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.