KATHMANDU, April 11: Private medical colleges have forced medical interns to work up to 36 hours in a shift while they are paid only around Rs 9,500.00 per month, it has come to light. Due to lack of binding guidelines regarding pay scale and working hours for interns, private medical colleges often exploit the interns with long working hours and low pay.

After completing a five-year MBBS course, medical students need to complete a one-year mandatory rotatory internship in their respective medical colleges. During admissions, private medical colleges charge Rs 120,000 to Rs. 300,000 from a student for the internship.

“Interns have to work shifts that span 32-36 hours at different departments on alternative days. It adds up to 120 hours per week, or 40 hours more than the norm. Interns are like captives and an easy source of cheap labor for medical colleges,” said Arun Upreti, an intern at KIST Medical College, Lalitpur. “Residents in the USA serve only 16-24 hours in a shift.”

At present, interns at the Institute of Medicine (IOM) are paid Rs. 15,250, or half the salary of a third class gazetted officer, while interns of TU -affiliated medical colleges have been paid a stipend of around 9,500 monthly. KIST pays Rs 9,600, Janaki Medical College in Janakpur pays Rs 8,500, Chitwan Medical College Rs 10,000, National Medical College Rs 10,000, Universal College of Medical Sciences in Bhairahawa Rs 9,500 and Gandaki Medical College in Pokhara Rs. 9,600 monthly, since about the last four years.

Gandaki Medical College and KIST currently have 41 and 48 interns respectively. The colleges have a low number of faculty doctors and given the absence of PG programs; they don't hire a sufficient number of medical officers. “Interns should be supervised by the doctors but we are frequently left on our own to check up the patients. This is risky for both patients and students” said an intern at KIST. “We have not even been paid for 49 days now.”

Students at KIST also complained that they face various problems in the college such as regarding sleeping chambers, canteen facilities during the night, library, laboratory, and sufficient open spaces. “We are even barred from using the college hospital phones for official work,” said the interns.

While asked about the concerns voiced over working hours and low pay, Dr Suraj Bajracharya, deputy director at KIST, said that he belongs to the academic sector and asked to consult the spokesperson for the official response. However, Akshya Gautam, the spokesman, could not be contacted by phone despite several attempts.

The interns protested many times in the past, leading to temporary suspension of internships and academic programs over the last few years, including at UCMS in 2013, KIST in 2014, and Nobel Medical College in 2016. After protests at Nobel Medical College, Kathmandu University issued a minimum stipend of Rs 11,000+1,500 monthly for night shifts for a maximum of 11 night shifts monthly. All KU affiliated colleges now abide by these arrangements.

Demanding similar regulations, interns at five out of the seven TU affiliated medical colleges--KIST, Gandaki, UCMS, CMC and Janaki MC-- submitted a letter to Dean JP Agarwal on April 7. “We requested the administration of the respective colleges to revise the stipends and limit the work hours, but our grievances were met with nothing but threats and abuses,” said another intern at KIST.

Dr JP Agrawal, the dean, said the interns have submitted their concerns. “We have started asking for details of work hours for interns, supervision and pay scale,” he said. “We will come up with proper decisions soon.” Charging students fees for internship was not rational, he also said.

The Accreditation Council for Graduate Medical Education (ACGME), USA on March 10 issued a revised common program of requirements for residents that is to go into effect from July. The new rules maintain a 80-hour-per-week cap on residents' work averaged over four weeks, and permissible work shifts of 24 hours. No such guidelines exist in Nepal.

Public concern has been strong in the USA ever since Libby Zion, an 18-year-old college student cared for by overworked and under-supervised interns, died in a New York hospital in 1984. Private Medical Colleges in Nepal are unaware of the Libby Zion incident.