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‘गम्भीर अवस्थाका बिरामीको उपचार गर्ने ‘रिक्स’ नलिनु डाक्टरको गैरजिम्मेवारीपना हो’

यौन र प्रजनन स्वास्थ्य विश्वव्यापी अधिकारको एक महत्त्वपूर्ण पक्ष भएतापनि नेपालमा यो विषय ओझेलमा परेको छ । अझ पछिल्लो समय महिलाहरु आफ्नो स्वास्थ्यका बारेमा सचेत छन् भनिए पनि यौन तथा प्रजननको बिषयमा भने आम रुपमा अनविज्ञ नै देखिन्छन् ।

राज्यले हरेक व्यक्तिको यौन र प्रजनन स्वास्थ्य अधिकारको इज्जत, संरक्षण र पूर्ति गर्नुपर्छ भनेको छ । त्यसका लागि प्रजननको विषयमा प्रशस्त वहस हुनु जरुरी छ । यसले यौन तथा प्रजनन स्वास्थ्यका विषयमा महिला पुरुषमा जागरुकता ल्याउने छ । 

यौनिक तथा प्रजनन स्वास्थ्य र अधिकारको विषय हरेक महिलाको मानव अधिकारको विषय पनि हो तर आफना अधिकारहरू माग गर्ने वातावरण हाम्रो समाजमा अझै विकास हुन सकेको छैन । समाजमा ठूलो समस्याको रुपमा खडा भएको किशोरकिशोरीहरूको यौनिक तथा प्रजनन स्वास्थ्य एवं अधिकार संरक्षणका लागि राज्यबाटनै पहल हुनु जरुरी छ । 

प्रजनन स्वास्थ्यभित्र परिवार नियोजन, सुरक्षित मातृत्व, नवजात शिशु तथा बाल स्वास्थ्य, स्याहार, गर्भपतनको कारणबाट उत्पन्न हुने समस्याहरुको रोकथाम तथा उपचार, यौन रोग संक्रमण र एचआईभी र एड्स, बाँझोपनको रोकथाम तथा उपचार, किशोरकिशोरीहरुको प्रजनन् स्वास्थ्य, प्रौढ महिलाहरुको स्वास्थ्य, लैंगिकतामा आधारित हिंसा आदि पर्छन् ।

नेपालमा महिला प्रजनन स्वास्थ्यसम्बन्धी समस्या र यसबारे राज्य तहबाट भएका काम कारवाही अनि चिकित्सा क्षेत्रमा भएका सुधार बारे ३५ वर्षदेखि स्वास्थ्य सेवामा क्रियाशील नर्भिक इन्टरनेशनल हस्पिटलकी वरिष्ठ स्त्री रोग विशेषज्ञ प्रा.डा. अचला वैद्यसँग हामीेले कुराकानी गरेका छौं ।

–तपाईं स्त्री रोग विशेषज्ञ, विगतमा लामो समय सरकारी स्वास्थ्य सेवामा पनि विताउनु भएको छ । नेपालका महिलामा प्रजननसम्बन्धी सबैभन्दा बढी के कस्ता समस्याहरु देख्नु भएको छ ? के ती समस्याहरुलाई सम्बोधन गर्नको लागि सरकारले अपनाएका विधि र प्रक्रियाहरु पर्याप्त छन् ?

महिला प्रजननको अवस्थालाई हेर्दा नेपालमा विशेष गरेर सबैभन्दा बढी देखिएको समस्या भनेको प्रोल्याप्स (पाठेघर झर्ने समस्या) नै हो । यो समस्या निकै पुरानो समस्या हो । यो पुरानो समस्या आज पनि उत्तिकै मात्रामा छ भन्नु पर्दा हामी कुन अवस्थामा छौं भन्ने थाहा हुन्छ । राज्य तहबाट विभिन्न काम नभएको पनि होइन तर खै समस्या ज्यूँ का त्यूँ छ ।

ग्रामीण भेगमा घरमै बच्चा जन्माउने चलन अझै पनि व्याप्त छ । यसले समस्या यथावत राखेको छ । लामो वेथा पछि बच्चा जन्माउने अनि बच्चा जन्मिएको छोटो समयमै पून काममा फर्कने हुनाले ग्रामीण भेगका महिलाहरुको पाठेघर झर्ने समस्या उच्च विन्दुमा छ ।

शहरी भेगमा भने यस्तो समस्यामा कमी आएको छ । विशेषतः कम उमेरमा विवाह गरेका, असुरक्षित रूपमा बच्चा जन्माएका, गर्भावस्थामा पोषिलो खानेकुरा नखाएका महिलामा आङ खस्ने अथवा पाठेघर झर्ने समस्या बढी हुन्छ । ग्रामीण भेगका जनता अझै पनि हस्पिटलको पहुँच भन्दा बाहिर छन् । यसले पनि ठूलो समस्या निम्त्याएको छ ।

सरकारी तवरबाट महिला प्रजनन स्वास्थ्यसम्बन्धी विभिन्न काम भइरहेका छन्, जस्तोः विभिन्न संघसंस्थाको सहयोगमा जनचेतनामूलक कार्यक्रमहरु संचालन गर्ने, सुत्केरी हुनु पूर्व र पछिको अवस्थामा पोषणयुक्त आहारको व्यवस्था, निःशुल्क औषधी, भ्याक्सिन आदि  । तर यस्ता कार्यक्रम पर्याप्त रुपमा लिएर हरेक दुर्गम क्षेत्रमा पुग्न नसकेकै कारण समस्यामा कमी आउन नसकेको हो ।

चेतनामूलक कार्यक्रमको पनि अभाव भएको हो । महिलाहरु अझै पनि आफ्नो प्रजनन स्वास्थ्यबारे अनभिज्ञ देखिन्छन् । सरकारले कामको सुरुवात गर्छ तर त्यसलाई निरन्तरता दिने अनि उचित रुपमा काम भएको वा नभएको अनुगमन नहुँदा पनि यस्ता कार्यक्रम फेल हुने गरेका छन् ।

यसका लागि हामी टाढा जानु पर्दैन, यही भक्तपुरको कुरा गरे पुग्छ । भक्तपुर अस्पतालमा ५ वर्ष मैले काम गर्दा त्यहाँका जनताको चेतना स्तर देखेर अचम्ममा परें । यहीँ त यस्तो छ भने अन्य जिल्ला लगायत दुर्गमको अवस्था कस्तो होला ? त्यो अनुमान लगाउन सकिन्छ । सरकारको आँखा यहीँ १३ किलोमिटरमा त पर्न सकेको छैन भने अन्य क्षेत्रमा के होला अवस्था ?

–नेपालमा मातृमृत्युको मुख्य कारण के हो ? त्यसलाई सम्बोधन गर्नको लागि सरकारले अपनाएको नीति र विधिहरु पर्याप्त छन् कि छैनन् ? त्यसलाई घटाउन वा लक्षित उद्देश्यलाई हासिल गर्नका लागि सरकारले के गर्नु जरुरी छ ?

महिला गर्भवती हुँदा वा बच्चा जन्माउने क्रममा सो कारणले हुने मृत्यु मातृमृत्यु हो । गर्भावस्थामा हुने विभिन्न समस्या जस्तोः उच्च रक्तचाप, धेरै रगत बग्ने समस्याले आमाको मृत्यु हुने गर्दछ । मुख्य रुपमा हेर्दा उच्च रक्तचाप र रगत बग्नुनै मातृमृत्युको मुख्य कारण देखिएको छ ।

विशेष गरेर गर्भावस्थामा डाक्टर र हस्पिटलको पहुँचबाट टाढा भएका महिला यस्तो समस्याको सिकार हुने गरेका छन् । गर्भावस्था भनेको जोखिमयुक्त अवस्था हो । पोषिलो खाना, आराम, नियमित स्वास्थ्य परीक्षणका साथै डाक्टरको सल्लाह अनुसार बस्नुपर्ने अवस्थामा त्यसका ठीक विपरीत महिलाहरुले गर्भावस्थाको बेला पनि जोखिमयुक्त काम गर्दा वा गर्नुपर्दा मृत्युसम्मको अवस्थामा उनीहरु पुग्छन् ।

सरकारले  गर्भजाँच, गर्भावस्थामा हुने रक्तअल्पता कम गर्न वडा स्तरसम्म आइरन चक्की वितरण कार्यक्रम चलाएको थियो । स्वास्थ्य संस्थामा सुत्केरी गराउन प्रोत्साहन भत्ता, यातायात खर्च र सुविधासम्पन्न स्थान वा अस्पतालमा पठाउन परे हवाइभाडा दिनेलगायत थुप्रै कार्यक्रम पनि ल्यायो । तर दुर्गम क्षेत्रमा कार्यक्रम व्यवस्थित नहुँदा सामान्य समस्याको पनि उपचार नपाएर सुत्केरीको ज्यान जाने गरेको स्थिति छ ।

मुख्यतः उच्च रक्तचाप, रक्तअल्पता (एनिमिया), घरमै सुत्केरी गराउने गर्नाले पनि मातृमृत्युको जोखिम बढी छ । सुत्केरी अवस्थामा रगत धेरै बग्ने, साल नखस्ने समस्या भएपछि अस्पताल लैजादालैजादै धेरैले ज्यान गुमाउनु परेका थुपै्र उदाहरण छन् ।

सरकारले मातृमृत्यु दर घटाउन २०६५ सालतिर देखिनै हो ‘आमा सुरक्षा’ कार्यक्रम सुरु गरेको । अझ हस्पिटलमा गएर बच्चा जन्माउन प्रोत्साहन गर्न २ हजार भत्ता समेतको व्यवस्था गरेको छ ।

सरकारले  गर्भजाँच, गर्भावस्थामा हुने रक्तअल्पता कम गर्न वडा स्तरसम्म आइरन चक्की वितरण कार्यक्रम चलाएको थियो । स्वास्थ्य संस्थामा सुत्केरी गराउन प्रोत्साहन भत्ता, यातायात खर्च र सुविधासम्पन्न स्थान वा अस्पतालमा पठाउन परे हवाइभाडा दिनेलगायत थुप्रै कार्यक्रम पनि ल्यायो । तर दुर्गम क्षेत्रमा कार्यक्रम व्यवस्थित नहुँदा सामान्य समस्याको पनि उपचार नपाएर सुत्केरीको ज्यान जाने गरेको स्थिति छ ।

भत्ता दिने अनि चक्की बाँडेर मात्र यो समस्याको समाधान हुने होइन । जबसम्म जनताको पहुँचमा अस्पताल, डाक्टर हुँदैन, तवसम्म यो समस्याको समाधान हुनेमा विश्वास गर्न सकिँदैन ।

अहिले आएर पनि तपाईले मातृमृत्युसम्बन्धी कुनै केश हेर्नु भएको छ ?

छ, भर्खरै मात्र बुटवलबाट एक विरामी ल्याइएको थियो । उनको रक्तचाप यति उच्च थियो कि उनलाई ५–६ पटक फिट्स (लगलग कामेर मुर्छासम्मै पर्ने अवस्था) आइसकेको थियो । भैरहवा हस्पिटलमा उनको केशलाई लिएर डाक्टरहरु निकै त्रसित बनेका थिए । अझ नेपालको मुलुकी ऐनले डाक्टरहरुलाई निकै त्रसित पारिदिएको छ जसले गर्दा अस्पतालहरुले केही क्रिटिकल केशहरु आयो भने लिइहाल्न डराउँछन् । यो स्वभाविक पनि हो । केश निकै क्रिटिकल र जोखिमयुक्त थियो ।

भैरहवा बुटवल जस्तो सुगम क्षेत्रमा पनि यस्तो केश देखेर हामी पनि अचम्ममा परेका थियौं । भैरहवामा सम्भव नभएपछि विरामीको परिवारकै सल्लाहमा म कहाँ ल्याइएको थियो । विरामी कोमामा थियो । यही ल्याएपछि पनि उसलाई दुई तीन पटक फिट्स आएको थियो । सुरुमा त विरामीको अवस्था देखेर म पनि निकै त्रसित भएकी थिएँ । विरामीलाई जसरी पनि बचाउन तत्कालै तत्काल सुरु गरें । बिरामीको अवस्था निक्कै गम्भीर रहेको र बचाउन सक्ने सम्भावना कम रहेकोबारे हस्पिटल व्यवस्थापन, मेडिकल काउन्सिल, सिनियर डाक्टरहरु लगायत परिवारसँग पनि छलफल गरें ।

ब्लड प्रेसरलाई सामान्य अवस्थामा झारेर अपरेशन गरियो । ७ महिनाको बच्चा एक केजीको पनि थिएन । त्यस्तो अवस्थामा बच्चा निकालेर आमा बच्चा दुवैलाई बचाए । करिव ५० दिन अस्पताल बसेपछि आमा बच्चा घर फर्किए । उनीहरु अहिले स्वस्थ्य छन् ।

हुन त सरकारले गर्भवती, सुत्केरी, सुत्केरीपछिको ४२ दिनसम्मको समस्यामा काँप्ने, मुर्छा पर्ने समस्या हुँदा विरामीलाई म्याग्नेसियम सल्फेट दिनु पर्छ भनेर निःशुल्क वितरण पनि गरेको छ । सुत्केरी किटमै यो औषधि राखेको छ । तर औषधि पर्याप्त वितरण नहुँदा यस्ता समस्या आउने गरेको छ ।

–त्यस्तो गम्भीर अवस्थाको विरामीलाई डाक्टर र हस्पिटलले बचाउन लाग्नु भन्दा अन्त रिफर गर्नु गैरजिम्मेवार तरिका भएन र ?

एकदमै गैर जिम्मेवारपन हो । अन्तिम अवस्थामा विरामी छ भन्ने डाक्टरलाई थाहा छ तर त्यो रिस्क लिने कि नलिने त पुरै हस्पिटलको व्यवस्थापन र डाक्टरहरुले नै निर्णय गरेर उपचार थाल्नु पर्ने हो । तर त्यो रिस्क लिन नचाहेको हो वा जागिर जाने डरले हो त्यस्तो अवस्थाको विरामीलाई माथिल्लो वा सुविधासम्पन्न हस्पिटलमा रिफर गरियो । सामान्य उपचार गर्नसम्म पनि डराउनु त एकदमै गैर जिम्मेवारपन हो । त्यस्तो अवस्थाको विरामी आएको खण्डमा हामीले तत्काल बिरामीको उपचार थालेर हस्पिटल व्यवस्थापन अनि मेडिकल काउन्सिल लगायत परिवारसँग पनि छलफल गर्नुपर्ने हुन्छ । किनकि भोलि केही गरी तलमाथि भएको खण्डमा डाक्टरले अधिकतम् कोसिस गरेको हो, त्यसमा ऊ दोषी होइन भन्ने जानकारी हुनुपर्छ । हामीले जिम्मेवारी लिन डराउनु हुन्न । हाम्रो पहिलो कर्तव्य भनेको नै विरामीको उपचार हो ।

अहिले हस्पिटलले अडोलेसन क्लिनिकहरु संचालन गरेको पाइँदैन । यूथ हेल्थ सवैभन्दा मेजर समस्याको रुपमा आएको छ । धेरै अविभावकहरु आफ्ना वच्चा कोठाबाट बाहिर नै ननिस्कने अनि भर्चुअल दुनियामै रमाउने गरेको समस्या लिएर आउँछन् ।

–अनि, नेपाली महिलाहरुमा प्रजनन स्वास्थ्यसम्बन्धी अर्को मुख्य समस्या फिस्टुला पनि हो । यसको कारण र उपचार के हुन सक्छ ? यसलाई रोकथाम गर्न के गर्नु जरुरी छ ?

फिस्टुला भनेको बच्चा जन्माउने बेला बच्चा जन्मन नसकेर अड्कियो भने बच्चाको टाउकोले पिसाव थैलीलाई थिच्छ र उक्त स्थानमा रक्तसंचार बन्द हुन पुग्छ । त्यसले उक्त भाग मर्छ । जसले गर्दा त्यो ठाउँमा विस्तारै प्वाल पर्छ र त्यहीँबाट पिसाव चुहिन थाल्छ । यसरी पिसाव चुहिनुलाई फिस्टुला भनिन्छ । विशेष गरेर ग्रामीण भेगमा वा घरमै प्रसुति गर्नेहरुमा यो समस्या धेरै छ ।

डाक्टरको निगरानीमा रहेर निरन्तर चेकअप गर्ने अनि स्वस्थ्यकर, पोषिलो खाना खाने गर्ने  र प्रसतिपछि राम्ररी आराम गर्ने हो भने यस्तो समस्या आउँदैन । तर भौगोलिक विकटताले गर्दा हस्पिटलको पहुँच कम भएका नेपालका केही जिल्लामा यो समस्या धेरै छ ।

यसबारेस्वास्थ्य सम्वन्धि जनचेतना जगाउने र स्वास्थ्य सेवा दिने हो भने यो समस्यालाई न्यूनीकरण गर्न सकिन्छ । तर अहिले दुर्गममा डाक्टरहरु जान मान्दैनन् । उनीहरुलाई उचित सेवा सुविधा दिएर पनि त्यस्ता स्थानमा लैजानु सरकारको कर्तव्य हो । कतिपय ठाउँका जनताले त हस्पिटलनै देखेका हुँदैनन् । त्यस्तो ठाउँमा स्वास्थ्य संस्था खुल्नु पर्छ र सेवा दिनु पर्छ जसले गर्दा यस्ता समस्यालाई कम गर्न सकिन्छ ।

–एएसआरएच (अडोलेसन सेक्सुअल एण्ड रिप्रोडक्टिभ हेल्थ) सम्बन्धी नेपालले अपनाएका प्रावधानहरु के के हुन्? तपाईको अनुभवमा कस्ता समस्याहरु बढी आउने गरेका छन् ? यसबाट नेपालका किशोरकिशोरीहरु कसरी लाभान्वित हुन सक्छन् ?

१० देखि १९ वर्ष उमेर समूहमा रहेका किशोरीहरुमा आउने मानसिक परिवर्तन अडोलेसन हेल्थभित्र पर्दछन् । जसलार्ई यूथ हेल्थ पनि भनिन्छ । किशोरावस्थामा आउने परिवर्तनलाई लिएर मैले प्रसुतिगृहमा रहँदा देखिनै काम गरेको थिए ।

सरकारसँग छलफल गरेर हामीले वीर हस्पिटलमा अडोलेसन हेल्थ क्लिनिक पनि खोलेका थियौं । हामी सवै डाक्टरहरु मिलेर पालै पालो गएर सेवा दिने गरेका थियौं । अडोलेसन हेल्थ क्लिनिकमा किशोरीहरुलाई परामर्श दिनेदेखि उनीहरुमा आएका मानसिक समस्याको समाधानमा हामीले काम गरेका थियौं ।

सरकारले यसलाई निरन्तरता दिएन र यो बन्द भयो । अहिले सरकारी तवरबाट यो काममा चासो दिएको पाइदैन । पछि सरकारले एल्डर हेल्थमा भने केही काम गरेको थियो तर त्यसमा पनि निरन्तरता दिएको जस्तो छैन ।

यो विल्कुलै गिनिपिग बनाउन खोजिएको होइन । यो एकदमै राम्रो प्राक्टिस हो । नेपालमा यो भ्याक्सिन आज आएको होइन कि २००७ तिर नै आएको हो । यो भ्याक्सिनको सुरुवात मैले मेरै छोरीहरुबाट गरेको थिए । विभिन्न संघसस्था, अष्ट्रेलियन एम्बेसीसँग मिलेर हामीले यो भ्याक्सिन ल्याएका थियौं । इअन फ्रेजरले एचपीभी (ह्युमन प्यापिलोमा भाइरस) पत्ता लगाएर यसको प्रयोग गरिसकेको थियो । इअन फ्रेजर आफै नेपाल आएर यो भ्याक्सिन वितरण गरेको थियो ।

अहिले हस्पिटलले अडोलेसन क्लिनिकहरु संचालन गरेको पाइँदैन । यूथ हेल्थ सवैभन्दा मेजर समस्याको रुपमा आएको छ । धेरै अविभावकहरु आफ्ना वच्चा कोठाबाट बाहिर नै ननिस्कने अनि भर्चुअल दुनियामै रमाउने गरेको समस्या लिएर आउँछन् ।

सरकारी तवरबाट विभिन्न अस्पतालमा अडोलेसन क्लिनिक, मेनोपज क्लिनिक, एल्डर क्लिनिकहरु स्थापना गरी सेवा प्रदान गरिनु उचित हुन्छ । क्लिनिकमा परामर्श पनि हुने भएकाले किशोरावस्थामा यो आवश्यक छ । किशोरावस्थामा हुने परिवर्तनहरुका बारेमा अविभावकलाई पनि ज्ञान हुनेछ कि यो हर्मोनल परिवर्तनको नियमित प्रक्रिया हो । किशोरावस्थामा मानसिक, शारिरीक विकासको क्रममा आउने परिवर्तनलाई सही ढंगले मार्गदर्शन गर्न यस्ता क्लिनिक सहयोगी हुनेछ । किशोरावस्था भनेको निकै नै ट्रान्जेशनल समय हो जुन वेला उनीहरुले सही परामर्श पाउनुपर्छ । यो अवस्थामा इमोसन्सहरु निकै नै तलमाथि भइरहने हुँदा पनि सही परामर्शको आवश्यकता पर्छ ।

यहाँ थुप्रै अडोलेसन र मेनोपजका समस्या लिएर आउनेहरु छन् । उनीहरुलाई हामीले सेवा दिइरहेका छौं । हामी डाक्टरहरु मिलेर मेनोपोज सोसाइटी अफ नेपाल (मेसोन) भनेर संस्था खोलेका छौं र सेवा दिइरहेका छौं । हामीले एल्डरहरुमा आउने समस्याबारेमा काम गर्छौ । विभिन्न भेगहरु स्कूल, हस्पिटल लगायतका ठाउँमा गएर जनचेतनामूलक कार्यक्रमहरु गर्ने, परामर्श दिने गरेका छौं । यो कार्यक्रम विशेष गरेर स्कूलहरुमा बढी प्रभावकारी भएको छ ।

–तपाई। लामो अनुभव सँगालेका स्त्री रोग विशेषज्ञ हुनुहुन्छ  । हामीले देख्ने गरेको सत्य तेस्रो विश्वका गरिब तथा विकासोन्मुख देशका जनताहरु स्वास्थ्यसम्बन्धी खोजको लागि गिनिपिग (वैज्ञानिक अनुसन्धानको लागि प्रयोग)को रुपमा प्रयोग हुने गरेको भनी आलोचना हुन्छ । अहिले पाठेघरको क्यान्सरविरुद्धको खोप भन्दै नेपालमा पाइलट प्रोजेक्टको रुपमा २ जिल्लामा लागू गरिएको ह्युमन प्यापिलोमा भाइरस भ्याक्सिन (एचपीभी) पनि त्यसैको एक रुप हो भन्ने गरिन्छ । यसबारेमा तपाईको भनाइ के छ ?

यो विल्कुलै गिनिपिग बनाउन खोजिएको होइन । यो एकदमै राम्रो प्राक्टिस हो । नेपालमा यो भ्याक्सिन आज आएको होइन कि २००७ तिर नै आएको हो । यो भ्याक्सिनको सुरुवात मैले मेरै छोरीहरुबाट गरेको थिए । विभिन्न संघसस्था, अष्ट्रेलियन एम्बेसीसँग मिलेर हामीले यो भ्याक्सिन ल्याएका थियौं । इअन फ्रेजरले एचपीभी (ह्युमन प्यापिलोमा भाइरस) पत्ता लगाएर यसको प्रयोग गरिसकेको थियो । इअन फ्रेजर आफै नेपाल आएर यो भ्याक्सिन वितरण गरेको थियो । नेपालमा लगभग ३० हजार बच्चाहरुलाई भ्याक्सिन दिएर इअन गयो ।

९ देखि १३ वर्षबीचका बच्चाहरुलाई यो दिइन्छ । पछि सरकारलाई यो भ्याक्सिन ल्याउनु पर्छ, नेपालमा क्यान्सरको बढ्दो अवस्थालाई नियन्त्रण गर्न सहयोगी हुन्छ भनेर हामीले बारम्बार सरकारलाई नघच्घच्याएको होइन । तर सरकारले सुनेन ।

अहिले आएर बल्ल यसबारे काम सुरु भएको छ । सरकारले केही जिल्लामा यसलाई पठाएको छ । पहिलेनै परीक्षण भइसकेको हुनाले यसलाई पुनः परीक्षण गरिबस्नु जरुरी छैन । बरु सवैको पहुँच हुने गरी सरकारले यसलाई विस्तार गर्नु पर्छ । विश्वले अहिले यो एचपीभी भ्याक्सिनलाई निकै प्राथमिकतामा राखेको छ ।

बाहिर त छोरा बच्चालाई पनि यो भ्याक्सिन दिइएको छ एचपीभी भाइरसले जसलाई पनि अट्याक गर्न सक्छ नि, तर नेपालमा छोरी बच्चाहरुलाई मात्र दिइएको छ । अझ केही महंगो भएकाले सवैको पहुँचमा नपुग्न पनि सक्छ । त्यसैले यो भ्याक्सिन ल्याउन कि त प्राइभेट सेक्टरलाई अथोरिटि दिनु पर्यो कि त सरकार आफैले ल्याएर वितरण गर्नु पर्यो । त्यसो गरेमा क्यान्सरको अवस्था घट्ने निश्चित छ ।

–नेपाली महिलाहरुमा बाँझोपन एउटा समस्याको रुपमा देखिएको छ । त्यसैगरी, असुरक्षित यौन सम्बन्धका कारण विवाह पूर्व अनि अझ कलिलो उमेरमै गर्भवती हुने गरेको पनि पाइन्छ । यसबाट पर्न सक्ने असर के के होलान् ?

बाँझोपनको कारणमा पीसीओएस (पोलिसिस्टिक ओभरी सिन्ड्रोम) एक हो । पिसिओएस हुने कुनै कारक तत्त्व छैन । तर, पिसिओएस भइसकेपछि हर्मोनको परिवर्तनले गर्दा विभिन्न समस्या उत्पन्न हुन्छ । अण्डाशयबाट निस्कने जति पनि हर्मोन हुन्छन् ती सबै हर्मोनमा परिर्वतन ल्याइदिने भएकाले गर्भाधानमा असर गर्छ ।

त्यसैगरी मोटोपन भएकाहरुमा बाँझोपना हुन सक्छ । सुगर, थाईराइड पनि बाँझोपनाको अर्को कारक हो । कुनै पनि रोग लाग्न नदिने, लागि हालेमा पनि समयमै उपचार गर्ने हो भने समस्या आउँदैन । टीबी भएका महिलामा पनि बाँझोपनको समस्या हुन्छ । पाठेघरमा पनि टीबी हुन्छ र सुरुमै उपचार गर्ने हो भने निको हुन्छ । कतिपयलाई पाठेघरको टीभीबारे थाहा नै छैन । पाठेघरको टीभी भएकाहरुलाई महिनावारीको समय कि त धेरै रगत बग्छ कि त रगत नै बग्दैन । महिलाले यस्तो समस्याको बेलैमा उपचार गर्ने हो भ निको भए पश्चात बच्चा जन्माउन सक्छन् ।

कलिलै उमेरमा गर्भवती हुनेहरु बढ्दैछन् । योे निकै विकराल समस्या हो । असुरक्षित यौन सम्वन्धबाट कलिलै उमेरमा गर्भवती हुने अनि जहाँ पायो त्यही गएर गर्भपतन गर्ने गर्नाले पनि पछि बच्चा नहुने समस्या बढेको छ । कतिपय डरत्रासका कारण जस्तो पनि ठाउँमा गएर गर्भपतन गर्छन यसले इन्फेक्सन बढाउँछ र पछि क्यान्सर जस्तो खतरनाक रोग पनि लाग्न सक्छ । यसबारे किशोरीहरु सचेत हुन जरुरी छ ।

अर्को समस्या भनेको पुरुषमा नै बच्चा जन्माउन सक्ने क्षमता नहुनु हो ।

–निश्चय पनि तपाईंले त्यस्ता ( बाँझोपन) भएका महिलाहरुसँग उपचारको क्रममा भेटघाट गर्नुपर्ने हुन्छ । तपाईंले त्यस समस्याका कारण के कस्ता पारिवारिक तथा सामाजिक समस्या महिलाले भोग्नु परेको अनुभव गर्नुभएको छ ?

एकदमै । परिवारका सदस्यबाट दिनरात अनावश्यक प्रेसर दिने गर्दा महिलाहरु मानसिक रुपमै विरामी भएर आएका हुन्छन् । परिवार आफन्तले बच्चाको विषयमा दिनरात प्रश्न गर्दा उससँग के जवाफ दिने भन्ने हुन्छ । जसले उसको शारिरिक अनि मानसिक अवस्थामा पनि असर गरिरहेको हुन्छ । यसलाई म हिंसा भन्छु । ऊ पनि मान्छे हो नि, अनावश्यक टर्चर कति सहनु । आखिर बच्चा बनाउने रहर त सवै महिलामा हुन्छ ।

धेरै यहाँ रुदै आउँछन । कति त परिवार सहित आउँछन् । उनीहरुलाई लाग्छ, पुरुष सर्वेसर्वा हुन्., उसमा कुनै पनि समस्या छैन, समस्या त महिलामा मात्र हो । यस्ता समस्या लिएर आउनेलाई हामी सम्झाउँछौ । श्रीमान श्रीमती दुवैको प्रजनन क्षमता परिक्षण गरेर पठाउँछौं ।

अनावश्यक प्रेसरले गर्दा महिलाहरु मानसिक रुपमा कमजोर हुन्छन जसले प्रजनन स्वास्थ्यमा सिधै असर पनि गरिरहेको हुन्छ । यो कुरा परिवारले बुझ्नु जरुरी छ ।

केही समय पहिले म कहाँ एउटी महिला आइन् । विवाह भएको दश वर्षसम्म पनि बच्चा नभएको रहेछ । उनहरुले थुप्रै टेष्ट अनि उपचार गराएकी थिइन् । सवै रिपोर्ट हेर्दा नर्मल थियो । बायोप्सी पनि गरेको रहेछ सवै राम्रै देखिएको थियो ।

बच्चा नभएपछिको अवस्थामा उनी डिप्रेसनमा थिइन । श्रीमानले अर्को विहे गरेर बच्चा जन्माइसकेका रहेछन् । ती महिलाको अवस्था देखेर हामी पनि अत्तिएका थियौं । उनलाई अत्यधिक पेट दुख्ने र रगत बग्ने समस्या भएको थियो ।

मैले अल्ट्रा साउन्ड गरेर हेर्दा उनको पाठेघरमा मासु पलाएको देखें त्यसपछि त्यो मासु बढ्दै गयो भने भोलि त्यसले ठूलो असर गर्ने भएकाले पाठेघर नै फाल्नुको विकल्प भएन ।   उनलाई क्यान्सर भएको थियो । परिवारको साथ उनले पाइन् तर श्रीमानलेनै साथ दिएनन् । हाम्रो समाज यस्तो खालको छ । यस्तो केश ह्यान्डील गर्दा निकै पिडा हुन्छ ।

लामो समयसम्म बच्चा नहुँदा, महिनावारी हुँदा धेरै रगत बग्ने अथवा रगत नै नबग्ने, धेरै पेट दुख्ने जस्ता समस्या भएमा तुरुन्त उपचारमा लाग्नु पर्छ

 

 

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  153. L’UFCM a constaté depuis quelques mois l’accroissement des tromperies à la « roqya ». Les témoignages de personnes victimes de ces pratiques se multiplient et présentent les mêmes caractéristiques : « Une personne vous appelle et vous propose une séance de « roqya » gratuite. Cette personne vous propose de rappeler un numéro prétendu gratuit, souvent un numéro commençant par 0 800… » Mais, dans les faits, cette prestation est loin d’être gratuite, puisque la conversation est facturée à vos frais et à votre insu. Au-delà de l’aspect juridique qui est traité à ce jour par le pôle juridique de l’UFCM[1], ce procédé soulève la problématique de sa conformité au Coran et à la Sunna. En effet, la « roqya » peut se définir comme une thérapie qui permet de soigner les actes de sorcellerie, de mauvais œil et également de se protéger contre ces derniers. Par conséquent, est-il possible de la pratiquer par téléphone et quelles sont les exigences édictées par le Coran et la Sunna ? Nous présenterons ainsi successivement les conditions liées au soignant (I), les exigences relatives à l’environnement où est réalisée la « roqya » (II). Nous aborderons ensuite la question de la gratuité de la prestation ou de sa contrepartie financière et enfin les conditions dans laquelle elle est réalisée (III). I- Les conditions liées au soignant Souvent la « roqya » est perçue comme une pratique dispensée par un tiers. Or, il est essentiel de rappeler et de souligner un fait important : la meilleure des « roqya » est celle que nous dispensons nous-mêmes à travers le « dhikr » et la récitation du Coran. Ainsi, pour se prémunir des maux liés au mauvais œil ou à la sorcellerie, il convient régulièrement de lire le Coran et faire des invocations notamment celles du matin et du coucher, de réciter régulièrement la sourate « La vache », de renouveler son intention, de placer la certitude dans son cœur, d’effectuer ses prières etc., et surtout de demander à Allah la meilleure des protections. Toutefois, dans certaines conditions, il est nécessaire de recourir à un soignant. C’est à ce stade qu’il convient d’être vigilant. Il ne suffit pas de se rendre auprès d’une personne qui se présente avec la qualité de cheikh ou d’imam pour accepter de lui confier cette pratique. Comme pour tout procédé et encore plus lorsque cela relève de considérations religieuses, il est important de bien choisir son soignant car ce dernier est tenu de posséder des qualités bien affirmées. La maîtrise du Coran et des traditions prophétiques en la matière est une condition sine qua none, mais insuffisante. La personne doit également avoir des notions de psychologie afin de déterminer la part de sorcellerie et celle de troubles psychologiques fréquents chez les patients. La personne doit posséder une bonne hygiène de vie, notamment spirituelle puisqu’il n’est pas inutile de rappeler que le succès de la « roqya » dépend de Dieu. Ces critères sont difficilement évaluables, surtout par une personne qui est affectée par un mal-être, quelle que soit sa source. C’est pourquoi les proches doivent accompagner la personne dans la recherche d’un soignant qualifié et reconnu comme tel par des référents religieux de la localité (imam, responsables associatifs, etc.). De manière générale, le soignant doit posséder des qualités déterminées que nous pouvons synthétiser de la manière suivante. Il doit : être en capacité de lire le Coran, croire avec certitude au Coran, être empreint de piété, connaître les pièges et les caractéristiques du diable et des djinns, connaître la méthode prophétique de la « roqya », disposer de connaissances de base en psychologie, avoir la conviction que le succès de sa thérapie dépend de Dieu. A l’exception de la première exigence, il semble difficile de vérifier les autres conditions dans le cadre d’un entretien téléphonique avec une personne que nous n’avons jamais rencontrée, même si elle se présente sous le titre de « cheikh » ou d’un imam. Par conséquent, ces conditions soulignent une première limite quant au recours à la « roqya » par téléphone. Par ailleurs, à l’instar de tout médecin, le soignant doit, avant de prodiguer des conseils ou une médication, procéder à une consultation. Ainsi, un environnement adéquat est indispensable pour la réalisation d’une « roqya ». Il est enfin inconcevable qu’un médecin puisse vous affirmer par téléphone connaître votre maladie et attester pouvoir vous guérir. Vous auriez plus que des doutes sur ce prétendu médecin. II- Un environnement propice et la réalisation d’une consultation préalable à la réalisation d’une « roqya » Il est intéressant de noter que, dans son ouvrage « Comment se protéger des djinns & satan », Wahîd ‘Abdussalâm Bâli évoque l’importance du climat pour réaliser une roqya[2]. Ainsi, il expose les points suivants : « 1. Préparer le climat adéquat en faisant par exemple sortir les images et les statues de la pièce où on va soigner le malade, pour permettre aux anges d’y entrer. 2. Débarrasser le sujet de tout ce qu’il peut porter sur lui comme talismans ou amulettes et les brûler. 3. Éteindre tout ce qui peut émettre le son de la musique et des chants. 4. Vider le lieu de tout ce qui comporte une infraction à la shari‘a à savoir, par exemple, la présence d’un homme qui porte de l’or ou une femme qui ne porte pas le voile légal – al-hijab. 5. Donner au malade et à sa famille une leçon de dogme de façon à ce que leurs cœurs ne soient pas attachés à un autre qu’Allah. 6. Leur faire savoir que la façon de soigner est différente de celle des sorciers et des charlatans et que le Coran recèle guérison et miséricorde, comme l’a informé Allah le Puissant et le Majestueux. 7. Diagnostiquer son cas : pour cela poser des questions au malade pour s’assurer de la présence de tous les symptômes (…) ». Or, dans les témoignages communiqués, l’interlocuteur qui se présente comme soignant ne pose aucune question aux personnes. Il débute ainsi la « roqya » directement par une récitation du Coran. En outre, il est intéressant de souligner que dans l’un des témoignages communiqués à l’UFCM, l’interlocuteur demandait à la personne de remplir successivement des verres de lait, d’huile, d’eau etc. et de les poser par la suite sur la table de la salle à manger. Au point que la personne s’est retrouvée avec une multitude de verres posés sur la table. Le comble est que la personne ignorait ce qu’elle devait en faire lorsqu’elle a pris conscience de la tromperie. Nous constatons par conséquent qu’une « roqya » ne peut être réalisée dans un environnement quelconque. En effet, une procédure de diagnostic est essentielle. Nous pouvons à titre d’exemple faire le parallèle avec un rendez-vous chez le médecin ; ce dernier ne peut vous prescrire une ordonnance sans au préalable vous avoir ausculté et interrogé sur les différents symptômes que vous ressentez physiquement. A défaut, au lieu de guérir vous allez aggraver vos maux. Cette attitude vigilante du médecin traitant doit se retrouver lorsque nous envisageons le recours à une « roqya ». Pour illustrer ce propos, nous citerons l’exemple de l’anthropologue, spécialiste de l’islam européen, Farid El Asri, chercheur associé au Centre Jacques Berque, qui nous rapporte une situation alarmante suite à une « roqya » : « Une jeune femme en Belgique (…) est morte suite à une tentative d’exorcisme. Pendant les séances, les fkihs (imams) utilisent normalement de l’eau « coranisée ». Pour cette jeune femme, prétendument stérile, les exorcistes ont carrément plongé son visage dans l’eau et quand elle tentait d’en sortir pour respirer, les guérisseurs estimaient qu’il s’agissait du jinn qui l’habitait et ils replongeaient son visage dans l’eau. Pendant le procès, la famille de la défunte s’est présentée comme musulmane et a accusé ces pratiques d’être extérieures à l’islam quand les guérisseurs estimaient qu’ils avaient simplement fait ce qu’ils pouvaient. Le fait de recourir trop systématiquement au fkih risque également de faire passer une crise d’épilepsie, par exemple, pour une crise de possession. »[3] Nous allons aborder enfin la dernière problématique, celle relative aux honoraires du soignant. III- Les honoraires du soignant Le Prophète, bénédictions et salut sur lui, « a agréé les Compagnons qui ont été payés pour la roqya ». Il est dès lors autorisé de rémunérer un soignant en contrepartie d’une prestation. Toutefois, cette rémunération doit être raisonnable et surtout clairement définie avant le traitement. En outre, nous ne pouvons que souligner et rappeler que, si la roqya est réalisée dans un cadre sérieux, il convient de procéder à toutes les déclarations administratives. Comme pour tout contrat, vous devez exiger un document écrit et le praticien doit préciser quels sont ses engagements exacts afin d’éviter tout litige postérieur. Malheureusement, tous les témoignages transmis à l’UFCM soulignent que l’interlocuteur insiste à plusieurs reprises sur la gratuité de la prestation. Or, dans les faits, cette dernière est payante puisque le coût de la communication est surtaxé. Ainsi, l’une des victimes qui nous a contacté, s’est retrouvée avec une facture téléphonique (hors forfait) de 1800 euros. Par conséquent, nous constatons que ces « roqyas » gratuites sont fondées sur la technique dite du « call-back » qui consiste à amener une personne à rappeler un numéro surtaxé, information qui lui est bien évidemment dissimulée. Une « roqya » peut être payante à condition de respecter un cadre prédéterminé, fondé sur l’information et la transparence des honoraires. En conclusion A la lumière des développements susvisés, l’UFCM appelle d’une part à une régulation du métier de la pratique de la « roqya », d’autre part, à la vigilance de chacun à ne pas céder à la tentation d’une « roqya » qui ne serait pas réalisée dans les conditions requises et qui pourrait produire des effets inverses. Au-delà du cadre spirituel ou juridique, les divers témoignages reçus et étudiés par l’UFCM ne peuvent pas nous laisser indifférents à la question suivante : pourquoi des personnes sont-elles amenées à accepter aussi facilement une « roqya » par téléphone ? Est-ce la gratuité qui a déterminé leur choix ? Certes le mal-être produit par cette société est de plus en plus grand. Nous vivons une époque où les êtres sont de plus en plus coupés des signes de Dieu et vivent un rythme de vie effréné. Ces affaires sont révélatrices des maux les plus profonds qui touchent la communauté musulmane. Par ailleurs, comme l’ensemble des rites islamiques (hajj, halal, pompes funèbres) censés nous rappeler les limites qui déterminent la voie vers Dieu, nous constatons que leur marchandisation trahit de plus en plus leur vocation première. Suffit-il qu’un interlocuteur se présente à nous comme un « cheikh » ou un imam et qu’il nous propose une « roqya » gratuite pour l’accepter aussitôt Ne devrions-nous pas tous nous interroger sur le fait qu’il y ait des musulmanes et des musulmans aussi isolés et aussi ignorants de leur propre religion pour être trompés aussi facilement ? Sommes-nous devenus si dépendants des Hommes que nous en oublions de nous adresser directement à Dieu pour solutionner nos malaises ? Autant de questions que chacun d’entre nous a la responsabilité de se poser. En effet, aucun de nous ou de nos proches ne sont à l’abri d’une telle tromperie. Il convient enfin de rappeler que la « roqya » est un remède précis et qu’elle ne peut se faire que sous certaines conditions et surtout qu’elle demeure l’exception à la règle, qui est de toujours s’adresser directement à Dieu. Avant de recourir à une « roqya », il convient de faire une introspection sur ses propres pratiques cultuelles et de revenir.

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