When historians look back at the Covid-19 pandemic in 2020 (and perhaps beyond), a consistent feature they will discover is that responses from governments around the world fell quite short. Regardless of what spin one gives to it, Nepal’s lack of preparedness to a public health crisis foretold by experts weeks earlier will be no exception. The greatest infamy in our country’s story will perhaps be the sight of hundreds of Nepalis trying to make their way home to be with their loved ones blocked at the border with India. The video of one group demanding, ‘Take your citizens back!’, circulated on social media brings home how our compatriots are being treated by the state. Of course, the heavy-handedness of governments trying to deal with the crisis has been felt around the globe although perhaps nothing compares with the tragedy that has been unfolding in India with migrant workers and their families (including Nepalis) trying to cover hundreds of kilometres to reach home.

It was probably because the Nepalis were so near yet so far that our sensibilities could not but be aroused. Journalist Mohan Mainali recalls being recently informed at an event in Surkhet by the Chairperson of Simta Rural Municipality in Karnali Province that his municipality’s total income was Rs1.51 billion the previous year. More than half of that came in the form of remittances from outside Nepal, and more than 80 percent of the migrant workforce from Simta were labouring in India. Mainali is indignant that the state is now using force to keep out such of its citizens who had braved all perils of traversing an India under its own lockdown to somehow arrive at their home country’s gates. His article was most aptly entitled: ‘Those propping up the country not being allowed back in!’

Leaders of the ruling Nepal Communist Party still insist that the ultimate objective is a workers’ paradise this side of the Himalaya, but actions such as these certainly give the lie to their party’s name. Not to have anticipated the consequences of the Indian border closure on one of the most vulnerable and desperate population groups of Nepal says a lot about how far its priorities have moved. Likewise, not to have similarly anticipated the impact of the lockdown on daily wage earners and other similarly placed groups, to only belatedly announce mitigation measures that seem to have been cobbled together for effect rather than actual implementation is equally telling. The government’s criminal-like treatment of Indian workers who have been similarly been stuck on our side of the border is yet another reason to hang our heads in shame.

Politics as usual

If one looks back at what our political leadership was busy with these past few months, there appears to be some kind of expectation that we would be spared the ravages of Covid-19. I am not even referring to the foolhardy and ignorant claim in late January by the Minister of Tourism that Nepal is ‘corona-virus free’, and that we should be getting ready to welcome more Chinese tourists in line with the target set by Visit Nepal 2020. Rather, it was the nonchalance with which the national political machinery got bogged down in that bane of our country—non stop politicking.

Hence, on the day the first death from the virus was announced in China on 11 January, ruling party leaders were bickering about who should be anointed speaker of the House of Representatives. Two days later, the first case outside of China was reported, and on the 24th came the news that a coronavirus case had been confirmed in Nepal. Along with France, one of today’s hotspots, Nepal was only the 11th country in the world where the virus had been found; others such as Italy, Spain, Iran and the United Kingdom had not reported a single case by then. Then, on 30 January, the World Health Organisation (WHO) declared Covid-19 to be a global emergency.

We were by then being engulfed in the drama that had begun to unfold within the ruling party, and, by extension, the government, over the merits or otherwise of the Millennium Challenge Corporation (MCC) and the Belt and Road Initiative. And, thus we remained in thrall of an issue that seemed to have the potential to spiral into the unseating of the prime minister himself. The MCC question then morphed into another pointless distraction, that of the need to amend the constitution to accommodate a party honcho in the National Assembly before the space for public deliberation was overshadowed by the resignation of the Minister of Communication over suspected corruption.

Prime Minister KP Sharma Oli then went into surgery for a kidney transplant and was still indisposed at the time the WHO declared the coronavirus outbreak to be a pandemic. Oli has since insinuated himself into governance activities but the limits of a ravaged physical body is becoming apparent even though he persevered through some meetings after being discharged from hospital. And, amidst this lockdown and a state of an undeclared national emergency, a sign that politics continues as usual came with news reports of corruption allegedly going up to the highest levels of government in the now-scrapped procurement of medical supplies from China.

To give or not to give

As of this writing, we have not experienced the kind of viral onslaught that has overwhelmed countries, particularly in the global North. Whether the measures we have put in place will spare us a similar fate, in the long run, remains to be seen. There are so many expert opinions being expressed regarding the course the virus might take that making any reasoned judgement about it appears to be an exercise in futility.

What worries me though is how we will even begin to manage should we begin to see more infections. The preparations around the country so far are mainly for patient isolation and less so for treatment, which requires intensive care (IC). The number of IC beds in the country runs at most in the few hundreds and apart from the fact that nearly all of these are concentrated in Kathmandu one can be reasonably certain that many of these units do not have designated ventilators, that most crucial piece of equipment required for Covid-19 patients.

In such a situation, how health-care workers decide who gets into an ICU and who gets a ventilator becomes crucial, as much for the sake of transparency as much as for their own state of mind. In its set of professional ethics guidelines in the current situation, the Nepali Medical Council has said that it is only ‘preferable’ that hospitals set up triage teams to make decisions and communicate the same to patients and their relatives. It recommends that the triage team consists of ‘a clinician with training or interest or experience in the field of medical ethics, a representative of hospital administration (Director or a designate) and a social worker respected in the community’.

Since triage protocols usually come alive in times of war or serious epidemics, Nepal has never had any experience with decisions regarding who gets priority for treatment. Hence, if it ever comes to that it will be a huge learning experience for all concerned. The challenge is whether in a country like ours with its deep intersections of class, caste, ethnicity, language and religion as well as social and personal networks it will be possible to arrive at decisions on who gets ventilators based on zero direct contact with the patient and relying only on information provided by the physician. We can hope that hospitals have begun the process of forming triage teams and sharing notes with each other on the procedures to be followed. Thus far, none of the designated corona-treatment hospitals had anything up on their websites, even though that would be the first essential step towards assuring the public about openness and impartiality. Trust in health institutions and the government by extension will depend to a large extent on how fair the mechanism is perceived to be.

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