Nation on the brink

While the Eight Party Alliance's (EPA) government is trying hard to maintain its composure and portray things as normal, the situation in the country is obviously far from being normal. It has been more than a year since the despotic regime of King Gyanendra crumbled, but with each passing day the future of this largely hungry nation appears bleaker than ever.

People have started asking: What have we, as citizens, achieved since the fall of King Gyanendra's despotic regime?

The nation's democracy is becoming a casualty in the "crossfire" of partisanship. Peace, which the Nepali people longed for so dearly, appears no-where in sight. The outrages against the defenseless populations: the senseless robbing and murder continue unabated. Incidents of marauding raids are increasing at an unprecedented rate.

Our combined desire to have Constituent Assembly (CA) elections is in limbo due to the intra and inter-party power struggle amongst the political parties representing the EPA. Because of inability of the EPA government to secure peace, hold CA elections on time, and bring other positive changes that are long over due, people have started referring the past one year as a "lost year."

The Maoist leaders that once ran for life have become parliamentarians and ministers and are enjoying their heyday. While the Internally Displaced Persons (IDPs) are forced to live under sub-human conditions away from their home, the Maoists that chased them away from their homes are riding imported cars — be it state owned or forcibly seized from private citizens.

The NC and UML stalwarts seem to have forgotten the promises made to ordinary Nepalis during the April uprising and are once again busy enjoying their field day in the corridor of Singha Durbar.

The Youth Communist League's (YCL) mayhem continues unchecked in the capital and elsewhere in the country. The two rival factions-the Maoists and the Madhesi People's Rights Forum — are locked in a deadly duel for power in terai. The society that once exemplified harmony is now inching towards anarchy.

To some extent, the ongoing political violence is influenced by opportunities arising from state's weakness to ensure inclusion of ethnic communities and control political nudity of the Maoists.

The government offices in terai have been shut down for months now. The Pahadis have started leaving terai, fearing their lives. The government's power and the administrative structures vital to securing the law and order are shrinking.

Clearly, the political order is being founded on and sustained by violence. In the present day Nepal, violence, not public virtue, seems to be the basis of authority. The ordinary citizens have started suspecting the ability of the government to secure peace, and the Maoist commitment towards democracy.

Unfortunately, they are forced to keep their heads down in the face of the guns that the Maoists have covertly stored and the absence of viable options.

How do these symptoms of a dying political and social order play out? The signs of morbidity are very much evident in the present political, economic, and social life. With the ongoing decay of political and social order, politics is no longer the instrument through which contending interests are conciliated in a structured framework. Investors are shying away and moving towards greener and safer pastures and people have started suspecting those that do not belong to their own ethnic community.

The only things that will be born of this condition is a regime of rapine, despotism, poverty, and powerlessness. The current situation, if not corrected, would lead to an accelerating loss of state sovereignty, concomitant decay of state institutions, and worsen communal violence that is already reshaping social relations.

Furthermore, it will slow down the democratization process, which is essential for pulling Nepal out of poverty and placing it more firmly on the path of stability and sustainable development. It is necessary to stop political violence and lawlessness, because it impedes the necessary economic development. It does so by destroying human lives, economic assets, and through penalizing the accumulation of capital and wealth.

Every society that witnesses political upheaval confronts political violence and lawlessness for a while, but if not controlled, it can spread faster than wild fire and destabilize the essential democratic foundations in long term. Thus, political violence and lawlessness syndrome should be controlled effectively, because if allowed to persist, they could destroy people's right to life, liberty, and pursuit of happiness.

Organized criminal groups, having nexus with the corrupt officials and politicians, will start mushrooming. Organized crimes as a result of such nexus will be extremely hard to control. A country, if infested by the twin problems or crime and underdevelopment, would have little prospects of developing into a stable and prosperous democracy.

A country like Nepal which has weak institutions is an idle breeding ground for an organized crime and corruption. Crime and corruption thrive best in unstable situations, such as the one Nepal is facing. Thus, before organized crime syndicates and warlords root into our society, the current EPA government should contain political violence and lawlessness.

Nepal is already confronted with high incidence of poverty and backwardness, and therefore, it cannot afford to get locked in a double bind of political violence and poverty. There are no easy ways out of this vicious circle. Thus, political leaders should not commit the same mistakes that they committed during the 1990s. This time around, they should do it and do it right. The Nepalis, who fought hard for democracy, do not deserve anarchy, poverty, and powerlessness.

Establishing a state's authority both in and out of the capital is an essential condition for any political order, including democracy. Building a decentralized system, through devolution of power, may ultimately be the best deterrent against future guerrilla resurgence and sudden outburst of political violence. A well functioning democracy is in everyone's best interest. Hence, the EPA government should work towards strengthening the capacity of the state in traditionally "stateless" areas in order to rein in violence and create space for an unbiased civil society to take root. It is crucial for the consolidation of peace, stability, and democracy in Nepal.

Iatrogenic Deaths: Error or Laxity?

By Dr Sanjana Dhungana-Dulal and Hari Bansha Dulal

Society entrusts doctors with the burden of understanding and dealing with illness, but every now and then we come across news where a doctor is intimidated and in some cases assaulted by an unruly mob. Doctors are manhandled and their clinics vandalized. What follows the intimidation is an idea of fair trial. It gets floated for a while in the media. At the end of the day, nothing happens to the perpetrators. The perpetrators never get apprehended and punished.

The time has come to pull the curtain back and get a clear view of what causes medical mistakes to occur. Medical mishaps can be broadly categorized in four areas: physician stressors like the lack of sleep; patient characteristics and complexity; process of care factors such as job overload; and physician characteristics such as experience and exposure. These problems are related to the system and are inherently system problems warranting system solutions. It is not only the doctors that are responsible for the mistakes. In most cases medical mistakes occur because of multiple system failures and involves a number of individuals.

In the United States, the estimated total number of iatrogenic deaths (ie, deaths induced inadvertently by a physician and surgeon or by medical treatment or diagnostic procedure) annually is almost 800, 000. If we compare this number to the deaths caused by heart disease and cancer, it becomes evident that iatrogenic deaths surpass the number of deaths due to heart disease and cancer in America. Compared to 783,936 iatrogenic deaths, only 699,697 and 553,251 Americans died of heart disease and cancer in 2001.

Despite the availability of cutting edge medical technology and well trained doctors the American medical system is itself the leading cause of injury and death. Medical mistake is the 8th leading cause of death in the United States. All doctors, however, experienced and conscientious they may be, make mistakes at some point during their career. Like any other human being, doctors too are susceptible to error. It is a downside of being human.

When it comes to dealing with medical mistakes, we should come up with a more rational way of dealing with the problem, and try to move beyond a punitive mind-set. The punitive mind-set of the general public is the biggest obstacle to acknowledging mistakes by doctors and health care professionals.

Intimidation and physical harm towards doctors will prove counterproductive in the long run because if you punish doctors for making errors, they will never acknowledge any error and out of fear will never try to correct it.

Several studies carried out in the United States have demonstrated that when there is a punitive environment, more than 95 percent of errors do not get reported. Thus, harming doctors does more harm than good. If we are really serious about the safety of a patient, we need to know what is going on with the patient, and we are not going to find out what is going on if we intimidate or harm doctors.

According to Dr Lucian L Leape, a prominent health policy analyst at Harvard Medical School, "the two cornerstones of safety are, one, creating an environment where it's safe for people to talk about their errors and, two, leadership".

Doctors are ethically bound to tell their patients that they have made a mistake and patients have the right to know what is being done to them. However, the question here is: Will doctors be more forthcoming in acknowledging and correcting their mistakes if they are intimidated and harmed?

Like many developing countries, Nepal has difficulty attracting doctors to serve in remote areas. The distribution of doctors is skewed in favor of urban areas. Many district headquarters in hilly areas lack doctors due to which health and wellbeing of citizens living in such areas are being severely compromised.

Initially, like many policymakers in many developing countries, policymakers in Nepal too embraced a notion that the best way to get doctors to go to rural areas was to overproduce them. This notion has failed miserably. What policymakers in developing countries including Nepal failed to factor into the equation is the global labor market. The health workforce is strongly linked to global labor markets. Shortages in health care professionals in developed countries send strong market signals to poorer countries.

In poor countries such as Nepal the pay is low and working conditions are not so encouraging. When the doctors are quite often intimidated, an inevitable response would be to migrate towards greener pasture. Instability and insecurity does propel exodus of doctors and healthcare professionals.

It is estimated that there are more than 21, 000 doctors from Nigeria in the United States and more Sierra Leonean doctors are said to be living in Chicago than in all of Sierra Leone.

The flight of the creative class has begun. The number of Nepali doctors in developed countries such as the United States, England, and Australia is increasing rapidly. Every year the cream of the crop chooses to migrate, rather than stay home and face the lack of educational opportunities, career advancement, and on top of it intimidation.

Out of the many reasons why doctors choose to move towards greener pasture is because they refuse to practice in second-class health systems. Many think it is ethically incorrect to practice in unsafe conditions, where they cannot meet the needs of their patients.

If they decide to stay put and practice in second-class health systems, there is a big probability that some day they will be the victim of intimidation and humiliation at the hands of an unruly mob. Slowly but surely public misgivings continue to rise.

Medicine is a noble profession; there is no doubt about that. However, doctors are human beings too with craving for a better life and a secure future for themselves and their family. When politicians cannot devise a policy that guarantees security and incentives, they should not expect doctors to stay and serve the rural poor about whom they care least anyway.

Counteracting Maoist Strategies in Nepal

After the April uprising, the mood of general public seems to be upbeat. People have begun to see a silver lining in the otherwise murky cloud. With the eight point pact between the government and the Maoist rebels, bloody insurgency that took lives of approximately 14,000 people seems to be coming to an end, hopefully a logical one.

However, even after the eight point pact, kidnappings and extortion of innocent citizens have not subsided. Kidnappings and extortions by the Maoists continue unabated.

Thousands of homes of internally displaced citizens padlocked by the Maoist insurgents are yet to be unlocked. Their lands have been distributed to create an utopian society and movable assets used up. Despite such atrocities, the current government seems to be reluctant to vigorously raise the issue and force the Maoist leadership to do something about it. The Maoists as usual have not been sticking to the agreements whole heartedly. This is not the first time they have breached an agreement. If one can get away with crimes, why bother about its judicial ramifications? It makes perfect sense.

While the Maoists seem upbeat about their political future, the government appears helpless, feeble, and in disarray. For now, its main agenda seems to be keeping insurgents happy, contended, and engaged. However, with Maoists' chairman blowing hot and cold on politicians, Nepalese Army, and the king concurrently, the political landscape is dangerously tilting in Maoists' favor and may not remain the same for long. Keeping the Maoists engaged is necessary but not enough to ensure the dominance of democratic forces. With an increase in dominance of CPN-Maoist in national politics and supposedly end of the monarchy after constituent assembly, what will the Nepali political landscape look like? With an increase in Maoist dominance in Nepali politics, members of UML and other splinter communist groups that share the same common minimum values may desert their parties and readily join the Maoist bandwagon. That will push social and liberal democrats towards oblivion. Their very existence may become questionable.

After constituent assembly when monarchy is undone, what happens if the Maoists do not gain majority in parliament? Will they resort to persuasive politics and try winning mind and hearts of ordinary citizens whom they frightened and intimidated for one and a half decades? Big brains churning out political strategies for SPA should be pondering upon these questions, sooner the better.

If the Maoists lose elections and become a minority group in the parliament, it is very likely that some of their leaders will again head out to jungles and resort to guns to maintain their fiefdom or they may resort to guns and rig their way to the power. It is all together a different question whether or not they will be able to hold on to power in the current geopolitical settings for long. Either of these two routes is alarmingly dangerous.

Prime Minister Koirala's instance on ceremonial monarchy is very insightful. It may not be a very popular or politically correct thing to do now, but it is the right thing to do. Politicians like Koirala should demonstrate the courage and do the right thing rather than cruising in with popular opinion. Having a ceremonial king may not be a popular idea but it serves the people's interests. It will provide international community a base and a space to operate in case communist groups go out of whack and follow Cuban, North Korean, or for that matter Venezuelan path.

Mere signing agreement does not mean anything. It is not only about bringing the Maoists on-board and keeping them engaged. The SPA should work towards retaining their lost grounds by proving themselves strong and visionary.

They should try defending their existence and redefine their strategy in order to gain public confidence in them.

Even after the 12-point pact, 25-point code of conduct and the eight-point agreement, Maoists' brutality continues unabated. It is propagating the perception of lawlessness. But establishing the rule of law and maintaining security is very important for the success of any peace process and beyond. Failure to establish the rule of --- and maintain --- law and order effectively has left East Timor in a lurch.

The government should not ignore Maoist atrocities or any other criminal groups. We may choose to ignore lawlessness, but the only thing we can hope after that is social unrest, untold bloodshed, and the end of our dreams.

A well functioning legal system is in everyone's best interest. It provides an arena in which citizens can hold politicians and civil servants to account. In addition, it helps citizens protect themselves from exploitation by rich and powerful, and help resolve conflicts in an amicable manner.

A rule of law is central to the realization of constitutionally guaranteed rights and is important to achieve the broader goals of development and poverty reduction.We had a well functioning parliament a decade ago. It did not take very long for things to go out of hand and we risked ourselves of becoming a failed

state. Be it an irrational thinking of bunch of leftist radicals that thought power comes from the barrel of gun or incompetent politicians who think they could get away without serving their constituents and enriching themselves. The decade old insurgency brought us nothing but made us to realize that the armed struggle is an incorrect approach. Sanity has finally made a come back, better late than never, and let us hope it prevails.

Nepal is confronted with significant challenges and seemingly intr-actableproblems. Corruption and weak adherence to the rule of law are the biggest blems. Political will to address governance and ensure economic development is central to the Nepal's future.

Challenges for Civil Society in Nepal

More than dozens of innocent civilians have been killed by the Maoists after the revival of parliament in April. The Maoists hacked to death NC cadre Sushil Gyawali in broad daylight in Bardia. They attacked and injured over eighteen people, including lawyers, journalists and pedestrians while they were demonstrating against the Maoist atrocities in Bara. Raj Kumar Kusiyat was abducted from his house in Sunsari district.

These are some of the Maoist atrocities that surfaced in the media in the last couple of weeks. All these cases have one thing in common -- the perpetrators. The perpetrators in all these cases were the Maoists who believe in Mao Tse-tung's "power comes from the barrel of a gun".

While the Maoist atrocities continue unabated in post-April Nepal, the human right activists are nowhere to be seen as they were during King Gyanendra's heydays -- crisscrossing the globe attending talk programs and delivering lectures on human rights abuses taking place in Nepal.

Shouldn't they be protesting against the Maoist atrocities and pressurizing them to denounce violence? However, it is not the silence of human rights groups that surprises me the most but the silence of the "official" civil society that vehemently opposed and helped bring down King Gyanendra's despotic rule.

Civil society can and has played a significant role in safeguarding human rights, peace building, and democratization in different parts of the globe.

In countries such as South Africa, Mozambique, Mali, the Philippines, Guatemala, Liberia, and Northern Ireland peace, reconciliation, and democratization became possible in part due to the relentless effort and neutral stance of civil societies.

During the April revolution, hundreds of thousand of citizens participated in mass rallies organized by the "official" civil society. Nepali citizens ignored and betrayed by politicians for decades had found a strong platform for citizen activism in the form of civil society.

However, the failure on part of "official" civil society to condemn the Maoist atrocities which is against the ceasefire code of conduct signed between the government and the Maoists has raised a question on the neutrality of the civil society.

The civil society of pre-April revolution era was the projection into the future of a vision that rested upon an emotional unity. However, the civil society of post-April revolution cannot and should not base itself on mere emotions. The leaders of civil society should strive hard on the building of carefully nurtured institutions, practical realization of ethical values, and involvement of the greatest possible numbers of people in public life.

The main task of civil society in post-April revolutionary era is to construct democratic mechanisms of stability that secure constitutional checks and balances, increase public awareness in the spirit of respect for law, and encourage citizen activism.

Civil society is a major component of democracy. It creates a much needed participatory space for the citizens. In Nepal where radical communist insurgency has taken a heavy toll, existence of an active and neutral civil society has an ideological function: as a component in a counter ideology to "authoritarianism".

The civil society has a greater responsibility towards safeguarding political freedom and legitimatization of a social space in which private property and economic institutions ought to develop independently without state's interference.

The obvious obstacle to democratization is the civil disorder, violation of human rights, and civil liberties. There has been an unprecedented upsurge in crimes, vandalism, and vigilantism in the last decade or so. Such social pathologies have tremendously eroded the levels of trust and social capital. The civil society now must work towards revival of the lost trust and societal capital that is necessary for democratic stability and societal well-being.

Both in the liberal and the socialist visions of civil society, the basic organizing principle is the same-human rights. The official civil society which once enjoyed tremendous public support and played an important role bringing down the autocratic regime may lose societal trust and support if it fails to voice concerns and protest against indiscriminate killings, tortures of innocent civilians, abductions, and extortions.

Indifference and passivity on part of citizens is the greatest threat to democracy. A democratic state cannot survive without active citizens.

Civil society does not act in opposition to the democratic state, but cooperates with it and helps achieve democratic stability. Instead of staying silent on the Maoist atrocities, the leaders of civil society should raise the concerns.

For the consolidation of democracy, we need a civil society whose members agree that we should all live together under a common system of rule making and enforcement. Human rights and democracy are inseparable and interdependent. Human rights standards underpin a meaningful conception of democracy and democracy offers the best hope for the promotion and protection of human rights and civil liberties.

The civil society should strive towards promoting truth, justice, and reconciliation. The parties involved in violation of human rights that took place in the last one and a half decades have not sought any kind of forgiveness. The victims of human rights abuses continue to suffer psychologically. These victims, most of which are internally displaced citizens do not even have a choice between either justice or peace because neither option explicitly or officially is offered to them yet.

Internally displaced citizens are still forced to live in subhuman living conditions. Their plight is still being undermined and ignored by both the government and the Maoists.

Like many post-revolutionary societies, political landscape in Nepal has evolved and changed tremendously in the past couple of months. Civil society should take a lead in promoting accountability and justice for past abuses.

It should assist in the long-term task of reconciliation. It would be extremely hard and in some case impossible for internally displaced people to forgive the Maoist cadres in their villages that forced them to flee their homes.

Nepal's future as a well functioning democratic state to a large extent rests on effectiveness of the civil society. The leaders of the civil society should not let public trust be eroded because when people are pessimistic and lose confidence, they withdraw from the effort to build a better life and community. Society begins to lose its talent and energy. The decade-long bloody insurgency has claimed thousands of innocent people and displaced millions of fellow citizens. We cannot and should not withdraw from the struggle of building our nation.

Whither Nepal's Future

April revolution in Nepal has pumped up unmatched enthusiasm among Nepali citizens. Enthusiasm is most potent among those championing domestic political reform –constituent assembly. The April 2006 popular revolt ended King Gyanendra's increasingly authoritarian fourteen-month rule. However, the leaders of Seven Party Alliance and Maoists (SPAM) face significant obstacles.

If the situation is mishandled, and Nepali people conclude nothing has changed except the names at the top, Nepal could become seriously unstable and politically vulnerable to the external interference. In order to become successful, it is extremely important to know your potential. Thus, political leaders of SPAM should shed negativities, vengeance, and explore new opportunities.

It was easy to point mistakes of the royalist government, but to maintain a clean image and fulfill citizens' aspiration is not an easy task. Like in the past, Maoists have once again started exhibiting their dual character by not sticking to spirit of the ceasefire. Recruitment of cadres, killing of innocent people, and extortion have not stopped yet. An unprecedented rise in criminal activities and extortion has forced Dabur Nepal to shut down its factory in southern Nepal.

Industrial climate has deteriorated to such a level that industrialist have been seeking the government's intervention. While the country's economic backbone is suffering, the leaders seem to be busy bursting out anti monarchy venom rather than trying to address pressing domestic and security issues. When it is all said and done, people will start demanding for jobs and security.

With the closure of factories, not only the already high unemployment rate will spike further, but also the tax base will dwindle. Already poor and foreign aid dependent impoverished nation may become further unstable and malnourished. As far as Prime Minister Girija Prasad Koirala is concerned, he may be enjoying an unequivocal support from radical communists for now, but time is something that is certainly not on his side. His poor health may ultimately force him to exit politics. Thus, he has a responsibility of unifying divided congress party and strengthening his party's already weakened base.

Koirala's exit or absence may be the end of an era for social and liberal democrats in Nepal. No second generation leaders seem to have same stature and hold among the party cadres as Koirala does. So, what next? We may be heading towards a long haul of communist rule in Nepal which may turn out to be an authoritarian in nature.

When communism is seeing its slow but steady demise throughout the world, rise of communism in Nepal is in part because communists have been so far successful in selling dreams of equality, prosperity and ownership, and political bickering among the social and liberal democrats. Despite the fact that every communist economy in the world has failed, communists in Nepal have been so far successful in selling dreams.

Communist economy has not only failed, but miserably failed to support the country that tried it. The USSR is a history now, and Cuba is struggling hard to keep its populace happy with slow paced prosperity and high dose of ant-capitalist rhetoric. When it comes to red North Korea, it can not even produce enough food to feed its citizens. China is long past the communist economy stage, even if the rest of the government is as commie as can be. Forget about current level of development, it could not be able to feed its gigantic population with a communist economy.

When it comes to the right to differing opinion and personal freedom, communism has a belief system keeping the people in line. Killing non-believers is certainly an effective way to maintain control of those who don't accept the party line. For example, fate of journalist Dekendra Thapa and expulsion of Rabindra Shrestha and Anukul shows dictatorial face of a communist outfit. The minute you dissent, you are a traitor.

"Intra party feud and failure to deliver developmental benefits to oppressed, poor, and unemployed citizens by the social and liberal democrats created a political vacuum which socialist propaganda promptly filled. It was not hard to brain wash already disenchanted populace with socialist propaganda of equality and freedom from feudalism."

Freedom of expression tends also to be mediated by the state to maintain the 'integrity' of a communist regime. You can find a Marxist book in a US bookstore but it is impossible to find a Ludwig von Mises in a North Korean or Cuban library. After the reinstatement of democracy in 1990, social democrats dominated Nepal's politics with 114 members in parliament. None had thought that things would change so soon in favor of communists. After barely 16 years, country has gone all red. You agree it or not (depends on your political inclination), rural areas are completely controlled by radical communists (the Maoists) and urban areas by comparatively liberal communists (UML).

Intra party feud and failure to deliver developmental benefits to oppressed, poor, and unemployed citizens by the social and liberal democrats created a political vacuum which socialist propaganda promptly filled. It was not hard to brain wash already disenchanted populace with socialist propaganda of equality and freedom from feudalism.

So, this may be the last chance for social democrats that are at the helm of affairs in seven party alliance's government. Few things they may consider doing is (a) get Maoists on board and persuade them to submit there arms to credible institution (b) address unemployment problem (c) provide security to threatened industrial sector (d) establish rule of law, and (e) ensure economic development of rural areas. Do it, and do it right this time or else we may have a new authoritarian communist nation in the globe.