CPN(M) - Worker #10
The Worker, #10, May 2006
Article
NEPALESE PEOPLE'S WAR,Vibhishikha
THE WAR CASUALTIES AND MEDICAL SCIENCE
It is no longer a matter of secrecy that the hindrance to the development, progress and prosperity of Nepal is the Nepalese feudal monarchy backed by Indian expansionism, which in turn complies with the plans of American Imperialism. This undoubtedly has been the reason why Nepal, a South Asian Himalayan country with approximately 4000 Village Development Councils (V.D.C.), 60 Municipal Corporations and 75 Districts, remains one of the most underdeveloped and poverty-stricken countries even amongst the third world. On February 1996, the Nepalese people took to the path of a protracted People's War to get rid of the long-standing poverty, illiteracy, depravity, inequality and foreign dominance. This great People's War has entered into its tenth year since its initiation from February 1996. Within this great period it has not only witnessed the destruction of counter-revolutionary and feudal monarchical forces but has also seen development and constructive measures in various fields. In this process of a new societal changes, together with the achievements in justice delivery, construction programmes, industries, agriculture, education etc. profound achievements have also been accomplished in the field of health that are worth mentioning. Science demands advanced development after it has been put to practice. Reiterating this universal scientific truth the M-L-M ideology practiced in the Nepalese soil is giving birth to a new thought and development in the 21st century. This has not only been analyzed as 'Prachanda Path' but has also universal oriented unique and exclusive thought. In the course of inculcating and refining this unique and exclusive 'Prachanda Path', the field of medical science has also undergone a series of refinement and improvement. In this article I have endeavored to present a discussion on the events and works that have taken place in the Health Sector from the very inception of the People's War till the present date.
The Historic Initiation of PW And The Health Field
When the historic initiation of the People's War took place on February 1996, the state of health services provided by the old state was dismal. Every V.D.C. was supposed to have a Sub-Health Post (SHP) but the truth was that many V.D.C. remained devoid of this facility. Also much success could not be attained where SHPs were established to acquire services of Auxiliary Health Worker (AHW). In some Health Posts there weren't even health assistant, not to talk of AHW. The old government's proclamation to establish primary health posts in 205 constituencies has not yielded any results till today except in some urban and developed areas. At that time only, barring some developed districts, in most hilly and rural districts there were some hospitals to mention but without any doctors, where there were doctors there were no medicines and basic infrastructure. Despite the claims of effective functioning being made, under the above said conditions it has been quite difficult to bring about changes. Most of the M.B.B.S. doctors are concentrated in Kathmandu valley or few urban centres. They avoid working in hilly, Himalayan even in terai (plain) areas, which still have some infrastructure. It is therefore obvious that they would do anything to avoid working in hilly and mountainous areas. Even the centre of class struggle and People's War, Rolpa district, doesn't have a district level hospital till date. There is a primary health centre, but a building built has remained in a dilapidated condition. Doctors come and attend once in a while but soon either they get scholarship to go abroad (this is especially if one has worked in Rolpa) or they get transferred to some other advanced hospitals. Rolpa is not alone; the conditions in many other hilly areas and districts are no different. That the internal warfare has made it impossible for doctors to go and work in these areas has been the most common reason cited for Nepalese people's poor health condition. The truth, however, is that there has been a lack of proper program, management and effective implementation irrespective of the internal disturbances. There were days when one couldn't
even find Cetamol in the villages, even if there were, one would have to buy them at higher prices. Curable diseases like dysentery and pneumonia often were the causes of premature deaths. It was the realisation that the above and related problems could be solved only by the destruction of the feudal state power and the construction of a democratic republic that the oppressed masses rose up to rebel against the old feudal state when the Party appealed them to do so.
Under the guidance of the world vision, thoughts and principles of M-L-M and with the help of the organized power of the set of ideas of our Party Chairman Com. Prachanda, the initiation of a well planned-out struggle took place. Keeping in mind the possible increase in the number of wounded people during wartime, preparations were made for adequate medical treatments and other arrangements. Discussions on such related preparations became the main emphasis in Party meetings, gatherings and trainings. A process of sensitization and organization of the doctors in cities and paramedical in villages started taking place. In the course of class struggle, medical teams with necessary medical equipments were sent to participate in physical, ideological and political trainings, gatherings and meetings. This way some part timers and some whole timers paramedics started coming. Though less in numbers, the initial days of the revolution did see such mobilization of manpower. From combat groups to self-defense groups, they were kept in all teams for the purpose of primary health service. People trained in the medical institutes of the old state and people who learnt while being assistants to medical doctors were the ones who joined the movement in the early days. In a team there would be a separate person for primary health service besides the other four categories of work done by others: political, organizational, struggle and propaganda. This not only led to better management and arrangements for the wounded during combats with enemies (so called khukuri dals—i.e., armed anti-Maoist vigilante groups and police), at the same time it also led the medical teams to play an important role in establishing good relationships with the masses and help carrying out political and ideological works in many new and autonomous areas. Many such villages continue to remain under our stronghold even today. Numerous health workers who received first aid training for a week and moved around with first aid box became very close and popular amongst the people.
The Autonomous Area And Health
At the time of initiating and providing health service to the people, community health workers were groomed in every area of mushrooming base areas, keeping in mind the purpose of Health Centers which is to take primary health service to every village. For this, training lasting from one and half to two weeks were organized resulting in production of dozens of health workers. For each team a paramedic was appointed for treatment of the wounded while they fought with the police in the course of building base areas. Such manpower was deputed in Special Task Force and in Platoons that were reorganized later. In accordance with their capabilities as well as the movement's requirements, arrangements were made for their presence and participation in Companies, Battalion, Brigade and Division accordingly. With one Paramedic in each Section, one Section Medical Team in each Company, a Medical Platoon in a Battalion, a Medical Company in a Brigade and a Medical Battalion in a Division, the Medical Team has gone a long way. This high demand for manpower in increasing formations is met by the political and organizational training of people who have already been trained in the institutions of the old state.
Strategic Equilibrium And Health
When the People's Liberation Army, under the program of the Party, underwent massive military preparation and carried out successful military attacks on District capitals, such as Dang, Syangja and Solu, the power centers of the state, it was concluded that the Party had entered the stage of strategic equilibrium. The form of the war underwent advancement from guerilla warfare to mobile to positional warfare. Naturally, with this came the increase in number of casualties and amount of losses. Keeping these things in mind, works under the Medical field began to be carried out with full determination. There began a process of improvement in the quantity and quality of health workers. There has been development of fresh human resource in the form of technical manpower through new training from the relatively more experienced and competent people within the military formation. For further nurturing of talent there has been encouragement for self-studying and also sharing of each other's experiences and knowledge. Occasional training related to War Trauma Rescue and Management has been organized. In this course, urban doctors, who have remained Party members, supporters, well-wishers or helpers, have also been playing important roles in the treatment of referral cases, in making formations more competent and at times even providing help in the cities. Many doctors who have taken a neutral stand but nevertheless believe in genuine humanitarian responsibility have also been quite helpful to us. At a later stage we have even managed to get cooperation from ICRC in matters related to surgeries and treatment of the injured. To put down some examples, earlier simple wooden structures or 'dokos' (a big eyed bamboo basket carried on the back) were used to transport injured people in the battles, they are now being transported through ambulances, jeeps, motorcycles and other vehicles. Earlier one or two Health Posts used to be erected in the battlefield, now we have dozens of Health posts erected. 31 Health Posts were built on spot during the historic Beni battle. Not only this, we also had another Hospital post at adjoining circle of the battlefield for proper arrangement and treatment of injured comrades. While marching, mobile clinic and camping hospitals too accompany in an organized manner. It should be mentioned here that in the Myagdi Beni battlefield when a mortar struck our medical group in the Hospital Post, 8 Health persons got injured, one became martyr and the leg of one paramedic had to be amputated. Despite this, out of a total of 458 injured con-wades only 23 had to be referred outside. All the rest got cured in the camping hospital. The medical team also has had to handle cases of head injuries, peritonitis, compound fracture etc. Amputation, Haemothorax, Gas Gangrene and other such operations have also been successfully carried out. Success has also been attained in surgeries that take 3-4 hours and which involve Anesthesia. Cases of bullet injury are uncountable.
In the last military attack only 5% of the hundreds of those who got injured had to be referred outside, the rest got cured without any complications and complaints. This has come as a great achievement for the Medical Team. Together with hospital management and operation theatre management, other important works such as Psychotherapy for patients are also being focused on. The patient's psychology of feeling better when being referred to urban doctors has now changed into a psychology that enjoys not being referred outside. This has also lightened the physical, material and financial weight that comes with referring outside. Now it is not through treatment done by urban doctors costing hundred thousands of rupees but the treatment by one's ideological conviction, by Prachanda Path and by doctors born in the process of our own revolution, who don't find time to take sip of tea before conduction of long continuous hours operations. Unlike well-equipped cemented rooms of urban centres the operation theater in base areas are simple houses, huts, caves or even cow-sheds. It is worth noting that in the process of marching for weeks in Beni operation without food or sleep, even then treating wounded combatants is the result of unification of ideology and technology unmatched with any material incentive.
Medical Team In Battlefield
The Medical Department, which comes within the PLA's different formations, comprises of levels from Sections to Divisions or in other words, from Medical Sections to Medical Battalions. Together with the marching of the PLA, the Medical Team organizes mobile health clinics. While camping also the medical team is forever providing daily service in groups. In the battlefield, a group of health personnel assists the Assault Group, another group situates itself in its periphery, and another organized group provides service upto RV. While marching too, they provide first aid. They are also always in the forefront to fill up the space in case the Assault Group requires more people. They treat even while being amidst offensive operation and this has greatly boosted the morale of the fighters. At the time of rest between one attack to another, when political works take place, camping hospital not only serve injured combatants but also provide services to the local villagers. There is one conviction amongst the Medical Team staying within the military formation that if the assault group moves forward in a 'fire and fight' attitude then the medical team too should proceed with a 'fire and treat' attitude. This strength and inspiration has come from the martyrdom of 7 of our brave doctors who sacrificed their lives while treating the injured soldiers.
Health Department And People's Health Service
From Centers to Districts, the Health Department has been providing health service in accordance with a Unified and Integrated Health Programme through People's Health Service, management of People's Health Training Center and Hospitals etc. An Ayurvedic wing has also been built to provide health service to the people. Through methods of ayurveda, jadibuti (medicinal herbs) and other natural treatments, this wing has been trying to make people less dependent on others when it comes to matters in health. In the base areas every village has a cooperative medical shop whereas in a model Village People's Government this is accompanied by a provision for health checkup. In the process of conducting political programs together with cooperative health service, the manpower contained in such medical groups are providing primary (preliminary) treatments along with others works such as keeping the environment clean, promoting health education etc. For example, previous year many programs including cleaning up of roads, building of water tanks, taps and thousands of toilets were implemented.
Health Department And People's Health Training Centres By creating People's Health Training Centres of Central and District level standards, there has been a process of preparation of medical manpower of different standards, which is expected to fulfill the requirements (War Service Management, basic health service for the people) of health service demanded by objective necessities. Trainings that have been taking [several words illegible here —Ed.]
such processes are being operated through centralization. In accordance with what Mao said: "in the field of health, focus on rural areas" and the principle of "bare-foot doctors", experienced and competent doctors and nurses are giving theoretical and practical trainings to others. This way, hundreds of health techniques have evolved and this has brought newness into the health sector. This manpower which has been created through training has its educational standard of its own. Named "New Model Health Worker" this manpower has been divided into community health workers, ordinary level, medium level, secondary level and advanced level. Till now, two thousand such workers have been prepared.
Hospital Management
Hospitals are being managed through the cooperative centralization of doctors and nurses who have received special and specific knowledge from the techniques and methods shared by ICRC. These hospitals are being run for the war casualties, patients within the community and military organization. This also includes organization of refreshers and meetings for further exchange and sharing of knowledge and experience. Just as Norman Bethune and Kotnis from Canada and India respectively had helped China in the Chinese Revolution, in the same spirit the Specific Medical Training given to our Medical Team by our fraternal doctors from India has played an important role in making our doctors more competent. It is worth remembering that psychological cases are less because of the fact that true treatment involves ideological treatment, sharpness and clearness in thought.
Apart from these works and achievements, it should be mentioned that the Medical teams and the works done by them are not free from problems and challenges. They include challenges in traumatic surgery, Anesthesia, further increase in competence of physicians, quantitative together with qualitative increase of health workers, increase of women health workers, making health persons politico-technical and politico-militant and providing reliable and safe protection to the injured and the doctors at least on humanitarian grounds. In this, ideological affirmation remains the principal aspect. To overcome these challenges and problems the Medical Team is undertaking intense preparation for strategic offensive.
Conclusion
Where the party line is correct there unachieved things also become achievable. Going by this scientific belief, the Nepal which had been undergoing oppression and depravity, where in the beginnings there were negligible number of health workers, where there was lack of adequate knowledge and competence, today there has been a total change of air in that country. Despite the fact that the Nepalese People's War has begun in an age of imperialism, it has been able to safely cross the innumerable storms, hurricanes and lightening that have come on its way and it has, thus, landed itself in the first stage of strategic offensive. In the same spirit, the Medical team has successfully and gloriously arrived at this stage after overcoming various obstacles and opening new horizons. Till [while] there is guidance from correct ideology, the medical sector will never be unsuccessful. True there are challenges but it is certain that we will reach the pinnacle of victory soon.
"Our nation is wanting in strength. ...To attain our goals and to make our influence felt are external matters, results. The development of our physical strength is an internal matter, a cause. If our bodies are not strong we will be afraid as soon as we see our enemy soldiers, and then how can we attain our goals and make ourselves respected? The advocates of physical education have not failed to devise various methods. If their efforts have nevertheless remained fruitless, it is because external forces are insufficient to move the hearts ... If we wish to make physical education effective, we must influence people's subjective attitudes and stimulate them to become conscious of physical education."
—Mao Tsetung: A Study of Physical Education