Nepal’s health system cracks under the strain of rising Covid-19 casesMore people are in dire need of oxygen, but plants are falling short of production, as hospitals say they cannot take in new patients for lack of the life-saving gas.
Shuvam Dhungana & Prithvi Man Shrestha
Two days after he said that the Covid-19 situation in Nepal was under control in an interview to the CNN, which invited widespread ridicule, Prime Minister KP Sharma Oli reached out to the international community on Monday. This time he seemed to be in damage control mode for his earlier chest-thumping.
In an opinion piece for the The Guardian newspaper titled, “Nepal is overwhelmed by Covid. We need help”, Monday Oli wrote, “Nepal’s history is one of hardship and struggle, yet this pandemic is pushing even us to our limits. The number of infections is straining the healthcare system; it has become tough to provide patients with the hospital beds that they need.”
He went on to claim that his government has “tried to make sure that those needing interventions such as oxygen support and ICU care get access to the treatment they need.”
Those attempts of the Oli government so far seem to have fallen flat. Oli, however, is right in saying Nepal’s healthcare system has collapsed.
Suraj Shrestha, 32, was admitted to Vayodha Hospital, Balkhu for Covid-19 treatment two days ago, but as his oxygen level sharply dropped, the hospital asked his family to get oxygen for him.
According to Shrestha’s friend Sanjeev Dhakal, they have been trying hard to get oxygen but without success.
“We tried to contact oxygen distributors on numbers we got from social media but no one responded,” Dhakal told the Post. “When we tried to reach out to the government through their helplines, the numbers were constantly busy. When someone finally picked up the call, the patient’s information was asked and we were told they would get back to us.”
But there has been no response since then, he said.
On Saturday, the Ministry of Health and Population directed 10 manufacturers not to sell or distribute oxygen without the government's recommendation. The ministry said the step was taken to curb the ongoing shortage of oxygen cylinders and make an equitable distribution.
Hospitals, however, say that they have not been getting enough oxygen.
On Tuesday, Jorpati-based Nepal Medical College published a notice telling its Covid-19 infected patients to get discharged from the hospital as it was short of oxygen and the government has been informed of the decision.
“The hospital does not have an adequate amount of oxygen supply and it’s not getting oxygen from anywhere,” it said in a statement.
Kathmandu’s premier private hospital, Nepal Mediciti Hospital, is also facing a shortage of oxygen.
“The hospital needs 450-500 oxygen cylinders a day. However, the government has allocated only 100 cylinders,” said Dr Raj Rana, medical superintendent and spokesperson for the hospital. “The oxygen allocated by the government is not enough to treat the admitted patients, and with limited supply, hospitals cannot admit more patients.”
According to a statement the hospital issued Tuesday, it is providing treatment to over 120 Covid-19 patients and of them, 40 are on ventilator support.
Nepal Medical College is treating 16 Covid-19 patients, said Dr Qamran Ansari, a medical officer at the hospital. “Every day we get innumerable calls to admit virus-infected patients, but we can’t, as we are facing trouble to supply oxygen even to those who are already admitted,” said Ansari.
Relatives struggle in panic trying whatever way they can.
Suraj Raj Pandey, one of the founders of Covid Connect Nepal which connects assistance seekers and providers, said since the government’s decision on the need for recommendation, the number of people demanding oxygen has soared.
“We have over 357 oxygen requests on our site but we can’t assist them as the government has ordered manufacturers not to provide oxygen without its permission,” Pandey told the Post. “The government’s helpline numbers are busy most of the time. If anyone is lucky, they pick up, but they obviously won’t provide you ICU beds or oxygen anytime soon.”
The government has been operating a Covid-19 hotline to assist the general public. As per the Health Ministry, people can reach out to 1133 round-the-clock, while 1115 from 6am to 10pm, and 9851255834 and 9851255837 from 8am to 8pm for support.
When the Post tried to reach out on these numbers, they were either busy most of the time or not reachable. After several attempts, 1115 received the Post’s call. When asked how to get oxygen, the operator directed to 1140 or 01-4271730, hotline numbers of the Covid-19 Crisis Management Committee.
The Covid-19 Crisis Management Committee, or CCMC as it is known, has been managing the oxygen-related issues since the Health Ministry’s decision Saturday.
“If a hospital needs oxygen supply, it can visit the CCMC website and fill up the demand form and send an email,” said the operator who answered the hotline 1140. “The CCMC will give permission to the hospital and they will receive the required amount of oxygen from the suppliers everyday.”
Even individuals who are in home isolation need recommendations from hospitals and respective District Covid-19 Management Centres, according to him, who refused to provide his name.
“The process of getting oxygen is time-consuming,” he admitted, nonetheless.
On its website, the CCMC has listed names of 83 hospitals and the amount of oxygen they are receiving everyday.
According to the official who answered the CCMC hotline, the amounts allocated were determined after evaluating the need of the hospitals per day.
“Oxygen is a life-saving component at these difficult times,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at the Sukraraj Tropical and Infectious Disease Hospital. “If only we can ensure high flow oxygen therapy, we can save over 50 percent of the people who are at risk.”
Nepal on Tuesday reported 9,317 new infections, the highest-ever single day spike, taking the nationwide tally to 413,111. Of these 97,008 cases are active. The Health Ministry said there were 225 deaths. The figure includes deaths from the last few days and has been updated with data from the Nepal Army which manages the funeral of those who died of the disease.
According to Samir Kumar Adhikari, joint spokesperson for the Health Ministry, more than 100 died in the last 24 hours.
The country’s death toll stands at 4,084.
With the government’s failure to check the spread of the virus as well as make arrangements for the supply of oxygen and treatment since the second wave hit the country in mid-April, the Supreme Court on Tuesday told authorities to ensure oxygen supply, medicines and well-equipped hospitals with adequate human resources immediately.
“To manage facilities which are directly related to human life, an interim order has been issued in the name of defendants [federal and provincial governments] to ensure that people’s problems are effectively resolved even if there is need to form a working committee including all the stakeholders,” states the interim order issued by a single bench of Justice Bam Kumar Shrestha.
However, there seems to be no plan in place to ensure the smooth supply of oxygen as cases and deaths continue to rise exponentially. A number of health officials the Post spoke to said they were not sure exactly how much oxygen is needed now or will be needed in future.
“The current production has been insufficient and there must be a significant rise in availability of oxygen,” said Dr Jageshwar Gautam, spokesperson for the Health Ministry.
Of the 185 hospitals in the country, only 26 have their own oxygen plants and many of them are not operating, including the one at Tribhuvan University Teaching Hospital, one of the big hospitals visited by many Nepalis for treatment at a lower cost. Those whose plants are functioning, cannot produce enough.
Hospitals and, by extension, patients have been forced to reach out to oxygen manufacturers.
But they simply do not have the capacity to meet the demand even though they are running their plants round-the-clock.
“For example, Patan Hospital used to demand around 50 cylinders a day in normal times, but it is demanding over 700 cylinders a day,” said Narayan Timilsina, chairperson of Sagarmatha Oxygen Nepal Limited.
Its daily capacity is 800 cylinders, but it also has several other hospitals as clients.
According to Gaurav Sharda, president of the Oxygen Industries Association of Nepal, Kathmandu-based oxygen plants have the capacity of producing 8,000 cylinders a day while those outside have a combined capacity of producing 9,000 cylinders a day. There are 24 private oxygen plants nationwide, according to the Oxygen Industries Association of Nepal.
Kathmandu-based oxygen plants have 80,000 cylinders but that is not enough.
In talks with the government on April 22, oxygen manufacturers said they needed 20,000 more cylinders.
On Tuesday, a Nepal Airlines plane brought 400 oxygen cylinders–about 27 tonnes—from China.
China has said it would provide 3,500 cylinders in grants, but they will take three weeks to arrive, as cylinder valves in Nepal and those available in the Chinese market are not compatible and new valves need to be designed and manufactured.
The government plans to bring 2,000 cylinders by air and 1,500 by land.
But additional cylinders are not likely to solve the problem of oxygen scarcity in the country as manufacturers cannot simply fulfil the demand.
“The arrival of 400 cylinders will not solve the current oxygen crisis,” said Gautam, the spokesperson for the Health Ministry. “But it will give some respite to the hospitals which are struggling to get sufficient oxygen for a growing number of patients.”
(Anup Ojha contributed reporting).