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Nepal may have enough doctors but they’re in the wrong place

BMJ 2014; 349 doi: (Published 14 August 2014) Cite this as: BMJ 2014;349:g4913
  1. Pranita Ghimire, medical officer, general practice, Manmohan Memorial Eastern Regional Community Hospital and Research Centre, Birtamode, Jhapa 00977, Nepal
  1. pranitaghimire690{at}

The vast majority of Nepalese people struggle to access even basic medical care, says Pranita Ghimire, because it is focused in cities rather than where the need is greatest and where most opportunities exist for doctors

Low-income countries have two parts. One is rich. Children go to decent schools, get a good education, grow up watching Star Wars and Disney, play the same video games as children from rich countries, read Harry Potter and Lord of the Rings, eat at KFC and Pizza Hut, and live as globally as the internet permits.

The other part is chaotic and underdeveloped, where the country is so mismanaged that nothing makes sense—wealth inequality, a never rising gross domestic product, an unmanaged health system, a lack of governance and education, and the list goes on.

But how does the rest of the world see Nepal? The stereotypical image is of political crises, including monarchical massacres, strikes and hunger. Statistically, we must be a 10-90 country, with a wealthy 10% and the remaining majority struggling to survive. A brain drain is a contributing factor—that is, migration to foreign countries or nearer to home to the urban centres of Kathmandu, Pokhara and Dharan.

A local newspaper in Rajbiraj reported a recent telling example. A woman had died of postpartum haemorrhage because she did not have the 20 Nepalese rupees (£0.12; €0.15) to enter the emergency …

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