Sunday, December 17, 2017

न्यानो माया


तराईमा कस्तो छ कुन्नी तर काठमाडौं उपत्यकामा शीत सहितको एकदमै ठिहिर्याउने जाडो छ। भुकम्पपछि पालको बास भएका या तराई डुवान पछि घरबार र लत्तकपडा बिहिन भएकाहरुको त बिजोगै भो होला , बिहान होला र न्यानो होला भन्ने आशामा छन् होला ।



सदियौ देखी केही नभएका मान्छेहरु पनि यहाँ धेरैनै छन् , सुकम्बासी भनेर चिनिन्छन् । कसले एक सरो लुगा देला र  जाडो  काट्म्ला भनेर बसेका छन् । चिसो सडकमा  सडक बालबालीकाहरु कसरी निदाए होलान् ।

दिन  रात काम गरेर पनि खान नपुग्नेहरु कि त भ्रष्ट भएका छन् , जो पढेलेखेका गरीबहरु हुन् , या त अर्को कुनै क्रान्तीको तानाबाना बुन्दै छन् ।
जुन ठाउँमा हाम्रो न्यानो माया पुगेको छैन मिसीनरी पक्कै पुगेको होला । बिडम्बना आजको जल्दो बल्दो ब्यवसाय त्यही भएको छ। गाउँ गाउँमा र बस्ती बस्तीमा भोका नांगा त पक्कै बढेका छन् । मान्छेहरु जन्मी रहेछन् तर प्राकृतीक स्रोत घटीरहेको छ , अस्तब्यस्तता बढिरहेको छ , रोजगार छैन ।

अब अरु कुरो होइन , आफ्नो मनको ढोका खोल्नुस्  अनि घरको दराज, बाकस र सुन्दुक । त्यहाँबाट , तपाईले नलगाएका लुगाहरु धेरैनै छन् र न्याना पनि होला , निकाल्नुहोस् , सुकाउनुस् , धुनुस र र लिएर पुग्नुस् नजीकैको गरीब धनबहादुरको  घरमा या फाटेको फ्रक लगाएकी सिर्जनाको घर । मनग्य आशीस पाउनुस् ।
सबैलाई न्यानो माया शुभ आर्शीबाद ।
आज जन्मदिन हुनेहरुलाई बिषेश शुभकामना ।


संसारभर एक डिग्री सेल्सीयसले तापक्रम बढ्ने कुरा भईरहेको छ , तर काठमाडौंको जाडो ५ डिग्री सेल्सीयसले बढेको अनुभव हुन्छ । २०३४ साल पछि जन्मीएका हाम्रा पिढिका मान्छेहरुले माईनस ० डिग्री सेल्सीयस भन्दा बढि जाडो अनुभव यस पलि न्यानो सानो कोठामा बसेर चिसो तातो सुरुप्प गर्दै अनुभव गर्न पाईयो । तर जाडो मुटुनै काम्ने छ ।


भुकम्पको महाबिपत्ति , त्यसपछिको भारतीय नाकाबन्दी र उर्जा संकट अनि दिनहुँको महंगी र के खाउँ र के लाउँ भन्ने बाध्यता माझ यो  जाडोको महाबिपत्ति अनि छाप्रो र पालको बास । फेरी पाल बाट चुहिने जीउ छेड्ने शीत अनि बिहान कहिले होला भन्ने झिनो आशा र उहि प्रदुशषणले तुषारापात गरेको घाम । यो अत्यन्तै बिपतको स्थीति हो , सारा नेपालीका लागी र यो कठिनतम् स्थीतिबाट उन्मुक्ति पाउने भनेकोनै सारा नेपालीको न्यानो माया र सद्भाव हो ।

बर्षौ देखी तपाईको दराजमा थन्कीएका ,  ढुसी गनाउनै लागेका , किराले खान्छु भनेर आँ गरेका , नाती पनाति, छोरो बुहारीले कासेली पाएका कपडा कहिलेको लागी साँचेर राखेको , छोरीलाई चाहिंदैन , नातीनीले लगाउँदैन । मन फराकिलो गर्नुस् , निकाल्नुस् , धुनुस् र पुगोस् बिधालय जाँदा ठिहिराई राखेका नानीहरुका आँगमा , सुत्केरीको छातीमा , बृद्धहरुलाई न्यानो सेक्न ,चीसोमा कर्मबादी हात चलाईरहेका मजदुरहरुको भक्कानो रोक्न ।

तपाई शीत लहरले छोपेको भुकम्प पिडित टहराहरुमा पुग्न सक्नुहुन्छ , महोत्तरी र रोतहट पुग्न  सक्नुहुन्छ या काठामाडौंकै गणेश स्कुल या दरबार हाईस्कुल पुग्न सक्नुहुन्छ एक कुटुरो न्यानो बोकेर ।  उनीहरुले तपाईको सहयोग लिन अस्वीकार गरे भने भन्नुहोस् - "यो जाडोमा न्यानो मेरो तर्फबाट , अको बर्ष तपाईको सदाससयताबाट ।"

नेपाली पहिचना फहराउने बेला यहि हो । आखीर झण्डा बोल्दैन र ति दुखी मनहरुले माग्न जानेका पनि छैनन् । तपाईनै अघि सर्नुस्।

बाँडेर र दान गरेर अखिर कोही गरीब भएको , छैन । नेपलीलाई चेतना होस् ।

हामीहरु पनि तपाईकै साथमा छौं ।

Monday, October 16, 2017

पोष्ट ट्रम्याटीक स्ट्रेस डिसअर्डर (PTSD)


पोष्ट ट्रम्याटीक स्ट्रेस डिसअर्डर (PTSD) या बिपत्ति पछिको तनाब केन्द्रीत आघात (छोटकरीमा मानसिक आघात) एउटा यस्तो किसीमको मानसीक बिकारको (स्थीति) हो जसको बिकास तब हुन्छ जब एक मानीसमा यौनजन्य हमला , युद्धइतर परीस्थीतिको समाना , आतंक , डरधम्की , आक्रमणको सम्भावना , सवारी दुर्घटना , प्राकृतीक बिपत्तिको सामना या अरु कुनै जटिल परीस्थीति जसलाई आफ्ना सीमित मानसीक , शारीरीक, सामजीक – आर्थीक सहयोग र नियत्रण भन्दा बाहिरबाट प्रतिरक्षा गर्नुपर्ने हुन्छ ।
२०७२ सालको महाबिपत्ति पछि धेरै भुकम्प पिडित माझ यो समस्या तड्कारो रुपमा देखा पर्यो । कुनै किसीमको बिपत्ति लगत्तै यो समस्याले सताउँछ नै भन्ने छैन किनकी बालबालीकाहरुको मष्तिष्कले खेल मार्फत यसका असर , जोखीम र सम्भावनाहरुलाई न्युनिकरण गरीदिन सक्छ ।
यौन जन्य आधात सहेका र बालब्यभिचारमा परेका अधिकांशहरुमा भने यसले दिर्घकालीन समस्याको रुपमा उनीहरुको मनोसमाजीक बृत्तमा असर गरेको पाईएको छ । यस्तै सशस्त्र द्वन्दको बेला या पछिको स्थीतिमा यो समस्या एकदमै टड्कारो रुपमा देखा परेको छ । यस्ता परीस्थिति जुझेकाहरुले आत्महत्या जस्ता अरु आत्मघाती प्रयास गर्ने गरेको देखीन्छ ।
पुरुषहरुको संख्याको अनुपातमा दूई गुना महिलाहरुमा यो बिकार देखीएको छ ।
समयमै उपचार नहुँदा यो समस्याले रोगी – पिडित मात्र होइन उनीहरुको परीवार , साथीभाईहरुको जीन्दगीमा पनि अरु धेरै जटीलता थप्न सक्छ । त्यसैले तपाईको परीवार , छिमेक , साथीभाई या उपचाररत संघ संस्थामा निम्न प्रकारमा लक्षणहरु भएका ब्यक्तिहरु फेला परेमा नजीकको मानसीक स्वास्थ्य केन्द्र , मानसीक अस्पताल या दक्ष मनोबिद् , मनोपरामर्षदाता , थेरापिष्ट या चिनेजानेको कुनै मनोसामाजीक कार्यकताहरुलाई तुरुन्त खबर गरेर उपचारमा सहयोग पुर्याउनु हुन अनुरोध गरीन्छ ।
जति छिटो यो या अरु कुनै मानसिक समस्याको पहिचान – निदान त्यतीनै प्रभावकारी समाधान ।
 भुकम्प जस्तो प्राकृतीक बिपत्ति या मानसीक आघात पर्ने कुनै परस्थीतिको सामना पछि पिडितहरु निरन्तर रुपमा आत्तिने , झगडिने या भाग्ने, डरलाग्दा सपना देखेर निन्द्रामा बर्रबराउने ,रात बिरात जाग्राम रही आफैसँग बोलीरहने , छट्पटिएको र अतिनै तनाबमा रहेको असामान्य ब्यवहार बिरामीहरु देखाउने गर्छन् । यस्ता बिरामीहरुमा चेतना हराए जस्तो , होश नभएर मान्छेलाई चिन्न र उनीहरुका कुराहरु पहिल्याउन गाह्रो भए जस्तो , एकदमै अलमलिए जस्तो बेसुरका पनि लाग्न सक्छन् । साथसाथै अरुहरु प्रति केही या धेरैनै शंकालु बन्न सक्छन् ।
 यसका बिरामीहरु चलचीत्रको पर्दामा जस्तै बिपत्तिका घटनाहरुलाई निरन्तर , क्रमबद्ध रुपले सम्झने (अस्वेच्छीक) र आत्तिने गर्छन् । आफुलाई बिपत्तिले या दुश्मनले लखटीरहेको मान्ने , आयो – आयो भनेर ठुलो स्वरमा कराउने या तर्सने , कुनै निश्चित त्रासदीको सुचक बिनानै एकदमै डराउने गर्छन् । पिडितहरु बिपत्तिको बेलामा आफुले यस्तो या उस्तो गरे भए हुन्थ्यो भन्ने र आफु त्यो बिपत्तिमा बाँचेकोमा ग्लानीबोध गर्ने गर्छन् । घटना घटेको प्रकृतीसँग उनीहरु टाढा रहन खोज्ने हुन्छन् ।
 बिरामीको स्मरण शक्ति पुरै रुपमा क्षीण भएर घटना सम्झन नसक्ने र ध्यान पनि बरालीएको जस्तो देखीने हुन सक्छ । साथसाथै उनीहरु आफु भावशुन्य भएको या आफ्नो शरीरमा कुनै अंगले काम नगरे जस्तो , आफु यस लोकमा नभए जस्तो बोध सुनाउँछन् ।
 यस्ता पिडितहरुमा निन्द्राको समस्या , चीढ्चीढेपन , रीसाहा प्रबृती (बच्चाहरुमा झगडालु या अभिभावक झम्ट्ने प्रबृती) देखापर्न सक्छन् । उनीहरु टोलाईरहने या एकदमै सर्तक भए जस्तो देखीने या कुनै पनि कुरामा त्यती ध्यान नभए जस्तो , आफैमा अलमलीए जस्तो पनि देखीन सक्छन् । यी पिडितहरु समाजीक रुपमा आफैलाई एक्ल्याउने प्रयास पनि गर्न सक्छन् या एकलकाटे हुन्छन् । यो एक्लोपन आत्महत्या या आत्मघाती कदमको प्रयासको कारक पनि बन्न सक्छ ।
 चिन्ता या निराशाले गाँजीरहेको परीस्थीतिबाट उम्कन पिडितहरु मध्यपान र दुब्र्यसनको शरणमा परेर यो र दुब्र्यसनको समस्या अझ बिकराल भएको देखीन्छ । हिजोको बारेमा धेरै सोच्ने , भोली त्रासदीपुर्ण भएको अनुमानले चिन्तीत हुने र आज बाँच्न नसक्ने जस्ता संसयहरु देखा पर्न थाल्छन् । साथै पुराना मानसीक रोग र उस्तै खाले घटनाहरुलाई अहिले घटेको घटनाले बिउँत्याईदिन र रोगीहरुलाई अझै पिडित बनाईदिन पनि सक्छन् । बास्तबमा मानसीक आघात पछि अवशाद, स्कीजोफ्रेनीया , उन्माद , दुष्चिन्ता , आदीका लक्षणहरु अझ संबेदनशील रुपमा देखापर्न सक्छन् ।
 बिपत्ति पछिको केही दिन भौतिक र शारीरीक राहतमै पिडितहरु अल्झने भएकाले तब मात्र समस्याका लक्षणहरु देखापर्न सक्छन् । यो क्रम ६ महिना पछि सम्म पनि चल्न सक्छ ।
 मनोबिज्ञ या मनोचीकित्सकको उचीत सल्लाह र अग्रसरतामा दुष्चिन्ता र अवसाध घटाउने औषधिको सेवन , उपचारका पद्दतीहरु (Therapy) , मनोपरामर्ष (Counselling) र रोकाथामका उपायहरु प्रभावकारी रुपमा बढाउन सके लक्षणहरु हराउँदै जाने र बिरामीको दिनचर्या स्वतस्फर्त हुँदै आरोग्यता बढ्दै जाने हुन्छ ।

Written for https://www.facebook.com/klubsetoghoda by https://twitter.com/classicejunkie

Wednesday, October 11, 2017

जनहितमा जारी – अनिवार्य स्वास्थ्य बिमा ??



हुन त गगन जी ले लोककल्याणकारी उद्देश्य राखेर अनिवार्य स्वास्थ्य बिमाको कुरा ल्याउनु भएको हो र बिधेयक पनि स्वीकृत गराउन सफल हुनुभयो । तर उहाँले बुझ्नु जरुरी के छ भने शोक, शौच , स्वास्थ्य र सेक्स मान्छेका निजी सोच , ईच्छा र गोपनियताका बिषयहरु हुन् । यहाँ के गर्ने , कसरी गर्ने भन्ने कुरा तपाईको समाजबादले निर्कयोल गर्ने तथा बाध्य गर्न पाउने आधिकार राख्दैन। 

मान्छेले आफुले कमाएको चाहेको कुरामा खर्च गर्न पाउनुपर्छ । यो नियमवालीले धेरै बिषयहरुमा राजश्व पक्क्ै बढ्ने छ र बढ्नुपर्ने देखीन्छ । अर्काको उपचारमा म किन खर्च गरु या भाँजो हालुँ , आम मानीसले यसरीनै सोच्ने छ । ओवामा केयरलाई हटाउनुपर्ने माग रीपब्लीकनहरुले यसै उछालेका होइनन् होला । यो बिमाको मुल्य बार्षिक जसो बढ्दैन भन्ने के छ र ? र के यो बिमाले सबै किसीमका उपचारहरु समेट्न सक्छ र ? 

बिभिन्न किसीमका मानसीक र शारीरीक रोगमा मनोपरामर्ष र उपचार पद्दतिहरु बिभिन्न मुल्य र समय लाग्ने हुन्छन् । के यस्तो स्थीतिमा उपचारहरुमा एकरुपता होला । सबैभन्दा महत्वपूर्ण प्रश्न –

अनिवार्य बिमाका लागी स्वास्थ्यग्राहीहरुले तिरेको रकम बाहेक एउटा ठुलो बजेट कहाँबाट उठाउनु हुन्छ ?

गरीबिको रेखामुनी भएका सबै नेपालीलाई , लगभग ५० प्रतिशत जनसंख्यालाई , सरकारलेनै बिमा गरीदिनुपर्ने हुन्छ । रोजगारी सृजाना गरेर आफ्नो रजगजमा उपचार गर्ने बाटो खोलीदिने कि बिमाका लागी त्यत्रो ठुलो रकम र कर्मचारी तन्त्र जुटाउने ? के नेपाल त्यो ब्ययभार बोक्न सक्षम छ । नेपालको सन्दर्भमा सेयर मार्केट र बिमाले हामीलाई आर्थीक रुपमा उकास्ला या राहत देला भन्ने त नसोच्दानै राम्रो । ग्रामीण अर्थतन्त्रलाई उकास्ने प्रयास गरे बरु पर्यटन पनि उकासीन्थ्यो र नेपालीको आयस्तर पनि ।

जुन देशको अर्थतन्त्र ध्वस्त छ या छदैं छैन , जहाँ कण्डम , सीटामोल र जीवनजल पनि राहतको या कम मुल्यको जनतालाई उपलब्ध गराउनु सरकार बाध्य छ , जहाँ झाडा पखाललाले मान्छेहरु मरीरहेका छन् , जहाँ प्रशव पिडामा आमाहरु अस्पताल पुग्नु अगावै मरीरहेका छन् त्यहाँ आवश्यकता बिपरीत आदर्शहरुको कार्यान्वयन गर्न खोज्नुको तुष्टी – तुक के हो ? 

तपाईका सल्लाहाकारहरुले बस्तुस्थीति बुझेका छैनन् कि ? 
तपाइको बिमा सन्चालन गर्न तपाईका कर्मचारीहरु सक्षम छन् त ?

नेपालको बिमा प्रक्रिया आफैमा झन्झटीलो छ र आम मान्छेले यसको बारेमा बुझ्न त गाह्रो छ नै । यसका अलावा बिमा सन्चालन कसले गर्ने हो ? दाबी माग गर्ने तरीका के हो ? कहाँ गएर ? भएका बिमा कम्पनिहरुले पोलीसी त सजीलै बेच्छन् तर बिमा दाबी गर्ने प्रक्रियालाई लम्बेतान र बोझिलो बनाईदिएका छन् । अनिवार्य स्वास्थ्य बिमाकोे परीधि के हो ? के के सेवा सुबिधा यस अन्तर्गत पर्छन् , आम जनतालाई बुझाउनुहोस् । कतै अन्धाहरुको देशमा ऐना बेच्न लागेको त होइन ?

यो हिमालै – हिमाल , पहाडहरु , कन्दरा र कोप्चानै कोप्चाले भरीएको देशका उपचारका उपकरण र सामाग्रीहरु ति उच्च भेगहरुमा पुर्याउन गाह्रो छ । कर्मचारीहरु सुगम र दुर्गमको बहस र बहानाले गर्दा त्यहाँ जान खोज्दैनन् । 

नजीकैको काठामाडौंका सरकारी बिर हस्पीटलको भिड र अब्यवस्था अनि प्रसुतिगृहको नर्सहरुको किचकिचले स्वाभावले आम मानीसहरुको धारण नेपाली स्वास्थ्य क्षेत्र प्रति उदासीन छ । जहाँ उपचार या औषधि सित्तैमा बितरण गर्ने भनीएको छ , त्यहाँका कर्मचारीहरु नेप्रिएकै छन् , डाम्रीएकै छन् , आफैैले ब्यहोर्नुपर्ला जस्तो गरेर । मृगौला डायलीसले त्यती प्रभावकारी र पहँुच योग्य सुबिधा दिएको सुन्नमा आएको छैन । 

नेपालमा मात्र ७ वटा एअर एम्बुलेन्स भईदिए या हरेक प्रसुती गराउनु पर्ने अस्पतालमा न्युनतम २ जना मात्र भए पनि कर्मचारी – नर्स थपिदिए जनतालाई र जन्माउनुपर्नैलाई राहत हुन्थ्योकि ? बरु खोलामा गएर सन्तान जन्माउँछु यहाँ अब फर्केर आउँदीन भन्ने पिडित महिलाहरु पनि छन् ।

हाम्रो अर्थतन्त्रले थेग्ने भनेको ५ रुपैंयामा २५ को काम गरेर हो । अब यो बिमा अनुसारको कर्मचारी , प्रबिधिक र उपकरणहरु सबै ठाउँमा जुटाउनु पर्यो र एकरुपता ल्याउनु पर्यो । सम्भव छ , स्वीकार्य हो ? १०० रुपैंयाको मासुमा तिनसय रुपैंयाको मसला ।?

नेपाली स्वास्थ्य क्षेत्रमा अनिवार्य बिमा भन्दा पहिले गर्नुपर्ने काम धेरैनै छन  । तपाईले शायद नसुनेका केही –

१) अरु क्षेत्रमा झैं प्रतिभा पहिचान – पलाएन – ब्यवस्थापन नेपाली स्वास्थ्य क्षेत्रले गति दिन र लिन नसकेको जीम्मेवारी हो । स्वास्थ्यकर्मि हुने बित्तिकै बिदेश हुँईकनुपर्ने बाध्यता भएका या नभएकालाई किन स्वास्थ्य कर्मि बनाउनु पर्यो या बन्न दिनु ? उनीहरुको समर्पण के का लागी र किन उनीहरु नेपालकै स्वास्थ्य क्षेत्रका लागी समर्पित भएर काम गर्न सकेका छैनन् त < त्यत्रो मिहिनेत गरेर आर्जेको ज्ञान र सिकेको शीप देशका लागी काम लाग्दैन भने के का लागी त ?

२) पहिलो चरणको काम त भएका मेडिकल कलेजलाई कजाउन एक चीकित्सा बिश्वबिधालय बनाउनु आवश्य भईसक्यो , छ । यसरी नियम र नियतीमा एकरुपता होला । अनि त्यो बिश्वबिधालय र त्यसका टिचिङ्ग अस्पतालहरु स्वास्थ्य मन्त्रालय अन्तर्गत राख्न जरुरी छ न कि शिक्षा मन्त्रालय या त्रिभुवन बिश्वबिधालय अन्तर्गत । हो स्वास्थ्य मन्त्रालय भित्र एउटा शिक्षा बिभाग राख्न सकिन्छ । 

बिभिन्न बिश्वबिधालयहरुले दिने सम्बन्धन र त्यो अन्तर्गत भएका बिभिन्न भ्रष्टचारहरुको मियोनै यी दुई मन्त्रालयले सहि तरीकाले बाँड्न नसकेको जीम्मेवारीले गर्दानै आएको हो । नत्र डा . केसीको सबै मागहरु पुरा भए पनि स्वास्थ्य क्षेत्रका अरु धेरै समस्याहरु ज्यूँका तिहुँ रहने पक्का छ । त्यसैले स्वास्थ्यको काम स्वास्थ्य मन्त्रालयलेनै गर्दा राम्रो ।

३) नेपाल जडिबुटीको खानी देश हो । यहाँका सस्तमा र कौडिको भाउमा दिईएका जडीबुटीबाट बनेका महंगा औषधिहरु बिदेशबाट आयात भईरहेको अवस्था छ जसले औषधोउपचारको खर्च आकासीएको छ । 

हामीले हाम्रै प्रावीधिक , पद्दति र प्रकृतीक श्रोतहरु सन्चालन गरेरनै नेपालको स्वास्थ्य क्षेत्रलाई अधिकतम् जनमुखी र प्रभावकारी बनाउने हो । त्यसैले अब आयुर्बेदका चीकित्सकहरुले झैं एलोपथीका चिकित्सकहरुले पनि अनिवार्य रुपमा आयुर्बेद र अन्य प्रकृतीक तथा मानवीय चिकित्सा पढ्नुपर्ने नियम बनाउनु जरुरी छ भलै त्यो मात्र ६ महिनाको लागी किन नहोस् । 

प्राकृतीक तथा आयुर्बेदको औषधो उपचार र एलोप्याथीको पद्दतिले ५० – ५० प्रतिशतको जीम्मेवारी बाँडे भने मात्र नेपालको स्वास्थ्य क्षेत्र प्रभावकारी , समय सापेक्ष र देश –  अर्थतन्त्र हितकारी बन्ने छ । समग्रताका आधारीत समायोजीत उपचार (Holistic-Integrated Medicine) पद्दतिनै नेपालको लागी समय सान्दर्भीक र सर्वसुलभ स्वास्थोउपचार पद्दति हो ।

४) लोककल्याणकारी अवधारणामा स्वस्थ्य क्षेत्र चलाउँछू भन्ने हो भने दास्रो चरणमा सबै मेडिकल कलेज र स्वास्थ्य निकाएहरु सरकारलेनै अधिकरण गरेर चलाउनु पर्ने देखीन्छ । बिभिन्न खाले स्वस्थ्यकर्मिहरुका लागी चाहीने काउन्सील या परीषद् बनाउन पनि स्वास्थ्य मन्त्रालयनै अग्रसर हुनुपर्ने देखीन्छ । जस्तो कि मनोबिज्ञान र त्यस अन्तर्गतका उपचारहरुलाई सम्बन्धन दिन एउटा परीषद् बनेको नै छैन र यस्तोमा दिईने सेवा सुबिधा कमसल खाले पक्कैनै हुने देखीन्छ र भएको छ ।

पहिले घर टाल्ने कि छाना छाउने भन्दा हामी घर टाल्ने कामलाई प्राथमीकतामा राख्छौं । हो बिदेश काम गर्न जानेलाई बिमा प्रति बिमती नहोला र जरुरी पनि छ तर स्वास्थ्य क्षेत्रमा जस्ता किसीमका संरचनागत ट्रुटी र बिसंगतिहरु छन् त्यसले नेपालीको बर्तमान र भविश्यको स्वास्थ्य समास्या माथी निकास देला भनेर कमैले बिश्वास गर्छन् । यस्तोमा अनिवार्य स्वास्थ्य बिमा नेपालीले किन्लान् त , चल्ला त ?

यो पनि पक्कै हो कि हालका स्वास्थ्य क्षेत्रका बिसंगतिहरुलाई छेउ नलगाईकन अनिवार्य बिमा ल्याईयो भने हिजोसम्म धेरै स्वार्थी समुहले थीलोथीलो बनाएको स्वास्थ्य क्षेत्र अब केही मुठ्ठीभरका स्वार्थी ठेकेदारहरुको हातमा जानेछ । अझ डरलाग्दो गरी स्वास्थ्य क्षेत्र भताभुङ्ग हुन बेर छैन र यसको बिश्वसनीयता गुम्ने अझ धेरै सम्भावना छ ।

त्यसैले यी सबै समस्याहरुले पार पाए तपाईको अनिवार्य बिमा प्रति कसैको बिमती हुने , रहने छैन । लागु गर्नु अघि अरु यथेष्ठ गृहकार्य गर्न नचुक्नु होला ।  अहिलेको नेपालीको आवश्यकता अनिवार्य बिमा भन्दा पनि स्वास्थ्य सन्चय कोष देखीन्छ र नेपालीहरुको अर्थतन्त्रले थेग्न सक्ने पनि त्यही हो । बिचार गर्नु होला ।

शुभ कामना ।
Discourse by Raj Basyal 
राज बश्याल
मनोबिद्, अध्यापक ।
Email: raazjj@gmail.com
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Thursday, September 28, 2017

डिप्रेशन सराेकार - The Depression Concern

अवशाद – डिप्रेशन सरोकार


मानसीक रोग जीन्दगीका हरेक पाटाहरू छोप्ने कडा रोग हो तर पनि गरीब र गरीबिको रोग हो । मुटु रोग , चिनीरोग हुँदो हो त अरबौको बजेट आउँथ्यो होला तर यसमा स्वास्थ बजेटको १ प्रतिशात भन्दा पनि कम अर्थ छुट्टयाईएको छ ।

खबरदारी गरौं । आउ सबै मिलेर मानसिक रोगलाई हाम्रो समाजबाट हटाउँ ।
आजको छलफलको बिषय हुनेछ अवशाद भन्नाले डिप्रेसन ।

यो एउटा अन्तरक्रिया हो र तपाईको सहभागीताका लागी यहाँ प्रश्नहरु राखीएको छ ।

बितेको ६ महिनामा तपाईको जीन्दगीमा के कस्ता घटनाहरु घटित भए र परीवर्तनहरु अाए ?
बितेको १५ दिन कस्तो रह्यो ?
तपाइले बुझेको डिप्रेसन के हो ?
मानसीक समस्याहरुसँग तपाई कसरी जुध्नु हुन्छ र कसरी जुघिरहनु भएको छ ?

बुझ्नु पर्ने फरक –
यस्तैनै धेरै मान्छेहरु मनोबिज्ञलाई सडकमा पनि आफ्नो पसल चलाउने ज्योतीष ठान्दा रहेछन् अथवा त्यस्तै कर्म जो हात हेरेपछि सबै कुरो थाहा पाउने भनेर दाबी गर्छ । हो हात या मुख हेरेपछि मान्छे कहाँ जान खोजीरहेको छ , के पिडा बोकिरहेको छ र के गर्न खोजीरहेको छ आँकलन त पक्कै हुन्छ । मनमा जे छ मुखमा त्यही देखीने हो । आफुले सोचेको गन्तब्य हातमा कुँदीने हो , चिनाको नक्षत्र गणितमा देखीने हो । यो सडकमा बसेका जोगीहरु , हस्त बिधहरु या आफुलाई ज्योतीष भनेकाहरुले गर्न सक्ने या दाबी गरेको कुरो ।
हामीले जानेकोे ज्योयोतिष शास्त्र नक्षत्र र अंकहरुसँग खेल्छ । शायद ज्ञाताहरुको लागी यो गणित र बिज्ञान हो । यता मनोबिज्ञान तथ्यपरक र बस्तुपरक हुन खोजेको छ , भन्छ यस्तै । भन्नाले उ देखेको, सुनेको, बोलेको र नापेको कुरामा ज्यादा महत्व दिन्छ । यसरी हेर्दा के देखिन्छ भने मनोबिज्ञानले पहिला एउटा समस्यालाई बिस्तार गरेर हेर्छ र बल्ल त्यसमा गणित (तथ्याङ्क) जोड्छ र सार निकाल्छ ।

शायद ज्योतीषशास्त्र प्रकृती , नक्षत्र, ग्रह र गरुत्वाकर्षण मा धेरै आधारहरु खोज्छ तर मनोबिज्ञान ब्यक्तिबादीतामा आफ्नो आधार माग्छ ।

यस मानेमा दुबै बिज्ञान हिट एण्ड ट्रायल हुन् , प्रहार र परीक्षण गर , प्रयोग – जाँच गर र थाहा पाउ । यता बिज्ञान आफैमा प्रहार र परीक्षण हो र यहाँ पनि निरिपेक्ष भन्ने त्यस्तो केही दृष्टान्त छैन ।

अझ आधुनिक चिकित्सा र मनोचिकित्सामा त कुनै रोग भनेर तोक लगाउनु अगाडी रोगीको स्वीकार्यता माग्नुपर्छ , मागीन्छ । यसलाई मनोबैज्ञानीक सम्झौता (Psychological Contract) भनिएको छ । यस अर्थमा मनोबिज्ञान  र ज्योतिष शास्त्र बिल्कुलै फरक बिज्ञान हुन तर पनि जसको साईनो गणित मार्फत जोडीएको छ ।

र आजै देखी यो कुरा स्पष्ट होस् ज्योतीष र मनोबिज्ञहरू कुनै पनि हालतामा एउटै कसिमको काम गदैनन् ।

प्रश्न उठ्छ के भैेतिक बिज्ञान र गणितका स्थिराङ्कहरु निरिपेक्ष हुन् त ? के शुन्य एकं निरिपेक्ष अंक हो त ? के बिज्ञान आफैमा सम्पूर्ण ज्ञान हो त ? के त्यहाँका दृष्टान्तहरु निरिपेक्ष हुन् त ?

यी प्रश्नहरुको  निरिपेक्ष उत्तर छैन र जबसम्म यी दृष्टान्तहरु सापेक्ष रहन्छन् तबसम्म प्रकृती र मानव बिज्ञान सम्भावनाको बिषय हुन जान्छ । यसमा मनोबिज्ञान पनि अपबाद रहेन । सम्भावनामाथी हामीले तथ्याकं लगाएर खेल्ने हो र सक्छौ , र त्यहींबाट बस्तुहरु र बिचारहरु निर्माण हुने हो ।

न्युटनको चालको तेस्रो नियमले भन्छ – हरेक क्रियामा त्यतीनै तर बिपरीत प्रतिकृया हुन्छ ।  यो बिज्ञानको कुरो भयो । तर मनोबिज्ञान गणितमा भन्दा तथ्यमा आधारीत रहन्छ । माया प्रेम जस्ता बिश्वासहरुलाई चलाएमान मान्ने हो भने मायाको प्रतिकृया घृणा हुँदैन । कसैले कसैलाई गरेको माया या घृणा बराबारको प्रतिकृया पनि आउँदैन । किन त ? अाम मान्छे जस्तै मनाेबिज्ञहरू पनि भन्छन्– हुन त बिश्वास , आस्था , भावना बराबर लिनु दिनुपर्ने हो तर साँन्सारीक जीन्दगीमा समाजीक ब्यवधान र वैयत्तिक – पारीवारीक झन्झट – झमेलाहरुको पत्र पत्रहरु यति धेरै थुप्रिएका छन् कि उनीको र मेरो माया बराबर हुनै पाउँदैन । मनको जीजीबिषाहरुको (मनोबिज्ञानको) लेनदेन बराबरको हुँदैन र आशा पनि गर्नु हुँदैन ।

बिद्वानहरु संसार शब्दै शब्दको शब्दजाल मात्र हो भनेर बुझ्छन् , कुर्लन्छन् । आधा सत्य यो पनि हो । त्यसैले शब्दहरु रोग हुन्, शब्दहरु सुख हुन् , शब्दहरु उपाय हुन् र शब्दहरु समाधान हुन् । शब्दहरुको रासलीला बुझ्नेले रोगहरु उल्टायाउन सक्छ , उपायहरु निकाल्न सक्छ ।  अहिलेको आधुनिक मनोबिज्ञानले शब्दहरुसँग धेरै नै पैंठाजोरी खेल्छ र त्यसैलाई लगाएर मनोपरामर्ष गर्छ , थेरापी गर्छ , बिचारहरु सुल्झाउँछ , बिचारहरु बढ्याउँछ , बिचारहरु रोप्छ, बिचारहरुलाई बिकास क्रममा लिएर जान्छ । यसरी शब्दहरुलाईनै लगाएर आधाआधी मानसीक रोग सुल्झाउनुपर्ने हुन्छ जुन मनाेपरामर्षमा भईरहेकाे छ।

निर्कयौल यो हो कि बिज्ञानका आयामहरु सम्भावनाका बिषयहरु हुन् ।

अब हामी हाम्रो अन्तरक्रियाको मुख्य पाटो तर्फ लागौं - डिप्रेसन ।

आम मान्छेले बुझेको डिप्रेशन निराशा हो । तर यो कुरा स्पष्ट होस्  निराशा यसको एक लक्षण मात्र हो । डिप्रेशनको नेपाली रुपान्तरण हो अवशाद । के हो त डिप्रेशन ? के यो रोग हो या समस्या ? यो शब्दजाल हो या के हो ?
रोग पत्ता लगाउने कामनै मुख्य चासोको बिषय हो र उपचारको पहिलो र आधाआधी खुड्किलो । रोगको बारेमा प्रश्न गर्न सक्नु आफैमा आधा उत्तर थाहा पाउनु बराबर हो । प्रश्न गरे पछि लक्षणहरु थाहा पाईन्छ , सुनिन्छ र देखीन्छ ।
उसले के कुरालाई समस्या देखीरहेछ , कसरी देखरहेकोछ ?
उसको शरीरीक  अवस्था र मनका भावहरु के कस्ता छन् ?
उसको खाना , निन्द्रा र यौन चाहना के छ ?
उसको एकान्त प्रियता सृजनशील दृश्टी हो या ग्लानी ?
कहिं उ समस्याबाट भाग्न त उ खोजीरहेको छैन ?

चिकित्सक , मनोचिकित्सक, मनोबिद्, स्वास्थ्य कार्यकर्ता , मानसीक स्वास्थ्यको बढोत्तरीमा लागेका स्वयंसेवी , आदी निम्न बस्तुपरक लक्षणहरुको त्यान्द्रो समातेर अवशाद हो होईन निर्कयौल गर्छन् र त्यसै अनुरसार उपचार ।

 बितेको २ हप्ता या बिगत केही समय देखी या धेरै समय अघि देखी तपाईमा पनि निम्न जाँच – परीक्षण सुचीमा भएका लक्षणहरु देखापरीरहेका छन् भने तपाईलाई अवशाद हुनसक्छ । सावधान , यी यस्ता लक्षणहरु देखापरेमा तपाई परीक्षणका लागी स्वास्थ्य केन्द्रसम्म जान त सक्नुहुनेछ तर कुनै किसिमको चिकित्सीय ठहर गरेर आफ्नै उपचार गर्न भने होइन । त्यसका लागी मानसीक स्वास्थ्य क्षेत्रका ज्ञाताहरुनै उपयुक्त  दक्ष प्राबिधिक हुन ।

हालैका दिनहरुमा निराशा , हताशा , दुष्चिन्ता आदीलाई पनि मान्छेहरुले अवशादकाे नाम दिएर लहडै लहडमा कडा खाले अाैषधि खाने जोखीम लिएको पनि देखीन्छ जसले कालन्तरमा अरु धेरै समस्याहरु निम्त्याउने स्पष्ट छ ।
लक्षणहरु शारीरीक, जैबिक, मानसीक र ब्यवहारजन्य किसिमका हुन्छन् । तिनिहरूले आफ्नै किसीमको दवाब र बिसन्चो मानबीय आरोग्यता माथी थुपारीरहेका हुन्छन् । तर हालको लागी हामी सार संक्षेपमा निम्न लक्षणहरुको जाँच सुची हेछौं ।

१) निरन्तर दुखी , उदास , दिक्दार हुनु र जीवन प्रति त्रासदी बढेर जानु । रमाईलो प्रत्याभुती नहुनु  या कतै रमाउने प्रयास नगर्नु।

२) हतोत्साही हुनु , स सानो  कुरामा खीन्न हुनु र आफुलाई लाचार देख्नु । ठाउँ कुठाउँ आफुलाई पिडित पाउनु । आफु या अरुलाई गाली गर्नु र ग्लानीबोधले ग्रस्त हुनु ।

३) आत्मविश्वास र आत्ममुल्याङ्क घटेर आफु र आफ्नो जीन्दगीलाई बोझ ठान्नु र भविश्यलाई अन्धकार । मनमा आत्महत्याको बिचारले जरो गाड्नु ।

४ ) दिनहुँको जीन्दगी प्रति जाँगर हराएर जानु । अर्थोपाजन र सामाजीक कार्यमा रुची कम भएर एक्लिदैं जानु र एकान्तमा रहनु ।

५) एकोहोरीनु, सोच्न र सम्झिन नसक्नु , बिर्सने बानी बढेको भान हुनु । ब्यवसाय र नोकरीमा गयल भईरहनु ।

६) अन्त्यहिन गुफा भित्र उज्यालोको खोजीमा निरन्तर हिंडिरहेको जस्ता किसीमका सपना दिनहुँ जसो देख्नु ।

७ ) निश्चित समय , मौसम र रीतुहरुमा छट्पटि र त्रास बढीरहेको पाउनु ।

८) अवशादका बिरामीहरुमा निर्णय क्षमता र ध्यान कम हुँदै जान्छ । साथसाथै यसका दिर्घ रोगीहरु जोखीमजन्य जीम्मेवारीबाट सँधै टाढा भागेको जस्तो देखीनु , आर्थीक सामाजीक पक्ष उकास्न नसक्नु र समाजले असफलको बिल्ला भिराईदिनुले पनि समस्या जटिलता तर्फ जान्छ ।

९) बिहानपख हात र गर्धनमा रगत जमेको जस्तो र झम्झमाउने हुनु । शरीरका अंगहरु सुस्त भएझै या कामीरहेको पाउनु । ब्लड प्रेसर घट्दै गईरहेको आभाष हुनु ।

१०) बोल्ने चाहना , भोक , निन्द्रा , यौन चाहनामा धेरै जसो कमि हुनु । एकदमै न्युन प्रतिशतमा भोक र बजन बढेर जानु ।

११) कब्जियतले जरो गाड्नु र महिनावारीमा पनि गड्बढी हुनु ।

१२) डिप्रेशन कडा हुँदै जाँदा भ्रमात्मक लक्षणहरु – नभएको कुरा देख्ने, सुन्ने , बिश्वास गर्ने जस्ता मनाेभावनाहरू उत्पन्न हुन्छन्।

माथीका १२ मध्य कुनै ७ लक्षणहरु निरन्तर र बोझील रुपामा मान्छेको मनोबिज्ञानलाई गाँजीरहेको छ भने अवसाद हुँदै गईरहेको ठहर गर्न सजीलो हुन्छ । तनाब, दुष्चिन्ता , निराशा हुँदै अवशादमा पुग्न यो रोगले एक उल्लेख्य समय र कालखण्ड भाेगेकाे हुन्छ ।

अवशादका आर्थीक मनोसामाजीक कारणहरु त छन् नै त्यसका बाहेक जैवीक रसायनीक कारणहरु जस्तो कि स्नायु रसायनको घडबढीले यो रोग उत्पन्न हुने यथेष्ट काराणहरु जुटाईदिन्छन् । पारीवारीक कलह , सामाजीक कुरुती , ऐतीहाँसीक बेथीति , भौगोलीक स्थीति, बंशाणुत कारण, आदीले रोगलाई अझ जटील अन्तरक्रियामा पुर्याईदिन्छन् ।

जब जीन्दगीको समग्रताबाट आशा हराएर जान्छ र हरेक घटनाहरुको पाटो मान्छेले नकरात्मक रुपमा लिन थाल्छ , जब मान्छे आफुलाई दिन हिन , असाहय, बिवश देख्न थाल्छ , जीन्दगीको दिनहुँ पाटोमा रुची हराएर जान्छ र शारीरीक उर्जा एकदमै न्युन हुन जान्छ तब हामी मानसीक स्वास्थ्य कर्मिहरु त्यसलाई आवशाद या डिप्रेशन भन्छौं । यसमा अरु किसीमका दुष्चिन्ता र तनाबहरू पनि हलक्कै बढेर जान्छन् र त्यसका शारीरीक मानसीक लक्षणहरु पनि देखा पर्न थाल्छन् , सक्छन् ।

मानीस जे छ ,जस्तो छ , जसरी सोच्छ , जुन किसीमको ब्यवहार गर्छ त्यो सबै उसको स्मरणले सिकेको , सिकाएको हाे र गर्ने हो । हामी भित्रकाे म र म भित्रको अहं स्मरण हो । हामी जे हौ त्यो स्मरण हो । जब यो स्मरणमा बिभिन्न कारणले प्रहार हुन्छ र अाघात पर्छ तब मान्छे बिक्षिप्त हुन्छ र बिभिन खाले मानसीक रोगहरु उसकाे मनाेबिज्ञानकाे सतहमा देखा पर्न थाल्छन् । त्यसैले त भनीन्छ सहि सोच , सहि स्मरण गर र गराउ ।
मान्छेको मन एउटा अध्यात्म हो । जब त्यो खाली हुन्छ त्यसले एउटा भरपाई खोज्छ । त्यो भरपाई कुलत हुन सक्छ या बिग्रिएका , भत्कीएका , भत्काउने बिचार या उर्जाहीन गन्तब्य । जीन्दगीलाई खाली राख्न सकिन्छ , मान्छेहरुले सन्यास लिईरहन सक्छन् तर मनमा केही सृजनशील कुराहरुको खान्की दिईरहनुपर्छ । मनलाई काममा लगाउने मान्छे , बौद्धिक काम गर्ने मान्छेलाई स्मरण सम्बन्धी अल्जाईमर्स रोगले पनि त्यती छिटो छोप्दैन ।

तर यस कुराले महत्व राख्छ कि दुखी मात्र हुनु या निराश मात्र हुनु मात्र डिप्रेशन होइन , समग्र कान्ति क्षय भएर जानु डिप्रेशन हो । भोक पनि घट्ला , निन्द्रा पनि घट्ला, जैवीक चाहनाहरु घट्लान् र आत्महत्याको सोच पनि आउला तर उर्जाहीन मन र शरीरनै यस रोगको मुख्य लक्षण हो । मनको अध्यात्ममा उर्जा थपे उपचार हुन्छ ।

यसका केही लक्षणहरु बारे तपाईहरु पनि जानकार हुनुभएको छ । यदी तपाईले चीनेजानेका या अरु कसैलाई यस्ता लक्षणहरु देखापरेको भए त्यो समस्या अवशाद हो भन्ने पनि बुझिसक्नु भएको छ । जान्नुपर्ने कुरा के छ भने धेरै जसो लक्षणहरु वैयक्तिक हुन्छन् र एक ब्यक्तिमा देखापरेका लक्षणका अनुहारहरु अरुका अनुहार संग नमिल्न सक्छन् । अब यी बिरामीहरुको अर्को गन्तब्य भनेको मनसीक स्वास्थय केन्द्रमा स्वास्थ्य कर्मिको साथ पुर्याउनु हो । कृपया लिएर गईदिनुस् र समग्र समाज, समुदाय र देशमा उर्जा थप्ने काममा सहयोगी बनिदिनुस् । अर्थशास्त्रले मान्छेलाई पुँजी बुझ्छ र त्यो बढाउन सहयोगी बनिदिनुस् ।

जब शारीरीक रोगको उपचार हुन्छ तब मान्छे निको हुन्छ तर जब मानसीक रोगको उपचार हुन्छ मान्छे सन्चो भएर आरोग्यता आत्मसाथ गर्छ र अझ सकरात्मक बिकासक्रममा जान्छ । त्यसैले उपचार गर्न ढिलो नगरौं , यो आफुलाई परीस्कृत गर्न पाउने मौका हो ।

अब उपचारको पहिलो खुड्किलो के त ?
सबै किसीमका मानसीक रोगको उपचार बहुआयामीकनै हुन्छ । खान पान , आहार बिहार ,घर, गाउँ , ब्यवसाय , समाज , साथीभाई इष्टमित्र आदी , ईत्यादी सबै पक्षमा ब्यवस्थापन गर्न सके र नयाँ संरचनामा ढाल्न सके कुनै पनि मानसीक रोग निको हुने सम्भावना बढेर जान्छ किनकी जीन्दगीको धेरै पक्षमा गडबडी आएर समस्या उब्जीएको हुन्छ र त्यसलाई त्यसरीनै सबै पक्षमा काम गर्दै र ब्यवस्थापन गर्दै लिएर जाने हो भने रोग निकोनै हुन्छ । एक हिसाबले उपचार भनेको भत्कीएको मनको Reverse Engineering हो , साथसाथै जीन्दगीका नयाँ आयामहरु थप्ने प्रयास पनि। हरेक कुरा सबै कुरा होईन , जीन्दगीमा बिकल्पहरु छन् र बिकल्पहरुको आत्मसाथनै उपचार हो । जीन्दगीका सबै प्वालहरुलाई ति बिकल्पहरुले टाल्ने हो नयाँ बिकल्पको ईटा पनि हाल्ने हो । अतित त गईसक्यो , भविश्य आउन बाँकी छ तर बर्तमानमा बाँच्ने हो ।

हाल चलनचल्तीमा रहेका उपचार पद्धतिहरुलाई हामी बुँदागत रुपमा हरौं ।
१)मनोपरामर्षबाट बिग्रीएका सम्बन्धहरुमा अन्तरक्रिया बढाईदिने ।
२) कग्निटिभ बिहेभेरीयल थेरापीले या संज्ञानात्मक ब्यवहारजन्य उपचारले बिचार सन्तुलन र तनाब बहनमा क्षमता बढाइदिने काम गर्छ ।तनाब र चिन्ताका कारकहरूलाई स्वयम् बिरामीलाई बुझाउनमा याे उपयाेगी देखीएकाे छ । सामुहिक सृजनात्मक थेरापि पनि जीन्दगी र समाजलाई बुझ्न र लक्षणहरू स्खलन गर्न सहयाेगी छन् ।
३) परीवार, साथीभाइ र हेरचाह गर्नेको साथ सहयोगमा आहार बिहार , ब्यायाम, योग, अाैषधि सेवनमा निरन्तरता दिनुपर्छ । बिरामीलाई सकेको कामको जीम्मेवारी दिनुपर्छ ताकी उसको अध्यात्म मन सृजनशील र उर्जाशील रहिरहोस ।

तपाईहरु सतर्क रहनुपर्छ किनकी उपचार नगरीएको , आधा-आधी या सतहिमा उपचार गरीएको कडा खाले मानसीक रोग सधैंजसो अवशादकाे रुपमा थिग्रीन्छन् किनकी अवशाद मानब ईतरहरुको क्रम बिकासको पहिलो चरणमानै देखापरेको जैबिक - मानसीक रोग हो ।

अवसाद उर्जाहिनता र निष्कृयताको रुपमा पहिलो पल्ट देखापरेको हो । जस्तो कि महिलाहरु गर्भवति अवस्थामा ९ महिना आँशीक निष्कृय रहन्छन् । बच्चा जन्माउनु अघि र पछि केहीलाई त साँच्चीकै नरम या कडाखालको मात्रीय अवशाद हुनसक्छ ।
चमेराहरु र धुब्रिय भालुहरु पनि जाडोको समयमा आफ्नो जैबिक प्रकृयालाई न्युन गरेर , स्वासलाई रोकेर र शारीरीक ताप न्युन गरेर ओडारहरुमा सुरक्षित बस्छन् जसलाई शीत निन्द्रा या Hibernation पनि भनिन्छ । डिप्रेशनको पहिलो खुड्किलोको यो दृश्टान्त हो ।
यस बाहेक यो नौलो अवधारणा डिप्रेशनको रोकाथाम र उपचार मितब्यगी होस् भनेर अघि सारेको छु ।
टि बि उपचारमा जस्तै यसलाई पनि डाईरेक्ट्ली अबजबर्ड थेरापीको (DOT, Directly Observed Treatment Short  Course , DOTS) नाम दिन सकिन्छ । यो दिवा स्याहार केन्द्र र पुर्नस्थापना केन्द्रको मिश्रित रुप हुनेछ ।

यहाँ दैनिक रुपमा मानसिक स्वास्थ्य कर्मिको उपस्थीतिमा औषधि प्रदान गरीनेछ । यसका साथसाथै परामर्ष सेवा दिईनेछ र दैनीकी जस्तो बनाएर अरु सृजनात्मक उपचार पद्दतिमा बिरामीलाई लगीनेछ ।

यहाँ योग , ब्यायाम, ब्यवसायीक शीप आर्जन सम्बन्धि कक्षाहरु सन्चालन गरीनेछ । भोजन , पोषण , बसोबास सम्बन्धि अन्तरक्रिया पनि गराईनेछ । समाजमा पुर्नस्थापना हुन चाहीने सबै शीपहरु , बिचारहरु र ब्यवहारहरु सिकाईनेछ ।

सामान्य रुपमा भन्नु पर्दा निश्चित संख्याका बिरामीलाई महिनामा १२ दिन – हरेक दिन तिन घण्टा सँगै राखेर ६ महिना सँगै उपचार गर्न सकिनेछ , गरीनेछ । यसका साथसाथै रोगसम्बन्धी सुचनाको लेखा , रीपोर्टिङ्ग र राेगी माथी उपचारकाे असर पच्छयाउने काम पनि यो उपचार केन्द्रले गर्नेछ ।

मानसीक स्वास्थय बिभागको यो केन्द्रको मुल मन्त्रनै – ३ घण्टा आफ्नो स्वास्थ्यको लागी केन्द्रमा बसेर बिभिन्न उपचार पद्दतिका काम , ३ घण्टा बर्रबराउन पाउने छुट (कडा मानसीक रोग छ भने) , ८ घण्टा अर्थोपार्जको लागी ब्यवसाय र २ घण्टा परीवार साथीभाईसँगको साथ र ८ घण्टाको सुताई । हो रोग निको भएपछि त्यो ८ घण्टाको समय तपाई र्सिजनशीलतामा खर्चनुसक्नु हुन्छ या मनोरन्जनमा । कहाँ पुग्ने नपुग्ने तपाईको बिचार हो ।
यो दिवा स्याहार केन्द्रमा मानसीक स्वास्थ्य सम्बन्धि अरु के के गर्न सकिनेछ त ? तपाइहरुनै हामीलाई सुझाब दिनुहोस् ।

अहिलेको लागी शुभकामना किनकी तपाईले आफुलाई परीस्कृत गर्न पाउने मौका सम्बन्धी महत्पूर्ण ज्ञान पाउनु भएको छ ।

शुभ आर्शीबाद , शुभबिजया ।

राज बश्याल
मनोबिद्, अध्यापक  ।
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Wednesday, April 5, 2017

Satya Mohan Joshi and his Transfer of Intangible Cultural Heritage




It was privilege to meet our very own cultural advocate Mr. Satya Mohan Joshi at his residence near Mangal Bazaar, Patan.  He was accompanied by his son 68 year old Anu Raj Joshi, a retired air traffic controller. 

Mr. Joshi is very renowned for his research in history and culture of Nepal and has more than 60 books in his credits. He is the 3 times winner of Madan Puruskar. He is currently the Chancellor of Nepal Bhasa Academy.

No one can imagine that this 98 year old cheerful, spirited and assertive person is still occupied for a new publication. Certainly he has a deep understanding about Nepali way of life, culture and philosophy.

With reference to a Chinese Nobel laureate he illuminates on the amorphousness of Life and Death. If there is a life within us, a death is also present in us from the very start. There are chances that one can overpower the other any moment. Life and death are indeed hallucinatory realism for him.

He emphasized the transfer of Intangible Cultural Heritage among the Nepali citizen. This would foster brotherhood between the people of Nepal and with international community. Why would a person harm other if there is such an emotional connection? The deadlock in the current social scenario; the ongoing debate in caste, ethnicity, regionalism and our struggle for development could have been addressed way earlier if this rope of cultural heritage was intact and active.

My motto: One step ahead, everyday.

Monday, April 3, 2017

Chapter 23 - Khushi: In the line of Sorrows

Please read the following synopsis of the novel before reading the chapter below which be found at - http://classicjunkie-media.blogspot.com/2009/07/synopsis-khushi-in-line-of-sorrows.html

This segment of Novel carries important aspects and message about Maternity Blues about which you can be informed at - 



Chapter 23

“Mamu, were you ever like this?

Have you been fighting all your life?
Has there been effort to any sort of reconciliation?
Mamu?”

These were not unexpected inquiries but Aakash made it little later. May be there was never an empathetic discourse between the mother and the son where he could intrude his question.

Indeed she was surprised. She might have assumed it was a normal life for her. She could have accepted the turbulence in her life and munched the rock and roll within.

People chew miseries and they become used to it.

She was very unaware of the miseries, loneliness and insecurities of Aakash. She might have never given a thought or ignored everything carelessly. She never tried to know who the real victim was due to their everyday brawl. They never took parenting as a serious endeavour. And probably they didn’t even try to notice that there was a growing child under the same roof to whom they have neither become a role model nor the epitome of love. They have shut their eyes wide open.

Can anything virtuous be expected from this boy?

She is willing for an answer. But in an instant her glow changes from unstable pink to pale-green. She is offended.

“Why?
Why do you need that?”

She is in self defense mode.

Why do I need that?
Hunh!
You people are so unkind to me!
I have forever been victim of your hostility and you want to know why!"

There is certain harshness in the tone. It indeed lowers down the dominance and stance of Seema. She surrenders her ego and in a soothing tone.
“No it was never like that in the beginning.
We should say we had happily compromised in this relationship.
We intended to start everything fresh!
Yes indeed we had dissent on some points.
We both concealed many things from each other.

As people grow old they become better liar and pretender.
We were two of them.

But after marriage, at least I was determined to bring the best out of this second patch up!”

She takes a sigh of relief.
“Practically it was not a love marriage!
We never dated!
However Mr. Rajesh would assert that he loved me and it was a love marriage.
I don’t believe him.

I think he had a sort of sympathy for me.
And he always had that cunning restlessness to prove everything on his own term.
You see he is so stubborn.

I am sure if you ask him he would tell you otherwise.
There were some attractive qualities in him!
Not sure what are they; maybe gentleness!
Obviously he was an educated and income stable person!

I should have appealed to him anyway!
I was beautiful.
Hah!
,
,
But, I have to say we stumbled upon each other!

And I know, we were never made for each other.
I am 12 years younger to him.
He is a placid personality unless we are fighting!
We know we can blow fire!

I was too much frustrated about relationships after my first marriage failed or made to fail.

We are two extremes like fire and ice!
And we are equally sensitive and dominating in our own ways.
We won't allow anyone to hurt us.
Or if we do the same, we won't be saying sorry.

Priorities, personalities and the meaning of coexistence changes in a conjugal life!
We didn’t accept that change; we didn’t compromise anyway.
We thought we can be funny with each other or disrespectful to any length.
But things don’t work like this.

Sometimes it is better to fake good if the relationship is not getting altogether.
If he was fire, I should have been the cold water and not the ice.
 And if I was fire he should have been the water.
We disrespected any opportunities because they came as a form of responsibility!
Working in responsibility is indeed a difficult prospect.

And for a woman like me who has gone to so much of upheaval in life, once I distrust anybody, he is always a fraud to me!
I can go to any length to prove that.”

Aakash is excited because at least she has something to say. Her revelation is slightly different than the version dramatized in their last battle. She has revealed her part of truth and cunningly able to mask the remaining half truth.

The hidden part of the truth is always responsible for blowing the conflict out of proportion.
There are always two sides in a coin.
Which side she would pick as the weapon of battle would be her personal choice.

 “You were born to us 4 years later.
By then, we were just struggling to adapt to each other.
I was trying to undo his habits and he was trying to do the same on mine!
How we endured each other those years, I don’t.

We thought you would bring fortune, happiness, peace and their abundance in our lives. 
So we gave you the name Aakash; the space we wished to build for three of us and only 3 of us!
The irony is we never build any space for any one of us.
This house has just become a four wall system!

Your father was so obsessed with geometry and space that he forced the name Aakash upon you.

He has always been a mad like this!
Ha! Ha!

Usually woman love bright pink colours but I was obsessed with this sky blue.
And there was nothing abundant in my life; neither love, nor relationships or materials.
So I always dreamt of abundance of everything.
Hence I should say I forced the name Aakash upon you.
Ha! Ha!

I have always been mad like this!
Ha! Ha!


There was something in you, some very intelligent aura.
Bright as blue and maybe I thought the name Aakash was suitable for you.
I hope you like our choice of your name!"

It was the first time she pleaded a sense of humbleness and empathy in her outlook. Aakash definitely wants to know how his history was shaped by his parents. Excited and a bit satirical

“Oh, thank you!
Thanks God!
I was not responsible for my name or the family I was born with!
Ha! Ha!

Then?”

She looks into his

“It was as usual.
There was some emptiness in our lives.
Our marriage was not a spiritual connection.
Yes there was spiritual emptiness.

But we tried to force-pull our cart as far as possible!

After you were born things changed.
Priorities changed; you become our priority amidst this hate for each other.

He seems distracted and losing interest on me.
He had become rude; I don’t know whether it was his weakness or strength!
I thought I lost all my charm.
Most of the times women change physically and mentally after giving birth.
I should say I changed for distractions.

He wouldn’t call me.
I demanded more attention.
He was not there to hug me during the desperations of labour pain I endured for you.
I thought it was all because of you, he neglected me!
I cursed the unborn you.

Suddenly I thought I was the share of enjoyment for two men; one already there and one not born.
One my husband and one my son!

I become a bit mad about this unwanted intrusion forced upon me.
I even thought, I have to shed a part of myself to bring back the life in you!
I was not ready for that!

I was thoroughly depressed.
I also developed a compulsion to repeat things.
I would hear voices, voices that would question me about the rationale to that labour pain –

'What would he do when you are dead?
No one to care and no one to love'

I thought if I die giving birth to you; you would suffer a lot in life.

At once I wanted to save you from all the terrible things in this world; immoral indulgence and wickedness.
I wanted to know if I was capable of killing you and then killing myself!

I have to tell you I was not in my proper frame of mind.

At one time I even thought it was better you were never born to me!
I thought I should have aborted the child of a man I don’t love.
I thought I would throw you away!

And after you were born, I thought you were a monster suckling on my breasts and scrubbing my beauty.
 I despised myself for the dark pigmentation all over my face and sagging breasts and belly!

And I believed I was an evil person!
I was aware I was sick yet I was also confident that I was being a rebel for a cause.
I thought I can be a saviour.

If I was sure of myself, why would I ask for help!
I had become confident in myself; the false confidence.
I rejected the idea to ask for any help because there are lots of stigma surrounding mental illnesses.
I never wanted to be called a mad the very next day.
.

Anyway I endured such monstrous maternity blues!
Thanks, I didn’t do any damage.

I am sorry because there was no one to backup my emotions or hold my tears.
I was lonely and desperate!
I don’t know why I thought ill of you.
You were the flesh of me never born.

In a country like Nepal, where women get so much of attention, care and support from both the family and society while they are pregnant or after they have delivered, I was deprived of that emotional pleasure.
No one was there to attend me.

He wouldn’t let my parents to come and he didn’t have his parents.
I don’t have any sisters and all of my 3 brothers were working abroad.
In a place like Kathmandu, there was an easy access to hospitals but not care and support.

Everybody thought they were busy.
If that is the case why is Nepal not going anywhere?
Why are we deprived and underdeveloped?

My son a women can have more psychological problems during pregnancy or after delivery than any other physical complications.
As the doctor said that time, cases like me are rare, 1 in thousand.
But normally the cases of maternity blues are like among 20 to fifty percent of the deliveries.
And they may not exhibit psychotic features of thinking between two extremes.
So, the proper diagnosis of this illness is categorically complicated.

There is a lot of time left for your marriage.
However I insist you that please do support and care your wife while she is pregnant.
That is the best you can do as a man and a father!
Other than that, you know the health care professionals will be standing there for any interventions necessary.
Do care your mother and mother of your child.
Let both the father and husband be standing for the expecting woman.

My son, I am sorry for my madness!
Those were not my genuine intentions."

Aakash just gives a normal reaction to whatever he heard. He didn’t pretend being shocked. Probably he was satisfied to know the precious truth. He empathized with the difficulties in post partum psychosis. He tries to console his mother.

"Don’t ever feel sorry, mother!
You landed safely out of that illness!
And thanks you are here for me and with me!
I need you!"

Children are way more realistic than adults and much more forgiving. It's better not to pretend to them.

She continues.
"He ought to take some role because you are our mutual investment!
He should have been there to bath you, feed you, pamper you and kiss me!

But that lousy bastard was nowhere there!
He even discouraged spending so much of time with you!
Why wouldn't I?
You are my son, the pearl of my eyes!
A part of my flesh for whom I had endured so much of labor pain!

We ceased talking to each other and starting fighting whenever; wherever we can!
One day, two day and we never had any healthy conversation again.
We were already physically and emotionally separated.

You see the way he talks; he never misses a chance to call me a whore.
I am his wife and I need a certain respect.
I demand and I command a respect!
Yes I do!

But son, I know, things don’t go as the way I wish, in this realistic world.
The problem with women like us is we want so much of drama and attention until we are married.
Obviously a wrong person, maybe right for somebody else, approaches us and stirs the emotion in us.
After marriage, we don’t want any drama in life and that doesn’t happen easily.
We are used to drama and they are used to abuse our emotion.

Never cheat a woman!

I can't understand men!
I really can't!
They would say the same about us.
Ha! Ha!

He is a passion less, cold man who doesn’t know how to win the heart of a woman!
Whore is the most beautiful word that he has ever said to me!
Now days, I am used to enjoy that suffering.
,
,
And then, we just started detesting each other's presence!
As always, hatred was our weapon that we used against each other; whenever we could!
Today I realized we were the culprit and you were the only victim.
,
It has been 16 years since then!

My poor little child I am sorry!”

She takes a deep breath after flooding all her guilt. She is stuck in her past, probably not nostalgic, but largely worried about her future.

Aakash, as inquisitive as his nature is, asks a very critical question.

“But you can see, your ways of hatred brought so many unwanted twists and turns in our lives?
You are not happy.
I am not happy.
And he is not happy.
Can we really continue in this momentum?
Who will fix this problem?
Who has to take the initiatives?”
Seema Devi nods but with her stubborn helplessness.
“Why don’t both of you compromise?
For me, at least!

Perhaps things get better that way!
All of us will have a safe landing.
We must!
We can always change for better!
We are not the culprit to be defined by past mistakes!
Are we?
,
And I deserve a far better life than this; probably more peaceful and better loving, better living!”

He pleads. But Seema Devi is willing to continue in her stubborn apathy. She is not willing to bank her ego. Probably she has no fitting reply for their situation. It is not that she has ignored the prospect. But compromise and peace is a two way process and she knows that. She looks as if she is contemplating something deep within.

Don’t do drama; write drama!

And to assess the half of the problem and devise something to solve it, Aakash enters his father’s room.

Baba Hajur, I have heard part of our story from Mamu.
Would you please tell me the half part of truth?

A lot of things came into frame and need a strict revision.
But let it be!

At this point in life, while I am growing for a reason and you are getting older day by day I don’t see any difficulty for reconciliation.
I think we should straighten out our priorities and strengthen our relationships for better.

Why don’t you two compromise with your self-worth and clear the misunderstanding?
Please let peace befall on this house.
Let’s begin a new episode of love and life.
Let it be before I go to college.

If she walks one step towards you, just walk two steps towards her!
You will find her; you will meet her.
I will see the rest.
Just take that one single step!"
  
He came to the room willing to question the past, the useless past. But the blue colour painted in the walls and the spacious airy room suddenly illuminates with brightness and changes for good. And now he becomes more assertive about the resolution than tempering on the past through question. Rajesh Pratap, who seems more occupied to the screen on the computer, listen his proposal with grim interest and a sort of disrespect to the growing son.

He reflects an ' I know everything attitude.'

It seems Rajesh Pratap has ignored the prospect of reconciliation.
He denies any direct eye contact or proper respect to his son.
He doesn't attend to his son probably because he has no any formalities to fulfill with him.

Rajesh,
"Is that?
What was the half truth she told you?
She is a passion less cold- stubborn bitch!

The problem with the women we have got, I mean what most Nepali have, is that they always want to prove themselves virgin and innocent.
They would try to prove that they don’t have any part to play in the heap of miseries and mess we are suffering from.
As if always clean and innocent!
But which is not true.

I had heard both of you talking!
I am not interested in her bullshits!
She has been nail in my heart since the day I married her.

Oh, she still thinks that I was no way around while she was crying with labour pain!
Ha! Ha!
Gross lies!


I was there all the time.
I never left her side when she was in dire need of a strong man to hold.
I married her.

I was there but she couldn’t notice because she was having hallucinations and didn’t orient properly with time, place and person.
She had become so much demanding and attention seeking I bet anyone other than me could have tolerated her.

I know it was not her fault; it was all because of all those blues.
I never tortured her but yes there were lesser people around.
I couldn’t arrange so much of emotional support around her.
But what she told you is fabrication of everything; she just wants to demean my presence and my effort.

I accept I have done mistakes in life.
And I take full responsibility for that.
Like, I was out of city that day attending a seminar for engineering consultant.
I should have stayed with her all throughout the week.
But how can I?

I was informed of a date 4 days later for delivery by the physician.
That was the reason for me not being present that day.
I can be accused for my mistakes but every charge for this mess in our lives doesn't have anything to do with him.
I have always thought the best of everyone and strived for it.

She is a good fabricator and you better be aware of that.

You can't imagine how much attention seeking, manipulating and dramatic your mother is.
She has an immense grudge against me and she uses it to nag you and me.
She has been doing that all her life; she is a revengeful woman.

She tells everything according to her convenience.
She fakes herself good and constructs an evil person around me, about me.
That is all she is capable of.

Her relatives should have taught her about compassion, consistency and honesty.
They have always enjoyed the heat of the scuffle between we husband and wife.
She brought her poverty, hatred, insecurity and the burns of a failed relationship with her!
And that evidently ruined my life; our lives!

She was unwilling to realize that our role and priorities and role changes as we bear a child!

I was busy to set up everything right for both of you!
You were born and that was my best day.
I can't explain my delight and dreams!
I thought I could push a mountain to secure safety for you.

But I will tell you one truth.
As the time went, I was bit worried she was more indulged with you!
Oh, I thought she don’t love me anymore!
Neither I was neglecting nor did I lose interest on her.

I have never been expressive person in life and you know that.
Yes indeed I have my drawbacks.

And I can't attend an insecure woman's mood every moment of the day!

Son you can't understand the complex situation weaved in our house!
If possible don’t ever get married!

A person twice married like me neither belongs to house nor hell.
Yes indeed I have done injustice to your step mother and I am suffering for that.
,
,
How can she know the mess she created if she had already lost contact with the reality?
Just one week after you were born and there was this problem.
She won't eat, she won't take care of you or breastfeed you.
She was angry all the time!

Those were difficult days my son!
,
She would weep, cry and be shamelessly violent.
She would be violent to stranger and visitors.
She striked a nurse with an iron stand meant to hold curtains.

And then the next moment, she would be like rain drenched cat, shaking and timid.
Whimpering and disturbing all other people around.
You can't imagine how chaotic could be a situation.
And for a public service holder like me it was embarrassing.

People could accuse of violence against woman!

She would be talking to herself or unknown person I never saw!
She would particularly curse her police constable uncle.
It is possible that he could have beaten or intimidated both of her and the former husband.
The Dalit was accused for raping a minor, cheating to marry a girl of upper caste and was beaten in police custody.
They were separated by force.

I would particularly be embarrassed when she would narrate her past very loud, like a shaman trying some sort of sorcery over his subjects.
Those obscene words, the detail of their sexual intimacies; I was a shameless husband standing there!

If you had seen her eyes those days, you would have noticed there was no hope left for life.
Vigourless!
She would look at us as if we are a recipe on her plate everyone she is salivating eat.
Her big eyes could scare anybody.

I endured all those episodes and saved her from any untoward consequences.
And she would tell everyone that I was not present!
Poor me!
Gross lies!"

Rajesh Pratap looks shattered and doesn’t know how to pick the bits and pieces. All of sudden Aakash hurls a question piercing the silence.


"She revealed something like she wished to kill me and throw me away!
Is that true?"

Aakash should have thought over the intensity of the question and expected a worst scenario be revealed. Rajesh is stunned, worried and answerless for a moment but assemble his strength to tell the objective part of the truth.

"Oh!
No! No!

You know how her condition was!
She was not able to decide the right from wrong!
Totally disoriented!
She was not able to rationalize anything!
It was just the idea that sneaked into her troubled mind!
But she never meant to harm you my child!
There was no such motivation!
You know how horrendous and volatile are transient psychosis!
,
She is your mother and she loves you!
She was worried about you all the time.
Like who would care you if she was not there, etc. etc.
You shouldn’t think otherwise!
,
,
"

It is not clear why Aakash was so eager for a clarification. He should have been deeply hurt listening to what happened or maybe he was trying to strengthen himself by confronting the pure truth.

As long as Aakash can remember, this must be the first time his father defended his mother. Well he should have intended to save the notion of 'MOTHER' from mother!

"The only person she hates is me!
But I can empathize over her situations.
This marriage was indeed a second chance for her to revive the broken spirit!

But she brought along with the disapproval, difficulties, worries, apprehensions and insecurities of the failed first marriage.
She says that her relatives schemed to fail her first love and the marriage.
She peels the scab of those burns again and again to torture me, you and herself.
She was never ready for this marriage and despised me from the very first day; I think.
,
,

The rock hard she is, the rigid she has made out of me.
I don't have anything remaining in me to celebrate.
No emotion, no compassion.
I have become totally dark and pointless figure

I am just breathing and not living anymore.
Don’t know what is propelling this soulless body!


But I am sure of one thing, her outlook of relationships have brought so much of shame to this sacred relationship called marriage."

Rajesh Pratap is way more frustrated. He knows Nepal is a culturally matriarchal society though it is politically patriarchal. And there is confusion around how to treat woman.
"Are there any chances for compromise?"

It looks like the end of discourse for the day and the concluding inquiry. Aakash is very clear; these two stubborn people are less likely to deal a compromise. However he expects an answer for the question he asked hopelessly.

But Rajesh Pratap denies any answer. He is used to the way of life he is living. He may have never thought about reconciliation.

The fading sun leaves a colorful sky.
This gloomy Saturday evening is spreading its worries for tomorrow.
Is there hope?
...................................................................................................................................................................
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