Most district hospitals in Gandaki Province fail to set up ICU wards despite having the budgetThe provincial government has allocated budget to nine district hospitals to set up facilities but only two have been able to follow through.
The Cabinet meeting of Gandaki Province on April 28 had decided to set up an Intensive Care Unit (ICU) in all district hospitals. Accordingly, the Social Development Ministry disbursed a total budget of Rs 149.8 million to nine different hospitals in the province on May 19.
The Cabinet's decision was expected to enhance the institutional capacity of the hospitals to provide quality health facilities to combat the Covid-19 pandemic. However, the majority of the hospitals have yet to set up ICU wards even after four months of the decision.
Out of the nine hospitals that were supposed to set up an ICU, only Myagdi Hospital and Gorkha Hospital started the facility aiming to treat critically ill coronavirus patients. A five-bed ICU ward with two ventilators in Myagdi Hospital and two ICU beds with as many ventilators came into operation a few weeks ago.
Dr Pratibha Gauli, the medical superintendent of Matri-Shishu Miteri Hospital in Pokhara that received the amount under the scheme, said the hospital has been unable to set up an ICU, as the arrival of ICU bed panels from India has been delayed due to the lockdown and prohibitory orders enforced amid coronavirus fear.
"We have already procured two ventilator machines. The process of purchasing medical equipment required for ICU is underway,” Gauli said. “Preparation is on to operate the ICU service by managing the required infrastructure."
The ministry provided Rs 16.9 million each to Matri-Shishu Miteri Hospital in Pokhara, Syangja District Hospital, Lamjung District Community Hospital, Madhyabindu Hospital in Nawalparasi (East), Parbat District Hospital, Beni Hospital in Myagdi and Damauli Hospital in Tanahun to set up five-bed ICU wards. Similarly, the district hospital of Manang and Mustang were provided Rs 9.7 million each to manage a two-bed ICU facility.
Despite the spike in the number of coronavirus cases in the province, the hospitals receiving the budget have not set up the ICU facilities. And the ministry is not abreast of the progress report of those hospitals.
Dr Ram Bahadur KC, chief at the hospital development and health service division at the ministry, admitted that there’s been a delay in operating ICU wards in those hospitals. According to him, the division wrote to the hospitals on September 9, instructing them to expedite the procurement process and operate the ICU wards at the earliest.
"There was a shortage of medical equipment and tools in the international market due to the coronavirus pandemic. Therefore, there was a delay in the procurement process. But now, the process should be initiated through tender," said KC.
According to the ministry, at present, there are a total of 175 ICU beds and 53 ventilators in all private, community and government hospitals of Gandaki Province.
"The treatment of Covid-19 patients with serious health conditions will be easy if these nine hospitals start operating ICU facilities," KC said.
In Lamjung, coronavirus patients in critical conditions have to go to Kathmandu or Pokhara for treatment, as the district does not have any ICU facility. Lamjung District Community Hospital received the amount to set up an ICU ward some three months ago but it is yet to initiate the ICU service.
"We had to cancel the first tender as the supplier did not meet the deadline. The procurement process only began after the signing an agreement on August 30. All the work to set up the ICU ward will be completed within a month. Some equipment and tools have already arrived and others will be arriving soon," said Amar Dawadi, the chief at the district health office.
On August 25, the Office of the Prime Minister and Council of Ministers had also allocated Rs 20 million to Lamjung Hospital to establish a 10-bed ICU facility with four ventilators. However, there is a legal hurdle to use the amount since there is no hospital in Lamjung with that name.
"The budget has been sent to Lamjung District Community Hospital. But there was an error while writing its name. Efforts are on to correct the mistake and utilise the amount sent by the federal government as soon as possible," said Krishna Prasad Sharma, the chief district officer of Lamjung.
Likewise, the district hospitals in Syangja and Tanahun have also failed to procure the medical equipment and tools to set up an ICU. The administration of both hospitals claimed the procurement process was delayed due to a shortage of medical equipment in the international market and the lockdown. They, however, said they would purchase the necessary goods soon and operate the ICU ward.
The Parbat District Hospital has also been unable to initiate the ICU service. Though the hospital management has already procured the medical equipment and tools for the ICU ward, the health facility is yet to come into operation due to a lack of human resources.
"The hospital has procured the ICU bed panel, ventilators and oxygen plant. But we are unable to kick start the ICU facility since the hospital does not have the required manpower," said Govinda Pahadi, chairman of the hospital development committee.
The 15-bed hospital is currently being upgraded to a 50-bed health facility. The hospital aims to provide dialysis services, ICU, operation and ENT services.
"But we do not have the required human resources to operate all these services," said Dr Shishir Devkota at the hospital.
Manang District Hospital and Madhya Bindu Hospital in Nawalparasi (East) also have similar problems. ICU facilities have not come into operation for a lack of human resources, the hospital administrations claim.
A total of 3,064 people have tested positive for Covid-19 with 1,155 active cases in 11 districts of Gandaki Province as of Monday. The ministry said 29 people have died of the virus so far.
(Deepak Pariyar in Pokhara, Aash Gurung in Lamjung, Agandhar Tiwari in Parbat, Narayan Sharma in Nawalparasi (East), Pratiksha Kafle in Syangja, Samjhana Rasaili in Tanahun, Ghanshyam Khadka in Myagdi and Hariram Uprety in Gorkha contributed reporting)
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19?
Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19?
Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from?
The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territories around the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe?
The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.