The power of the people — Nepal’s local response to surging COVID-19 cases

Yuxuan Liu, Yue Li

For Nepal, having more than 60,000 new COVID-19 cases per week is a big number. For a country with a population of merely 28.6 million, this dramatic increase meant that two per thousand people were diagnosed with the virus that has swept across the globe. This number came from the week of May 10, Nepal’s second peak since COVID-19 broke out at the start of 2020. Compared to the first peak that appeared in October 2020, the number has almost doubled.

Source: WHO Coronavirus (COVID-19) Dashboard

This emerging public health crisis has crashed the already weak health care system in Nepal, according to Aneka R. Rajbhandari, a fundraising volunteer at NHR Isolation Centre, an institution in Lalitpur, Nepal that provides locals with a place to isolate themselves when they are diagnosed with COVID-19. “Things are completely out of control,” she said. “All resources are used to treat COVID-19 patients, and some patients are still unable to get treatment and some just die in the ambulances that have already taken them to the hospital.”

In Rajbhandari’s opinion, the second lockdown is caused by a combination of various factors, a major one of which has to do with the geographical location of the country. “India is in Nepal’s east, west, and south,” said Rajbhandari. “As you know, the situation got worse in India, and basically we have an open border with India.” With the introduction of the highly infectious COVID-19 variant from India through “a lot of people traveling across the open border, in and out,” Nepal is facing the largest surge of new cases since the pandemic started.

In addition to cross-border travel that is not constrained in any way, social factors in Nepal also played a role in the upsurge of COVID-19 cases. “It is also because of our political instability. Plus our health system is pretty weak,” said Rajbhandari. Political instability could lead to less attention to the well-being of the population, as different political forces in Nepal are trying to get into power. This lack of intervention would ultimately lead to weaker governance, and of course, less measures taken to tackle the pandemic.

Therefore, instead of expecting the government to do anything, people are taking matters into their own hands to deal with the situation. “I feel like people are doing more than the government,” said Rajbhandari. “Nepali people are very resilient, and we don’t wait for the government to come.” Local fundraising is ongoing to provide food and medical supplies for those in need. As the medical system crashes and all resources are focused on COVID-19, local NGO groups are opening isolation centers with the medical support from the local government. One of the examples is the NRH Isolation Centre, where Rajbhandari works in response to the second surge of COVID-19.

NRH Isolation Centre in Lalitpur, Nepal. Photo provided by Aneka Rajbhandari.

Before the pandemic, the Centre, run by the Nepal Youth Foundation, was dedicated exclusively to treating malnourished children and women. It was transformed to an isolation centre in response to the second wave of COVID-19 in Nepal. The capacity of the Centre is 60 beds and it provides services to patients of all age groups with mild and moderate symptoms. With the Centre’s own ambulance, the isolation centre provides pick up service for people who reach out to them. Staff at the Centre also reached out to and received patients from other organizations such as orphanages and nursing homes they are working with.

Inside NRH Isolation Centre. Photo provided by Aneka Rajbhandari.

At the Centre, patients can get basic medical services including check-ups, oxygen and other medical supplies. The Centre is also planning to open a mini High Dependency Unit (HSU) to treat patients who develop more severe symptoms, as the isolation centre is far from major cities and transferring patients to the hospital carries a high risk. The Centre’s previous experience in treating malnutrition also comes in handy in response to the crisis. “We provide a Nepali balanced diet of rice, lentils, greens and meat, which is really nutritious and suitable to treat malnutrition,” said Rajbhandari. “The menu has remained the same after we transformed into an isolation centre and every patient gets three to four meals a day including snacks for free.” Under the care and treatment of the isolation centre, as well as support from its donors, 90 patients—of which 47 are children—have already recovered.

Staff at NRH Isolation Centre preparing food for patients. Photo provided by Aneka Rajbhandari.

Besides those who are treated in the isolation centre, volunteers are also proactively reaching out to other organizations or those who isolate at home in the neighbouring regions. They provide a hotline and a door-to-door service to those who need medical assistance. Specially designed aid packages are delivered to elderly patients who suffer from other health conditions. Nutritious food and medical supplies are also provided to the orphanages and nursing homes that are in need of assistance.

Apart from the basic medical service, NRH Isolation Centre is also taking measures to address the psychological issues. “People are scared,” said Rajbhandari, “especially elderly people with other health problems like diabetes and heart diseases. They see people die because of COVID, and they are worried that they are losing this battle to the young people and might be the next to go.” Despite the tight human resources at the isolation centre, it provides a 24/7 psychological counselling service. Experienced staff are answering the hotline and providing services onsite to put people’s minds at ease during this intense time.

Although the NHR Isolation Centre is successful in helping the people in the region, Rajbhandari still identified some challenges facing the Centre and Nepal in the future, as well as the limitations of the Centre itself when facing the national crisis.

Staff at NHR Isolation Centre. Photo provided by Aneka Rajbhandari.

“First of all, we really lack medical manpower as well as resources,” said Rajbhandari. “Medical manpower mainly in village areas where people could not go to the hospitals.” The uneven distribution of trained health professionals and resources across the nation poses geographical barriers for rural populations, making it hard for them to access the care they need. This disparity is further exaggerated during the pandemic. “A lot of doctors are also stuck in the city, especially in these instances,” said Rajbhandari.

The lack of personnel also poses difficulties as the Isolation Centre runs. “People are working in an Isolation Centre where there are a lot of infected people,” said Rajbhandari. “For example, if we bring in oxygen cylinders, we need people to bring them up to the Centre, because the Isolation Centre is at a height and is kind of secluded.”

The NHR Isolation Centre on top of a slope. Photo provided by Aneka Rajbhandari.

Rajbhandari also doubts that many barriers would exist if other locations in the country were to adopt the operating model of the Centre. “Right now it’s very difficult to travel,” said Rajbhandari. “We were lucky that we were able to transform an already-established place into an isolation center.” The preexisting staff, expertise, physical properties and services has laid a firm foundation for the successful operation and functioning of the Centre. But even with these “steps ahead,” training staff members to cope with COVID-19 was still a lot of work. “Imagine trying to replicate that completely in another place at this moment is quite difficult.”

To successfully apply this model to other parts of the country and save more lives, Rajbhandari believes that many resources are needed. “We definitely need someone we can trust to take charge of everything,” she said. “Secondly, we also need medical supplies, medical staff and buildings.” And since the purpose of an isolation center is for the patients to be healthy and isolated, food is also required.

Despite all these challenges that must be addressed during and after the public health crisis, Rajbhandari and her isolation center have shown the power of the people. As some local governments, many communities and international organizations are acting, she believes that the nation will eventually overcome the hard times. “We are pretty resilient,” she said. “We are seeing a decreasing number of new cases, and I’m sure we will see more of that in the future.”

About the authors

Yuxuan Liu is a journalist/columnist at the Writing and Interview Program of Social Responsibility Practitioners. She is a rising junior studying Global Health who loves mint and chocolate chips ice cream.

Yue Li is a journalist at the Writing and Interview Program of Social Responsibility Practitioners. She is a recent graduate from University College London where she studied Education and Technology. Her areas of interests include women’s rights and education equality.

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