privacy – not so third world problem?

Yes, developing nation like Nepal first needs food, shelter and clothing first. Then comes the health, education, and better society. Somewhere in the middle, what we need to balance are the three Ps  – privacy, piracy and plagiarism. I will write about “privacy” today. Remaining two will take some more time.

Privacy International 2007 privacy ranking map. Orange – Extensive surveillance societies. Red –  Endemic surveillance societies. Green – Consistently upholds human rights standards

privacy

what is privacy in Nepal?

Before anything, I would strongly suggest reader to know the variation in definition of privacy in Eastern vs. Western society.  Nepali culture as like many South Asian, has fair share of situations which might get misinterpreted as breach in privacy. We have pretty thin line in few too many situations where privacy in not so big a deal. However, there are limits, and we do have bigger issues, when privacy does get messed up. The lines of privacy when compared, are drawn in different places.

example – one usually does not own a private room in most of Nepal. the notion of your private space is probably at best only in bathrooms and toilets. Not many understand the luxury of  this a private space.

how private is Nepal?

Sure, In Article 22 of the Constitution of the Kingdom of Nepal 1990, the right to privacy was addressed as a fundamental right for the first time in the constitutional history of Nepal. The right to information was also included in this Constitution. The right to privacy was retained in the 2007 Interim Constitution, which remains in force today. Article 28 provides:

Except in circumstances as provided by law, the privacy of the person, residence, property, document, statistics, correspondence, and character of anyone is inviolable

However, individual privacy is something else. Privacy has rock bottomed for majority Nepali, part in due to the cultural dogma.  Although there is constitutional protection for the right to privacy, no law or acts have been made to protect this fragile right. However, the right to privacy is addressed by some laws, such as the following:

  • Postal Act, 1962 (Section 47 and 58)
  • Telecommunication Act, 1962 (Section 23 (a), 24 and 27 (b))
  • The Chapter on Court Procedure (Section 172) of Muluki Ain

In September 2012 right to information activists launched a public interest litigation seeking a court order that the government promulgate an Act specifically protecting the right to privacy as guaranteed in the Interim Constitution. The writ petition referenced measures taken by police to access individuals’ text messages while investigating the murder of Supreme Court Justice Rana Bahadur Bam. The petitioners requested the Supreme Court direct the government to promulgate the Right to Secrecy Act to protect the private communications of individuals from government interference.1

There is no government authority to receive complaints regarding violations of privacy rights, although people may submit applications and reports concerning violations of their privacy rights to the National Human Rights Commission (NHRC). However, to date, not a single application/report/case has been brought to the NHRC regarding privacy rights violations.2

my (personal) privacy related problems

  • Public Transportations – These have the worse privacy records for me. I usually travel through the battery powered three wheeler (aka. Vikram Tempo) in Kathmandu. Whenever there come a time to send in a SMS, or call someone, there are at least two pairs of eyes watching me dial/type in my mobile device. Somehow, they think its there to watch. I try to avoid bus and micro bus rides for this same reason.
  • Sod Casting –  next to my worse list on breach of privacy. Not to be  prejudice here, but there certainly is that demography of Nepali population cohort here, who could really learn something more about privacy. I do not want to hear Bollywood songs, especially those from 90s, and English Pop culture – from Justin B, and gangs. I regret that very few listen to Kings of Leon – Queen – Daft Punk – Bob Dylan genres that I am comfortable with. For the record, Indian remixes of PSY – Gangnam style is abomination to creativity.
  • Walking a busy street – One is sure to get hit by too many hands and shoulders. For women, it gets worse. This is more a problem of not having personal space, but all purpose intended, I consider this to be a privacy breach as well. Privacy of walking safely, and not banging to every other person. I strongly believe that, one can walk in a huge crowd of hundreds or even thousands, with least possible number collisions.
  • The telephone call conundrum – Growing up adolescent life meant one landline per household in Nepal. A friend’s call to a landline in the late 90s and early 2000s was a double edge sword. You could never leave with that short cord, and the cordless phone were usually listened to.

“Who is? TA or T?”

  • If there was a call for me, the first question my mom would put – “Who is? TA or T?” Literally “Ta” meant short for K-ta, which is basically “a boy” and “T” meant short for K’T, meaning “a girl”. I kept things at minimum, usually didn’t pick up any call at all.

what is privacy?

Privacy can simply be defined as the right to be left alone. ‘It is a comprehensive right and it is the right most valued by a free people. It is a fundamental human right.  A society in which there was a total lack of privacy would be intolerable; but then again a society in which there was a total privacy would be no society at all’ (the is a balance needed).

Privacy is the right of people to make personal decisions regarding their own intimate matters, it is the right of people to lead their lives in a manner that is reasonably secluded from public scrutiny, and it is the right of people to be free from such things as unwarranted drug testing or electronic surveillance (from Answers.com http://www.answers.com/topic/privacy)

‘Privacy’ is a broad, abstract and ambiguous concept

UN Declaration of Human Rights.

The UN Declaration of Human Rights defined Privacy as this:

No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honor and reputation. Everyone had the right to the protection of the law against such interference or attacks.

what if there were no Privacy?

Without privacy life would be hell. It would mean that you would be highly vulnerable to the control of others, you would lose your freedom which may lead to inhibition and tentativeness and you may be less spontaneous and you would be more likely to be manipulated. Given below are four aspects of privacy that I think are important, in Nepal.

privacy I: the internet

Yes, because I am a tech enthusiast, I made sure this was written in the beginning. The Internet threatens privacy in a number of ways, partly because it is possible to record everything that you do on line (IP addresses remember?).The governments of developed nations and few developing countries regularly monitor electronic communication as do commercial companies such as Google, and Microsoft. Nepal Government may not have so much a control over its netizens, but since India has already initiated a tighter control; I won’t be surprised if Nepal did the same thing. In any manner, If there is communist government in Nepal, internet will be watched even more so ever, including this post (“read as a political satire, please don’t arrest me”)

Info Graph by – 1984 in 2013: Privacy and The Internet via HostGator

privacy II: medical?

Since August 2009, when the USA government regulated that any breach affecting more than 500 patients be publicly disclosed.3 Nothing sort of it is in Nepal, as far as my understanding goes. Medical privacy breach is rising in the world, and we in Nepal, have very little or no clue about this. As a student we are taught not to speak of our patient, and there is a tremendous effort put into making a Case Report (or any other Medical Journal article/s) anonymous.

My personal experience has given me the glimpse of complete lack of data privacy in most of the Nepali Health Setting. There is privacy screened from the public eye, but within the medical fraternity, be it a doctor, nurse or a paramedic; or within a hospital/clinic/health post setting there aren’t even rules or contingency plan in case of privacy breach.

Legally, Nepal has prominently recognized the confidentiality of medical records. But there are some major systemic loop holes.

privacy III:  for women?

Legally speaking, men and women in Nepal are equal. But there still remains a deep rooted caste and cultural divide. The existing hierarchies that does not let these two gender have equal footing. This is true for every aspect including the privacy related to the following three things.

Ask your self, if we need privacy for

  1. family planning,
  2. violence against women, and
  3. women empowerment.

The former two require privacy to be neglected for the benefit of a woman, while in latter case may require a stronger support. In any case, I definitely would love to read more before writing anything else. From what I think, I have already written absurdly in the last few sentences, better keep mum till I know more. In the mean time, I would like to share here a wonderful passage from Martha C. Nussbaum. (web link). A very intriguing article where the author talks about privacy being bad in few cases – which are elaborated in detail.

Despite its commitment to sex equality, Indian constitutional law increasingly relies on the concept of privacy in matters of sex and family. This concept, traditionally conservative and associated with “family values,” has long been criticized by feminists as a bad way of gaining rights for women. Feminists typically make four criticisms of the privacy right: the concept of privacy is unworkably murky; the privacy right protects male bad behavior; protecting important liberties under the rubric of privacy unfairly discriminates against those who perform the same acts in a space denominated “public”; and privacy is simply irrelevant to a number of important liberty interests that need explicit protection.

privacy IV: Organizations

Here are some of my suggestions on what should be guiding principals on privacy in Nepal. I do not know, if its already written somewhere in Nepali, but most here are compiled (and no original ideas). I am listing some that is in my mind.

  • Only collect personal information that is necessary for performance of functions.
  • Use and disclose of personal information only for the primary purpose. Use for other secondary purposes should have the consent of the person.
  • Organizations (or anything similar) must be open about how they handle personal information.
  • Individuals have a right to seek access to their personal information and have it corrected if it is inaccurate, incomplete or out-of-date.
  • Individual option of not identifying themselves when entering transactions with organizations (if its would be lawful and feasible) should be present.
  • Sensitive information must require consent when collected and higher levels of protection should be afforded. These includes information of – caste, ethnical group, political views, religious views, criminal record, professional association, etc.

conclusion

I read a a total of seven web articles and three papers, but this was not enough. I could write more about the Internet privacy breach and its threat, and probably could lay out some ground work on how to stay secure on one of my next post. I definitely  need to read more with privacy concerning the social aspect (focusing on women).  I am not, at the moment, interested on the medical privacy breach (despite being a doctor). May be some day.

references

  1. Newspaper Article – Secrecy right Act sought. web link.
  2. Web Article – Privacy International Report – on Nepal. web link.
  3. Journal Article – Roger Collier. Medical privacy breaches rising.  CMAJ. 2012 March 6; 184(4): E215–E216. doi:  10.1503/cmaj.109-4116. –  web link.
  4. Website – Privacy International

more reading (highly recommended)

  1. Web Article – by Seema Dhami – Balancing Individual Privacy with Press Freedom. Nepal Monitors. 2008. web link.
  2. Web Article – by Martha C. Nussbaum – Is privacy bad for Women? – Boston Review. 2000. web link.
  3. Book Read – by Martha C. Nussbaum –  Women and Human Development: The Capabilities Approach (The Seeley Lectures). Amazon.com. haven’t read it myself but would love to if someone gave  it as a gift.

Tune in Next Wednesday for –

where did the cotton go? Bangladesh, China and Nepal

a wristwatch, a radio, and a cycle

evolution of dowry in Nepal – part I (of II)

The (not-so-evil) dowry culture of 70s and 80s in Nepal.

I say 70s and 80s to be – not-so-evil, because this is somewhat simpler, when compared to the present dowry culture in Nepal. Read my next post for the bad omen dowry system. For now, read below.

Railroad watch
Railroad watch (Photo credit: mpclemens)

Mr Sukhiraam (name changed) stood up and ran towards the paddy field. This happened when he was getting married (arranged marriage) to a girl from next village, five kilometers south-east from his own.

why did Sukhiraam ran?
There was a specific wristwatch he demanded as his dowry. This was Seiko Day-n-Date wrist watch, the one with the “second”-hand and leather strap, which had dates shown. The one which was considered as the highest class of gift, at that time, in that region. This was an era when there were no Television in Nepal, and Radio had just made it inroads. The watch was one of the most useful technological advancement for Sukhiraam, and he’d hope it be on time for all his work and duties from hence forth. His work duties related to grazing and then milking his cows and buffaloes, working at rice field, bringing about drinking water from a fifteen minute walk, helping his landlord with various household chores and agriculture related work and mostly being on time for the morning cup of tea at the village tea shop. The shop, where he had boasted a day earlier that he’d be getting a watch, not just just any watch, but a “Seiko Day-n-Date Watch”. His reputation and family honor were on line.

what were his dowry options?
The three most prevalent dowry gift in those days (for this region) were – a wristwatch, a cycle and a radio, Second after the aforementioned wristwatch was a cycle. The cycle from “Hero” company, which had no gears, or front or tail lights, was the heaviest thing around, and quite uncomfortable by today’s standard. But in those days, Hero cycle was the speed demon, and a status symbol. Sadly, Sukhiraaam had one of these, and this was the very reason, why he was to married.

Paarvati’s father had searched for three months when he got the news of a handsome Sukhiraam who had a Hero cycle. Paarvati would be very happy, if she’d marry to this richness, which was only three hours walk from her fathers home, Paarvati, the eldest, was of age, and her father had two more daughters to marry off in the next three years time. Paarvati was lucky that Sukhiraam liked her on first visit, and since he already had the cycle, there was only wristwatch which was demanded.

how long before a wristwatch?
Paarvati’s father had to ask his elder brother’s son – Lakhan, who’d be going to the nearest market (Manhari Market) to sell his land lord’s agricultural goods in about three weeks time. Lakhan, would take extra money with him, and provided there were no Dacoits and Loot on the way, he’d be going to the nearest city, in India, to get this watch.

Gorakhpur city was roughly 200km south, and it would take a train ride of six hours to reach there. If you weren’t careful, you had a very likely chances of getting robbed or pick pocketed. Plus, you would not go there alone, and usually took someone with you. There was only one train every day, so, Lakhan had to spend one day in Gorakhpur, with a paid travel allowance by Paarvati’s dad. All in about – seven weeks time. The wedding was scheduled on the eighth week.

who became greedy?

you tell me.

 

experience at medical (specialist) conference

English: Kathmandu sunrise
English: Kathmandu sunrise (Photo credit: Wikipedia)

I was fortunate enough to be a part of ten volunteers at a conference this past week. This was a specialist conference in medicine, and most of the attendees were prominent Nepali clinicians. I had a good opportunity to see these faces for the first time, and this post is dedicated to these heroes from Nepali Medicine Fraternity. I write names of few who were really impressive, quote few that were good, and mention some that were plain dumb. The conference was held in Kathmandu, for two days.

the good
As I see it, Dr SL (nickname) had the best presentation (also read the disclaimer below). He talked about emergency medicine and critical care management, and it was the most fruitful 20 minutes of learning experience during that 48 hours. Everyone else was mostly mediocre and some simply dumb. The post presentation / oral session discussions were quite good (all expect one related to Vitamin D). Few good questions and some great answers. Few faces came out again and again, with good talks and reasoning. Great learning experience.

Food was “okay” – nothing out of the world, but rather a standard Nepali set (of good looking rice, vegetables, meat and some cakes). Tea break had good tea/coffee, but very bad cookies selection. Lunch was crowded, but dinner was calm. As usual, dinner was served along with alcohol and 40+ doctors joined us (out of no where) during this feast.

the bad
There were ten of us (volunteers) and we did not get any public appreciation. We were junior doctors, working tireless throughout these two days and there was very little or no acknowledgement for us. There were few (three – to be precise – part of organizing committee) personal note of thanks from good people out of the 250 that attended. This, compared to another conference I attended three years prior, is a nightmare when it came to management (cultural and copycat) aspect.

Every speaker somehow had to be presented with a certificate of appreciation after the sessions, and even those who chaired the session got it. Then there were felicitations to some prominent senior doctors (read more than ten senior doctors). Then there were pharmacy company giving out weird appreciation/gift wrapped up. The so called prominent doctors society had very less ingenuity and patient to sit and listen properly. At one time, there were six audience/participants (three were volunteers), the MC was calling out names, and four doctors lined up to receive their post presentation certificates. The hall was empty.

There was virtually no interaction among the me and these senior doctors. This was mostly my fault (read busy). However, this is also due to our culture of not standing along with the senior faculty members and teachers. Asian education (Indian sub-continent) to be precise, has this great barrier among the teachers and student, which was very evident at this conference. Most of the junior doctors had no urge to question the authority and reason with our senior faculties.

we have this absolute anarchic culture; taught in medical school, not to question our teachers and seniors

The result of which makes most of us a little less bold, and we lack confidence. I know, that among the 45 of us, in my medical school, only handful were bold enough to utter wrong stuffs with absolute confidence. I wasn’t one of them, and a little part of me regrets for not being this. We were not to speak unless we were knew absolute concrete knowledge. If we spoke, were ridiculed and smirked upon.

the ugly
The last two years after my graduation has been very much revealing in aspects related to drug companies. I don’t hate them, but I am not comfortable with some marketing gimmick they put up with. They sure know how to suck it up to the doctors fraternity. There were around 20+ stalls of various pharmacy products just outside the hall where the conference was happening. One stroll through this, and I was filling my complementary bag with free pharmacy gifts, brochures, drug trial literatures/papers, posters/pamphlets and sample medicines.

I am uncomfortable with this. But hey !!! couldn’t resist the free stuffs that they were giving out. All my friends were getting it, some even went the second time, and came back with two sets of everything.

On the medicine side, I god ampules clindamycin (anti-biotics). Oral Tablets of PPI (proton-pump inhibitors) the brand name of which i don’t remember (they were not omeprazole or pantoprazole though). I got a month supply tablets of combination drug – Losartan + Amplodipine. This combination drug has something I will write in my next post. There were paracetamol leafs, and some wet-wipes also. Out of the ordinary, I got a key chain, a pen (good one), numerous cheap pens, coffee mug, a calendar, a beer glass, and lots of chocolates.

I took papers/pamphlets from all the available stores representing some 40 drugs. Read them, and found out that only seven of the medicine had mentioned their side-effects and adverse effect on these advertisement. Another thing I am uncomfortable with. It ought to have been written there. Only three pharmacy provided the drug trials (trials done in USA – sadly Nepal is too poor to conduct RCTs).

There was one strange oral tablet for curing hemorrhoids. It had not pharmacological name, and the brand name suggested it to be an ayurvedic medicine. This oral drug also had a small trial conducted in India among 300 patients with 90% cure rate. I am unaware of Ayurvedic medicines, and my knowledge to this is very limited, so I can’t really comment on it. However, this whole thing looked extremity dubious.

other stuffs…
Both of us went (my wife and I). She was the MC, and I was (as she put it) – “volunteer-by-relation”. We did had our friends circle there, and it was definitely an educational (some) and fun filled event. I had my camera, and at times, I’d go out and take pictures here and there (perks of being a volunteer). Some presentations were plain boring, so we (me and friends) would go out and talk, walk, or eat. With few extra passes, we’d also called our friends for dinner and free alcohol. I must thank Dr PP (nickname) for inviting us to this conference (as volunteers). We did not need pay the usual Nrs.2500 participant fee.

my judgement criteria (my perspective for presentations/oral-sessions)
I looked for the following criteria, in all the presentations for my judgement; and even though I was not present in all of the presentations and discussions, I now have the rough idea of who could present. It would be wise to mention that I very much like reading journal paper, and am keenly interested in public health issues, so my judgement – may be biased.

1. Simple English, Short Presentation.
2. Evidence based Medicine (preferentially local – Nepali evidence)
3. Up dated and latest research findings (with landmark research included)
4. Public or Primary Health related component.

Based on this, there were only three presentations that had all four components, five that had at least three of the component. Remaining were not so appreciable. The international faculty members who presented (read – four – from India) were all good. One of them even questioned the standards of Ethical Review Board (ERB) in Nepal. Rude thing to say, but somehow, he was correct and spot on on pointing out mistakes. So like can’t judge that.

in the end..
The weekend was not that bad, but it could have been a lot better. My past experience attending international conferences, tells me we need to do a lot. But, somehow, I am content, to know that, this is evolving and in times, we will get there. Still, there was no need to gift wrap every presenter with a certificate as soon after he/she spoke. Thats just stupid.

disclaimer – Dr PP and Dr SL was a faculty member to the medical school I graduated from, and I (we) have been in more than few of his lectures to highly appreciate them both.