INTERVIEW with OSAMU UNO, Vice-Minister for Foreign Affairs of Japan

Our support is for democracy and stability

Osamu UNO, 61, Vice-Minister for Foreign Affairs of Japan, was in Nepal on a three-day official visit. Son of the late Sosuke UNO, former Prime Minister of Japan, Osamu was once the executive secretary to his father when he was Prime Minister of Japan.  A second time member of the House of Representatives from the Liberal Democratic Party (LDP) of Japan, UNO, is also the director of the Committee on Environment and member of the Special Committee on Prevention of International Terrorism and Japan's Cooperation and Support for Humanitarian Assistance for Reconstruction in Iraq.

During his three-day busy schedule, he called on the leaders of main political parties and signed agreements with the government, among others, on improving the Kathmandu-Bhaktapur road which will be funded by Japan. Before his departure, UNO took out time, on Thursday evening, to speak with Puran P Bista and Kamal Raj Sigdel of The Kathmandu Post on issues concerning Nepal-Japan relations, economic cooperation, and its future policy on changed Nepali context. UNO, who is hopeful about the political development taking place in Nepal, says the future activities of the Maoists will decide whether Japan will continue its support to a Maoist-led government. 



Q: What is the purpose of your visit?

UNO: I have come here as a representative of the Japanese government to congratulate the government of Nepal. The first achievement of Nepal is that it has successfully held the Constituent Assembly elections. And the next one is that a new government is soon going to be formed.

Besides, the next important purpose of my visit is to convey a message that the Japanese support will continue even after the new government is formed.

Today (Friday) afternoon we had an agreement. The government of Japan is supporting Nepal to construct a four-lane road from Kathmandu to Bhaktapur. This would be the first gift of the government of Japan to Nepal after the formation of a new government.

In the first two days of my visit to Nepal, I have met many political leaders, and in each meeting, I have stressed only one thing that Nepal needs stability and a sustainable peace. I have heard that a new president and vice-president would be soon elected. I wish that to happen as early as possible and hope Nepal will soon establish a sustainable peace and stability. This is what I conveyed to Nepali leaders in my meetings.


Q: You have spoken of continuing support to Nepal. Does that mean Japan will continue its support even if the Maoists form the next government?

UNO: I believe the new government will be formed following due democratic processes and by the democratically elected CA representatives. Japan will accept the government which is formed democratically by the people's representatives elected through free and fair elections. I have been repeating this in all the meetings with the Nepali leaders that the constitution is such a thing which should be very democratic and even after the formation of new government we need to move ahead democratically. And all should make a collective effort toward that.


Q: This means you are satisfied with the Maoist performance. How do you assess the human rights records of the Maoists?

UNO: The problems associated with the Maoists are Nepal's domestic issues. Japan as an external force has no intention to interfere on that. In the future, I hope the Maoists change gradually and embrace democratic values.


Q: Does that mean if Japan is not convinced, or if the Maoists don't change, Japanese support to Nepal will be discontinued?

UNO: I cannot say that now without seeing what is going to happen in the days to come. But now, I am returning with a hope that the Maoists will change.


Q: Nepal-Japan relations have been very cordial and long one. Until recently both were kingdoms. And the bilateral relations at the level of royal families of both the countries were something very special. How do you assess Nepal's decision to go republic?

UNO: Until Nepal was a kingdom, Nepal-Japan relations were really strong. But after the 2001 royal massacre, a change is discernible on Nepali people's perception about the palace. In the past 5 or 6 years, Nepalis witnessed historic changes. In April 2008, the Nepali people themselves held the historic CA election, which was a big success. Nepal has been moving ahead democratically, and there are people's representatives, so we would like to respect the process.


Q: How will Japan support Nepal in the post-conflict days?

Uno: It is not that Japan could say it would support for this or that. After the formation of a new government based on what sorts of demand it makes, Japan will see and decide. The objective of Japan's international economic support is not just to continue it. Its objective is to make the reviving countries self-reliant. This should not be forgotten. For example, Japan's ODA is also directed toward that objective … toward how Nepal's economy can improve.

For instance, with the Japanese support the Kathmandu-Bhaktapur road will be upgraded to a four-lane highway from the current two-double road. This will help people transport products to Kathmandu easily. After the construction of the wider road, the people will not have to face any traffic jam; they could also save fuel and time. This will certainly help develop the economy and benefit the areas.

Q: Nepal and Japan are working on a deal to send industrial trainees to Japan. What progress has been made so far?

UNO: Nepal requested Japan to take in Nepalis as industrial trainees for vocational training in Japan. As one of the well-wishers of this country, Japan also accepted that. The objective is to help capacitate Nepalis who would return to Nepal after completing their vocational training in Japan. Japan has no policy to use these trainees as manpower there. This is also a kind of support to a developing country like Nepal.


Q: When will this start?

UNO: Today afternoon we heard that the FNCCI interviewed six women to send them as trainees to textile industries in Japan. So this has already started.


Q: Was there no such training in the past?

Uno: No, this one is the first of its kind.


Q: Will Japan be able to give trade preference to Nepal? If so, what sorts of items will Nepal export to Japan?

UNO: Japan has not thought about any quota for now. Neither has it decided which product to import from Nepal. You too might have heard about the campaign called "one village one product". But this is also misunderstood. People think that this "one village one product" project is to export products directly to Japan. That is not true. The objective of the project is to exchange products in local markets and help boost the local economy. There is a need for promoting this "one village one product" concept in Nepal at the beginning. Then only can we think of exporting the products in foreign courtiers. This is a suitable campaign for Nepal. So what we suggest is, Nepal should first promote the product in domestic market and then in the international market. That will be better. In the future if this goes on flourishing, we will think of even bigger projects similar to this but it depends also on Nepal and on how it presents itself to Japan.


Q: How can Nepal attract FDI from Japan? What type of policy Nepal should take to attract Japanese investors?

Uno: When it comes to trade relations, what is important is peace and stability. Without this nothing can progress. And provided this is achieved, if Nepal likes to develop trade relations with Japan, it has to produce the quality that Japan likes. What is the level or quality of products produced in Japan? Nepal should also try to reach that level and if such things are taken into consideration, Nepal-Japan trade relations could flourish. It is not that Nepal can send anything and Japan accepts them without any hesitation.


Q: I mean Nepal has a huge potential for foreign investors. Japanese investors could be interested in investing in different potential sectors, for instance in hydropower, in Nepal. So what could Nepal do to capitalize on this potential?

UNO: Of course, Nepal is rich in water resources. But now there is no such environment to deicide on this because the new government is yet to be formed. Who will look after water resources sector? Once these things are decided, it could be easier to say something on this. But for that, first the government should be stable.

In my meeting with the prime minister also the issue of hydropower dam was raised. But constructing dam for hydropower projects is a very costly business, which is not possible with grant support alone. Loan is an alternative but it is difficult because Nepal will have to return it. So now I cannot say anything about this.

Regarding suggestions on FDI, Japan can never say what you need to do regarding foreign policy. The past experiences show that Japan itself sees the attraction in certain country and goes there to invest. And there are also some examples where the government of the host countries make an appeal to the Japanese government and the Japanese investors may be attracted. So once it is stable and peace is institutionalized, Nepal can send its trade- related people to Japan to show the possibilities and potentials and attract investors.


Q: Japan has been world's best producer of renewable energy technologies (RETs). How could Nepal move for technology transfer in the renewable energy sector? There have been some activities in this sector through JICA (Japan International Cooperation Agency), but this seems to be limited to some small-scale projects. Do you see any possibility for any large-scale programs in the energy sector? 

UNO: JICA has both big and small grants in operation. In small grants, JICA is supporting solar panels, micro hydro and other renewable technologies at the local areas. We can also build large-scale renewable energy projects, for instance a big solar energy plant, which could supply power to a large area like Kathmandu. But that demands big investments, which may not meet the criteria of the JICA. Such projects could be done through loan. But when it comes to loan, it will be a problem for Nepal. [July 21, 2008, TKP]

INTERVIEW with French Ambassador to Nepal

'Nepal needs real and deep devolution of powers'


We have French ambassador Gilles-Henri Garault as our guest for this week's interview. A few days before Bastille Day, the national day of France which is celebrated on July 14, Puran P Bista and Kamal Raj Sigdel of The Kathmandu Post caught up with him to discuss Nepal-France relations in the changed political context.

Garault, who was special advisor to the French Minister for Foreign Affairs before assuming the current post, is a PhD in history and archaeology. He has served as second counsellor at the French Embassy in Madrid, as counsellor at the cabinet of the speaker of the National Assembly looking after European and international affairs, as deputy director at the Department for Economic and Financial Affairs of the Ministry of Foreign Affairs, special counsellor of the Minister for Civil Service, State Reforms and Territorial Planning and as head of the cabinet of the State Minister for State Reforms. Garault was also an associate professor at the Institute for Political Studies of Paris.

As a diplomat who has also written several books on economics, international relations and history, Garault says Nepal can attract French investment and joint ventures in different potential areas such as hydropower, agro businesses and even waste management. Excerpts:


Q: How have Nepal-France relations evolved?

Garault: We have very good relations with Nepal. We have had permanent relations with this country since 1949. We had the first diplomatic mission in 1933. In fact, we are the second country after the United Kingdom to set up diplomatic relations with Nepal.

If you ask about the relations from a political point of view, our relations have been of very low intensity during the last 10 years. We didn't have contacts with very high level people here because of the decade-long Maoist insurgency, the massacre and so forth.


Q: In what areas were Nepal-France relations concentrated in the past?

Garault: In the past, that is in the 1960s, we helped the Nepal Army in training. We also provided them with some French helicopters and other vehicles. But after the 2001 royal massacre, nobody understands what is happening; it is like a black hole. So now we are trying to understand; we are trying to improve relations. But if you ask me if we have some very important strategic and geopolitical interest in Nepal, the answer is NO. We don't. We are not Chinese; we are not Indians. We are not British. We have fruitful relations but of low intensity.


Q: Will there be any change in France's approach once the Maoists form the government?

Garault: I think there will be no special approach, no real change towards the new government to be formed or led by the Maoists. Maoism is not a disability, it's a political current which won the last CA elections quite free and fair. France respects the choice of the Nepali people. Now the Maoists have to show their political will and competency to improve the condition of Nepal's people, and to handle the government. But why shouldn't they be able to lead and govern this country? I think the CPN (Maoist) is a very structured party and have competent leaders and cadres. France is quite confident, and we will see the concrete results of the new government.


Q: What is your analysis of Nepal's underdevelopment? What do you think are the key factors affecting the country's development?

Garault: It is a very interesting question, but difficult to answer in brief. Nepal is suffering from certain handicaps, which explain its poor economic performance. I think the most important factor is the poor level of education and training connected with the demographic issue. The manpower is not skilled enough. The literacy rate is still lower than 50 percent. It is a big challenge if you consider the fast growing population. It also explains why it is so difficult to provide jobs to the 300,000 newcomers arriving each year on the labor market. There is also a problem of rural exodus from the countryside to urban areas due to lack of job opportunities, which finaly gathers jobless people in congested areas. This situation led more than one million Nepalis to leave for other countries in search of jobs.

The second prominent factor is the geographical situation of Nepal, a landlocked country enclosed between two growing giants, China and India. The 10 years of civil war had also a great effect, but I think Nepal can easily and successfully face this situation as Cambodia has done in the last few years.

Lastly, Nepal's underdevelopment is also a result of its competitive positioning. Industries are insufficient and not competitive enough. Poor industries are lowering the progress of Nepal in the international stage. Firms suffer from a serious lack of infrastructure and power. On top of that, they depend on imports for nearly all the raw materials and, above all, petrol. That's why you note this increasing trade gap.

Concerning agriculture, this sector still depends on the weather, which is becoming more and more unstable in the context of global warming. The fragility of agriculture goes along with the inefficiency of agricultural methods and infrastructure leading the sector to absorb 80 percent of the workers while producing only 33 percent of the GDP. Land reform organized in partnership with competent organizations and structured around educational programs could be set up. Also, with reinforced structures of maintaining stocks, Nepal could anticipate and handle more efficiently any food crisis.


Q: You have been heading the European Commission in Nepal. How is the EU thinking of carrying out its activities in Nepal in the changing context? What role will it play in Nepal's post-conflict transition?

Garault: I think the changing context of Nepal will not induce the EU to change deeply its strategy in Nepal. Last year, the EU adopted a new country strategy for Nepal for the period 2007-13 with a budget of 120 million euros (US$ 190 million). The priorities are known: education, stability and peace building, trade facilitation and economic capacity building. The action of the EU fits into this framework. Education is certainly the first priority in Nepal. That is why it will account for 60 percent of the allocation. We must improve enrolment, quality and access to education, especially for girls, the poor and minorities.

Concerning the EU's role in the post-conflict transition of Nepal, we have already incorporated all the issues of the post-conflict environment. The EU monitoring mission for the election to the CA, consisting of more than 100 people, was a significant sign of our support for stability and peace building in Nepal. The EU will continue to support the current peace process, political dialogue, social challenges and drastic changes in the political situation. Nepal is undergoing deep political and constitutional changes. The country has conducted the elections successfully, and a new republic has been proclaimed. The peace agreement is on the right track, and the EU will remain the first partner of Nepal. We are confident in the future of this country.   

But the EU's main priority in Nepal is reducing poverty (Nepal is still the poorest country in Asia) by promoting sustainable development and economic growth.


Q: Some political parties, for instance the Maoists, are speaking of the French model of federal government. What would that mean in Nepal's context? Would it be a suitable model for us too?

Garault: We heard, indeed, about this interest in the French constitutional model and our political system. And we are happy to know that. But let me give some more details about the French model. It is anything except a federal government. France has been a centralized state for almost 1,500 years. During the last 25 years, we have made several important constitutional changes in order to promote local powers. Now the three levels of local government – municipalities, districts and regions – have been entrusted with important responsibilities like local development, social policy, transport and infrastructure.

But we are still far from a federal model. There is no real autonomy. Our model is, therefore, different from the full-fledged federal systems found in Germany, India and the United States. Constitutional changes were made for the devolution of power. We have a strong central government with a mixed system: presidential, with a president directly elected by the people and assuming real powers; parliamentary, with a national assembly elected by the people, and a prime minister accountable to parliament but, at the same time, politically responsible to the president. This system is quite unique and has promoted, during the last 50 years, political stability and efficiency of the executive.

I don't now if this model is suitable for Nepal. But I am sure that Nepal needs, above all, real and deep devolution of powers, giving more efficiency to the local authorities. The debate on autonomy is just a political and ideological issue. After 250 years of strong centralization, this country needs a strong, efficient and permanent presence of the administration and the state at the local level. France will continue to stand with Nepal in unity and solidarity. They are the main guarantees of progress for Nepal and are very important values.


Q: Why is France directing most of its support to Francophone countries instead of underdeveloped countries like Nepal which were not former French colonies? 

Garault: We assumed this choice. As you know, France is one of the top donors in the world, giving out around 9 billion euros (US$ 14 billion) representing 0.45 percent of our GDP in aid. Bilateral aid accounts for 70 percent of our Pubic Aid to Development, and 30 percent goes through European and multilateral channels. Concerning bilateral aid, France has made the choice to concentrate financial assistance to a limited number of countries. The SPZ (Special Priority Zone) includes 55 Least Developed Countries, 43 of which are African. France allocates 70 percent of its bilateral aid to Africa and an additional 12 percent to the Middle East. Only four Asian countries, all former French territories, belong to the SPZ.

Asia gets only 8 percent of French bilateral aid given to Developing Countries. We are thinking enlarging the concentration of our bilateral aid. We don't believe in the efficiency of scattering aid that leads to sprinkling of resources. That is why in 2007 the EU adopted a code of conduct in order to target certain countries and to share the efforts. France is, therefore, targeting more countries in Africa than elsewhere.

However, France is one of the big donors in Nepal. In terms of the EU countries, France is the second biggest benefactor after Germany. Out of every million euros spent by the EU in Nepal, 200,000 euros are given by France.


Q: What could be the areas of interest for prospective French investors in Nepal?

Garault: We are arranging a business trip for French companies next October. It was postponed due to the unfavorable political situation in Nepal. We have planned to hold it at the end of July. This could hopefully be a fruitful trip to draw the interest of French investors to Nepal.

We think there are some possibilities for investment in hydropower. This is our first priority in Nepal. We could make a huge investment in Nepal the way we did in Laos and some other countries. In Laos, we have constructed a 1500 MW hydel project, twice as big as the Seti project. We made turbine engines for the Three Gorges dam in China. We have the world's largest electric companies. So it is relatively huge. For instance, France generates 25 percent of Europe's entire electricity supply. We are also thinking of investing in the Himalaya with local partners and buyers.

We are also interested in aeronautics. We sent three small aircraft to Buddha Air. We may have an interest in waste management in Kathmandu.


Q: If the government shows an interest in waste management, will French companies come over here?

Garault: We have the best companies in waste management. Some of them are doing waste management in Shanghai and other big Chinese cities. So for us, waste management in Kathmandu is nothing. But the main problem for us is who is going to be our partner? Kathmandu Metropolitan City [KMC] doesn't even exist.


Q: Have you had any discussions about this?

Garault: I don't have any information about that. We are preparing a report on garbage management in Kathmandu. We will send that to French companies who are involved in waste management. Maybe one of them will be interested.

But we have a lot of problems here. We have problems of garbage storage and we have a lot of strikes. So we have to change the system completely. Waste management in Kathmandu has been a complete failure. Some tourists I have met say, "Oh my God, how is it possible?"

We are also interested in agro business because we have the most modern agro-based companies, particularly in terms of modernized markets, storage, commercialization and the like.

If you talk of export, Nepal's competitive position is not good. Its exports have been limited to pashmina and handicraft. Nepal must find new products. Items like coffee, tea, medicinal herbs, herbs for perfumes and the like could be the new products to export from Nepal.

The normalization of oral sex

Oral is normal

The normalization of oral sex.

Every day, thousands of parents sit down with their children to talk about the facts of life. They want their kids to know how babies are made, how serious sex is, and how they can protect themselves. For most of us, the topic is awkward enough without getting into advanced stuff. That's why the coverage of President Clinton's blow jobs felt like such a cultural assault. We just want to stick to the basics.

Well, you can kiss that era of innocence goodbye. I'm not talking about your kids' innocence. I'm talking about yours. For your information, Mom and Dad, oral sex is now more basic than vaginal sex. That may not be part of God's or nature's plan. But according to survey data, it's a fact of life.

The latest evidence comes from "Noncoital Sexual Activities Among Adolescents," a study published in the July issue of the Journal of Adolescent Health. The study analyzed the US government's first survey of such practices, conducted in 2002 and released three years later. When the data first came out, I chided the media for ignoring the findings of widespread anal sex. Don't worry: I'll spare you that topic today. What's interesting in the new analysis is the correlation between oral and vaginal sex. If your kid is doing one, he or she is almost certainly doing the other.

The raw numbers indicate that 50 percent of teenagers aged 15 to 19 have had vaginal sex. Fifty-five percent have had heterosexual oral sex. Are kids substituting oral for vaginal? Nope. Among technical virgins—teens who have never had vaginal sex—23 percent have had oral sex. That number sounds high until you notice that among nonvirgins, the oral-sex figure is 87 percent. If your teenager has had "basic" sex without somebody's mouth being involved, congratulations. You're probably the only such household on your block.

The data on timing underscore this connection. Among teens whose first vaginal sex happened less than six months before the survey, 82 percent admit to oral sex. That figure barely increases for teens who began vaginal sex three years before the survey. In other words, teens lost their oral virginity at around the same time they lost their vaginal virginity. If you think your daughter is going to learn the basics now and the advanced stuff later, you've got another thing coming.

Look at the data for older adults, and you'll see similar patterns. At ages 20 to 24, the percentage who admit to oral sex trails the percentage who admit to vaginal sex by around five points. (A study of Georgia college students, published last year, produced similar numbers: 96 percent of those who had lost their vaginal virginity had also lost their oral virginity.) At ages 25 to 44, the gap is around eight points. If anything, these numbers understate the prevalence of oral sex, since they're based on self-reporting. The discomfort most of us feel around this topic surely affects some survey responses, even with guaranteed anonymity.

The near-disappearance of lifetime oral virginity makes sodomy laws fairly ridiculous. The percentage of Americans aged 25 to 44 who deny ever having had oral sex now barely exceeds the percentage who admit to same-sex activity. By empirical standards, if gay sex is deviant, so is chastity of the mouth. Indeed, there's some evidence that what's vanishing isn't oral abstinence—which perhaps never really existed—but stigma. That's the implication of a decadelong Australian college study, published three years ago, which showed a significant increase in female, but not male, admission of oral activity.

So cheer up, Mom and Dad. You don't have to be embarrassed any more about discussing the facts of life with your child. She'll be happy to explain them to you.


Body Painting

Body Painting, fashion is gaining popularity among teens. 

Interview with Dr Bhagawan Koirala

'We don't turn away patients because they don't have money'

This week's guest for our Monday Interview is Dr Bhagwan Koirala, 45, executive director and senior consultant cardiac surgeon at Shahid Ganga Lal National Heart Center. He is an acclaimed heart surgeon well known in all South Asia. An MD from Kharkov Medical Institute, Ukraine, Dr Koirala played a key role in bringing the Heart Center to its present enviable position. The hospital has 150 beds and is equipped with all modern technologies to perform major heart operations. It has also been providing free and affordable heart care services, which are otherwise very expensive, to an ever increasing number of poor and deserving patients. In the last year alone, his team at the hospital saw more than 70,000 outpatients, did 1,200 cardiovascular operations and 2,500 cath procedures. There were more than 5,000 in-patient admissions.


Dr Koirala spoke to Kamal Raj Sigdel of The Kathmandu Post on different issues ranging from the hospital's welfare schemes to the future of Nepal's public health care system. Excerpts:


Q: Where do you see Nepal's public health care system in the next 10 years?

Dr Koirala: There are a number of possible scenarios. It will largely depend on how politics evolves. It seems that social welfare is going to be strengthened. Many state-sponsored health care delivery systems will be established, and similar other social welfare programs launched. In the health sector, I believe that we will have more free access to health care for poor people. There will be some sort of health insurance policy implemented in the next 10 years.


Q: What progress will we see in the treatment of heart disease, particularly at this hospital?

Dr Koirala: Progress in this particular field is an evolutionary progress. We now have all the basic infrastructure providing cardiac care in this country. Obviously, it is not enough. We have to improve the quality of service, and we have to expand into different geographical areas of the country, and we also have to go for research and do more training and teaching programs. And I think that is what is going to happen in the next five to 10 years in this institute.


Q: What sort of welfare schemes does this hospital offer to poor patients?

Dr Koirala: The government demonstrated appropriate responsibility by supporting this institute to provide free cardiac care to poor children below 15 years of age. This has been in place for the last two years. It has been a highly successful and satisfying program. We've given service to hundreds, if not thousands, of poor children under this scheme. We have also started giving free cardiac treatment to senior citizens over 75 years of age. And we have a rule to provide over 100 free valves to poor patients annually.


Q: How do you identify poor and deserving patients? I mean, how transparent is the process of selecting patients for these free services?

Dr Koirala: There is a transparent mechanism for selecting them. There are criteria for selection. There is a committee to look into it. They recommend the names to me. Obviously, the doctors make the initial recommendation, but then there is an administrative mechanism to screen the potential beneficiaries. The selection cannot be done personally, it's all formal applications, formal selection process, formal approval, and it's notified publicly. In general, I have been very satisfied with the selection process.


Q: What are you doing to expand these free services?

Dr Koirala: Besides the aforesaid three major welfare schemes, we also provide free patient care for those who cannot pay. For example, 20 percent of the hospital beds have been declared free for poor people. All the costs, including hospital fees and lab services except medicines, are free for patients occupying these beds. Apart from this, the hospital has been making other efforts. And there are groups who raise money for donating to this institute for patients like these because they trust us. A group of 180 managers have each been collecting Rs 1,000 every month for the hospital.


Q: Who are they?

Dr Koirala: They are managers and executives of different levels. They volunteered after they saw what we were doing. They call themselves "Sahayog Group".

Q: Are they part of the hospital's mechanism to raise funds?

Dr Koirala: No. They are a group of people who have volunteered to help our patients. We call them whenever some patient is stuck without enough money. There are also other groups who sometimes come to help.


Q: What is the trend of patients coming to this hospital for treatment? Do you accept all of them?

Dr Koirala: We do. When we started these welfare schemes, the number of patients, particularly children, coming to us rose suddenly. This is good news. The people know that there is a state system to help them. The number of patients coming from the far west, remote areas and Madhes and Dalit groups rose manifold. And this category constitutes about two-thirds of the beneficiaries who receive this subsidy. That is a great help.


Q: Are you handling all these patients?

Dr Koirala: We are struggling to provide services to all those who come to us. We don't want to turn away anybody because of patient volume or money.


Q: Have there been cases of patients being turned away for technical reasons or due to lack of certain machines, for instance?

Dr Koirala: No, we don't turn away any patient for such reasons. Also, we don't refuse treatment to patients just because they don't have money. We try to find resources for them.


Q: So you have all kinds of facilities to deal with all sorts of heart diseases?

Dr Koirala: We have facilities to deal with most heart diseases. I cannot say "all of them" because that does not happen anywhere in the world. Some American centers do close to all, but not all of them. Most of them do little less than that. Japanese hospitals provide most kinds of services, but not some operations which are done in America. So that is a very relative term.


Q: Do you think the quality of this hospital matches international standards?

Dr Koirala: We have to define what we mean by international standards. By and large, we provide most of the services at par with most regional centers. We cannot match the best centers of the world. But we have to look at the regional standard, the South Asian standard rather than American standards. 


Q: Of late, private operators have been entering the hospital sector. How do you analyze this?

Dr Koirala: Private institutions are important for health care delivery. But there are many issues which need to be dealt with first. They are about the practice of allowing [medical] institutions [to operate] without an accreditation system, quality control, declaration of their social responsibility and constant monitoring. And obviously, there is a huge problem with the substandard quality of training provided at private institutions. These are serious issues the government has to look into.


Q: Do you think there is a need for policy reform in the health sector?

Dr Koirala: That is what we are talking about. There are lots of things which I would rather say to policymakers face-to-face than letting them hear it through the media. But I would like to speak at least one sentence here publicly. I have strong opinions about rationalizing the establishment of new academic institutions. They are big institutions, and that needs to be justified by local needs and the needs of the inhabitants rather than business people's needs or professionals' needs.


Q: There are some new ideas that the health sector could be developed as an export-oriented sector where Nepal could have comparative advantages.

Dr Koirala: It is happening by default. It was not planned like it was in Bangladesh, for example, where the government planned to produce more doctors with the intention of exporting them. Medical professionals were not created in Nepal with that goal. There is a huge exodus of medical professionals to foreign countries. Not just doctors, large numbers of nurses are going abroad too.


Q: I don't mean exporting health professionals but developing health tourism and the like.

Dr Koirala: That is the key. That would be a good business for us. There is a lot of talk about it now. Americans are spending billions of dollars on medical care abroad. Why can't we get a share of that market? We could if we had good medical services. But it's not just about one thing. The security situation has to improve, and the political situation has to settle down. Then there is the problem of adequate air connections. If we can build good institutions, which is possible, I see a lot of our people coming back over the next five or 10 years. Right now they say that they have no place to work here. Our challenge is to create an environment where they can work. Another thing is that if we can provide services of standard quality and have good networking internationally, we can attract many medical care seekers as they are doing in Thailand, India, Singapore and Malaysia.


Q: Health insurance is not very well organized here. Who do you think should do it? Should this be left to the private sector alone?

Dr Koirala: There should be involvement of both the government and the private sector. The state could run health insurance programs for marginalized and poor people. They could have non-governmental organizations organize insurance schemes in which the government pays the premium for the poor.

The private sector is not doing it because they fear that they will suffer massive losses. I agree with them for two reasons. Health care has not reached a level where insurance companies can promise their clients a full range of services. People will pay only if they can get assurances that they will get all the services. Second, there are many cases of malpractice in which patients and medical professionals have been involved. They falsified documents, wrote wrong prescriptions and forged bills. These malpractices have to be stopped.

And we are yet to develop a culture of health insurance. You have to start paying now if you want to secure your health in your old age. At this point in time, there has to be a combination of government and private sector initiatives. (TKP, July 6, 2008)


Army Integration in Nepal

Army Integration in Nepal: Democratization or politicization?

Bishta makes a strong argument that the Nepal Army should never be politicized in the name of Loktantrikaran. He has a striking question: if the Maoists achieved so much with some 3400 crummy weapons, cannot the Nepal Army which has 95,000 trained soldiers equipped with all modern ammunitions revolt it the Maoists try to politicize it on their will?


Recently, Nepal marked the 50th anniversary of participation in UN Peacekeeping operations worldwide. It is rather ironic that the same army that contributes the fifth largest contingent of peacekeepers in the entire world, and which has won many accolades in the international arena is considered in need of 'reform' by non other than a Maoist-led government. As such, it is about to be laid on the alter of sacrifice at the mercy of those whose intent is at best unclear and at worst an unmitigated disaster for the prospects of democracy.

Integration and other 'reforms' in the national army may be understandable and justified at the logical end of a political process. In other words, if we were a hundred percent clear that the Maoists have come into the democratic political mainstream and no longer harbor any further designs for seizing unchallenged power, almost any measure, including the integration of all 19,000 UNMIN-verified Maoist combatants into the army, would have been justified. However, in Nepal, the Maoists are very clearly on the path of defeating all opposition to their unilateral rule.

Indeed, the Maoists have not even tried to disguise their unchanged objective of eventually establishing a communist republic. The problem in Nepal lies in the wider community deliberately choosing to ignore these clear indicators and indulging in wishful thinking--arguing that surely, the Maoists do not really mean what they say! In this context, allowing the removal of the army as the last line of defense of democracy--following on the heels of the end of monarchy, sidelining of the NC and now the compromise of the UML--is nothing short of political suicide by the democratic front.

Without a doubt, the peace process must come to a logical conclusion with Nepal achieving an enduring peace, stability and economic progress under a multi-party democratic framework. The Nepal Army, which has been instrumental in promoting peace nationally and internationally, now clearly relies on objective civilian control to maintain its apolitical and neutral status. This is apparent from the very mature and measured manner in which the army accepted the reality of the demise of the monarchy. At the core of the concept of objective civilian control is the recognition of the professional military's right to retain control of its fundamental values and procedures.

Today, it has become common practice, even in backward Nepal, to consider stakeholder interests while making decisions that ultimately affect their future. Yet, while the future of 95,000 army personnel is being decided, it is apparently left up to a closed group of politicians, most of whom, in Nepal's new reality, are going to be from the Maoist pact.

Is it that difficult for the politicians and the international community to realize that what is happening, in essence, is that those in power are taking the army for granted simply because it is disciplined, cohesive and intact--the very values that the Maoists now seek to destroy?

It does not take the brains of a rocket scientist to figure out that, in Nepal's reality where one has to revolt to be heard, it may not be too long before the army is forced to assert itself. And rightly so. If the Maoists achieved so much with some 3400 crummy weapons, is it really in anybody's interest to destroy the very fabrics that hold the army together and restrain it? The purity, sanctity, and integrity of an army that has proven itself apolitical and restrained, should never be compromised in the name of 'loktantrikaran'. Certainly, it should not be left at the mercy of a proven undemocratic force to grab unequivocal power.

Till date, the army has obeyed the orders of the legitimate government mandated by the people. However, it is unlikely that it will take its own destruction and the compromise of Nepal's territorial integrity and sovereignty lying down. Democratic politicians should start listening to the genuine stakeholder concerns of the army and provide ownership to it. Only then can it stand as bedrock upon which Nepal's burgeoning democracy can be built. (TKP, July 3, 2008)

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