist party, but the Maoists were key in initiating it. It is free or cheap for those who cannot afford health-care and for the families of martyrs of the revolution, and bases itself off a completely non-profit model.

Serve the People

Janamaitri Hospital literally translates to “friends of the people hospital.” Unlike other hospitals which are only available to the wealthy, or which are tied to foreign powers, grants, and NGOs, this hospital is based completely on donations and volunteer work by doctors who accept less pay for their work, out of a sense of “serving the people.”

And you can get a sense of how core “serving the people” is to the mission of this hospital. Krishna Sharma gave up his career as an engineer to play a role in this hospital. Before, he used his engineering skills to help the Maoists to construct Martyr’s Road, a major roadway going throughout the country, constructed by volunteer labor of the people who want to be part of constructing a new revolutionary Nepal. Now he is putting his efforts into this hospital.

This hospital contained just over 100 beds last year, but now the number has doubled to 200 as the hospital expands its facilities. Many of the beds are reserved for those who need free health-care. There are many departments including cardiology, neurosurgery, dermatology, urology, gynecology, ICU, pathology, psychiatry, radiology, orthopedics, pediatrics, maternity, general surgery, general practice, and even a cheap pharmacy.

Even though this hospital functioned with less funds and without outside support, it was shocking to see the quality of healthcare. In fact, one person from our group who had previously visited a state hospital was shocked by the cleanliness and extent of healthcare offered by this hospital. In comparison to the unclean, over-extended, poorly lit, outdated state hospital, this hospital seemed new, well-equiped, modern, and actually in people’s interests.

We saw doctors from many different fields dedicating their time to this hospital out of larger political consciousness. Many people were there for treatment from the number one problem of diarrhea (which can be life threatening in countries like Nepal, where people do not have access to clean water). We were also introduced to “two idiots” who were undergoing surgery after hacking each other up in a drunken khukuri fight.

We even saw classes being taught to new nurses and paramedics who couldn’t afford to be formally educated, but which the hospital had decided to train themselves to be able to better serve the people.

Throughout the hallways were young volunteer nurses and doctors, who smiled at us with big toothy grins (but often became shy and tried to hide their faces from the camera). The whole scene seemed to be one of excitement with this new project.

Though they have made many gains at this hospital, much of its achievements and continuing operation have been dependent on loans from the banks to keep it functioning. It is an on-going struggle to make the hospital work. The subsidized and free healthcare for those who cannot afford it has also meant that much higher prices must be charged for the middle and upper classes, which I suspect have sent them to the government and NGO hospitals.

A Healthcare Plan for a New Nepal

Dr. Rajbandari went on to describe some of the problems they are facing, and ways they will face them:

“We don’t have doctors in the remote areas of Nepal. Not only doctors, but not even paramedics. That is why we have to depend on paramedics who bring people to Pokhra or Kathmandu, big cities. We don’t have doctors in Jumla, Rolpa, Rukum, 80% of the country’s land.”

“We want to make this hospital a center for all the satellite hospitals. In ten years time, we are planning to make satellite hospitals in different districts. There are 75 districts in the country, and in most of those districts we are planning satellite hospitals. We are even planning to give the satellite hospitals a form of satellite service. We do video conferences from time to time, we will talk to them from here. We will do telemedicine.

For example, if I’m a doctor and there is a patient in a remote area where there is no doctor, we will have paramedics there. Paramedics are not sufficient to treat many diseases, but they can take the history of the patient and ask the patient questions and obtain all of the findings. They can tell the doctor here in central how is the condition, the findings, everything. The doctor will see him on video, and advise him to take, for example, blood samples, urine, etc. Then I will tell him to take such and such medicine. If it is not possible to treat there, I will say ‘Transfer to a helicopter and transfer to here. We will have to operate immediately.’

Still Orbiting the Sun

I asked Krishna Sharma what he thought of the political debates in the country, and on the line struggle within the Maoist party. He said to me, “whatever happens, our hospital is still like an earth orbiting the sun. Whatever happens in politics directly decides what will happen in this hospital.”

Krishna Sharma told me about how they have been trying to pursue the projects of telemedicine that Dr. Rajbandari described, but the government refuses to give them funding for this project. Their inability to acquire necessary resources has meant that the equipment to conduct telemedicine in remote Nepal has remained impossible.

Some Thoughts

My suspicion is that the future of this project depends upon the victory of the Nepalese revolution, upon a people’s insurrection, and the establishment of revolutionary New Democracy and socialism in Nepal. The consolidation of a bourgeois republic, including bringing the IMF and NGOs to develop Nepal (instead of relying on the people and their initiative), would mean Dr. Rajbhandari’s dreams of healthcare in the countryside of Nepal would become impossible.

One need only look at the fate of China’s barefoot doctors. For the first time in history, the people of China had access to healthcare. Half a million doctors and paramedics, mainly trained in basic medicine, travelled to the countryside to serve the people. Many diseases were wiped out for the first time in the history China.

Today these very diseases which were wiped out have returned. Healthcare is limited to the very wealthy rising Chinese elite. Barefoot doctors and rural healthcare collapsed with the privatization of agriculture. 79% of people in modern China have no access to health insurance.

Different roads are being posed in Nepal, and the question of healthcare in a New Nepal remains to be settled.