Lives in perilAs the blockade and protests continue, patients struggle to get adequate medical care
It was too late for Amit Kumar Yadav when he reached the hospital on September 6. The 13-year-old from Bengashivapur-3, Dhanusa, looked pale, and had fainted often. Amit was accompanied by his father, Mukeshwor, to the Gangalal Heart Centre, Bansbari. It did not take long for the doctors to realise that something was wrong with his heart. They immediately admitted him to the Intensive Care Unit and began his treatment. In less than 24 hours, Amit was declared dead.
Amit was first admitted to Gangalal earlier this year on July 2. He underwent a valve surgery on July 9 after being diagnosed with Mitral Regurgitation—a leakage of blood through the mitral valve. He was discharged seven days later. Amit’s discharge summary read that his “health conditions have improved.” Before leaving the hospital, he was advised by doctors to conduct a blood test called Prothrombin Time or International Normalised Ratio which help doctors calculate the amount of drugs that needs to be prescribed. In failing to conduct the test, the blood, which detects the artificially inserted valve, may get clotted and eventually block the entire passage.
“We returned back to our home and conducted the test a month after the discharge, as recommended,” said Mukheshwor over the phone.
As the dates for the next blood test fast approached, the Tarai protest quickly escalated. Mukheshwor could not take his fifth-grader son to Bardibas, where a group of doctors from Kathmandu were conducting the test for free. The doctors did not arrive at the centre citing the bandha and the Yadav family decided to postpone the test for another time. In the meanwhile, the blood began to clog Amit’s heart passage and the symptoms of fainting resurfaced all over again.
“There was no way we could make it to the town due to the bandhs and protests. Even buses to Kathmandu were not available then,” Mukheswor complained. “I called the hospital to inform them about my son’s status. They urged me to come as early as possible. But it took me a week to make my way to the hospital.”
Dr Raamesh Koirala, a senior surgeon at Gangalal, had conducted the operation on Amit. He attended to the boy during his last day. Had Amit arrived at the hospital earlier, he could have been saved, says Koirala, recalling the event.
On November 26, the face of Jageshwor Thakur of Sarlahi was swollen when he sought out Dr Anil Baral, a kidney specialist at Bir Hospital. While Jageshwor made it to the hospital on time, the medicine he had been taking for his condition had run out. Unable to find the drug in the market, the effect of it was apparent on Jageshwor—his swollen face and feet were signs of kidney dysfunction. The blood test was appalling. The protein count in the urine discharged by a normal body is less than 150 milligrams but Jageshwor’s body had discharged some 8,500 milligrams in 24 hours.
“It was a tough journey to Kathmandu. I feel distraught, sad, and annoyed,” said Jageshwor. Dr Baral claimed that Jageshwor’s disease which had been in remission had now relapsed. More delay could have led to kidney failure.
Of late, stories like these have started haunting hospitals in Kathmandu Valley and other urban centres where the big hospitals are based. As protests in the Tarai continue, the patients are the ones bearing the brunt. The highways, which are frequently obstructed, make travelling to Kathmandu from far-flung districts a daunting task. The loss of lives due to the lack of treatment or the inability to access basic health services including medicine breaches international human and health rights. The emotional distress that a family suffers remains unaccounted for.
Despite commitment from agitating sides to ease the flow of trucks carrying medicines, the frequent violence along highways and sporadic arsons make it impossible for safe delivery of medicinal goods. It is up to the patients to travel on busses or fly on hiked price rates.
Owing to the unofficial blockade, the health sector in Nepal is reeling under acute shortages of medicine and unavailability of surgical goods. The doctors now fear of the onset of another health crisis—patients, who miss their appointments to the unavailability of transportation, returning with aggravated conditions later. The decreased number of patients in OPDs is also a clear indication of the looming crisis, as major hospitals in Kathmandu Valley including Gangalal, Bir and Tribhuvan University Teaching Hospital have seen a dramatic decrease in patient flow. “Patients who are in dire need of operations at this time have little hope,” says Dr Koirala.
Doctors have also begun getting calls from patients asking for suggestions regarding their health after being unable to travel to Kathmandu-based hospitals. On November 25, Dr Baral got a call from his patient Kamala Sunar of Jumla who is a patient of Lupus Nephritis, a kidney disease resulting from Lupus. Kamala was seeking Dr Baral’s counsel as she couldn’t come to Kathmandu. “I talked to a doctor in Nepalgunj and hopefully she will get some remedy there,” said Dr Baral.
The recent hardship faced by patients also highlights the need to decentralise specialised health services in the country. Many speciality hospitals of heart, neurology and nephrology, among others, remain centred in Kathmandu. Patients have to take on the trouble of travelling to the Capital to seek any form of care. “This blockade is also an urgent reminder to start opening up speciality care hospitals in districts and to upgrade existing regional and zonal hospitals,” said Dr BD Chataut, former Director General of the Department of Health Services.
While Amit paid the ultimate price and Jageshwor has to start his medication all over again, it remains uncertain as to how many more patients might be struggling to get access to the basic healthcare.