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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 24; 335(7629): 1096.
PMCID: PMC2094187

Doctor only to the dead

Laxmi Vilas Ghimire, junior doctor, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

I worked as a clinical skills assessor in a research project in Nepal. Apart from seeing the health situation in rural Nepal, I heard dozens of stories about their work from the mid-level healthcare workers who had come to be assessed.

One of them said that in his area patients do not get an opportunity to see a doctor as “only the dead can see doctors.” I asked why that was, and he replied, “As you know, in Nepal the doctors are not available in villages. The mid-level healthcare workers like me, who have 18 months of medical training, are the ones responsible for most health care. We do almost anything—like the GPs in the developed world. We prescribe medicine, perform procedures, even do minor surgery and conduct deliveries.

“But we are not authorised to do a postmortem examination. At that time a doctor (the only authorised service provider) is needed to write a postmortem report. They have to come from the district headquarters or even the zonal hospital, which is days' walk from most villages. So we have the saying that ‘only dead people can see doctors.'”

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