Bijendra Aryal, Nestling Trust director in Nepal has been to visit Bikram Bhadel, a pharmacist whose workplace is opposite the Tribhuvan University Teaching Hospital in Kathmandu. The visit was the result of the Nestling Trust seeing the following article:
(https://apnews.com/c1cd52ef723a5435aef7dd339a99af23?fbclid=IwAR0Gxd19tIvWBVWXC1aq6qQT7EfSJmWToDNIy52bVDjzewfB6dTb9E_Ii28)
The following was reported:
 KATHMANDU, Nepal (AP) — From his pharmacy outside Tribhuvan University Teaching Hospital, Bikram Bhadel saw what happened when coronavirus lockdowns closed the facility’s cafeteria and nearby cafes.
“Every day I watched the patients, their families, doctors and other health workers struggling to get a good meal,” Bhadel said. “They were already having a tough time and the food situation was making it worse. This is where I decided that I need to step in and help out.”
He took 1 million rupees ($8,333) out of his family’s savings. And with the help of his friend Indra Kumar Newar -- a taxi driver who had no work in recent months due to the lockdowns -- he rented a vacant restaurant across the street from the hospital, bought groceries and hired a few helpers.
Now, at one of Nepal’s largest hospitals, more than 200 COVID-19 patients, doctors, nurses and workers get hot, tasty and nutritious food three times a day.
“I have heard there is no medicine for the COVID-19 patients and the only thing to do is to take care of them and give them health food to help recover and regain their immunity. This is what we are trying to do to help,” Bhadel said.
The meals are vegetarian, prepared after consulting with nutritionists. They offer a combination of rice, lentil, beans, vegetables, fruit and salad for brunch and dinner, and snacks in afternoon.
They begin their day early in the morning. preparing hundreds of meals. Food is packed in disposable packets and carried by Bhadel and Newar to the hospital reception area, where the staff eagerly awaits.
“The doctors and health workers have been working risking their own lives and away from their families. It was time to do something for them when they need them,” Newar said.
Staffers work and stay at the hospital for a week on duty and then another week in quarantine before they are allowed to return home for a week off work. While they are at the hospital, their only access to hot meals has been what the team delivers.
Nepal -- which has 49,219 confirmed cases of the coronavirus and 312 deaths -- first imposed a lockdown in March, which lasted for four months. A second lockdown was set last month in nearly half the country when the numbers kept rising.
Bhadel and Newar estimate they spend about 50,000 rupees ($416) a day for groceries. They have hired 11 cooks and helpers, all of them paid minimum wage and are regularly tested for the virus.
Families, friends and neighbours have donated food, money and supplies. Bhadel and Newar have paid the rent for three months.
“We are hopeful the situation will get better in three months,” Bhadel said, “but if that does not happen, we will continue our work.”

KATHMANDU:  The Health Ministry has reported 1,325 new cases of coronavirus infection in the last 24 hours taking the national tally to 64,122.

Today’s reported infections in the Kathmandu valley is 59.05 per cent of the country’s total cases.
11 more Covid-19 fatalities were recorded on Saturday bringing the total nationwide death toll to 427. Despite the escalating figures the government released the lockdown in Nepal on Thursday. Thousands have already lost jobs and livelihoods due to the lockdown which has been in place since March.
It has been reported in the Himalayan Times that 400 Nepalese people per day are risking the high prevalence of Coronavirus in India (cases now estimated as 90,000), and are returning in order to find jobs.

The Himalayan times reported today that the total number of people infected with coronavirus has increased to 50,465. 1246 new infections were reported in the last 24 hours.
The death toll now stands at 317.
The lockdown is beginning to be eased albeit with restrictions.

The Health Ministry on Wednesday reported 1120 new cases of coronavirus infection from across the country. Nepal’s Covid-19 tally now stands at 41,649 with 251 deaths. Lockdown has now been extended until at least 9th September '20, causing extreme hardship for families who now have no work. Schools remain closed and children from the poorer backgrounds are unable to access distance online learning.

Those known to have Coronavirus has now reached 29,645 with numbers escalating daily especially in the Kathmandu valley. This has led the government to announce a week long prohibitory order enforced in Kathmandu valley effective from Wednesday 19th August at midnight.
The Himalayan Times reports that the prohibitory order has been issued to 'discourage unwarranted movement of people in order to control the increasing spread of coronavirus infection in Kathmandu, Lalitpur and Bhaktapur....'

 I am Dr. Arun Upreti.
​ I am currently working as a Staff Physician in Charikot Hospital from Nyaya Health Nepal. Previously I worked as a medical officer for Government of Nepal in the same institute for 2 years. Charikot Hospital is operated in by Nepal Government in Partnership with Nyaya Health Nepal. Charikot Hospital is the largest health care provider in the district and provides health care services to over 50,000 annually. 

COVID has been a unique challenge for Nepalese health care system. The rural health care system which is run mostly by paramedics, nurses and fresh MBBS graduates is particularly vulnerable due to lack of adequately trained human resource, unavailability of COVID tests, under funded quarantine and isolation centers.

Nepal government’s policies and guidelines are not replicated at the local level. I have now been working here for 2 months during the COVID pandemic - the only protection that I use is a N95 mask and gloves. The fever clinic is almost non functional. We feared working like that initially but now it has become a norm. There is a little difference between us practicing medicine pre and post COVID.

Other public health measures like point of entry testing, community screening, contact tracing and surveillance do not meet the standards recommended in national protocols. Most teams are formed with inadequately trained staffs without proper IT and communication facilities.

However there has been vast community engagement, thanks largely to the lockdowns which has completely changed the lives of everyone. Agencies and health care workers across all level are engaged in health education about COVID. Use of masks and hand washing has been prompted at all levels through available health facilities and FCHVs.

While lockdowns have been important in curbing the spread of COVID, it has brought several impediments to health seeking behaviour of people. Due to unavailability of transportation facilities the number of patients in our OPDs has halved. The obstetric cases have been on the rise probably due to lack of services in other centers and people not having access to higher centers. As many complicated obstetric cases cannot go to higher centers in Kathmandu, our CS rate has also been on the rise. We have also seen too many cases of ruptured appendix, strangulated hernia all probably due to lack of elective procedures.

Mental health is an aspect that has been overlooked. We have seen a significant rise in suicides in the district. We have been performing autopsies almost everyday, and the average autopsies for suicides has almost doubled in the last few months.

The elderly and single women have also been significantly affected by the lockdowns. Many of them cannot get the health care they need. We had one elderly women who presented to our center with fractured femur, which needed operative management. None of her family members were willing to take her to higher center for treatment. We get similar stories almost everyday. Some day its a fracture needing operative management, other days it COPD requiring ICU admissions. Most have given up on treatment for the elderly because of lack of transport and risk of COVID infection.

I strongly believe these are the areas that needs significant work and should be important part of the COVID response. I believe we need community based programs that are related to mental health. Also assistance to elderly, single women and pregnant mothers especially for transportation would be particularly helpful in the lockdown. 

​The Nestling Trust is running a campaign to Hike the Height of Everest (Virtually) The Team High Hopes has members in the Wiltshire and New Zealand. It is a huge effort with the aim of saving lives in the vulnerable communities of Nepal.
​Coronavirus is escalating in Nepal. It is reported that at least 83,020 Nepali migrant workers have returned from India alone, with at least 400 still entering Nepal daily. India is fourth in the table of the worst Coronavirus hit countries with figures still soaring. Thousands more are returning from the Gulf countries and China.
Nepal's frail health system is struggling with inadequate testing and with thousands heading for the remotes villages, the situation is of huge concern. The Nestling Trust with SITARA their partner NGO, has already provided vital medical equipment, PPE, disinfectant and soap for the Health Posts it has established, but much more is needed to support their work, to quarantine those newly arriving and to ensure needy families have food and soap at this time of crisis.

Marbu nurses check people returning to their village from kathmandu

As dawn broke today, Sitara General Secretary Chuda and TNT director Subash Shiwakoti travelled under special licence from Kathmandu to the mountainous region of Dolakha. Despite the 'lockdown' all over Nepal, permission had been grated for them to take much needed supplies of PPE and medical equipment to the Melung Health Post and to two District Public Health Centres. Each Health Post established by TNT as well as the two district public health centres  now have equipment to help reduce the spread of the Corinavirus. All the supplies and delivery costs have been funded by the TNT who have also provided soap to be distributed to the villagers.

TNT has funded essential items for helping reduce the spread of the Corinavirus Covid-19 in Nepal. Sitara our partner NGO arranged delivery to four Health Posts and a remote District Health Centre today, and a further delivery to the 5th Health Post in Lapilang and another District Health Centre is planned for Thursday. Prior to this delivery all the medical facilities  were desperately short of masks, aprons, gloves and had no infrared thermometers. At the time of such worldwide shortages it is amazing that Sitara has been able to locate these items and we thank them most sincerely for their hard work and perseverance. Thank you also to all our loyal supporters - it is because of you this has been possible.

​1. Health Posts In Marbu, Lapilang, Bhirkot, Chilankha And Melung
Migrant workers from China and India who have lost their jobs through the Covid-19 virus are returning to their villages. This is also true of thousands of workers in Kathmandu who have lost their jobs because of the 'lockdown' in Nepal now entering the 26th day. The likelihood of the virus spreading to the many remote villages is therefore extremely high.

The Nestling Trust(TNT) has through Sitara, our partner NGO, located masks, gloves, aprons, disinfectant, thermo thermometers and sanitizer, for the nurses and staff in the five Health Posts we have established, and also for the District Public Health Centre in Dolakha. We are currently seeking a special license (due to the lockdown) from the government, to allow transportation of the supplies to the remote villages of Marbu, Bhirkot, Lapilang, Chilankha, and Melung.

The Health Posts are currently providing Health education for villagers regarding measures to prevent the spread of the virus such as handwashing and self-distancing. We are supplying soap for families too poor to afford it.
​
The Health Posts of Marbu and Melung have taken over the local school building in each village, and are making isolation wards but there is desperate  lack of equipment in the face of the approaching disaster.
We know that no patient in these areas will have access to ventilators or anything like the facilities they might find in a city hospital. TNT is trying to raise funds to help in providing some equipment for these isolation wards, at present there is not even any oxygen. The photos below show the preparation of the isolation ward in the local school in Melung, it also shows the desperate need of equipment!

2. Preeti Project
The Nestling Trust and Sitara our partner NGO have been working with the Local government at Preeti, a very mountainous and remote area of Ramechap region. Here 30,000 people are without medical facility and we plan to help build and establish a Health and Birthing Centre. Sadly due to the Corinavirus and the lockdown in Nepal, the plan has had to be delayed. This is very frustrating however, money raised by TNT to commence this project has been 'ringfenced' until we have permission from the Social Welfare Council to go ahead. 

Report from Bijendra Aryal, Nestling Trust Director, Kathmandu
The number of Covid-19 infected people has now reached forty seven. As the number increases people are panicking - they fear that the government will increase the 'lockdown' and this will result in people dying of hunger rather than by COVID 19. The reason is that they have lost their jobs and livelihoods and so have no money to buy food. People are returning to their villages without caring about the possible effect of spreading the coronavirus, people are going on trucks and busses. There is a lack in coordination and effective management. It is affecting everyone but especially the underprivileged - children and families are suffering. 

Only the big supermarkets are allowed to open so people think that government is discriminating against the small shopkeepers who have been forced to close.
There is a lack of awareness of social distancing. Hundreds of people  gather in public places to get food and that has increased the chances of spreading of virus. We don’t know how many people are infected, one family who has been sewing and distributing masks was found infected with corona today.
​
In the villages there is a greater lack of awareness, due to gatherings and partying ,whole villages could be infected. 
When 'lockdown' is over and people start to come back to Kathmandu from the villages then the situation in Kathmandu will be made worse. Hospitals will struggle, already it has been announced that there is scarcity of blood in blood banks.

​Exhausted Families Rest Enroute To Their Villages

Coronavirus Covid-19 arrives into Nepal. 
A student doing his PhD in Wuhan, China,  returned to Nepal on 5th January 2020. He was admitted to hospital complaining of respiratory problems  on 13th January 2020. Throat swabs and blood samples taken from the student were sent to the WHO’s Collaborating Centre in Hong Kong. After treatment and medication the student's condition improved and he was discharged after five days, but crucially before a report showing positive results was sent back to the hospital. Efforts were made to trace the student's family but there was no indication as to where the man had gone or what his activities had been after discharge.

Development.
24th March 2020 Nepal Government announces a total lockdown which is being enforced by security forces.
17th April 2020 in a single day an increase of 14 active cases bringing the total to 30.
The Government is increasing the testing through Rapid Diagnostic Test and PCR Machine. So far nearly 25000 people have been tested and 30 confirmed positive. 

Observations
Today is the 25th day of the Lockdown of Nepal, now the social effects can be seen. Jobs and livelihoods are lost especially those earning daily labour wages such as those in city areas and those involved in construction suddenly there is no money coming in and so have no means to buy food. 
People are going to their villages by foot carrying the children and all their belongings. They have to walk 50 Km to 800 Km to reach their destinations. On the way, they have no place to eat and only streets and fields to sleep. It is difficult to cross from one district to another. Sometimes they are prevented by local people fearful of any virus they may have and sometimes stopped and turned back by police, but they have nowhere else to go. Now it is the matter of hunger and a humanitarian disaster.  Already many people in Kathmandu are hungry due to 'Lockdown' and being unable to work. These Government measures  have now been extended  until 30th April '20, and enforcement is very strict.
Subash Shiwakoti 
​