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Covid-19 exposes cracks in Nepal’s healthcare system

-Dr Hemanta Dhungana

     The wave of Corona virus is advancing gradually and surreptitiously. As warm season begin to wind down, the control of covid-19 upsurge is obligatory. With winter season, there will be rise in influenzas and other respiratory disease making it more difficult to grapple with.

     Corona virus has devastated the Nepal’s economy and immobilized the health sector. Students are less gung-ho about their study and are hunkered down at home. As tourism industry have been hobbled by pandemic, it is expected more than 20,000 people to lose their jobs. World bank predicts that remittance to Nepal is projected to shrink by 14% this year, which is an essential source of income for many households. Remittances assist families to buy daily groceries and spend on medical care.

     Since the easing of lockdown, medical system is creaking once again. Public rage towards government dealing with coronavirus is off the charts. People start resorting to spurious traditional treatment like turmeric and ginger. Public pundit says the government lift the lockdown too early at the beginning.

     As country hobbled by Corona virus, healthcare system is limping. With infection plateaued in recent days, expert says “Hospitals in Nepal are no position to handle current crisis”, which has around 300 working ventilators for 30 million people. Unfortunately, Government is not giving priority for importing more ventilator machines, as problem keeps piling for Nepal.

     The huge challenge for now is to cut the chain of virus transmission. Lockdown might slow the progress, but it is not a solution to halt it completely. While many of us glued to social media reports about Covid-19 news, the real battle is happening inside the ICU, but intensive care units (ICU) of Nepal are not fully designed to accommodate and provide medical care to Covid-19 patients.

     Nepal has failed to grip with this ongoing problem, which might weigh down the healthcare system, eventually tearing it apart. Government should develop a sense of urgency in increasing Covid-19 test, contract tracing and adequate quarantine facilities, which are the mainstay to deal with current crisis. We need to fight together to make a difference.

     As we anticipate inundation of critical cases of Covid-19 patient, hospitals are worried about shortage of ventilators, isolation bed, diagnostic kits, and PPE (Personal Protective Equipment). In a country like Nepal, where health system is fragile, with a smaller number of citizens working from home, lockdown will not be one-size-fits-all solution to this Covid-19 pandemic. There will be wider consequences of the lockdown, as limiting travel would make general population difficult to access essential healthcare such as routine immunization, maternal health services, emergency surgery management and blood bank services. “It will cause unexpected increase in preventable death among children and pregnant women”, recons UNICEF.  Robust planning and co-operation between healthcare providers and government is necessary to continue the service and manage other treatable condition.

     In this uncertainty situation, stringent restrictions can help in buying some time for essential preparation, but we should consider being vigilant and slowly lifting it to ease socio-economic burden. Furthermore, study shows the combination of wearing a facemask, maintaining physical distance and regularly washing hands slow down the virus, flattening the curve. Government plays an important role in educating its citizens about personal protective measures and raise awareness to put a break on this ongoing pandemic.

     Nepal rank 111th out of 195 in terms of global health security index, which is based on capacity to face communicable disease outbreak. Nepal lacks extensive testing as well as robust contract tracing, while hospitals do not have enough PPE for frontline health workers.

     Finance in the public sector in Nepal has been scrappy. Many hospitals in rural areas states that it hadn’t received adequate financial help from central government to grapple with corona virus pandemic. Rural areas in Nepal has 1 doctor for every 150,000 people, which is a very dire situation. Nepalese government also failed to invest on public hospital and community health, results in rapid increase of private hospital, which is only for the affluent population. 

     Lack of awareness in general population about the gravity of this pandemic is bringing more stress on healthcare System. Regardless of government stringent lockdown, people are still disobeying. While effective collaboration between central and local government is murky, the tattered healthcare system of Nepal is not adequately ready to cope up with high volume of covid-19 patients.

    Another big problem of Nepal is corruption in health sector. It displays in different forms all over the healthcare system. Ministry of Health personals were accused of receiving payola while buying medical equipment from neighboring country. This kind of looting debilitate healthcare system and weakens morale of doctors, nurses and health workers.

     Nepal which has a population of 30 million, aim to preempt the worst situation of this pandemic. Nepalese government prime concern should be increasing number of beds for Covid-19 patients, extending ICU facilities, involving more private hospital, recruiting more medical manpower and converting schools, hotels and open space to quarantine area. If central and local government works in tandem, we could easily curtail the ramifications of current Covid-19 pandemic. On the top of that, government should arrange PCR test and proper quarantine facilities to all immigrants from Indian borders.
     
      For as long as one can remember, healthcare was not given importance as required. Thousand more ventilators are required with adept personal to use them. With limited resources, there is huge challenge to grapple with Covid-19 virus and only with the strong willingness, the fight with virus can be conquered. If there is mass outbreak, the current healthcare system won’t be enough to accomplish the challenge. We need to communicate with neighboring countries, so we could get help to fight against Covid-19.

     Without a powerful and extensive effort to mitigate the current healthcare problems, there will be devastating and unforgettable consequences, that will linger for a long time .The final optimism is to find a corona virus vaccine which will act as a shield to everybody , but it will take some time to prove its benefits.

(Dr Dhungana is Consultant Orthopedic surgeon at Midat Hospital)

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