'Source force' and the Nepal medical profession.

The following is an account of how indigenous social structure in Nepal shapes the organization and functioning of the country's allopathic medical profession. There is a division between doctors who are well placed socially and politically, who would like to maintain the traditional kinship based patron-client system of promotions and placements, and doctors from less advantaged backgrounds who want reforms and state regulations that would organize the profession around merit and expertise. The struggle reflects a tension over the legitimacy of what Nepalis call 'source force', defined here as the use of patrimonialism within a bureaucratic structure. The controversial new medical school currently represents the interests of doctors without source force, although the increasing involvement of elite families may change this status. A case study of one doctor (whose name and location has been changed) posted in a remote area, one of many conducted by the author in 1987, is given.