Coronavirus in Nepal: Laborers returning home allege bias in hospitals

KATHMANDU, Nepal

Migrant workers, returning to their homes in the Himalayan nation of Nepal complain that they are experiencing a sort of apartheid in hospitals.

They allege that they are being turned away from medical facilities, as the suspected COVID-19 or coronavirus pandemic cases surge in the country.

Baburam Thapa, a 34-year-old working in the United Arab Emirates had arrived home late last month. But was put at a quarantine facility in the southern city of Butwal after complaining fever.

“Doctors and nurses refused to attend to my husband,” charged his 26-year-old wife Rita Thapa.

A few days later, his condition worsened as he developed trouble in breathing and speaking. His wife was trying to arrange a trip to Kathmandu, hoping for better healthcare. But on the same afternoon, he breathed last.

After his death, tests showed that he had not contracted the COVID-19.

"He had gone to the hospital hoping for treatment. But they killed him," said his widow now left to raise two children.

After local media reported that those returning from India had escaped from quarantine facilities built along borders, hospitals are turning away many sick people, fearing that healthcare workers there may contract the disease.

But the doctors have their own list of complaints. The Nepal Medical Association -- a 5000-member organization of doctors -- in a survey recently found that the country lacked enough protective gear for health workers.

"We have received complaints from our colleagues across the country regarding the lack of safety gears," said Lochan Karki, president of the association.

"It's like sending an army to the battlefield without weapons,” he added.

He said it was more dangerous if a health worker contracts infection at this critical time.

"If health workers are infected with the disease, it will be a double whammy. They will not only infect many others, but we will also lose critical human resources when we need them most," he told Anadolu Agency.

Karki warned that Nepal may face shortages of doctors and nurses similar to Italy and the U.K.

"Our health authorities must quickly ensure enough medical supplies. They must distribute it wherever necessary."

Hospitals ill-equipped

Besides the lack of protective gear, hospitals also are heavily ill-equipped. Shukraraj Tropical and Infectious Disease Hospital has only four intensive care beds and three ventilators. It has 18 medical officers, 6 consultants, and 20 nurses.

"We refer COVID-19 patients to Patan Hospital [another hospital designated for the virus treatment] because we don't have the infrastructure to provide health services to them," said a doctor at the hospital, who didn't want to be named.

The hospital is building a facility with 20 intensive care beds in its premises. On March 22, the hospital advertised posts seeking six consultant anesthetists, eight medical officers, four nursing officers, and 26 staff nurses.

He said the hospital management started to upgrade it only after the surge in the number of suspected cases.

"Until a week back, we were concerned, as we had no protective gear. We have it now so we are less stressed," the 25–year-old doctor told Anadolu Agency.

Pravin Dhakal, the editor of Swasthya Khabar, a Nepali language digital platform reporting on Nepal's health system, said the health sector in the country has received little attention from country’s politicians.

"Our hospitals would collapse if the number of cases surges like that of Europe. Our capacity to provide critical care is very low," he said.

Even before the pandemic showed its fangs, Nepal's hospitals were already ill-equipped to deliver even normal health care to its 28 million people.

Nepal has just one doctor for every 1600 people, compared with the World Health Organization (WHO) recommendation of one doctor for 1000 people.

The government allocates only 4% of its annual fiscal budget to the health sector against the WHO's recommendation of 10%.

An estimated 18,000 doctors and around 35,000 nurses serve at around 500 government and private hospitals across the country. But there are just 1100 intensive care unit beds and 600 ventilators.

Corruption in supplies

Recently, the government has been accused of corruption by purchasing faulty medical equipment from China.

Last week, the government had to cancel an agreement with a Nepalese company, which had procured medical supplies from China. Their first shipment, that included rapid diagnostic test kits were found below the standards as set by the WHO.

Arun Uprety, a medical doctor who completed a stint at a rural hospital in northeastern Nepal, slammed the health authorities for warning that they will revoke the license of doctors who refuse to treat the COVID-19 patients.

"It's the government's responsibility to protect frontline health workers. But we are getting conflicting instructions from officials. Their lack of planning and disregard for our safety is deeply worrying," he said.

"This is a new disease and we don't know so much about it. Therefore, saving ourselves and our family is our primary concern, “he added.

Precious time lost

Nepal confirmed its first case of COVID-19 as early as on Jan. 24, when a student returned from the Chinese city of Wuhan, the epicenter of pandemic.

Two months later, a female student returning from France via Qatar was detected COVID-19 positive. Two other women in the same flight and two men returning from India also tested positive.

According to the U.S.-based John Hopkins Coronavirus Resource Centre, Nepal has reported nine confirmed cases, with no deaths so far.

But experts say that the country has lost eight crucial weeks when it could have placed a robust system to track the returnees and test suspected cases.

In mid-February, Tourism Minister Yogesh Bhattarai had even boasted to market Nepal as a "coronavirus free country" to attract foreign tourists.

"The time between the first and second case was very badly squandered. It was never utilized to build a structure to respond to the crises," said a Nepali public health expert on the condition of anonymity.

"As a result of poor thinking in the government's part, there was chaos at the top. It resulted in very haphazard and ad hoc decision-making,” he said.